The weird thing about the diagnosis of auditory processing disorder is that, although most everyone agrees on the variety of symptoms, the actual testing of it can differ widely. Assessments, and therefore instructive strategies, can fluctuate by state, district, profession and resources, both public and private. The California Office of Administrative Hearings for [Public School] Special Education has over 500 notices of fair hearings with the term Auditory Processing Disorder, meaning that either a parent or a school district was attempting clarification or a decision regarding some aspect of this disorder. Further, the California Speech-language Pathology, Audiology and Hearing Aid Dispensers Board has published a notice-
It is incumbent upon the licensed audiologist and licensed speech-language pathologist to use only diagnostic assessments and therapies that are supported by rigorous empirical evidence. While it is important to conduct research studies on new and emerging assessment tools, such studies should take place within the confines of an approved experimental protocol, and it should be clear to consumers that assessment with such tools is experimental only and provided at no cost. In keeping with B & P Code 651(b)(7), licensees are prohibited from making scientific claims that cannot be substantiated by reliable, peer-reviewed, published scientific studies.
Even those websites designed to help navigate the issue can be confusing. This makes who really has it questionable and therefore what is done for it inconsistent.
Just the term “auditory processing disorder” is one of those phrases that make parents and teachers ask, “What?”
The first step in understanding what auditory processing disorder (APD), or central auditory processing disorder (CAPD) means, is to look at the definition. This can be tricky because APD and CAPD are often used interchangeably making them seem like two different but related problems when actually they are the same problem. Essentially the disorder means the person can hear but the brain does not understand.
The symptoms are as follows:
- Have trouble associating sounds with their meanings*
- Verbally indicate that they don’t understand*
- Not respond consistently to the same sounds*
- Misunderstand a lot*
- Want things repeated a lot*
- Be easily distracted
- Have trouble following oral directions*
- Not receive or express language well *
- Have a slow response to verbal instructions*
- Make mistakes repeating things that are said to them *
- Have trouble remembering things they hear*
The second step in understanding APD is to see where the diagnosis is made, typically in the public schools. Unfortunately, this is also where things start getting get confused. The diagnosis of APD usually is made by the IEP team after a battery of tests administered by three professionals- the School Psychologist, the Speech-Language Pathologist and the Resource Specialist. Each of these professionals, within each school district, gives their battery of tests.
The School Psychologist gives cognitive and behavioral tests, assessments designed to evaluate various learning skills. The Speech-Language Pathologist gives speech and language tests to describe the student’s abilities within that area. The Resource Specialist typically administers an academic test. Gathered together, these tests are designed to provide a valuable learning profile of the student. To qualify for Special Education- Resource Services, the student must usually be 2 grade levels below his/her current grade level and have a “processing disorder”. In the IEP paperwork forms, under qualifying criteria, is where the boxes of different learning problems come in to play, because “auditory processing disorder” is one listed. And, it gets checked a lot.
However, this is also when the educational and medical diagnoses differ. In the public schools, auditory processing is an educational diagnosis, and is usually never tested by an audiologist. (This does not include the hearing screening done for students in the schools.) Further, if the original symptoms listed above are reviewed by the *asterisk, it is readily apparent that those symptoms are typical of students who have speech-language problems. In fact, research has repeatedly shown that well over 80% of all learning disabilities are language based.
So what is happening?
During the IEP meeting, most learning disabilities are classified or added- a speech-language disorder becomes auditory processing disorder, or auditory processing disorder is added to another problem in order to qualify a student for resource services.
So is it one or the other or both? “What?”
A history of “auditory processing disorder” might help begin to answer that question.
Auditory Processing Disorder has been studied since 1954, when Helmer Myklebust, a researcher, emphasized its importance for those who had communication and learning problems. Then in 1977, a world-wide conference on the problem motivated considerable attention to the pediatric population. Since that time, Auditory Processing Disorder has been widely studied, symptoms have been delineated, tests have been developed and therapeutic strategies have been implemented.
But, this really only confused things more too, since all those researchers were from various disciplines latching on to the phrase “auditory processing disorder”.
Its enough to make anyone completely bewildered.
So, in 2005, the American Speech-language Hearing Association (ASHA), in an effort to clarify the term, published a technical report titled (Central) Auditory Processing Disorder. The group responsible for this report was a team of distinguished audiologists with expertise in the disorder. The report characterized (C) Auditory Processing Disorder as follows –
Broadly stated, (Central) Auditory Processing [(C)AP] refers to the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information. Narrowly defined, (C)AP refers to the perceptual processing of auditory information in the CNS and the neuro-biologic activity that underlies that processing and gives rise to electro-physiologic auditory potentials. (C)AP includes the auditory mechanisms that underlie the following abilities or skills: sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals (ASHA, 1996; Bellis, 2003; Chermak & Musiek, 1997). (Central) Auditory Processing Disorder [(C)APD] refers to difficulties in the perceptual processing of auditory information in the CNS as demonstrated by poor performance in one or more of the above skills. Although abilities such as phonological awareness, attention to and memory for auditory information, auditory synthesis, comprehension and interpretation of auditorily presented information, and similar skills may be reliant on or associated with intact central auditory function, they are considered higher order cognitive-communicative and/or language-related functions and, thus, are not included in the definition of (C)AP.
ASHA stipulates that (C) APD is an auditory neurological dysfunction, that is, physiological in nature, and that it must be diagnosed only after an auditory battery of tests performed by a certified audiologist, developmental history and speech-language evaluation by a certified Speech-Language Pathologist. In other words, the problem must be well documented, have a physical basis in auditory problems, and describe the communicative-cognitive behaviors of the client.
Let’s face it – students spend 40 to 65% of their day listening, so it is not unreasonable to expect that school special education learning issues typically result in a conclusion of auditory processing disorder, especially since that is the way most state educational codes are written for the diagnosis of learning disability. (There must be a documented processing disorder.) However, research has estimated that only 2-4% of children have (C) APD and that it can exist with other disorders in the same patient, so a differential diagnosis is crucial and never should be done with only psychological testing, even though many of the actual names of tests given by school psychologists have the term “auditory processing”.
No wonder everyone is confused. Even the test publishers use the term.
But a proper in-depth evaluation is crucial because the condition is uncommon and remediation strategies depend on an appropriate diagnosis. “To diagnose [true] APD, the audiologist will administer a series of tests in a sound-treated room. These tests require listeners to attend to a variety of signals and to respond to them via repetition, pushing a button, or in some other way. Other tests that measure the auditory system’s physiologic responses to sound may also be administered. Most of the tests of APD require that a child be at least 7 or 8 years of age because the variability in brain function is so marked in younger children that test interpretation may not be possible.” (Teri Bellis, Ph.D, CCC-A, www.asha.org, 2011)
To recap, it is important to know that there is distinction between the educational diagnosis of (C) APD and the medical diagnosis. The educational diagnosis is made in the public schools by a team for the purposes of qualifying a student for learning disability services. The medical diagnosis is made (usually) outside of the public schools by a certified audiologist who gives a battery of auditory tests in a sound proof room.
Why is this distinction so important?
Because in the public schools, the accommodations and strategies will be designed to help the student access the curriculum. They are educational in nature. Outside of the public schools, the interventions are therapeutic, meaning they are designed to help remediate the problem.
This is not to say that educational strategies cannot be therapeutic or that therapeutic interventions cannot take place in the school setting, but it is saying that there can be a huge difference on emphasis and delivery, and therefore outcomes. Most times a student needs both educational interventions AND therapy, but only after it is clearly delineated WHAT the problem is.
Auditory processing disorder can look like many things and can be manifested alongside of many problems.
Okay, let’s start over.Carol Murphy, MA, CCC-SLP Director- Speech, Learning and Psychology Services Santa Cruz, CA www.carolmurphy.org