Evidence-based managementLinking an individual’s test results and needs to specific management strategies can be done in 3 ways (BSA, 2011).
- Functionally-driven: the individual’s difficulties in everyday life and at school are matched with corresponding management strategies.
- Test-driven: the intervention strategies selected focus on auditory training to improve the discrete auditory skill/s determined to be poor, e.g. dichotic listening training etc. As discussed under the section ‘APD test and criteria’ the evidence for discrete skills auditory training generalising to everyday life is weak.
- Profile-driven: the results are analysed based on a theoretical model, for example the Bellis-Ferre Model (2003, no longer widely used), where patterns in test results are linked to a theoretical model, matching a region of dysfunction, sequelae and management strategies.
Current intervention strategies can be divided into 4 main areas
- Architectural considerations and acoustic environmental modifications.
- Technology (sound field systems, assistive listening devices/remote microphone technology, and noise-cancelling headphones).
- Auditory training programmes, computer software and apps.
- Compensatory strategies.
The strategies listed under areas 1 and 2 have greater supporting evidence than areas 3 and 4. Several ‘Auditory training’ approaches have been tested rigorously, with mixed results. ‘Compensatory strategies’ are widely advocated but have not been validated (BSA, 2018).
Ten tips for making good intervention decisions
- Rank primary versus secondary concerns (APD may not be the primary concern).
- What single thing can I do that will have the greatest impact?
- What can be changed/adapted at no cost?
- Review available interventions critically.
- Consider the scientific basis/research evidence. We expect stringent criteria for medication. Should we expect any less of other interventions?
- Make sure the intervention matches the actual difficulties and are not ‘distractors’ that take time away from real world tasks.
- Consider efficacy (test-retest in research/clinic setting) and effectiveness (impact on daily life).
- There is currently no evidence that formal interventions are any better than informal ones, nor that those with higher costs have better outcomes.
- Auditory training needs to done regularly and be sufficiently challenging to be effective.
- Work closely with the school and other professionals involved to ensure a cohesive approach.
How to judge the scientific basis (research evidence) behind intervention options?
The higher the level on the pyramid the greater the research evidence.
References
Bellis, T.J. (2003). Assessment and management of central auditory processing disorders in the Educational Setting from Science to Practice. 2nd Edition. Delmar: New York.
BSA APD SIG. 2011. Practical Guidance: An overview of current management of auditory processing disorder.
BSA APD SIG. 2018. APD Position Statement and Practice Guidance
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