Auditory Processing Disorder (APD) in Children: Guide

Controversy surrounding APD

Referrals for APD evaluation from teachers, psychologists, speech-language pathologists, and other professionals are increasing, and parents are demanding these services when they learn of the existence of APD on the Internet and other media sources.  Yet, despite the need for APD assessment and the availability of behavioural assessments, many audiologists have been reluctant to include APD assessment in their clinical practices (Kraus and Anderson, 2016).

Kraus and Anderson (2016) identify several factors that contribute to this reluctance:

• Disagreement about whether APD exists as a separate entity apart from deficits in cognitive functions such as attention and memory (Cacace and McFarland 1998; Moore et al. 2010).
• APD is often comorbid with other learning problems such as language, dyslexia, memory or attention deficit disorder (Sharma et al. 2009), with possible effects on the validity of the test results.
• Clinicians disagree on the definition of APD, the test battery and criteria for APD diagnosis.  Wilson and Arnott (2012) used nine different diagnostic criteria to determine the rate of APD diagnosis in 150 school-age children who completed an APD test battery and found that the rates of diagnosis varied from 7.3 to 96.0 %.
• Clinicians are unsure of the efficacy of the treatments purported to improve auditory processing.  Existing studies are difficult to compare because of methodological differences (Fey et al. 2011; Wilson et al. 2013).

In summary, some individuals have inordinate difficulty hearing speech in noise or paying attention to relevant sounds and excluding irrelevant stimuli, suggesting an auditory processing disorder but the field of APD is a complex and controversial one.  Large-scale studies in clinical settings combining behavioral and biological metrics are likely to be revealing and guide future practice (Kraus and Anderson, 2016).

References

Cacace, A. T., & McFarland, D. J. (1998). Central auditory processing disorder in school-aged children: A critical review. Journal of Speech, Language, and Hearing Research, 41(2), 355–373.

Fey, M. E., Richard, G. J., Geffner, D., Kamhi, A. G., Medwetsky, L., et al. (2011). Auditoryprocessing disorder and auditory/language interventions: An evidence-based systematic review. Language, Speech, and Hearing Services in Schools, 42(3), 246–264.

Kraus, N., & Anderson S. (2016). Chapter 3 Auditory Processing Disorder: Biological Basis and Treatment Efficacy. In Le Prell CG et al. (eds.): Translational Research in Audiology, Neurotology, and the Hearing Sciences, Springer Handbook of Auditory Research 58, Springer International Publishing, Switzerland
DOI 10.1007/978-3-319-40848-4_3

Moore, D. R., Ferguson, M. A., Edmondson-Jones, A. M., Ratib, S., & Riley, A. (2010). Nature of auditory processing disorder in children. Pediatrics, 126(2), e382–390.

Sharma, M., Purdy, S., Newall, P., Wheldall, K., Beaman, R., & Dillon, H. (2006). Electrophysiological and behavioral evidence of auditory processing deficits in children with reading disorder. Clinical Neurophysiology, 117(5), 1130–1144.

Wilson, W.J., & Arnott, W. (2013). Using different criteria to diagnose central auditory processing disorder - How big a difference does it make? J Speech Lang Hear Res, 56, 63-70.

Wilson, W. J., Arnott, W., & Henning, C. (2012). A systematic review of electrophysiological outcomes following auditory training in school-age children with auditory processing deficits. International Journal of Audiology, 52(11), 721–730.