For years the concept of an auditory processing disorder (APD) was daunting. I could easily carry a conversation with colleagues and parents about articulation, dysphagia, receptive and expressive language disorders, etc. I could recite norms and provide examples. But when it came to APD I was unsure of my knowledge. Every audiologist and psychologist I knew had a different definition for it.
I was to look for children who had difficulty understanding speech in noisy environments, following directions, discriminating (or telling the difference between) similar-sounding speech sounds . Those kids asking for repetition or clarification were suspect.
The school aged child who had trouble with spelling, reading, and understanding information presented verbally in the classroom must have APD. Those kids who performed better in multimodal teaching environments where the “hidden agenda” was verbally outlined for them versus a conventional classroom which was taught primarily orally were flagged.Â
I remember wanting  a clear “cookbook” approach or a checklist to aid in the evaluation  of  those kids because I didnt know enough to confidently add my “two cents” at a multi disciplinary team meeting when it came time to “label” the child.
Thankfully in recent years the definition of what APD is, and is not, has improved. SLP’s have a clear role. Auditory processing of information is very simply put how the central nervous system uses auditory information. It is not related to a hearing deficit nor a language or cognitive impairment. Language processing and auditory processing are not the same thing. It is our responsibility to ensure children with language processing deficits, or those kids whose challenges stem from a higher level or global disorder, are not misdiagnosed.
Many disorders impact a person’s ability to understand auditory information. Children diagnosed  with Attention Deficit/Hyperactivity Disorder (ADHD) may well be poor listeners and have difficulty understanding or remembering verbal information; however, their actual neural processing of auditory input in the CNS is intact. Instead, it is the attention deficit that is impeding their ability to access or use the auditory information that is coming in. Children with autism may have great difficulty with spoken language comprehension. It is the higher-order, global deficit known as autism that is the cause of their difficulties, not auditory processing challenges. Children with sensory integration dysfunction may exhibit symptomes of APD but their challenges with attention to task and comrehension are ultimately rooted in global CNS dysfunctyion not simply APD.Â
Remember these points when assessing your kids:
- Children with APD may exhibit a variety of listening and related complaints
- Not all language and learning problems are due to APD, and all cases of APD do not lead to language and learning problems.
- Â APD cannot be diagnosed from a symptoms checklist
- A multidisciplinary team approach is critical to fully assess and understand the cluster of problems exhibited by children with APD. A comprehensive picture of the child’s strengths and weaknesses as determined by an SLP, OT, Psychologist, and audiologist is essential.
- The actual diagnosis of APD can only be made by an audiologist.
In order to diagnose APD, an audiologist will administer a series of tests in a sound-treated room. The tests require a child (who must be at least 7 to 8 years of age) 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. Once a diagnosis of APD is made, the nature of the disorder is determined.
There are many types of auditory processing deficits and, because each child is an individual, APD may manifest itself in a variety of ways. In keeping with my evaluation and treatment stance, ASHA has specified the individualized management and treatment of children with APD as best practices.
There is not one “quick fix” method of treating APD. Resist the  “miracle cures” available on the internet.
Remember:
- Treatment of APD must be highly individualized and deficit-specific.
- A particular therapy approach may have been amazing and successful for another child but it does not mean that it will be effective for your child.
- Appropriate treatment begins with an expert diagnosis by an audiologist.
- Treatment focuses on three primary areas: changing the learning or communication environment, recruiting higher-order skills to help compensate for the disorder, and remediation of the auditory deficit itself.
Environmental modifications help to improve access to verbal or auditorially presented information. The modifications may include coaching teacher’s on different verbal delivery methods, use of an FM device, and so on.
Speech therapy which directly teaches Compensatory strategies in conjunction with self monitoring can strengthen central resources (language, problem-solving, memory, attention, other cognitive skills) so that they can be used to help overcome the auditory disorder.
Finally, direct treatment of APD seeks to remediate the disorder at its origin. Approaches include use of  computers or intensive individual sessions with a SLP either in home or in a clinic.
Not all kids with auditory processing deficits will overcome them or be “cured. As SLP’s we can provide children with strategies to make them successful in school and in life.
