Auditory Processing Disorder, Really?

School-based Speech Language Pathologists often encounter children with multiple diagnoses, such as dyslexia, attention deficit disorder, and auditory processing disorder (APD). Auditory processing disorder is a problem with processing auditory information in the presence of intact peripheral hearing. It is considered to be a central nervous system disorder. It is a controversial diagnosis, so controversial in fact, that many graduate programs don't teach courses about it, or discuss it as part of the standard curriculum (mine included).

So what exactly is auditory processing disorder, and how should the diagnosis factor into an intervention strategy for a child who has language-based learning disorders?  My graduate school friend and colleague Stephanie Adam sent me a copy of Dr. Alan Kamhi’s article “What Speech-Language Pathologists Need to Know About Auditory Processing Disorder” a down-to-earth discussion of the disorder by a researcher who studies reading disability, phonological disorders, and clinical decision making.

Kamhi remarks that although APD can be “one of the most appealing” diagnostic explanations for a child who seems to have language processing difficulties, the clinician should beware of interventions that target language processing skills. These “offer the promise of improving language and learning deficits without having to directly target the specific knowledge skills required to be a proficient speaker, listener, reader, and writer.”

He also points out that APD is a controversial diagnosis even among audiologists. Audiologists disagree about APD’s diagnostic criteria, and they disagree about appropriate test protocols (behavioral measures? electroacoustic measures? electrophysiological measures?). They even disagree that it is a distinct clinical entity. A systematic review of the evidence conducted in 2007 by an ASHA committee found “no compelling evidence” that auditory interventions provided any benefit to language, academic, or auditory outcomes for children with a diagnosis of APD.

Kamhi comments that the "theoretical and clinical problems with APD suggest that it may be more appropriate to view auditory deficits as a processing deficit that may occur with common developmental disorders (e.g., specific language impairment, dyslexia, ADHD) rather than as a distinct clinical entity."

So where does this leave Speech Language Pathologists working in the trenches? Kamhi's recommendation is to do a thorough assessment of the child's speech, language and literacy abilities "just as you would for any other child," and "consider other reasons for listening and comprehension difficulties, such as limitations in working memory, attention, motivation, language and conceptual knowledge, and inferencing abilities."

Finally, he recommends targeting skills over underlying processes when goal planning. In other words, target language-based skills such as reading, writing, and spelling, or executive function skills such as planning and problem solving strategies. (And of course, keep your mind open and stay on top of the research and effective interventions.)

You can download a copy of Dr. Kamhi's excellent article on his faculty webpage at University of North Carolina-Greensboro.