Issues and Controversies in Auditory Processing Disorders—2012
Auditory processing disorder (APD) remains a controversial and highly charged topic within the audiology profession. For example, Ferguson and colleagues (2011) reported APD and specific language impairment (SLI) groups performed no worse than mainstream children in quiet and noise, and they suggested “poor attention” may be responsible for the children’s listening difficulties. Further, they note a lack of a "gold standard" diagnostic test battery, which has facilitated a plethora of "un-validated tests." Ferguson and colleagues report that the specific diagnosis may actually have quite a lot to do with which professional renders the diagnosis (an audiologist might diagnose APD, a pediatrician may diagnose ADD or ADHD, a speech-language pathologist may diagnose SLI, etc.). They stated that "the children were differentially diagnosed based on their referral route rather than on actual differences."
Fey, Richard, Geffner, and colleagues reported "no compelling evidence that existing auditory interventions make any significant contributions to auditory, language, and academic outcomes of school-aged children diagnosed with APD or language disorder." Dawes (2011) evaluated the SCAN-A with regard to adults across the United Kingdom. Dawes reported that APD tests that use speech stimuli are problematic (for many reasons, see article) and indeed, the British Society of Audiology recommended “APD diagnosis should be made based on non-speech test materials to avoid linguistic confounds.” That is, tests that use speech stimuli cannot reliably “disentangle” the APD component form the language component. Dawes and colleagues (2009) reported APD assessment and identification methods appear to have “serious shortcomings and in agreement with Ferguson and colleagues (mentioned earlier), Dawes et al note the diagnosis (APD, ADHD, SLI, etc.) may be significantly related to the professional consulted. The authors reported no significant differences between the APD and dyslexia groups evaluated, and no evidence of a specific temporal auditory impairment. They reported auditory perceptual deficits may be multifactorial learning problems and distinguishing between children with APD or dyslexia may actually be counterproductive, as this approach focuses attention on one issue, potentially in the presence of multiple issues which would benefit from attention.
Dillon et al (2012) offered their collective opinion/report. They note that rather than defining APD, they chose to focus on the diagnosis and management of “listening difficulties.” Dillon and colleagues report with regard to APD, each clinic, clinician and each country adopts their own battery of tests and when “some pre-determined number of the tests are aberrant by more than some predetermined amount, the patient is diagnosed as having APD.” They report that in the case of a person suspected of having APD, “there is not even any way to calculate the sensitivity and specificity of the test for that APD, as there is no absolute gold standard against which the test results can be compared.” Further, they report as the size of the test battery increases, so too, does the probability of a failure for reasons unrelated to the patient’s real-life communication ability. Overall, Dillon and colleagues report the goal should be to determine if a listening problem is present. If a listening problem is present, professionals should describe the problem in detail and offer a disorder-specific remediation.
For More Information, References and Recommendations
Cox LC, McCoy SL, Tun PA, Wingfield A. (2008) Monotic Auditory Processing Disorder Tests in the Older Adult Population. Journal of the American Academy of Audiology 19:293–208.
Dawes P. (2011) The SCAN-A in Testing for Auditory Processing Disorder in a Sample of British Adults. International Journal of Audiology 50:107–111.
Dawes P, Sirimanna T, Burton M, Vanniasegaram I, Tweedy F, Bishop DVM. (2009) Temporal Auditory and Visual Motion Processing of Children Diagnosed with Auditory Processing Disorder and Dyslexia. Ear & Hearing 30(6):675–686.
Dillon H, Cameron S, Glyde H, Wilson W, Tomlin D. (2012) An Opinion on the Assessment of People Who May Have an Auditory Processing Disorder. Journal of the American Academy of Audiology 23:97–105.
Ferguson M. (2009) Diagnosing Auditory Processing Disorders. ENT News, In Audiology Matters. February 2009.
Ferguson MA, Hall RL, Riley A, Moore DR. (2011) Communication, Listening, Cognitive, and Speech Perception Skills in Children With Auditory Processing Disorder (APD) or Specific Language Impairment (SLI). Journal of Speech, Language and Hearing Research 54 (2):211–227.