Recently, I have noticed an increase in the number of children ‘diagnosed’ with auditory processing disorder. Some of these children are being referred to me for further assessment. I am grateful when these children are referred to me because I can do a full evaluation and explain the results of the assessment in detail.
However, many of the children are being ‘diagnosed’ by other professionals and ‘treated’ by the assessing professional using controversial Hearing Training approaches. Sadly, many of these children are never even referred for a speech-language assessment.
I wrote about auditory processing disorder (CAPD), a while back. You can find my post over here. Tatyana Elleseff from Smart Speech Therapy has written extensively on the subject and you can find detailed information with links to research over here
However, I feel that this topic needs to be re-addressed because the label Auditory Processing Disorder is being generalized, over-used, and most concerning, incorrectly treated.
There are a number of issues that need to be addressed:
1. Auditory Processing Disorder does not exist
Difficulties with auditory processing can occur. However, it is not a stand-alone disorder and there is no agreement about diagnostic criteria. Auditory Processing Disorder does not exist in the Diagnostic Statistical Manual (DSM – 5) of mental health disorders. Conversely, communication disorders attention deficit disorder and specific learning disorders are clearly specified.
2. There is no way to diagnose Auditory Processing Disorder
Even, if auditory processing disorder existed as a diagnosis, there is no agreed upon method of making the diagnosis. There are some more commonly used diagnostic audiology tests, but testing is expensive, and there is no agreement on which tests should be used. Nor is there agreement regarding how the information from these tests is interpreted.
In order to process spoken language, there is an ongoing interaction of attention, memory, language and thinking about the information that is being provided. It is impossible to separate these skills. Therefore, it is likely that ‘auditory processing’ difficulties are not confined to auditory skills. Auditory processing difficulties reflect broader underlying phonological awareness (sound awareness), language, and/or attention difficulties.
3. There is no specific treatment for Auditory Processing Disorder
Despite the above factors, there is a tendency to advocate for ‘quick-fix’ auditory interventions that promise to improve deficits without addressing the underlying skills that enable effective communication. These include attention, memory, comprehension, vocabulary, sentence structure, cognition, and conversational skills etc.
There are numerous studies that have demonstrated the lack of effectiveness of interventions that target isolated skills. For example, if you were learning a new language and you learned all the nouns in the language, it would not make you bilingual because you would not have any of the other language skills needed to communicate effectively. The same premise applies to ‘treating’ auditory processing by putting earphones on a child and getting them to listen to different sounds.
What do we do about it?
Tatyana Ellaseff suggests that we do not throw out the term auditory processing disorder because the symptoms are real. These children have difficulty processing language, and this difficulty impacts on a number of areas.
My reservation about using the label relates to the continued lack of understanding of the broader language and communication difficulties underlying this disorder.
Rather, I suggest labeling the difficulties in terms of the underlying deficits. This is likely to create a better understanding of the treatment complexity required. Hopefully, this will contribute to more children being referred for speech-language evaluation and the elimination of quick-fix approaches by ‘professionals’ who are not properly trained.