Auditory processing of spoken language requires rapid recognition, discrimination, and integration of what we hear in
order to understand the intended message. Accurate auditory processing is dependent on appropriate functioning of other
systems such as arousal, social/emotional, attention, memory, linguistic, and executive function. Those with normal
auditory processing ability know who and what to listen to, what and who to ignore (background noise), understand the
tone of the speaker, hold on to long and multiple step auditory information in an organized and sequential manner, and
integrate what we hear with other sensory input. Auditory processing has been described as “what the brain does with
what the ear hears,” by renowned researcher and scholar Jack Katz, Ph.D. The disorder commonly impacts listening,
spoken language, and learning.
Despite normal peripheral hearing sensitivity and intelligence, children and adults with auditory processing disorder (APD)
have an inability or decreased ability to attend, discriminate, recognize or comprehend auditory information. Individuals
with (C)APD may experience difficulty sorting auditory information, which may present in various ways also have difficulty
understanding speech in the presence of background noise, and following spoken instructions. Some of them being
difficulties listening to, comprehending, and/or remembering the information heard. Individuals with (C)APD may also
experience difficulties interpreting the subtle meaning of what has been said, such as sarcasm, irony, and humor.
Children with an auditory processing disorder often behave as if they have a hearing loss, and parents and teachers often
complain that the child is ignoring them or not paying attention. When concerns exist, an APD evaluation can help to
determine if there are medical aspects of the disorder that require treatment, to promote appropriate educational planning
and to implement interventions such as environmental modifications, management strategies, auditory training, and/or FM
assistive listening devices as necessary. Prerequisites for an APD evaluation include normal hearing sensitivity, normal
cognitive abilities and a minimum age of nine years.
What Is An APD Evaluation?
During the APD evaluation, a battery of tests designed to assess auditory processing abilities is administered to evaluate,
diagnose and formulate intervention strategies for persons suspected of having auditory processing disorders. The
specific tests selected depend on the age of the child, the referring complaint, test reliability and validity, and the specific
auditory process assessed by each test. If an audiological evaluation to confirm normal hearing sensitivity has not
previously been done, a peripheral audiologic evaluation including acoustic reflex testing, otoacoustic emissions and
speech-in-noise testing will be completed prior to the tests of central auditory processing. An integral component of the
APD assessment includes a thorough case history and observational checklists to be completed by the parent and
classroom teacher. The entire APD assessment takes approximately two hours or more, depending on the client's age
and needs. Once testing is completed, a report detailing the results, interpretation of results and recommendations will be
provided.
Our goal is to provide a multidisciplinary approach to evaluating and managing auditory processing disorders. Therefore,
a language assessment is recommended through our Centre as part of our Language, Listening and Learning Program.
Comprehensive Evaluation Of (C)APD:
AARAAYAN” provides a comprehensive evaluation process for (C)APD that involves a thorough assessment of the peripheral hearing system, behavioral testing for assessment of auditory processing, and a communication needs assessment. The Central Auditory Processing evaluation is broken down into three parts and requires three separate appointments
1. Pre-Auditory Processing Evaluation
The first part of the assessment is called “Pre-APD” and consists of the following evaluations:
- Case history
- Audiogram
- Tympanogram, acoustic reflexes and acoustic reflex decay
- Otoacoustic emissions
- Auditory Brainstem testing.
2. Auditory Processing Evaluation
The second part of the assessment is called the Auditory Processing Evaluation and is done entirely in the sound
booth using standardized testing materials. Five core tests are administered, in which the patient is asked to repeat
back information (words, numbers, and pitches) presented to either ear. The tests are designed to assess the auditory
skills of decoding, integration, and prosody. After this testing, the audiologist will have specific results regarding the
patient’s auditory processing ability. These results will be shared with the patient/parents. The audiologist and speechlanguage pathologist will then collaborate to determine the next steps.
It is important to note that each testing session spans from one to two hours depending on the number of
supplemental tests that may be used. Additional testing may be required based on the individual performance of the
child.
Tests From The Following Behavioral Categories Are Included In The APD Evaluation:
- Dichotic - Dichotic tests present a different stimulus to each ear simultaneously in order to assess binaural integration (repeat everything heard in both ears) or binaural separation (ignore what is heard in one ear and repeat what is heard in the other ear). Linguistically loaded and non-linguistically loaded dichotic tests are selected.
- Low-redundancy Monaural Speech - These tests, presented to each ear separately, modify the acoustic stimulus to reduce the signal's redundancy through low-pass filtering, added noise, etc., in order to test auditory closure ability, the ability to fill in missing components (e.g., phonemes, syllables, words).
- Temporal Processing - Tests using tonal stimuli, require the listener to discriminate sound based on a sequence of auditory stimuli or temporal order in order to assess pattern perception and temporal functioning abilities.
- Binaural Interaction - These tests present similar stimuli to each ear in a non-simultaneous or sequential manner in order to assess binaural integration or interaction between the two ears.
3. Communication Assessment & Treatment Planning
The third part of the assessment, the speech-language pathologist will determine what additional testing is required to
optimize their communication performance. Additional assessments may include tests of spoken language (receptive
and/or expressive), written language (reading and/or writing), executive function, working memory, and/or articulation.
The selection of tasks and tests will be based on the profile of each patient and is decided after a review of the case
history, APD test results, and parent/patient report of specific areas of difficulty.
Your speech-language pathologist will provide a customized and prioritized treatment plan for each patient based on
information obtained through audiology and speech-language pathology findings, as well as patient/family preference
and availability of resources.