Evaluating for Auditory Processing Disorder (APD)

You’ve read all the checklists, gathered information from multiple sources, and are convinced your child has auditory processing disorder (APD). There are lists of recommendations, classroom modifications, and therapies available⁠—so why get an evaluation?

Accurate diagnosis of APD is critical because:

  1. Not all listening problems are APD, although APD causes problems listening.
  2. APD can be associated with reading, spelling, and language disorders⁠—but so can other disorders.
  3. Other disorders⁠—such as ADHD, autism spectrum disorder, and mild mental retardation⁠—can mimic APD but require different treatment.
  4. There are different types of APD and they need to be managed differently. A generic list of suggestions may help certain types of APD but make others worse or at a minimum be ineffective.
Young boy with an audiologist
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How to Get Started

If listening or hearing is a concern, the first stop should be a complete hearing evaluation done by an audiologist experienced in working with children. You can find local audiologists using the American Academy of Audiology website or the American Speech, Language, and Hearing Association find an audiologist feature. Keep in mind that some physician offices offer hearing screening by nurses or techs so be sure to ask what the qualifications are of the person testing your child.

If there is no hearing loss, the question of APD should be looked into further. The audiologist will ask about your child’s language abilities, medical history, school performance, cognitive testing, and other areas of development. If other areas of development (such as speech/language, psychology, attention deficit, etc.) have not been completed you may be referred for these evaluations prior to testing for APD.

APD can never be assessed in isolation. Audiologists rely heavily upon information from other professionals, especially speech-language pathologists, neuropsychologists, neurologists, and teachers. Processing problems and cognitive and linguistic problems will often co-exist and having this information is critical to designing the best treatment program.

Factors to Consider Before Assessment

Does your child meet the criteria for APD testing?

  1. Screening may be done in children as young as 5 years of age, but a comprehensive test is reserved for children ages 7 years and older.
  2. There should not be significant cognitive or behavioral issues.
  3. The child must have a good understanding of the language being used to test. 

Other questions to ask yourself are: What is your desired outcome for testing? How much time are you able to devote to remediation activities?

After the Testing

Once all the information from testing is obtained, the audiologist will compare your child’s performance to age-related normative information. The questions we try to answer are:

  1. Does the child have APD or not?
  2. What processing areas are affected?
  3. What site of the brain is this occurring in?
  4. What type of APD is present and how should it be treated?

Types of APD

According to Bellis and Ferre (Bellis, 2003), there are three primary subtypes or profiles of APD. These are based upon the area of the brain affected:

  1. Auditory decoding deficit, with the region of dysfunction being the left auditory cortex;
  2. Prosodic dysfunction stemming from the right auditory cortex; and
  3. Integration dysfunction, which is a problem with the corpus callosum. 

Each of these categories has specific characteristics and management strategies and will be discussed in the following articles of this series.

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  • American Speech-Language Hearing Association. (2005). Central auditory processing disorders.

  • Bellis, T. J. (2002). When the brain can’t hear: Unraveling the mystery of auditory processing disorder. New York, NY: Atria Books.

  • Bellis, T. J. (2003). Assessment and management of central auditory processing disorders in the educational setting: From science to practice (2nd ed.). Clifton Park, NY: Delmar Learning.

  • Cunningham, R. (2013, July). APD in children: A time-compressed overview. AudiologyOnline, Article 11953.

By Melissa Karp, AuD
Melissa Karp, AuD, is a board-certified audiologist and the owner of a private audiology clinic in Charlotte, North Carolina.