Evolving concepts of developmental auditory processing disorder (APD): A British Society of Audiology APD Special Interest Group ‘white paper’

Abstract

Children with listening difficulties, but normal audiometry, may be diagnosed with APD. The diagnosis is typically based on poor performance on tests of perception of both non-speech and speech stimuli. However, non-speech test results correlate only weakly with evaluations of speech-in-noise processing, cognitive skills, and caregiver evaluations of listening ability. The interpretation of speech test results is confounded by the involvement of language processing mechanisms. Overall, listening ability is associated more with higher-level, cognitive and analytic processing than with lower-level sensory processing. Current diagnosis of a child with APD, rather than another problem (e.g. language impairment, LI), is determined more by the referral route than by the symptoms. Co-occurrence with other learning problems suggests that APD may be a symptom of a more varied neurodevelopmental disorder. Alternately, APD has been proposed as a cause of language-based disorders, but there is no one-to-one mapping between listening and language among individuals. Screening for APD may be most appropriately based on a well-validated, caregiver questionnaire that captures the fundamental problem of listening difficulties and identifies areas for further assessment and management. This approach has proved successful for LI, and may in future serve as a metric to help assess other, objective testing methods.

Auditory Processing Disorder (APD): Progress in Diagnostics So Far. A Mini-Review on Imaging Techniques

“…However, psychoacoustic testing is not considered to be a good representation of a patient's problems [1] . On the other hand, electrophysiological testing, such as for complex auditory brainstem responses (ABR), might give a better indication [2] .…”

“…Diagnosis is generally made using the test battery recommended by local guidelines, if available. If at least one core test results in poor performance, a diagnosis of developmental APD is made [1] . Detailed audiometry is necessary to exclude any peripheral ear problems.…”

“…Validated questionnaires exist to collect this information [1] . Diagnosis is generally made using the test battery recommended by local guidelines, if available.…”

“…In fact, several reviews and studies give an indication that APD tends to coexist with learning and language disorders [1] . There is evidence that shows that higher-order cortical functions, particularly attention, play a role in problems with listening, which implies that this is not a problem of the auditory pathway on its own [2,3] .…”

“…The definition that was agreed upon by the British Society of Audiology (BSA), the American Speech-Language-Hearing Association (ASHA), and the American Association of Audiology (AAA) is that auditory processing disorder (APD) is a deficiency in the central auditory nervous system that causes an impairment in the ability of the auditory pathway to integrate appropriately to enable normal sound perception [1] . Patients who are generally diagnosed with APD present with abnormal hearing but have normal audiograms.…”