Purpose

The purpose of this article is to review the literature that pertains to ongoing concerns regarding the central auditory processing construct among school-aged children and to assess whether the degree of uncertainty surrounding central auditory processing disorder (CAPD) warrants a change in current protocols.

Method

Methodology on this topic included a review of relevant and recent literature through electronic search tools (e.g., ComDisDome, PsycINFO, Medline, and Cochrane databases); published texts; as well as published articles from the Journal of the American Academy of Audiology; the American Journal of Audiology; the Journal of Speech, Language, and Hearing Research; and Language, Speech, and Hearing Services in Schools.

Results

This review revealed strong support for the following: (a) Current testing of CAPD is highly influenced by nonauditory factors, including memory, attention, language, and executive function; (b) the lack of agreement regarding the performance criteria for diagnosis is concerning; (c) the contribution of auditory processing abilities to language, reading, and academic and listening abilities, as assessed by current measures, is not significant; and (d) the effectiveness of auditory interventions for improving communication abilities has not been established.

Conclusions

Routine use of CAPD test protocols cannot be supported, and strong consideration should be given to redirecting focus on assessing overall listening abilities. Also, intervention needs to be contextualized and functional. A suggested protocol is provided for consideration. All of these issues warrant ongoing research.

References

  • American Academy of Audiology. (2010). Clinical practice guidelines: Diagnosis, treatment, and management of children and adults with central auditory processing disorder. Reston, VA: Author.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  • American Speech-Language-Hearing Association. (2005). (Central) auditory processing disorders [Technical report]. Available from http://www.asha.org/policy
  • Anderson, S., & Kraus, N. (2010). Sensory-cognitive interaction in the neural encoding of speech in noise: A review.Journal of the American Academy of Audiology, 21, 575–585.
  • August, G. J., & Garfinkel, B. D. (1990). Comorbidity of ADHD and reading disability among clinic-referred children.Journal of Abnormal Child Psychology, 18, 29–45.
  • Bamford, J., & Wilson, I. (1979). Methodological considerations and practical aspects of the BKB sentence lists.In J. Bench, & J. Bamford (Eds.), Speech-hearing tests and the spoken language of hearing impaired children (pp. 146–187). London, United Kingdom: Academic Press.
  • Barkley, R. A. (1997). ADHD and the nature of self-control. New York, NY: Guilford Press.
  • Barkley, R. A., & Cunningham, C. E. (1979). The effects of methylphenidate on the mother-child interactions of hyperactive children.Archives of General Psychiatry, 36, 201–208.
  • Bellis, T. J. (2002). Developing deficit-specific intervention plans for individuals with auditory processing disorders.Seminars in Hearing, 23, 287–295.
  • 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.
  • Bellis, T. J. (2006). Audiologic behavioral assessment of APD.In T. K. Parthasarathy (Ed.), An introduction to auditory processing disorders in children (pp. 63–80). Mahwah, NJ: Erlbaum.
  • Bellis, T. J., Chermak, G. D., Musiek, F. E., & Weihing, J. (2012). Efficacy of auditory interventions for central auditory processing disorder: A response to Fey et al. (2011).Language, Speech, and Hearing Services in Schools, 43, 381–386.
  • Bench, J., Kowal, A., & Bamford, J. (1979). The BKB (Bamford–Kowal–Bench) Sentence Lists for partially-hearing children.British Journal of Audiology, 13, 108–112.
  • Berlin, L., Bohlin, G., Nyberg, L., & Lars-Olof, J. (2004). How well do measures of inhibition and other executive functions discriminate between children with ADHD and controls?.Child Neuropsychology, 10, 1–13.
  • Bishop, D. (2003). The Children's Communication Checklist–Second Edition. London, United Kingdom: The Psychological Corporation.
  • Blenkarn, K., Fallon, K. A., Katz, L. A., Maag, A., & Smith, M. K. (2010). What makes a caseload (un)manageable? School-based speech-language pathologists speak.Language, Speech, and Hearing Services in Schools, 41, 139–151.
  • Blood, G. W., Blood, I. M., Gordon, R., & Mamett, C. (2010). Written language disorders: Speech-language pathologists' training, knowledge, and confidence.Language, Speech, and Hearing Services in Schools, 41, 416–428.
  • British Society of Audiology. (2011a). Position statement: Auditory processing disorder (APD). Reading, United Kingdom: Author.
  • British Society of Audiology. (2011b). Practice guidance: An overview of current management of auditory processing disorder (APD). Reading, United Kingdom: Author.
  • Cacace, A. T., & McFarland, D. J. (2005). The importance of modality specificity in diagnosing central auditory processing disorder.American Journal of Audiology, 14, 112–123.
  • Cacace, A. T., & McFarland, D. J. (2013). Factors influencing tests of auditory processing: A perspective on current issues and relevant concerns.Journal of the American Academy of Audiology, 24, 572–589.
  • Caesar, L. G., & Kohler, P. D. (2009). Tools clinicians use: A survey of language assessment procedures used by school-based speech-language pathologists.Communication Disorders Quarterly, 30, 226–236.
  • Cameron, S., & Dillon, H. (2007). The Listening in Spatialized Noise–Sentences Test (LISN-S): Test–retest reliability study.International Journal of Audiology, 46, 145–153.
  • Cameron, S., & Dillon, H. (2008). The Listening in Spatialized Noise–Sentences Test (LISN-S): Comparison to the prototype LISN and results from children with either a suspected (central) auditory processing disorder or a confirmed language disorder.Journal of the American Academy of Audiology, 19, 377–391.
  • Clark, C., & Kinsella, G. (2000). Do executive function deficits differ between adolescents with ADHD and oppositional defiant/conduct disorders? A neuropsychological study using the Six Elements Test and the Hayling Sentence Completion Test.Journal of Abnormal Child Psychology, 28, 403–414.
  • Cowan, J., Rosen, S., & Moore, D. (2009). Putting the auditory back into auditory processing disorder in children.In A. Cacace, & D. McFarland (Eds.), Controversies in central auditory processing disorder (pp. 187–197). San Diego, CA: Plural Publishing.
  • Cunningham, C. E., & Siegel, L. S. (1987). Peer interactions of normal and attention-deficit disordered boys during free play.Journal of Abnormal Child Psychology, 15, 247–268.
  • Dawes, P., & Bishop, D. (2009). Auditory processing disorder in relation to developmental disorders of language, communication and attention: A review and critique.International Journal of Language & Communication Disorders, 44, 440–465.
  • DeBonis, D. A., & Moncrieff, D. (2008). Auditory processing disorders: An update for speech-language pathologists.American Journal of Speech-Language Pathology, 17, 4–18.
  • 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.
  • Donaldson, G., Chisolm, T., Blasco, G., Shinnick, L., Ketter, K., & Krause, J. (2009). BKB-SIN and ANL predict perceived communication ability in cochlear implant users.Ear and Hearing, 30, 401–410.
  • Douglas, V. I. (1972). Stop, look, and listen: The problem of sustained attention and impulse control in hyperactive and normal children.Canadian Journal of Behavioral Science, 4, 259–282.
  • Edgar, D. L., & Rosa-Lugo, R. (2007). The critical shortage of speech-language pathologists in the public school setting: Features of the work environment that affect recruitment and retention.Language, Speech, and Hearing Services in Schools, 38, 31–46.
  • Etymotic Research. (2005). Bamford–Kowal–Bench Speech-in-Noise Test (Version 1.03) [Audio CD]. Elk Grove, IL: Author.
  • Ferguson, M. A., Hall, R. L., Moore, D. R., & Riley, A. (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, 211–227.
  • Fey, M. E., Kamhi, A. G., & Richard, G. J. (2012). Auditory training for children with auditory processing disorder and language impairment: A response to Bellis, Chermak, Weihing, and Musiek.Language, Speech, and Hearing Services in Schools, 43, 387–392.
  • Fey, M. E., Richard, G. J., Geffner, D., Kamhi, A. G., Medwetsky, L., Paul, D., … Schooling, T. (2011). Auditory processing disorder and auditory/language interventions: An evidence-based systematic review.Language, Speech, and Hearing Services in Schools, 42, 246–264.
  • Geurts, H. (2007). CCC-2-NL: Children's Communication Checklist-2. Amsterdam, the Netherlands: Harcourt Assessment.
  • Geurts, H., & Embrechts, M. (2008). Language profiles in ASD, SLI and ADHD.Journal of Autism and Developmental Disorders, 38, 1931–1943.
  • Gilbert, J. L., Tamati, T. N., & Pisoni, D. B. (2013). Development, reliability, and validity of PRESTO: A new high-variability sentence recognition test.Journal of the American Academy of Audiology, 24, 26–36.
  • Gioia, G., Isquith, P., Guy, S., & Kenworthy, L. (2000). Behavior Rating Inventory of Executive Function professional manual. Lutz, FL: Psychological Assessment Resources.
  • Halliday, L. F., & Bishop, D. V. M. (2006). Auditory frequency discrimination in children with dyslexia.Journal of Research in Reading, 29, 213–228.
  • Hautus, M. J., Setchell, G. J., Waldie, K. E., & Kirk, I. J. (2003). Age-related improvements in auditory temporal resolution in reading-impaired children.Dyslexia, 9, 37–45.
  • Hazan, V., Messaoud-Galusi, S., Nouwens, S., Rosen, S., & Shakespeare, B. (2009). Speech perception abilities of adults with dyslexia: Is there any evidence for a true deficit?.Journal of Speech, Language, and Hearing Research, 52, 1510–1529.
  • Hugdahl, K. (2003). Dichotic listening in the study of auditory laterality.In K. Hugdahl, & R. J. Davidson (Eds.), The asymmetrical brain. Cambridge, MA: MIT Press.
  • Hynd, G., Semrud-Clikeman, N., Lorys, A., Novey, E., & Elopulos, D. (1990). Brain morphology in developmental dyslexia and ADHD.Archives of Neurology, 47, 919–926.
  • Jarrett, K., Riccio, C., & Siekierski, B. (2005). Assessment of attention deficit hyperactivity disorder (ADHD) using the BASC and BRIEF.Applied Neuropsychology, 12, 83–93.
  • Jerger, J. (2007). Editorial: Dichotic listening in the evaluation of APD.Journal of the American Academy of Audiology, 18, 4.
  • Jerger, J., & Musiek, F. (2000). Report of the consensus conference in the diagnosis of auditory processing disorders in school-aged children.Journal of the American Academy of Audiology, 11, 467–474.
  • Kamhi, A. G. (2004). A meme's eye view of speech-language pathology.Language, Speech, and Hearing Services in Schools, 35, 105–111.
  • Kamhi, A. G. (2011). What speech-language pathologists need to know about auditory processing disorder.Language, Speech, and Hearing Services in Schools, 42, 265–272.
  • Katz, J., Johnson, C. D., Brandner, S., Delagrange, T., Ferre, J., King, J., … Tillery, K. (2002). Clinical and research concerns regarding the 2000 APD consensus report and recommendations.Audiology Today, 14(2), 14–17.
  • Keith, R. (2009). Controversies in standardization of auditory processing tests.In A. Cacace, & D. McFarland (Eds.), Controversies in central auditory processing disorder (pp. 187–198). San Diego, CA: Plural.
  • Kelly, A. S., Purdy, S. C., & Sharma, M. (2009). Comorbidity of auditory processing, language, and reading disorders.Journal of Speech, Language, and Hearing Research, 53, 706–722.
  • Kidd, B. G., Watson, C. S., & Gygi, B. (2007). Individual differences in auditory abilities.The Journal of the Acoustical Society of America, 122, 418–435.
  • Kimura, D. (1967). Functional asymmetry on the brain in dichotic listening.Cortex, 3, 163–178.
  • Kirk, K., Diefendorf, A., Pisoni, D., & Robbins, A. (1979). Assessing speech perception in children.In L. Mendel, & J. Danhauer (Eds.), Speech perception assessment (pp. 101–132). San Diego, CA: Singular Press.
  • Lawfield, A., McFarland, D. J., & Cacace, A. T. (2011). Dichotic and dichoptic digit perception in normal adults.Journal of the American Academy of Audiology, 22, 332–341.
  • Lewis, D., Hoover, B., Choi, S., & Steimachowicz, P. (2010). The relationship between speech perception in noise and phonological awareness skills for children with normal hearing.Ear and Hearing, 31, 761–768.
  • Loo, J. H. Y., Bamiou, D. E., Campbell, N., & Luxon, L. M. (2010). Computer-based auditory training (CBAT): Benefits for children with language and reading-related learning difficulties.Developmental Medicine and Child Neurology, 52, 708–717.
  • Loo, J. H. Y., Bamiou, D. E., & Rosen, S. (2013). The impacts of language background and language-related disorders in auditory processing assessment.Journal of Speech, Language, and Hearing Research, 56, 1–12.
  • Maerlender, A., Wallis, D., & Isquith, P. (2004). Psychometric and behavioral measures of central auditory function: The relationship between dichotic listening and digit span tasks.Child Neuropsychology, 10, 318–327.
  • Mahone, M., Cirino, P., Cutting, L., Cerrone, P., Hagelthorn, K., Hiemenz, J., … Denckla, M. (2002). Validity of the behavioral rating inventory of executive function in children with ADHD and/or Tourette syndrome.Archives of Clinical Neuropsychology, 17, 643–662.
  • Martin, J., Jerger, J., & Mehta, J. (2007). Divided-attention and directed-attention listening modes in children with dichotic deficits: An event-related potential study.Journal of the American Academy of Audiology, 18, 34–53.
  • Mayo, C., Scobbie, J., Hewlett, N., & Waters, D. (2003). The influence of phonemic awareness development on acoustic cues weighting strategies in children's speech perception.Journal of Speech, Language, and Hearing Research, 46, 1184–1196.
  • McAnally, K., Castles, A., & Bannister, S. (2004). Auditory temporal pattern discrimination and reading ability.Journal of Speech, Language, and Hearing Research, 47, 1237–1243.
  • McArdle, R., & Wilson, R. (2008). Predicting word recognition performance in noise by young listeners with normal hearing using acoustic, phonetic and lexical variables.Journal of the American Academy of Audiology, 19, 507–518.
  • McFarland, D. J., & Cacace, A. T. (2006). Controversial issues in CAPD: From Procrustes' bed to Pandora's box.In T. K. Parthasarathy (Ed.), An introduction to auditory processing disorders (pp. 247–263). Hillsdale, NJ: Erlbaum.
  • McFarland, D. J., & Cacace, A. T. (2009). Models of central auditory processing abilities and disorders.In A. T. Cacace, & D. J. McFarland (Eds.), Controversies in central auditory processing disorders (pp. 93–107). San Diego, CA: Plural Publishing.
  • McFarland, D. J., Cacace, A. T., & Setzen, G. (1998). Temporal-order discrimination for selected auditory and visual dimensions.Journal of Speech, Language, and Hearing Research, 41, 300–314.
  • Medwetsky, L. (2009). Mechanisms underlying central auditory processing.In J. Katz, L. Medwetsky, R. Burkhard, & L. Hood (Eds.), Handbook of clinical audiology (6th ed., pp. 584–610). New York, NY: Lippincott Williams & Wilkins.
  • Medwetsky, L. (2011). Spoken language processing model: Bridging auditory and language processing to guide assessment and intervention.Language, Speech, and Hearing Services in Schools, 42, 286–296.
  • Miller, C. A. (2011). Auditory processing theories of language disorders: Past, present, and future.Language, Speech, and Hearing Services in Schools, 42, 309–319.
  • Mody, M., Studdert-Kennedy, M., & Brady, S. (1997). Speech perception deficits in poor readers: Auditory processing or phonological coding?.Journal of Experimental Child Psychology, 64, 199–231.
  • Moncrieff, D. (2006). Identification of binaural integration deficits in children with the Competing Words subtest: Standard score versus interaural asymmetry.International Journal of Audiology, 45, 200–210.
  • Moore, D. R. (2011). The diagnosis and management of auditory processing disorder.Language, Speech, and Hearing Services in Schools, 42, 303–308.
  • Moore, D. R., Ferguson, M. A., Edmondson-Jones, M., Ratib, S., & Riley, A. (2010). Nature of auditory processing disorder in children.Pediatrics, 126, 382–390.
  • Nittrouer, S., & Boothroyd, A. (1990). Context effects in phoneme and word recognition by young children and older adults.The Journal of the Acoustical Society of America, 87, 2708–2715.
  • Norbury, C., Nash, M., Baird, G., & Bishop, D. (2004). Using a parental checklist to identify diagnostic groups in children with communication impairment: A validation of the Children's Communication Checklist-2.International Journal of Language and Communication Disorders, 39, 345–364.
  • Putter-Katz, H., Adi-Bensaid, L., Feldman, I., Miran, D., Kushnir, D., & Muchnik, C. (2002). Treatment and evaluation indices of auditory processing disorders.Seminars in Hearing, 23, 357–364.
  • Reddy, L., Hale, J., & Brodzinsky, L. (2011). Discriminant validity of the Behavior Rating Inventory of Executive Function Parent Form for children with attention-deficit/hyperactivity disorder.School Psychology Quarterly, 26, 45–55.
  • Richard, G. J. (2011). The role of the speech-language pathologist in identifying and treating children with auditory processing disorder.Language, Speech, and Hearing Services in Schools, 42, 297–302.
  • Rudner, M., Ronnberg, J., & Lunner, T. (2011). Working memory supports listening in noise for persons with hearing impairment.Journal of the American Academy of Audiology, 22, 156–167.
  • Schachar, R. J., Tannock, R., & Logan, G. (1993). Inhibitory control, impulsiveness, and attention deficit hyperactivity disorder.Clinical Psychology Review, 13, 721–739.
  • Schafer, E. (2010). Speech perception in noise measures for children: A critical review and case studies.Journal of Educational Audiology, 16, 4–15.
  • Schafer, E., & Wolfe, J. (2008). Acceptable noise levels in adults with cochlear implants.Canadian Hearing Report, 3(2), 32–35.
  • Scheffler, R., Brown, T., Fulton, B., Hinshaw, S., Stone, S., & Levine, P. (2009). Positive associations between ADHD medication use and academic achievement during elementary school.Pediatrics, 123, 1273–1279.
  • Schmithorst, V. J., Holland, S. K., & Plante, E. (2011). Diffusion tensor imaging reveals white matter microstructure correlations with auditory processing ability.Ear and Hearing, 32, 156–167.
  • Sharma, M., Dhamani, I., Leung, J., & Carlile, S. (2014). Attention, memory, and auditory processing in 10- to 15-year-old children with listening difficulties.Journal of Speech, Language, and Hearing Research, 57, 2308–2321.
  • Smoski, W., Brunt, M., & Tannahill, C. (1992). Listening characteristics of children with CAPD.Language, Speech, and Hearing Services in Schools, 23, 145–152.
  • Strong, G. K., Torgerson, C. J., Torgerson, D., & Hulme, C. (2011). A systematic meta-analytic review of evidence for the effectiveness of the “Fast ForWord” language intervention program.Journal of Child Psychology and Psychiatry, 52, 224–235.
  • Sutcliffe, P. A., & Bishop, D. V. M. (2002, April). Age-related changes in frequency discrimination: Tone duration and training can affect performance. Paper presented at the ISCA Workshop on Speech Perception, Aix-en-Provence, France.
  • Szatmari, P., Offord, D., & Boyle, M. (1989). Correlates, associated impairments, and patterns of service utilization of children with attention deficit disorders: Findings from the Ontario Child Health Study.Journal of Child Psychology and Psychiatry, 30, 205–217.
  • Tallal, P., & Piercy, M. (1973). Developmental aphasia: Impaired rate of non-verbal processing as a function of sensory modality.Neuropsychologia, 12, 83–93.
  • Tallal, P., & Piercy, M. (1974). Developmental aphasia: Rate of auditory processing and selective impairment of consonant perception.Neuropsychologia, 13, 69–74.
  • Tamati, T. N., Gilbert, J. L., & Pisoni, D. B. (2013). Some factors underlying individual differences in speech recognition on PRESTO: A first report.Journal of the American Academy of Audiology, 24, 616–634.
  • Thurstone, L. L. (1938). Primary mental abilities. Chicago, IL: University of Chicago Press.
  • Thurstone, L. L. (1947). Multiple-factor analysis. Chicago, IL: University of Chicago Press.
  • Volkow, N. D., Wang, G. J., Newcorn, J., Telang, F., Solanto, M. V., Fowler, J. S., … Swanson, J. M. (2007). Depressed dopamine activity in caudate and preliminary evidence of limbic involvement in adults with ADHD.Archives of General Psychiatry, 64, 932–940.
  • Wallach, G. P. (2011). Peeling the onion of auditory processing disorder: A language/curricular-based perspective.Language, Speech, and Hearing Services in Schools, 42, 273–285.
  • Watson, B. U., & Miller, T. K. (1993). Auditory perception, phonological processing, and reading ability/disability.Journal of Speech and Hearing Research, 36, 850–863.
  • Watson, C. S., & Kidd, G. R. (2009). Associations between auditory abilities, reading, and other language skills in children and adults.In A. T. Cacace, & D. J. McFarland (Eds.), Current controversies in central auditory processing disorder (CAPD) (pp. 217–242). San Diego, CA: Plural Publishing.
  • Watson, C. S., Kidd, G. R., Horner, D. G., Connell, P. J., Lowther, A., Eddins, D. A., … Watson, B. U. (2003). Sensory, cognitive, and linguistic factors in the early academic performance of elementary school children: The Benton-IU Project.Journal of Learning Disabilities, 36, 165–197.
  • Wechsler, D. (2004). The Wechsler Intelligence Scale for Children–Fourth Edition. London, United Kingdom: Pearson Assessment.
  • Wightman, F., Callahan, M., Lutfi, R., Kistler, D., & Oh, E. (2003). Children's detection of pure tone signals: Informational masking with contralateral maskers.The Journal of the Acoustical Society of America, 113, 3297–3305.
  • Wilson, R. H. (2003). Development of a speech in multitalker babble paradigm to assess word-recognition performance.Journal of the American Academy of Audiology, 14, 453–470.
  • Wilson, R. H., Farmer, N. M., Gandhi, A., Shelburne, E., & Weaver, J. (2010). Normative data for the Words-in-Noise Test for 6- to 12-year-old children.Journal of Speech, Language, and Hearing Research, 53, 1111–1121.
  • Wilson, W. J., & Arnott, W. (2013). Using different criteria to diagnose (central) auditory processing disorder: How big a difference does it make?.Journal of Speech, Language, and Hearing Research, 56, 63–70.
  • Wilson, W. J., Arnott, W., & Henning, C. (2013). A systematic review of electrophysiological outcomes following auditory training in school-age children with auditory processing deficits.International Journal of Audiology, 52, 721–730.
  • World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Geneva, Switzerland: Author.
  • Zaidan, E., & Baran, J. A. (2013). Gaps-in-Noise (GIN) test results in children with and without reading disabilities and phonological processing disorders.International Journal of Audiology, 52, 113–123.
  • Zametkin, A., Nordahl, T., Gross, M., King, A., Semple, W., Rumsey, J., … Cohen, R. (1990). Cerebral glucose metabolism in adults with hyperactivity of childhood onset.New England Journal of Medicine, 323, 1361–1366.

Additional Resources