Practice Forum

What school psychologists need to understand about auditory processing disorders

The author reveals some children with learning problems also suffer from overlooked underlying auditory processing deficits

By Jay R. Lucker

Abstract

Some of the children identified as having learning problems in schools actually have underlying auditory processing deficits or APD. Psychologists are part of the team that assesses these children, and many psychologists often wonder whether the child being assessed has an APD. Additionally, many psychologists complete tests that they believe are appropriate assessments of APD.

The present tutorial is a discussion of what psychologist need to understand about auditory processing disorders. A clear and simple description of auditory processing is presented along with a discussion of how deficits in such processes can lead to educational and communication problems in children who have APD. Tests claiming to evaluate APD are discussed along with an overview of how APD must be appropriately assessed. The conclusion is that the psychologist is an important professional involved in a multiprofessional, transdisciplinary approach to the assessment and identification of students with APD. Furthermore, the presence of APD can lead to identification of these children having auditory based specific learning disabilities or SLD.

Keywords: auditory processing disorder, specific learning disability, assessment of APD

What Psychologists Need to Understand About Auditory Processing Disorders

Sometimes students in schools are identified as having difficulties listening that someone has called an auditory processing disorder or APD. These students are often referred to psychologists to evaluate their auditory processing abilities. In other cases, the psychologist might notice problems with listening or say the child has auditory processing problems during the course of a standard psychological assessment, and the professional might want to evaluate the student’s auditory processing abilities to determine whether the child has APD.

A question arises whether psychologists are able to assess a child for APD. Very often, the author of this paper has come across psychological assessments by school psychologists, clinical psychologists, and neuropsychologists that identify a child as having an auditory processing disorder. But, in reviewing the psychological assessment, the author has noted that not one appropriate assessment of auditory processing has been completed on the child. The psychologist might even have used assessments that are called tests of auditory processing (Martin & Brownell, 2005; Woodcock, McGrew, & Mather, 2001), and the professional might have interpreted failure on such tests as indicating that the child has APD. However, the author has found that all too often the interpretation is incorrect because the psychologists might not understand what are APDs and how one can differentiate between APD, attention deficits such as ADHD, and language processing problems. It is the hope of this author that the present paper will help psychologists have a better understanding of what are APDs and how they should be assessed.

What is Auditory Processing?

For some psychologists, the differences between auditory processing and other factors, especially language, language processing, cognitive processing, and attention and executive functioning, are not well understood. Therefore, the following discussion is presented. Language is best understood as a system of rules and labels a society agrees upon using in order to share common knowledge and thoughts between people who use that language system. Thus, a verbal utterance may stand for the word “stop,” or a hand gesture can mean the same word, or a “sign” (such as used in American Sign Language) can mean stop, or a visually presented picture or group of orthographic symbols can all mean “you should halt where you are and go no further.” Yet, changing the verbal signal even slightly or changing the picture, the sign, or the gesture can mean a totally different thing. The society agrees on these changes and factors and, hence, develops a language and language system. The system usually has rules for what sounds or phonemes can be used in that language (phonology), what structures are to be used in forming word meanings (morphology), what rules tie words together to form sentences (syntax), and what are the social linguistic uses for the language (language pragmatics) (Owens, 2007).

Cognition involves thinking. We think, make decisions, focus our attention, place information into memory, etc. We often use linguistic symbols to help with our thinking, but when we consider new born infants, they can think without having these linguistic symbols. Actually, it takes a child time from before birth until a number of months of living have passed before that child is manipulating, understanding and using language. Yet, the infant thinks well before he/she has words to express his/her thoughts (Bensonb& Haith, 2009).

Involved with all of this thinking and symbol development and use, and all of the rules involved in using these linguistic symbols, the child with normal hearing and normal neurological development is experiencing a bombardment of auditory stimuli. The child’s auditory processing system starts recognizing the auditory stimuli, recognizing auditory patterns that are the same and those that are different, and, eventually, stores up meaningful information about the auditory events in the child’s listening experiences. Eventually, we will call this recognition and discrimination. However, from before birth, this auditory pattern recognition has begun. Thus, the new born child has come into the world already knowing about auditory processing (Karmiloff and Karmiloff-Smith, 2001). What the infant needs to learn are the meaningful symbols associated with the auditory patterns in his/her environment. Consider the following scenario.

An infant is in the living room of the house with his/her mother. The infant suddenly hears an acoustic or auditory pattern. It is of a specific frequency (low in pitch), a specific intensity (moderate in loudness), and has a very specific time pattern so that there is a noise, a pause, a noise, a pause, etc. until five noises with four pauses between them are heard. The infant then notices the mother getting up, walking over to a place in the living room that will later be labeled as “the door,” and hears the mother put out some auditory messages (i.e., speak). After the mother’s messages, another message is heard coming from the door. The mother then opens the door and in comes a thing (later to be labeled, a person) who then shares back and forth sound (utterances) with the mother.

The infant experiences the same scenario time and time again. Eventually, the infant’s auditory processing system has linked directly with the visual and cognitive systems, and the next time the infant hears this same auditory pattern, the cognitive system quickly searches memory, finds that the pattern has been heard before, forms mental images of the mother going to the door asking questions, hearing someone at the door, opening the door, letting the person in, etc. Although no linguistic labels are placed on any of these experiences, the child has developed internal labels whether they be visual or some other internal symbolic forms.

These experiences describe how a child learns to recognize the acoustic pattern we call “knocking at the door.” But, what if the infant who now understands this pattern hears five more “knocks,” but they are much louder than the usual knocking at the door, and the time between the knocks is much longer. The infant may first think the pattern is knocking at the door, but cognitively reflecting on the pattern, realizes it is a different acoustic pattern, especially the loudness of each “knock” and the time intervals between knocks. Later, the child may come to learn that the noise was daddy fixing something in his basement workshop, pounding away with his hammer. The infant’s recognition that the acoustic pattern of the father’s hammering and the knocking at the door are different leads to the formation of a second memory trace and the discrimination of these two auditory patterns as different. The infant is using his/her auditory processing abilities to learn a great deal about the world in which he/she lives.

As the reader can see, auditory processing is very important to a developing child. It is also the way we do a lot of our learning in school. We eventually learn not only to recognize and discriminate auditory patterns of sounds and noises, but to recognize and discriminate auditory patterns for speech which we can refer to as spoken language. The first step in understanding the verbal messages we hear is to gather, recognize, and discriminate the auditory patterns of the spoken language messages we hear. For example, consider the following.

We are students in school. We have three teachers. One comes from the midwest, one comes from a place like New York City (NYC), and the other comes from what we often refer to as the “deep south.” Each of them says a word such as, “man.” The person from the midwest says “man” with all phonemes as expected if we lived in the mid-west. The person from NYC says it with what we might call a “flat a.” The person from the south has changed the pure vowel of “man” into a diphthong. At some point in our auditory processing and learning, we might think the three teachers are saying three different words. Then, as we learn to use language and relate words to the things they represent, we realize (cognitively) that the three teachers are referring to a male person, but they have different accents or regional dialects because they come from three different areas of the country. At that point, our auditory processing will still hear the three words said (i.e., “man”) and realize they are spoken differently, but we will cognitively interpret the difference as regional dialects, and we will linguistically interpret the words as meaning the same exact thing. For a child with an auditory processing deficit, it is possible that the child cannot distinguish or discriminate the subtle difference in the vowels that make them regional dialects and not different words. For a child with a cognitive deficit, he/she may not be able to make appropriate decision to realize each teacher is saying the same thing. For the child with a language problem, he/she may not know what is meant by the word “man” regardless of which dialect is spoken. Thus, it is of critical importance for psychologists to understand such differences so that when they are looking at the behaviors of children, they can help distinguish between possible cognitive issues, language deficits, or APD. When we consider the question, “What are auditory processing disorders?” we realize that the first thing to come to mind is that the word “disorder” was pluralized. As such, there is no such thing as an auditory processing disorder. There are a number of different types, areas, or categories of auditory processing deficits that can lead to what we call APD. As such, assessing only one or two areas of auditory processing is not sufficient for evaluating the entire scope of APDs to determine whether a child has a specific APD and to identify in what specific area the APD exists. This brings up many questions regarding tests that psychologists might use if they feel they can assess auditory processing to identify whether a child has or does not have APD. Evaluation of APD is discussed later in this report.

There are a number of different “models” or approaches to auditory processing and APD that have been developed. For example, Dr. Jack Katz and his colleagues from the State University of New York at Buffalo developed a model they call the “Buffalo Model” (Katz, 2007). This model has four major categories and a few subcategories such as integration type I and type II. In contrast, Dr. Teri James Bellis and Dr. Jeananne Ferre developed a model that was originally called the 3M model, but has come to be called the Bellis/Ferre model or, sometimes, just the Bellis model (Bellis, 2002, 2011). It has different categories of APD totally based on neurophysiological evidence from brain injured subjects, mostly adults.

Lucker (2007, 2012a) presents a very different model of APD than these other neurophysiologically based approaches. His approach is very holistic looking at auditory processing using a developmental view starting from the time a fetus begins to process auditory information in the womb to elderly people who have lost hearing and some cognitive functioning showing changes and deterioration in their auditory processing abilities. In Lucker’s model, there are six different “systems” involved in processing what we hear including the auditory system, the cognitive system, and the language system. This paper will focus only on these three systems.

Lucker (2007, 2012a) defines auditory processing as those things the entire central nervous system does when it receives information through the auditory system and deals with that information so that meaning can be gained. He further states that auditory processing is auditory pattern recognition and uses examples such as those of the infant learning to make sense out of the knocking at the door vs. daddy hammering in the basement. From a spoken language perspective, auditory processing has to do with using the auditory feature differences that distinguish one phoneme from another so that, in the end, the auditory or acoustic patterns are identified as different and the things which they symbolize become related to each specific pattern. Later, these auditory patterns are learned as words and language starts to develop.

An example of auditory phonemic differentiation for the infant could be understood from the following example. During the course of very early development, the infant hears people in the environment use an auditory pattern when relating to the thing which the child will learn is the mother. The auditory pattern is heard with the following basic acoustic features (analyzed from an auditory-linguistic perspective). The first sound is a nasal, long/continuant, voiced low frequency sound. It is followed by a vowel and then repetition of the first sound and another vowel follow in sequence. This pattern is heard, in the English language as “mommy.” When this auditory pattern is heard, the total sensory experience of the child is to be in contact with (usually) the female caretaker. At other times, the child will hear people in the environment form a very different auditory pattern for the two consonants in the word, and they will reference a different thing that the child will later learn is the “father.” That pattern is a non-nasal, short/plosive, voiced or voiceless, higher frequency than the /m/ sound followed by a vowel, followed by a repetition of the initial sound, followed by another vowel. This auditory pattern in English is usually “daddy.” The sensory experience accompanying this auditory pattern is typically totally different from that accompanying the word “mommy.” When considering these two auditory patterns or words, there are many different features that distinguish the /m/ from the /d/ in these two words. If you consider most of the languages of the world, the word for mother is usually a nasal, continuant, low frequency consonant phoneme followed by a vowel (which usually has a repetitive pattern), while the word for the father is usually a non-nasal, plosive, higher frequency consonant followed by a vowel (which usually also has a repetitive pattern). Thus, the auditory feature distinctions between the /m/ and /d/ help the child differentiate between the sensory experiences of “mommy” and “daddy” so that when the word “mommy,” is used as the infant gains in age by a few weeks or months, hearing that distinct pattern, the mental image formed in the brain is of the mother and not the father, and the child reacts to what it expects from its mother. This is how words are discriminated and learned by every person who hears and has normal auditory processing abilities.

Auditory Processing and Learning

From the above discussion, it is hoped that the reader can better understand the importance of auditory processing and learning. As children going through life, until they read to learn, much of what a child learns about his/ her world (especially in school) is done through listening and, thus, through auditory processing. Therefore, auditory processing is critical to a child’s ability to learn. Many learning problems can be due to primary, underlying auditory processing disorders or APD. This actually was identified as early as the first definitions of a specific learning disability or SLD, and that same definition is still used in the IDEA today (IDEA, 2004). If we were to generically define APD, it might best be described as a disorder in understanding spoken language that is not due to a primary language disorder (such as a speech-language impairment), a second language factor (such as for English language learners (ELL) or for children with English as a Second Language (ESOL)). This disorder in understanding spoken language would be due to an imperfect ability to listen that would not be due to a hearing loss or deafness or a primary attention deficits such as ADHD or an executive functioning problem. Additionally, the disorder could also be called a perceptual disorder. What is interesting to note is that one of the diagnoses for APD is a disorder of auditory perception (ICD-9-CM code 388.40) (American Medical Association, 2011).

When reading the previous paragraph, all of the italicized wording is directly quoted from the IDEA definition of a specific learning disability (IDEA, 2004). This is why an auditory processing disorder (APD) should be considered as an auditory learning disability from an educational perspective (Lucker, 2007, 2012a).

Assessing Auditory Processing Disorders

If the reader is following the discussion in this paper, it can be seen that APD is an abnormality (disorder) in auditory processing, and auditory processing involves a number of factors, the three most relevant here being the auditory factors, the cognitive factors, and the language factors. As such, a comprehensive assessment of auditory processing should involve tests that limit and control for cognitive and linguistic variables as well as an assessment of cognitive factors that limit and control for auditory and linguistic variables, and an assessment of language factors that limit and control for auditory and cognitive variables. If the reader thinks carefully about the tests that might be used to assess auditory processing, the conclusions drawn might be that these tests do not control for or limit the cognitive and language variables. As such, the tests often used by psychologists, speech-language pathologists and some educational specialists are not tests that appropriately assess auditory processing as noted below.

One of the most common measures of auditory processing used by psychologists is the Woodcock-Johnson, Third Edition (NU), Tests of Cognitive Abilities or WJ-III-Cog (Woodcock, McGrew, & Mather, 2001). There is a section of this test called “auditory processing.” It is made up of two subtests and using only two subtests brings into question how comprehensive this can be when there are seven primary categories or areas of APD in Lucker’s model, four primary areas in the Buffalo Model, and a different four areas in the Bellis/Ferre model. One of the two subtests of the WJ-III-Cog is a measure of phonological blending or blending phonemes spoken to the subject by the examiner. This is one and only one measure of auditory phonemic processing also called auditory phonological processing. However, phonemic blending is only one part of phonemic processing. Additionally, the examiner is saying the phonemes without controlling for intensity (loudness) and regional dialectal differences. If the phonemes are said too loudly, this could cause the person to react by “shutting down” his/her auditory system, especially a child who has sensory processing deficits (Lucker & Doman, 2012b). If the phonemes are said too softly, the auditory features may not be heard appropriately and the child could mishear the word and, thus, blend the phonemes correctly, and, thus, say the wrong word and get the items incorrect. Consider the examiner saying the phonemes /h/ /ae/ /t/ and the child says “fat,” because the /h/ was so soft that the child’s auditory system could not distinguish between the /h/ and the /f/. But, on the test, a response of “fat” for the word “hat” would be an incorrect answer, and the psychologist might think the child has phonological processing deficits leading to a diagnosis of APD when the problem was that the presentation volume was too soft for the child to make appropriate phonological distinctions.

The second subtest on the WJ-III-Cog under the category auditory processing is a measure of auditory attention. Most children will fail this test because they have primary attention, self-regulation, or executive functioning problems and not because they have APD. Furthermore, if a child passes the phonological blending subtest at a low level (say a standard score of 8/25th percentile) and fails the attention task with a standard score of 1/<1st percentile), the overall auditory processing score would likely be something like a 4/2nd percentile which might be interpreted as the child having a severe APD while the child’s real problem might be a general attention deficit such as ADHD. Thus, the WJ-III-Cog is an incomplete and insufficient measure of auditory processing and should not be used to diagnose APD or even screen for APD when that assessment is used alone. Another commonly used test for measuring auditory processing by psychologists and speech-language pathologists is the Test of Auditory Processing Skills – Third Edition or TAPS- 3 (Martin, & Brownell, 2005). This test, and its predecessors, is not a measure of auditory processing. The TAPS-3 actually has three parts dealing with: phonological or phonemic processing, memory, and language comprehension and reasoning.

The first three subtests on the TAPS-3 deal with phonological processing. One is for blending words which has the same limitations as the WJ-III-Cog test since it is administered live voice. The other is segmenting words which can also be influenced by accents and regional dialects. However, if we accept that the examiner is of the same regional dialect as the examinee and is speaking sufficiently loud and at a proper timing for the phonemes in the blending task, these two subtests only evaluate one aspect of auditory processing, that is, phonological processing. Many students with severe APD have excellent phonological processing abilities, but lack the abilities to properly integrate what they hear, deal with speech in noise, and are overly sensitive to loud sounds. The third subtest in the phonological section of the TAPS-3 is for discriminating words. A sample question is for the child to tell whether the two words spoken are the same or different. The assumption by most evaluators and by the authors of the TAPS-3 is that the child is discriminating the phonemes in the words and making cognitive decisions as to whether the phonemes are the same in both words. However, if this is truly a test of auditory discrimination, then if the evaluator were to say the words “house, house,” and drop his/her volume for the second word, say the second word at an overall lower pitch, and pronounce the vowels in the two words differently, and the child truly used auditory based discrimination processing and said, “the words are different,” the child would get the item, “house/house” wrong and might be considered as having APD in the area of discrimination if this were a consistent problem. Yet, this child is using better auditory processing and auditory discrimination than the child who says that the two totally different auditory patterns for “house” and “house” as the same. But, this second child would get the item correct. The reason is that so-called tests of auditory discrimination are really tests of language discrimination or language processing tests. Regardless of what are the auditory patterns in saying “house” and “house,” the two words do not change in linguistic meaning, thus, the auditory discrimination task on a test like the TAPS-3 is really a language discrimination task. A child with language processing or language/cognitive decision making problem could fail the auditory discrimination subtest on the TAPS-3 and that child might have perfect auditory processing abilities.

The next section of the TAPS-3 involves memory. There is memory for digits, words, and sentences. The digit memory tasks are for repeating digits forwards and backwards, similar to what is done on the WISC-IV. Memory tests have nothing to do with auditory processing. Auditory processing has to do with auditory pattern recognition. Remembering and repeating numbers or words in appropriate sequence have nothing to do with your abilities to identify and discriminate the patterns of sound you hear. Digit memory often is associated with a variety of cognitive processes such as executive functioning/ working memory, chunking, and memory capacity. Word memory involves language and is often related to categorizing the words you hear, associating the words, and recalling the words from the associations and categories you created. As for sentence memory, it is largely a language based task. For example, if the sentence presented were, “The boy went to the store to buy bread,” you would identify the key linguistic elements such as “boy – store – bread,” and using your language knowledge, you would put them back together during the repetition task as “The boy went to the store to buy bread.” Therefore, a child with poor language knowledge can fail tests of sentence memory, yet the child might have an excellent cognitive memory capacity and an excellent ability to distinguish all of the auditory patterns as being different (or the same for the words “the” and “to”) in that sentence. Therefore, tests of memory are not tests of auditory processing.

The last section of the TAPS-3 relates to two subtests called Auditory Comprehension and Auditory Reasoning. By its name, the second subtest involves the high level cognitive processes involved in reasoning or thinking and decision making. For the TAPS-3, the reasoning aspect is to think about the linguistic message presented. Thus, the child must have the language processing capabilities to figure out the meaning of the verbal utterance on a linguistic level and the cognitive processing capabilities to figure out the general meaning of the utterance and how to answer the question asked such as a “Why” question. Auditory processing has nothing specifically to do with language reasoning.

The auditory comprehension subtest involves similar processes as for reasoning. The listener has to figure out the linguistic meaning of the words and the sentences spoken, has to remember (memory) the context of the message and the words used, and has to respond to a number of specific questions about the linguistic and cognitive details in the short stories spoken. Thus, it is really a measure of language comprehension and not of auditory processing.

When considering all of these critical analyses factors related to the TAPS-3, one can see that it is primarily a language and cognitive test and might be one of the best language processing tests around, but it is not a measure of auditory processing. Another test with similar criticisms as the TAPS-3 is the Auditory Processing Abilities Test or APAT (Ross-Swain, & Long, 2009). Both of these tests are also presented live voice spoken by the evaluator which brings in a number of auditory variables that can confound the results. These variables include the loudness or intensity level of presentation, the rate or speed of presentation, and the dialect or accent of the person speaking. Thus, in order to assess auditory processing we need to limit and control the cognitive variables, the language variables, and the auditory variables.

Some psychologists might choose to use pre-recorded tests for evaluating aspects of auditory processing. Tests like the SCAN for children (SCAN-3:C) and for adolescents and adults (SCAN- 3:A) (Keith, 2009a & b). Since all of the material on the SCAN is pre-recorded, factors such as variations in presentation rate (speed) and accents/dialects are controlled since everyone hears the same recording. However, a question arises as to what is the intensity level at which these recordings are presented? For most psychologists and even speechlanguage pathologists, they would present the records at a level they judge to be comfortable. So, consider the following scenario. A child is suspected of have an APD. The psychologist wants to use controlled listening tasks and uses the SCAN-3:C for this child. However, the psychologist has no control over the calibration of the volume level at which the test is administered. Thus, the psychologist asks the child “Is this loud enough? Is it too soft? Is it too loud?” The child wanting to please the psychologist says the first volume level is fine, and the psychologist presents the entire test at this level not knowing that it is actually a very soft speaking level. The child fails the test and is identified as having APD. Six months later, the child goes to another psychologist who presents the SCAN-3:C, but this time the level of the volume is at a much louder conversational listening level, such as a level at which a teacher might speak in a classroom. The child passes all parts of the SCAN. Did the child pass the second SCAN test because the child has developed normal auditory processing skills six months later or because the volume was more appropriate for the test the second time around? We can and would never know because the two psychologists have no idea how loud they presented the test. Consider another situation, the earphones used for the SCAN are not balanced, and the words presented in the left ear are much louder than the words presented in the right ear. On two of the subtests of the SCAN (Competing Words and Competing Sentences) the child performs poorly and fails because the right ear performed poorly. Additionally, the child is found to have a very highly significant left ear advantage and the child is right handed. Furthermore, on all of the single ear subtests (called monaural presentations), the left ear outshines the right ear leading to a strong and significant left ear advantage, but total subtest scores lead to failure for all of the subtests. The psychologist would likely conclude that the child has a very severe APD and might even think there were some neurological problems present. The likelihood that the psychologist does not knows how to check for calibrating the two earphones to insure that they are balanced in volume presentation of the test stimuli has misled the psychologist to misdiagnose the child. So, what does this all mean? Does it mean that a psychologist cannot assess APD? What it means is that the tests for APD must control for all confounding variables. The reason that most APD testing is completed by audiologists is that they learn to use equipment that is calibrated and presents auditory stimuli at set, known, calibrated loudness levels and the two earphones present an equal loudness for all stimuli presented. Also, the tests of auditory processing used by most audiologists only have the child repeat words or simple sentences (such as the Competing Sentences and Time Compressed Sentences on the SCAN-3). Phonemic processing tests do have a level of cognitive decision making involved that is greater than merely repeating what the child hears, but phonemic awareness tasks are related to early reading phonics and later reading fluency and accuracy. And, since the blending and segmenting of words is practiced during the lessons teaching the child the skills for reading and spelling, the student should be able to handle most phonemic awareness tests such as the Phonemic Synthesis Test (PST) (Katz, 2007) and CTOPP (Wagner, Torgesen, & Rashotte, 1999) which are two pre-recorded tests of phonological processing that can be used in assessments of APD.

Is It APD or ADHD?

Another important confounding variable in assessing APD is to rule out that the problems in processing what the student hears is not due to primary, underlying attention deficits. Many audiologists who conduct APD evaluations do not evaluate auditory attention and do not provide objective measures to help differentiate between APD and possible attention problems such as ADHD. There are a few auditory tests of attention. Thus, during the process of assessing APD, the evaluator must provide a formal measure of auditory attention to help distinguish whether the problems seen on auditory processing tests are due to APD or attention issues.

The author uses a test called the Auditory Continuous Performance Test or ACPT (Keith, 1994). This test was chosen because it is simple (reduced cognitive load) and does not require language processing. It is true that it uses words, a list of 96 words which have been prerecorded and are played in a “loop” over and over without stopping or signally that the list is starting again. The child’s task is to respond with a simple task when hearing the word “dog.” On the test are no other words that rhyme with dog and no other words starting with “d.” Thus, there is very little to discriminate in hearing the words spoken over and over for a total of six repetitions of the list.

During each repetition, there are 20 dogs, so there can be a maximum of 20 target words missed per list. However, there are 76 additional, non-target words, and the child can respond to these. The evaluator counts the missed target words (errors of omission) and the non-target word “hits” (errors of commission) as the total number of errors. Additionally, the number of errors for each of the six “trial” periods is counted and viewed. Therefore, the ACPT is a simple measure of auditory continuous performance or vigilance and can help differentiate between possible primary attention difficulties and probable APD when a child fails tests of APD.

Conclusion

The focus of this paper was to help psychologists and others better understand what are auditory processing disorders, how they can affect a child in the educational setting, and how they need to be appropriately assessed. In school, the learning of phonics assumes that the child has normal underlying auditory phonemic processing abilities, one area of auditory processing. When learning about science and history, or reading books about new people and different places, the student must be able to make the appropriate auditory  distinctions to identify new, unfamiliar words and to learn to associate them with their referents. Auditory processing plays a significant role in learning along with cognitive functions and language abilities. To overlook auditory processing is to overlook one of the three most important aspects of learning through listening. To assume that all auditory processing problems are really language deficits misses the understanding of what is auditory processing and what is language and language processing. As psychologists evaluate students for possible learning problems, they must be more aware of and better able to understand and identify auditory processing and the possibility that a child has an auditory processing disorder (APD). It is hoped that this paper provides the reader with greater understanding of and insights into what psychologists need to understand about auditory processing and its disorders.

References

American Medical Association (2011). ICD-9-CM – for Hospitals, Volumes 1, 2, and 3. Washington, DC : The author.

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. (2011). Understanding auditory processing disorders in children.

Benson,J. B. & Haith, M. M. (2009). Language, Memory, and Cognition in Infancy and Early Childhood. Philadelphia, Penn.: Academic Press Division of Elsevier.

IDIEA (2004). Individuals with Disabilities Education Act. (Pub. L. No. 108-446, 118 Stat. 2647).

Karmiloff, K., & Karmiloff-Smith, A. (2001). Pathways to Language: From Fetus to Adolescent. Cambridge, Mass: Harvard University Press.

Katz, J. (2007). APD Evaluation to Therapy.

Keith, R. W. (1994). Auditory Continuous Performance Test (ACPT). Upper Saddle River, NJ: Pearson Products.

Keith, R. W. (2009). SCAN-3: A Tests for Auditory Processing Disorders in Adolescents and Adults. Upper Saddle River, NJ: Pearson Publications.

Keith, R. W. (2009). SCAN-3: C Tests for Auditory Processing Disorders in Children. Upper Saddle River, NJ: Pearson Publications.

Lucker, J. R. (2007). History of auditory processing disorders in children. In D. Geffner & D.

Ross-Swain (Editors). Auditory Processing Disorders for Speech-Language Pathologists. San Diego: Plural Publishing.

Lucker, J. R. (2012a). What are auditory processing disorders? In H. Edell, J.R. Lucker, and L .

Alderman, Don’t You Get It? Living with Auditory Learning Disabilities (second release). Wood Dale, IL: Stoelting Publishers.

Lucker, J. R.. & Doman, A. (2012b). Auditory hypersensitivity in children in the autism spectrum. Autism Science Digest, in press.

Martin, N. A., & Brownell, R. (2005) Test of Auditory Processing Skills, Third Edition (TAPS-3). Novato, CA: Academic Therapy Publications.

Owens, R. E. (2007). Language Development: An Introduction, Seventh Edition. Boston: Allyn and Bacon.

Ross-Swain, D., & Long, N. (2009). Auditory Processing Abilities Test (APAT). Novato, CA: Academic Therapies Publications.

Wagner, R. K., Torgesen, J.K., & Rashotte, C.A. (1999). Comprehensive Test of Phonological Processing. Austin, TX: Pro-Ed.

Woodcock, R. W., McGrew, K. S., & Mather, N. (2001). Woodcock-Johnson III (NU ), Tests of Cognitive Abilities. Rolling Meadowns, IL : Riverside Publishing.

Author’s Note

Dr. Jay R. Lucker, EdD, CCC-A/SLP is an associate professor in the Department of Communication Sciences and Disorders at Howard University, Washington, D.C. He is also a certified and licensed audiologist and speech language pathologist specializing in assessment and treatment of auditory processing disorders and language processing deficits. He can be contacted as follows:

Mail to:
Dr. Jay R. Lucker
P.O. Box 4177
Colesville, MD 20914-4177
Telephone: (301) 254-8583