Canadian Guidelines on Auditory Processing Disorder in Children and Adults: Assessment and Intervention

Canadian Interorganizational Steering Group for Speech-Language Pathology and Audiology. (2012).

Canada: Canadian Interorganizational Steering Group for Speech-Language Pathology and Audiology, 1-83.

This guideline provides recommendations for the assessment and management of individuals with auditory processing disorders. The target audience for this guideline is audiologists and speech-language pathologists.

Canadian Alliance of Audiology and Speech-Language Pathology Regulators (CAASPR); Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA); Canadian Academy of Audiology (CAA); Canadian Council of University Programs (CCUP) in Communication Sciences and Disorders

Canadian Alliance of Audiology and Speech-Language Pathology Regulators; Canadian Association of Speech-Language Pathologists and Audiologists; Canadian Academy of Audiology; Canadian Council of University Programs in Communication Sciences and Disorders

<p>A number of classroom/environmental modifications are recommended for children and adults with auditory processing disorders, including:&nbsp;</p> <ul> <li>changes to the physical environment (e.g., the use of absorptive materials, fire codes, the ability to adequately clean classrooms); and</li> <li>changes to the listening environment (e.g., reducing noise, improving signal to noise ratios, and reducing the effects of distance and reverberation).</li> </ul> <p>The use of assistive listening devices and other technologies (e.g., personal frequency modulation, voice to text software)&nbsp;are not a standard recommendation for every individual and should be considered an option to assist adults and children with auditory processing disorders.</p>

<p>Audiologists working with children and adults with an auditory processing disorders should:</p> <ul> <li>be competent in the assessment and management of auditory processing disorders;</li> <li>possess adequate knowledge of the "anatomy, physiology, and vasculature of the central auditory nervous system" (p. 34);</li> <li>understand the potential auditory processing deficit underpinnings in children and adults with other types of cognitive, developmental, personality, and learning disorders;</li> <li>work closely with other professionals (e.g., physician, neurologist, educators) as needed to "ensure that any functional limitations of the individual's communicative abilities are identified" (p. 38); and</li> <li>understand community resources available to the individual.</li> </ul>

Consider electrophysiology testing (e.g., auditory brainstem evoked response, middle latency response, late latency response, P300 and Mismatch Negativity) as a complement to audiological assessment when evaluating children and adults with auditory processing disorders.

For children and adults with suspected auditory processing disorders, "assessment of the peripheral auditory mechanism is always the first step, and should include pure tone audiometry, immittance battery with both ipsilateral and contralateral acoustic reflexes, speech recognition testing and otoacoustic emissions" (p. 43).

<p>There is insufficient evidence to recommend an appropriate auditory processing test battery for children and adults with suspected auditory processing disorders. However, when choosing the components for a test battery, the following criteria should be met:</p> <ul> <li>"The test battery must accurately identify the presence of APD [auditory processing disorders]. This requires audiologists to carefully research and evaluate the psychometric properties of individual tests, and to choose tests with good test sensitivity, specificity and efficiency, and with clear pass/fail criteria.&nbsp;</li> <li>[The test battery] must also assess and describe the individual&rsquo;s functional difficulties related to auditory dysfunction (requiring some individualization of the test battery to the complaints and functional difficulties reported)" (p. 22).</li> </ul>

The effect of direct auditory training intervention is variable for children with auditory processing disorders. There is a growing body of research suggesting that direct auditory training for adults is beneficial, however, further research is needed.

Speech-language pathologists may address expressive and/or receptive language difficulties and work with the child when auditory processing difficulties impede the reception of auditory information. The use of metacognitive strategies may be helpful to assist the child in attending, organizing, and remembering auditory information presented verbally. Additional strategies such as verbal rehearsal, mnemonics, analogies, chunking, creating mind maps, note taking, and visualization may also be helpful.

<p>When assessing children for auditory processing disorders, a thorough case history should be completed during assessment and include information obtained from parents/caregivers, such as:</p> <ul> <li>"pre-, peri- and post-natal information;</li> <li>physical developmental milestones;</li> <li>speech and language development;</li> <li>family history of learning and hearing difficulties;</li> <li>incidence of middle ear problems (intervention);</li> <li>information about allergies" (p.21); and</li> <li>academic/social strengths and weaknesses.</li> </ul> <p>When assessing adults for auditory processing disorders, a thorough case history should obtain information to determine:</p> <ul> <li>"auditory and/or communication difficulties;</li> <li>family history of hearing loss and/or auditory processing deficits;</li> <li>medical history;</li> <li>educational history and/or work history;</li> <li>existence of any known comorbid conditions, including cognitive and/or medical disorders;</li> <li>social difficulties related to auditory/communication difficulties;</li> <li>linguistic and cultural background; and</li> <li>prior and/or current therapy for any cognitive, linguistic, mental health, or sensory disorder or disability&rdquo; (p. 42).</li> </ul>

<p>Auditory capacities recommended for assessment of children and adults with suspected auditory processing disorders include:</p> <ul> <li>temporal sequencing/ordering;</li> <li>speech in degraded listening situations;</li> <li>low redundancy speech;</li> <li>binaural separation, integration, interaction;</li> <li>localization and lateralization;</li> <li>temporal resolution;</li> <li>auditory attention; and/or</li> <li>auditory memory.&nbsp;</li> </ul>

For children and adults, re-evaluations at least every two years are strongly recommended with an auditory processing delay or disorder has been identified. Reassessments for children should be considered "more frequently when changes are observed in classroom performance, auditory performance, or when other unusual symptoms emerge" (p. 25).

<p>When assessing children with suspected auditory processing disorders, behavioral checklists and questionnaires can:</p> <ul> <li>determine whether a referral for auditory processing assessment is indicated based on observations from teachers, speech-language pathologists or other healthcare professionals;&nbsp;</li> <li>provide information to parents/caregivers about the child&rsquo;s performance prior to assessment; and</li> <li>screen for suspected auditory processing disorders prior to further assessment.</li> </ul> <p>"Behavioural checklists and questionnaires should only be used to provide guidance for referrals, for information gathering (for example, prior to assessment or as outcome measures for interventions, and as measures to describe the functional impact of auditory processing disorder not for the purpose of diagnosing auditory processing disorder" (p. 20).</p>

<p>Auditory processing disorders should not be assessed in children when:</p> <ul> <li>peripheral hearing loss of any degree or type is present; and/or&nbsp;</li> <li>the presence of intellectual disability has been confirmed through psycho-educational assessment.</li> </ul>

<p>When providing counseling and education to individuals with auditory processing disorders and their family/caregivers, the audiologist should:</p> <ul> <li>share current research evidence regarding various treatments so that the client can make informed decisions when planning care;</li> <li>ensure that individual and families clearly understand the results and recommendations; and</li> <li>develop treatment recommendations with the input and consideration of the individual and family.</li> </ul>