Practice Guidance: An Overview of Current Management of Auditory Processing Disorder (APD)

British Society of Audiology. (2011).

Bathgate (United Kingdom): British Society of Audiology, 1-68.

This is a guidance document developed by the Steering Committee of the British Society of Audiology (BSA) Auditory Processing Disorder (APD) Special Interest Group (SIG) in 2011. The guidance includes recommendations for the management of APD for all ages, including considerations for the listening environment, auditory training, reading and compensatory strategies. In 2018, the BSA APD SIG released an Interim Position Statement and Practice Guidance document that updates, but does not fully replace, the 2011 guideline. See the Notes On This Article section below for more information about the update.

British Society of Audiology

<p>Although the recommendations have not changed, the 2018 offers shortened and revised guidance that should be read in conjunction with the 2011 document and can be found:</p><ul> <li>British Society of Audiology. (2018). Position Statement and Practice Guidance: Auditory Processing Disorders (APD). Retrieved from <a href="https://www.thebsa.org.uk/wp-content/uploads/2018/02/Position-Statement-and-Practice-Guidance-APD-2018.pdf" title="http://www.thebsa.org.uk/" class="ApplyClass">https://www.thebsa.org.uk/wp-content/uploads/2018/02/Position-Statement-and-Practice-Guidance-APD-2018.pdf</a></li></ul>

<p>Recommendations to modify the listening environment include:</p><ul> <li>architectural interventions to reduce reverberation;</li> <li>acoustic treatments (e.g., addition of carpet, curtains, noise absorbent partitions);</li> <li>preferential sitting;</li> <li>teacher and speaker adaptations (2011 BSA Practice Guidance Document; pp. 15-18); and/or</li> <li>use of FM systems and other remote microphone technology (2018 BSA Position Statement; p. 11).</li></ul><p>Recommendations for compensatory, metacognitive and metalinguistic strategies include:</p><ul> <li>addressing auditory attention skills (e.g., preparatory attention, selective attention, divided attention, vigilance, and sustained attention); </li> <li>practicing auditory memory strategies (e.g., organizational skills, mnemonics, chunking, verbal rehearsal);</li> <li>training in the rules of language (i.e., linguistic and metalinguistic strategies); and/or</li> <li>training in self-regulation, problem solving, and other metacognitive strategies (2011 BSA Practice Guidance Document; pp. 31-32). </li></ul>

<p>Recommendations for auditory training include the use of:</p><ul> <li>formal, computer-based auditory training programs;</li> <li>formal training to improve phonological awareness and auditory discrimination;</li> <li>formal methods that employ dichotic listening tasks; </li> <li>informal training using binaural integration, separation activities, speech-in-noise training, sound localization, auditory closure training, auditory discrimination, prosody, temporal patterning, phonological awareness, and interhemispheric transfer activities (2011 BSA Practice Guidance Document; pp. 18-28); </li> <li>interactive training devices; and/or</li> <li>musical training (2018 BSA Position Statement; p. 12).</li></ul>

<p>The minimum multidisciplinary assessment for auditory processing disorders (APD) should include:</p><ul> <li>a review of the referral to consider "whether further assessment will add anything to a diagnosis and/or support already in place";</li> <li>a structured case history including well-validated questionnaires and review of previous assessments; </li> <li>audiometry testing, including pure-tone audiometry, immittance testing, acoustic reflexes and/or auditory brainstem response;</li> <li>speech perception tests in quiet or noise (2018 BSA Position Statement; pp. 8-9);</li> <li>auditory processing tests that include at least 1 non-speech test;</li> <li>language and cognitive assessments; and</li> <li>any additional tests based on caregiver-reported symptoms or if indicated by other testing (2011 BSA Practice Guidance Document; p. 10).</li></ul><p>APD assessment results should be integrated with all other assessment information (e.g., speech and language, cognitive, etc.) into a management plan that includes primary and secondary concerns. Any diagnosis of APD should include a statement of diagnostic criteria measures used during the assessment process (2018 BSA Position Statement; p. 10).</p>

Shared reading should be performed in order to provide "the opportunity to encourage reading with intonation, retelling of the story to ensure comprehension and talking about new and similar sounding words" (2011 BSA Practice Guidance Document; p. 30).