This article was originally published on our sister-website, "Audiology Online" (www.audiologyonline.com) and is republished here with permission. The editors of both websites believe this article has application for Speech Language Pathologists and is offered here for educational and academic purposes.
Teri James Bellis, Ph.D.
Department of Communication Disorders
University of South Dakota
Barbara Roe Beck, M.A.
Department of Communication Sciences and Disorders
Saint Louis University
St. Louis, MO
Clinical delivery of central auditory assessment and management services has become a much-debated topic in recent years partly due to explosive increases in referrals for such services. Requests for information regarding central auditory processing disorders (CAPD) commonly come from educators, pediatricians, speech-language pathologists, parents, educational psychologists and neurologists. The purpose of this article is to address some of the key issues the authors believe impact the delivery of central auditory services in a clinical setting.
CAPD has been defined as a deficit in one or more of the auditory mechanisms which underlie tasks such as localization and lateralization, discrimination, temporal processing and performance under conditions of degraded and/or competing acoustic signals. Furthermore, CAPD may occur alone or may coexist with higher-level, global disorders which impact general processing abilities, including attention- and language-related disorders (ASHA, 1996).
CAPD may occur in children and adults. In our experience, the majority of pediatric referrals are initiated by the child's school district (which then accepts responsibility for paying for the evaluation) or by the parent(s). In these situations, CAPD frequently is suspected prior to the referral. Conversely, the majority of adults arrive at the clinic for audiologic evaluation because of auditory difficulties that may be indicative of peripheral hearing loss. The topic of possible CAPD arises only after it is determined that the degree of auditory difficulty exhibited by the individual cannot be accounted for by the degree of peripheral auditory dysfunction, if any.
There are a number of common symptoms which may trigger a referral for a central auditory evaluation in a child or an adult (see Bellis, 1996 and Bellis & Ferre, 1999 for reviews). The most pervasive complaint is difficulty understanding speech in noisy or reverberant environments which cannot be accounted for by peripheral auditory dysfunction (Olson, Noffsinger, & Kurdziel, 1975).
Children with CAPD often exhibit a wide variety of academic and communicative complaints, including inability to follow complex verbal directions; poor verbal cognitive performance as compared to nonverbal performance; spelling and reading difficulties; receptive language delay or disorder; unwillingness to engage in classroom discussion or, alternatively, inappropriate or off-topic contributions to conversational exchanges; poor sound blending, discrimination, and segmentation skills and difficulty maintaining attention to information presented auditorily. These same children frequently request many repetitions, may be easily distracted and may exhibit signs of frustration, especially in language-based courses such as social sciences.
As such, it is important that children exhibiting academic or communicative difficulty be evaluated with respect to overall cognitive function, receptive and expressive language skills, and attention and psychoeducational/academic functioning. This serves to assist in the differential diagnosis of CAPD and to determine the relative contribution of a CAPD to the child's overall difficulties (Bellis & Ferre, 1999). For school-aged children exhibiting academic difficulties, such assessments frequently are completed as part of the special education evaluation within the school setting. The information obtained from such assessments is valuable to the audiologist engaged in assessing CAPD. Therefore, the authors recommend such assessments be completed prior to referral for central auditory processing assessment.
These non-auditory assessments help determine the child's levels of functioning for cognitive, language and academic domains which may impact the child's ability to process incoming information. It will also serve to determine the need for central auditory assessment. In short, the audiologist engaged in central auditory assessment of school-age children, whether in the educational or clinical setting, should be viewed as an integral part of the multidisciplinary special education team. Decisions regarding assessment and management should be undertaken from a team perspective. This requires close collaboration between the audiologist and the educational team members throughout the evaluation and management process.