SpeechPathology.com Phone: 800-242-5183

The Stepping Stones Group - We're Hiring - July 2023

Team Approach to Assessing APD

Stephanie Tarrant Martin, Ph.D

September 17, 2007



I am a speech language pathologist who is currently not practicing. I strongly suspect that my four year old has an auditory processing problem. He was evaluated. The speech therapist looked at his receptive and expressive language, but not his possible a


Thank you for your question regarding your four year old son and a possible auditory processing problem. In the fields of Speech/Language Pathology (SLP) and Audiology, the term "auditory processing" seems to evoke a variety of responses. Controversy, misperception (all pun intended) and confusion are but a few. While our understanding of the way our brain processes speech and language is constantly increasing, and we know more about the neurology involved in processing both speech and language than we have ever known before, we still have much to learn. Before addressing your questions, I need to provide some information which, hopefully, will give us a set of common terms and ideas.

Processing speech and language occurs on a continuum beginning with the peripheral auditory system, traveling on through the central auditory nervous system (central auditory processing) and continuing through the higher centers of the brain (language processing). Peripheral hearing testing and central auditory processing assessment are completed by an audiologist. Language processing assessment is completed by an SLP. If a peripheral hearing loss or central auditory deficit is present, it stands to reason that language processing will be affected by varying degrees depending on the type and severity of the hearing loss or central auditory processing deficit. If these two systems are intact, and there is a concern regarding language skills (in your son's case you stated concern regarding processing), a language processing deficit may be present.

Whenever there is question regarding actual "processing" of language, a team approach to evaluation and intervention is crucial. Usually a concern such as this concern arises due to issues with language, reading, following directions, marked phonological errors, frequent request for repetition, difficulty understanding in the presence of background noise, etc. When a team approach is used and processing of speech and language is viewed as a continuum, we can more effectively and accurately assess and prescribe the necessary intervention strategies. Conversely, if a team approach is not used, the result is rather like that of the four people with visual challenges inspecting the elephant. One thinks it's a hose (trunk), one deduces it must be a broom (tail), another pronounces it must be a tree (leg), and the last decrees it must be a fan (ear). Cleary, a team approach is more desirable. The questions then become "which professional will complete which component of the evaluation", "how will they collaborate", and "who will deliver which part of intervention should that be necessary".

Most audiologists will agree that evaluating a child for central auditory processing disorder (CAPD) under the age of six is questionable, and some even argue it is next to impossible. Others do not feel comfortable until the child is age seven or eight. This is based on neurological implications, personal preference, ability of the child, and several other factors. Some audiologists are trained to assess CAP and some are not. Some audiologists have an interest and some do not. It's important to speak with the audiologist to determine if the audiologist is willing to collaborate with the speech/language pathologist (and any educators who may be involved) regarding results of the evaluation as well as with possible intervention needs. You also need to ask whether the audiologist uses only a few tests or a battery of tests. There are many facets of CAP which need to be assessed and using only a few tests is usually less than adequate.

Moving on to the language processing piece, you have already investigated aspects of receptive and expressive language and that's a good place to begin with a four year old. However, you may want to continue with investigating your son's language processing skills. You mentioned receptive language was within normal limits and expressive language was one standard deviation below the mean. Since I don't know what tests were administered, I can't speak to the expressive language results, but it may be that language processing skills were not specifically investigated. I suggest you look further into these skills. While one standard deviation below the mean is not cause for alarm, it is cause for caution. You should ask the SLP similar questions to those suggested above to be asked of the audiologist.

So, in a capsule, here is a summary of my thoughts:

  1. You could discuss the original assessment results with your son's SLP and, if necessary, complete additional, focused assessment of language processing skills.

  2. Monitoring your son's language development will be very important as well over the next few years. Don't give up. You may have to insist!

  3. You may also want to speak with and audiologist who is specifically trained to complete CAP testing with children to gain more information.
These suggestions are not all inclusive, but I believe they will get you started. Thank you for your question.

Stephanie Tarrant Martin, PhD (Audiologist and Speech/Language Pathologist) is the Special Education Coordinator for the Sweet Home School District in Sweet Home, Oregon. Her primary areas of research and interest are in Central Auditory Processing, Language Processing and Language Disorders.

stephanie tarrant martin

Stephanie Tarrant Martin, Ph.D

Related Courses

20Q: A Continuum Approach for Sorting Out Processing Disorders
Presented by Gail J. Richard, PhD, CCC-SLP


Gail J. Richard, PhD, CCC-SLP
Course: #10008Level: Intermediate1 Hour
  'Well presented with a lot of good resources'   Read Reviews
There is a good deal of confusion among audiologists and speech-language pathologists when a diagnosis of “processing disorder” is introduced. This course presents a continuum model to differentiate processing disorders into acoustic, phonemic, or linguistic aspects so that assessment and treatment can become more focused and effective. The roles of audiologists and SLPs in relation to processing disorders are described, and compensatory strategies for differing aspects of processing are presented.

Auditory Processing Disorder: Overview of Assessment and Management for School-based Professionals
Presented by Gail M. Whitelaw, PhD, Kristine Ratliff, MEd, LSLS Cert. AVEd


Gail M. Whitelaw, PhDKristine Ratliff, MEd, LSLS Cert. AVEd
Course: #10538Level: Intermediate1 Hour
  'in the absence of an audiologist being present to conduct APD testing, an SLP can step in, in good faith, to provide support'   Read Reviews
An overview of auditory processing disorder (APD) specific to school-age children in classroom settings is provided in this course. Red flags, referrals and diagnosis, and different types of supports and practical interventions are discussed.

Mild TBI - The Not So Mild Effects
Presented by Liz Fuemmeler, AuD, FAAA, CCC-A, Julie Shoemake, MS, CCC-SLP, CBIS


Liz Fuemmeler, AuD, FAAA, CCC-AJulie Shoemake, MS, CCC-SLP, CBIS
Course: #10794Level: Intermediate1.5 Hours
  'The presenters were clear and knowledgeable'   Read Reviews
An overview of mild traumatic brain injury (mTBI)/concussion and its pathophysiology, with particular emphasis on diagnostic and rehabilitation tools utilized by SLPs and audiologists, is provided in this course. Impacts of mTBI on hearing, cognition, vision and the vestibular system, assessments performed by the two disciplines post-concussion, and treatments for cognition (including auditory processing disorder) are described.

Back to Basics: Practical Aspects of Auditory Processing Disorders
Presented by Gail M. Whitelaw, PhD


Gail M. Whitelaw, PhD
Course: #9294Level: Introductory1 Hour
  'This course clarified the roles of audiologists and speech-language pathologists in regards to APD'   Read Reviews
This course will provide an overview of assessment and management of auditory processing disorders (APD) in children. Interdisciplinary aspects of working with school-age children will be highlighted.

20Q: Auditory Processing - What You Always Wanted to Know
Presented by Donna Geffner, PhD, CCC-SLP/A, Deborah Ross Swain, EdD


Donna Geffner, PhD, CCC-SLP/ADeborah Ross Swain, EdD
Course: #10334Level: Intermediate1.5 Hours
  'Very organized and thorough'   Read Reviews
Behaviors and developmental/educational impacts associated with auditory processing disorder (APD) are described in this course. Methods and tools for identifying APD, including a list of tests for assessment, as well as treatment strategies for APD are discussed.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.