JCPSLP July 2014_Vol16_no2

Policy and practice

Screening and assessing for (central) auditory processing disorder and the role of the speech-language pathologist

A survey of Queensland clinicians Wendy L. Arnott, Caroline A. Henning, and Wayne J. Wilson

Methods of screening and assessing for (central) auditory processing disorder ([C]APD) continue to attract considerable controversy. This article (the first in a two- part series) surveyed 60 Queensland speech- language pathologists (SLPs) on how they screen and assess children suspected of having (C)APD. The majority of participants were found to favour using parent or teacher reports as indicators for the need to refer a child to audiology for a (C)APD assessment while simultaneously assessing the child’s speech and language. Most participants also reported rarely being asked by audiologists to contribute to (C)APD cases, although they found audiologists’ reports to be useful for diagnosing (C)APD. Overall, these results highlight a need for better communication between SLPs and audiologists if the screening and assessment of children for (C)APD in Queensland is to be improved. T he American Speech-Language-Hearing Association (ASHA, 2005) states that (central) auditory processing disorder or (C)APD refers to difficulties in the perceptual processing of auditory information in the central nervous system (CNS), as demonstrated by poor performance in one or more of the following skills: sound localisation and lateralisation; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination, temporal ordering, and temporal masking; auditory performance in competing acoustic signals; and auditory performance with degraded acoustic signals. ASHA also indicates that (C)APD may coexist with other disorders (e.g., speech language deficit and learning disability) and that (C)APD is not due to higher order language, cognitive, or related factors but may lead to or be associated with difficulties in higher order language, learning, and communication functions. The potential for these disorders to coexist appears to be high with Sharma, Purdy and Kelly (2009) reporting that in their sample of 68 children (aged 7 to 12 years) who either had (C)APD suspected by teachers and/or parents or had a diagnosis of (C)APD by

an audiologist, only 4% were subsequently shown to have a (C)APD only, whereas 10% were shown to have a (C)APD and a reading disorder; 10% were shown to have a (C)APD and a language impairment; and 47% were shown to have a (C)APD, a reading disorder and a language impairment. Despite the efforts of groups such as ASHA, the diagnosis and treatment of (C)APD, and indeed the existence of the disorder itself as a separate diagnostic entity, continues to attract considerable controversy (e.g., Dawes & Bishop, 2008; Fey et al., 2011, Kamhi, 2011; Wilson & Arnott, 2013). Caught in the centre of this controversy is the speech language pathologist (SLP) who must decide what role, if any, they should play in the management of this disorder. Current best practice guidelines according to the ASHA (2005) support a multidisciplinary approach to the differential diagnosis of (C)APD and recommend that audiologists collaborate with SLPs to screen, differentially diagnose, and manage auditory processing disorders when there is evidence of language or cognitive communication problems (ASHA, 2005). ASHA also acknowledges that SLPs are “uniquely qualified” to delineate between language/cognitive communication problems and auditory processing deficits. These ASHA best practice guidelines may not be widely followed, however, with a recent survey of 195 audiologists in the United States by Emanuel, Ficca, and Korczak (2011) showing that audiologists deemed they are primarily responsible for (C)APD diagnosis and recommending treatment/management, but this treatment/ management should primarily be provided by SLPs and educators. Further confounding the implementation of the ASHA (2005) guidelines is the current lack of compelling evidence to suggest that auditory interventions for (C)APD lead to any functional gains in language, literacy, or academic function (Fey et al., 2011). This suggests the role played by the SLP in the management of (C)APD should be limited to the direct management of speech/language disorders that might coexist with (C)APD rather than the direct management of the (C)APD itself (Kamhi, 2011). This position could be considered to be more consistent with The Speech Pathology Australia Scope of Practice (2003), which states that SLPs provide services such as hearing screening, auditory training, speech-reading, interpretation of audiological reports, and speech and language intervention/rehabilitation secondary to hearing loss or (C)APD (although Speech Pathology Australia does not have a formal position statement on [C]APD).

KEYWORDS ASSESSMENT SCREENING SPEECH PATHOLOGY (C)APD SURVEY

THIS ARTICLE HAS BEEN PEER- REVIEWED

Wendy L. Arnott (top), Caroline A. Henning (centre), and Wayne J. Wilson

66

JCPSLP Volume 16, Number 2 2014

Journal of Clinical Practice in Speech-Language Pathology