JCPSLP July 2014_Vol16_no2

Policy and practice

Treating (C)APD 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 treating (central) auditory processing disorder ([C]APD) continue to attract consider­ able controversy. This study (the second in a two-part series) surveyed 60 Queensland speech-language pathologists (SLPs) on how they treat children suspected of having (C)APD. The treatments used by these SLPs were found to be generally consistent with those recommended in the literature, with most clinicians treating the language and literacy deficits associated with the disorder rather than focusing on specific auditory deficits. (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 a range of skills such as sound localisation and lateralisation, auditory discrimination, auditory pattern recognition, temporal aspects of audition, auditory performance in competing acoustic signals, and auditory performance with degraded acoustic signals (ASHA, 2005). (C)APD may coexist with other disorders (such as language disorders) but is not the result of those disorders, although the rate of coexistence of (C)APD with other disorders appears to be high (Sharma, Purdy & Kelly, 2009). As is the case with diagnosis, treatment of (C)APD is a topic that continues to attract considerable controversy. While current best practice guidelines developed by ASHA (2005) support a multidisciplinary approach to managing (C)APD as a whole, treating (C)APD is often seen as the remit of speech-language pathologists (SLPs; Emanuel, Ficca, & Korczak, 2011). Deciding which treatments fall within the SLP’s scope of practice is confounded by debates over what separates auditory treatments from language and literacy treatments. Fey et al. (2011) described auditory treatments as being those that manipulate the acoustic features of non-speech and/or speech stimuli. These include, but are not limited to, nonspeech auditory training, nonlinguistic simple speech auditory training, speech-in-noise training, localisation training, and commercially available auditory training software packages. They described language and literacy treatments as those that manipulate language form, content, and use. These include, but are not limited to, individualised languagebased treatments, phonological awareness training, visualisation and verbalisation, individualised reading and spelling remediation, closure

training, prosody training, and commercially available auditorylinguistic training software packages. Fey et al. (2011) went on to review auditory interventions for (C)APD and concluded that while these interventions can lead to gains in discrete auditory processing skills, they do not lead to functional gains in language, literacy, or academic function. 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. Such a suggestion is more consistent with Speech Pathology Australia’s Scope of Practice (2003), which includes speech and language intervention/rehabilitation secondary to hearing loss or encouraged clinicians and researchers to work together towards better outcomes for children with (C)APD and Kamhi (2011) has suggested that SLPs treat children with (C)APD in the same way that they treat children with language and learning disabilities – by assessing and treating any coexisting language, literacy, and metalinguistic difficulties. Currently, however, there is limited information regarding the specific treatments used by SLPs to treat children with (C)APD. Hind (2006) and Logue-Kennedy et al. (2011) surveyed SLPs and other professionals in the United Kingdom and the Republic of Ireland, respectively, to explore all aspects of service provision for clients with (C)APD. Treatment-related questions were limited, with respondents being asked whether they provided verbal advice or programs of treatment to clients with (C)APD. Specific details regarding the nature of the advice or programs provided were not gathered. To our knowledge, there have been no surveys of how SLPs are treating children with (C)APD in practice. In light of the potential for confusion as to the role of the SLP in treating (C)APD, the major objective of the present study was to determine how SLPs currently manage (C)APD and to compare the results with published recommendations (ASHA, 2005; Fey et al., 2011; McArthur, Ellis, Atkinson & Coltheart, 2008; Wilson & Arnott, 2012). This study is the second of two articles, the first of which (Arnott, Henning & Wilson, 2014) considered how these SLPs screen and assess for (C)APD. Methods Participants Speech-language pathologists (SLPs, n = 1,536) registered with the Speech Pathologists’ Board of Queensland were sent (C)APD in its services to be provided by SLPs. Despite their conclusions, Fey et al. (2011) still

KEYWORDS TREATMENT SPEECH PATHOLOGY (C)APD SURVEY

THIS ARTICLE HAS BEEN PEER- REVIEWED

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

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JCPSLP Volume 16, Number 2 2014

www.speechpathologyaustralia.org.au