Auditory Processing and Functional Hearing Services

January 1, 2023 Update.

VT HEARS will be closing due to an inability to provide qualified providers and the limited capacity of Dr. Overman. We are grateful for the clients that we partnered with during our three-year run. We recognize the need for evidence-based auditory processing and functional hearing assessments, as well as limitations and access barriers. We will continue to advocate for services across the state whenever possible.

In partnership with you,

Dr. Margaret

What is Auditory Processing?

As Dr. Jack Katz has simply stated, auditory processing is what the brain does with what the ear hears. Every listening skill we have uses auditory processing.

What is an Auditory Processing Deficit?

Auditory Processing Deficits/Disorders (APD), also referred to as Central Auditory Processing Deficits/Disorders (CAPD), can occur in both children and adults. APD is an umbrella term that reflects poor performance within a behavioral test battery (Riccio, et. al, 1994; Bellis, et. al., 2003; Geffner, et. al., 2007). An APD refers to difficulties in the perceptual processing of auditory information in the central nervous system” (AAA, 2010). It is the result of the inefficient processing of what is heard that may be revealed in communication or academic difficulties (Katz, 2009). A child with APD often appears to have a combination of many symptoms. An Auditory Processing Disorder may coexist with other disorders (e.g., attention deficit hyperactivity disorder [ADHD], language impairment, and learning disability).


Auditory processing involves many skill areas, and therefore, depending on the area that is affected, there will be different impacts on different students. There have been documented, significant, relationships between auditory processing and: phonemic awareness (Smart et. al., 2012); reading abilities, and; classroom learning (Johnston et. al., 2009).


Common signs of Auditory Processing Deficits/Disorders, according to the American Academy of Audiology (2010), include:


  • difficulty hearing speech in noisy environments

  • difficulty maintaining attention

  • problems locating the source of a sound

  • difficulty following directions

  • commonly asking for information to be repeated

  • inability to detect subtle changes in tone

  • distracted and inattentive behavior

  • difficulty learning to read

  • academic difficulties, including poor reading and spelling


The causes of APD vary and are not clearly defined or understood at this time, but the condition is thought to be either developmental - having to do with delays in the maturation of the central auditory pathway or acquired - due to brain trauma or other health issues impacting the central auditory system (Schecter et. al, 2018).

How do we assess auditory processing skills?

There are several different protocols and methods to assess auditory processing abilities, depending on the training and professional preference of the audiologist performing the test.

The goal of Vermont HEARS, LLC is to provide insight to the school team based on the specific auditory processing profile of the student, to support the school team with understanding how the student’s ability to process sound may be impacting their education (e.g., reading and language skills) and success, and to help optimize the learning environment to account for their specific deficits. Vermont HEARS, LLC is committed to using evidence-based and evidence-informed diagnostic and treatment methods within a team-based approach. Although a multidisciplinary team approach is essential in order to fully understand the cluster of problems associated with APD, the diagnosis of APD can only be made by an audiologist.

At this time, Vermont HEARS assessment protocol focuses on assessing:

  • Hearing Levels and Lateralization Abilities

  • Temporal Processing

  • Non-linguistic Auditory Memory

  • Non-linguistic Dichotic Ability

  • Rapid Tonal and 'Pitch' Processing

  • Linguistic Auditory Memory

  • Linguistic Dichotic Ability

  • Degraded Speech

  • Speech-in-noise WITHOUT noise suppression cues

  • Speech-in-noise WITH noise suppression cues

  • Phonemic Decoding Ability

  • Other areas as identified during the assessment.

Management of Auditory Processing Deficits

Auditory processing deficit recommendations are individualized to each student and their areas of strength and weaknesses. In general, there are four areas Vermont HEARS will review for each student.

1.) Educational Accommodations. This includes environmental/physical accommodations and instructional accommodations. Accommodations are designed to ensure the child with an auditory processing deficit has the best possible access to information presented auditorily.

2.) Hearing Assistive Technology. These systems, often called FM/DM or remote microphone systems, are designed to ensure the volume of the speaker is steady and consistent for the child, even when background noise is present or the speaker is at a distance.

3.) Compensatory Strategies. This involves recommendations for the child to learn new skills to lessen the impact of the auditory processing. Practicing compensatory strategies can occur at home with the family and/or at school, depending on the child's educational setting and team.

4.) Auditory Training. Depending on the deficit area of the individual child, there may be computer-assisted programs available to practice and improve areas of auditory processing. The audiologist monitors performance and will reassess the child's skills at the end of the treatment program to update recommendations for accommodations, HAT, and compensatory strategies.


References:

Barker, M. (2020). Acoustic Pioneer. Retrieved from www.acousticpioneer.com

American Academy of Audiology (AAA) Clinical Practice Guidelines: Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder. 8/24/2010 LINK: AAA APD guidance

American Speech-Language-Hearing Association. (2005). (Central) auditory processing disorders – The role of the audiologist (Position statement). Retrieved from www.asha.org/policy

Barker, M. D., & Purdy, S. C. (2016). An initial investigation into the validity of a computer-based auditory processing assessment (Feather Squadron). International Journal of Audiology, 55(3), 173–183.

Bellis T. New York, NY: Delmar Learning, Thompson Learning; 2003. Assessment and Management of Central Auditory Processing Disorders in the Educational Setting from Science to Practice, 2nd ed.

Bellis, T. J., Barker, M. D., & Martin, M. J. (2015) Training CAPD: The what, who, how, and why of Dichotic Listening Training. Presentation at ASHA conference, Denver. CO. November.

Bellis, T. J. (2003). Assessment and management of central auditory processing disorders in the educational setting: From science to practice (2nd ed.). New York, NY: Delmar Learning.

Chermak, G. D., & Musiek, F. E. (1997). Central auditory processing disorders: New perspectives. San Diego, CA: Singular.

Corriveau, K., Pasquini, E., & Goswami, U. (2007). Basic auditory processing skills and specific language impairment: A new look at an old hypothesis. Journal of Speech Language, and Hearing Research, 50, 647-666.

Geffner D, Ross-Swain D. San Diego: Plural Publishing; 2007. Auditory Processing Disorders: A Handbook for Management and Treatment for Speech-language Pathologists.

Hallett, T., & Proctor, A. (1996). Maturation of the central nervous system as related to communication and cognitive development. Infants & Young Children, 8(4), 1-15.

Johnston, Kristin N., et al. "Multiple benefits of personal FM system use by children with auditory processing disorder (APD)." International journal of audiology 48.6 (2009): 371-383.

Katz, J. (2009). Therapy for APD: Simple, Effective Procedures. Westminster Colorado: Educational Audiology Association.

Mamatha, N. M., & Yathiraj, A. (2020). Comparison of Diagnostic Auditory Processing Test Scores Measured in Clinical and School Settings. Language, Speech, and Hearing Services in Schools, 51(4), 1071-1080.

O’Hara, B. (2016). The Auditory Processing Domains Questionnaire:Differential Screening for APD Overview. Retrieved from https://hearinghealthmatters.org/pathways/2016/auditory-processing-questionnaire-differential-screening-apd-overview/.

Riccio, C. A., Hynd, G. W., Cohen, M. J., Hall, J., & Molt, L. (1994). Comorbidity of central auditory processing disorder and attention-deficit hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 33(6), 849-857.

Schow, R. L., Seikel, J. A., Brockett, J. E., & Whitaker, M. M. (2018). Multiple Auditory Processing Assessment–2 (MAPA-2). ATP Assessments.

Sharma, M., Purdy, C. S., & Kelly, A. S. (2009). Comorbidity of auditory processing, language, and reading disorders. Journal of Speech, Language, and Hearing Research, 52, 706-722.

Shechter J.A., Caplan B., Leinen S.J. (2018) Central Auditory Processing Disorder. In: Kreutzer J., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, Cham. https://doi.org/10.1007/978-3-319-56782-2_1527-3

Smart, J. L., Purdy, S. C., & Leman, K. R. (2012). Evaluation of (central) auditory processing and phonological/phonemic awareness in 6-year-old children: A pilot study to determine test efficiency and inter-subject reliability. Journal of Educational Audiology, 18, 6-15.

Tomlin, D., & Rance, G. (2016, February). Maturation of the central auditory nervous system in children with auditory processing disorder. In Seminars in Hearing (Vol. 37, No. 1, p. 74). Thieme Medical Publishers.