Assessment Options for Auditory Processing Disorder
There are different approaches we can take in our goal to assess auditory processing.
There are benefits and limitations to each of these approaches.
Part of what you need to clarify is this, what are you trying to accomplish with your assessment?
The answer is not as obvious as it may seem.
If your goal is to obtain a diagnosis for the sake of being “classified” for legal purposes, which would garner IEP or ADA accommodations, you actually have fewer assessment options than if your purpose is to treat the APD.
Approaches:
1) Physiology
Using objective measures, such as EEG or fMRI, allows us to look at the functioning of the auditory parts of the brain. We evoke a neurological response by presenting very specific auditory stimuli, depending on the test being performed. Stimuli may include clicks, chirps, tones, or short speech such as a consonant + vowel combination.
2) Function
Using a combination of objective and subjective measures, we can look at the individual’s performance in specific auditory skills. This may include skills at the micro-level, such as gap detection, or more gross skills, such as speech understanding with competing background noise.
3) Activities of Daily Living
Using a combination of questionnaires and behavioral measures, we can look at the individual’s real world function and quality of life. The questionnaires will look at a variety of listening situations and ask the person how well and easily they feel they can listen. The behavioral measures tend be those that look at gross functions which are commonly challenging, such as speech understanding in noise or phonemic blending and segmenting.
How To Choose:
Both physiological measures and functional measures have the potential to be used diagnostically. This is if the measures have sufficient research behind it informing us as to what results fall within the range of “normal” and what qualifies as “abnormal/disordered”. Different tests have been standardized on people of different ages. This has lead to a disagreement as to how young APD can be diagnosed. The youngest is 5 years old. However, using a developmental model we can (and a select few audiologists do) assess younger than age 5. While such an assessment cannot result in a diagnosis, it can identify areas of delay. This approach offers the benefit of allowing remediation to begin before we have a cumulative impact on academic skills due to a neglected deficiency.
Questionnaires have not been shown to correlate with specific types of auditory processing disorders in the research. For this reason they are not considered a viable basis for diagnosis. However, questionnaires offer you the benefit of allowing you to tap into the emotional state of the person. This information can be invaluable in picking up on clinically significant emotional states, such as anger and depression. (For more about depression inducing auditory conditions see here.) Questionnaires also allow you to identify which real life circumstances need to be addressed on a situation basis e.g. listening to the TV vs general hearing.
Degree of Disability vs Handicap
Degree of disability is a measure by a third party through objective and subjective (auditory) function measures.
Handicap is entirely a subjective measure that is independent from a need to be demonstrated, it merely needs to be reported and is accepted at face value without confirmation of a third party.
(It’s one of my favorite parts in doing an assessment, as often this is the first time a client is truly validated. Too often there is a glaring discrepancy with how the parent perceives their child’s struggle with their disorder and the child’s actual experience. One of my favorite encounters was a teenager that reported he was weak in sports, while mom reported sports as a strength. They were both right! He did poorly in sports involving fine motor skill and excelled in sports involving gross motor skill.)
Degree of disability is what garners a diagnosis. Handicap is what lets you know intervention is needed and what type. Both components add significant value to the discovery process in identifying disorders.
This is a simplistic and broad overview on considerations in APD assessment. To be continued next time.
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