Team Approach to Assessing APD

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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.