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Dig Deeper if Treating a Child With Suspected APD

by Tatyana Elleseff
written by
A teacher is reading books with an elementary age girl in the library.

Editor’s note: In response to our recent School Matters column, Don’t Wait to Diagnose Auditory Processing Disorder,the Leader is presenting a series of blog posts sharing different views on the validity of APD as a specific diagnosis. The first in this series appeared April 27 and was written by Andrew Vermiglio, AuD, CCC-A: “Does Auditory Processing Disorder Meet the Criteria for a Legitimate Clinical Entity?” This is the second in the series.

In recent years, I’ve noticed an increase in research on the diagnosis and treatment of auditory processing disorders (APD)—also known as central auditory processing disorders or CAPD. Many studies confirm the lack of validity of APD as a stand-alone diagnosis. The American Journal of Audiology, for example, published an article by David DeBonis, “It Is Time to Rethink Central Auditory Processing Disorder Protocols for School-Aged Children.” In this article, DeBonis pointed out numerous inconsistencies involved in APD testing, concluding that “routine use of APD test protocols cannot be supported” and that APD “intervention needs to be contextualized and functional.”

The APD controversy has been going on for years, with no end in sight, so speech-language pathologists will continue to treat students diagnosed with APD. I hope to share some useful suggestions for SLPs serving students with suspected APD. Students diagnosed with “APD” present with legitimate symptomatology—usually issues with processing language, organizing narratives or decoding text—however, most research indicates these symptoms are indicative of broader language-based deficits, which require targeted language/literacy-based interventions.

To provide the appropriate interventions, SLPs can dig further by performing a more comprehensive assessment and then formulating language goals based on the areas in which a student experiences challenges. Avoid formulating goals based on targeting isolated processing abilities—such as auditory discrimination, auditory sequencing and recognizing speech in noise—because these processing abilities may not improve language and literacy skills. Instead, I suggest targeting the language underpinnings of these skills and turning them into language and literacy goals.

For example, if the student has difficulty recognizing speech in noise, improve the child’s knowledge of and access to specific vocabulary words. This will help the child detect the word when the auditory information is degraded. Do you have a student presenting with phonemic awareness deficits? Figure out their strengths and weaknesses within the hierarchy of phonemic awareness and generate goals based on the remaining areas in need of mastery. Turn “prosodic deficits” or difficulty understanding the intent of verbal messages into “listening for details and main ideas in stories” goals. In other words, figure out the language goal related to an “auditory processing” deficit and replace it!

The post as an excerpt, but you can read the complete article at SmartSpeechTherapy.com.


Tatyana Elleseff, MA, SLP, is a bilingual speech-language pathologist with Rutgers University Behavioral Healthcare. She also runs a private practice, Smart Speech Therapy LLC, in New Jersey. She specializes in working with multicultural, internationally and domestically adopted children, and at-risk children with complex communication disorders. She is an affiliate of ASHA Special Interest Group 16, School-Based Issues. Visit her website for more information or contact her at tatyana.elleseff@smartspeechtherapy.com.

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Susan June 6, 2017 - 9:43 pm

What do you offer when a child is diagnosed with an integration disorder?

elleseta June 7, 2017 - 11:25 am

What exactly do you mean by integration disorder? what weaknesses did the audiologist identify and how do these weaknesses manifest themselves linguistically? (language and literacy wise)

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