Chapter 1: Auditory Processing Disorder in Children and its Relation to Language and Literacy Disorders

What is an auditory processing disorder? The children under assessment at APD clinics in the U.K. have usually been through two stages of referral (detailed as follows), but their presenting symptoms appear to be similar to those seen in other APD clinics across the world. Audiologists often interpret the children’s primary complaint as one of difficulty hearing in noisy environments, but the actual statements made by parents or other caregivers paint a slightly different and broader picture. Consider the following statements:¹

While the first statement may suggest a speech-in-noise problem, it may also indicate either inattentiveness or conversely an excessive level of attentive focus. The second statement could describe a child with listening, language, attention, or memory problems. The important points from these and the other examples are (a) that listening problems usually cooccur with other developmental issues (Sharma, Purdy, & Kelly, 2009) that may be of a primarily cognitive² rather than a sensory nature, and (b) that audiologists and other medical and related professionals tend to arrive at diagnoses based on their particular fields of expertise. In fact, the selection pathway toward a diagnosis of APD begins before the APD clinic. Among other possibilities, children may receive primary referrals from (a) their schools due to listening difficulties, (b) their family doctors due to initial complaints from parents or (c) speech/language therapists due to their apparently normal productive language (Hind et al., 2011). In each of these instances, the initial suspicion may be that the child has experienced hearing loss, so the audiology referral is intended to explore this possibility. Some children turn out not to have an audiometric hearing loss but are still referred by audiologists who are aware of APD. We (Ferguson, Hall, Riley, & Moore, 2011) and others (Dawes & Bishop, 2010; Sharma et al., 2009) have shown that children diagnosed with or suspected of APD may be nearly indistinguishable symptomatically from those diagnosed with language disorders.