Laying Auditory Processing Disorder to Rest

There is nothing wrong with the auditory processing of people with dyslexia. They can hear sounds just fine. It’s all about language processing, folks. When the sounds we are talking about are phonemes in a word we enter the domain of language. Auditory processing is an outdated diagnosis and now that we know better, we do better. Back in the days when central auditory processing was commonly diagnosed by audiologists it was the job of the speech-language pathologist to do the intervention. I remember checking out the materials in the materials library when I was a graduate student trying to make sense of all of the different types of processing. One of the materials I found was one that used pictures and recorded environmental sounds. The child would match the environmental sound that they heard with the picture of what makes that sound. This isn’t a common problem among children, I have seen it in stroke patients and patients who had a traumatic brain injury but in my 25 years of practice I have never heard of or worked with a child that had this difficulty.

At some point years ago some audiologists started applying that diagnosis to children who had difficulty learning to read and spell. It took off like a rocket and folks were happy to have a concrete reason for their difficulty. But… the thing is people who receive this diagnosis pertaining to difficulty with reading and spelling process sounds just fine. What they have difficulty processing is language. They also have difficulty using their working memory to artificially separate spoken words into individual speech sounds. I used the word “artificial” because speech sounds don’t occur in isolation, they occur together in words.

Along with this misguided diagnosis came the misguided notion that children should be drilled on phoneme segmentation, addition, deletion, and substitution. Truly a nightmare for any child or adult with lower working memory scores. Even worse, these skills aren’t even necessary to learn how to read or spell. They are metalinguistic skills, or word play skills that may or may not develop after full literacy has been achieved. Have you ever played the game Mad Gab? You read a passage that doesn’t make any sense and you have to figure out what actual common phrase is represented. I was all excited when I got the game and was surprised when my dyslexic husband told me I was the only one who would enjoy playing at the family party. This was in the beginning of my journey to become a literacy specialist and I hadn’t thought about these metalinguistic skills in that light before. All of the dyslexic people in his family were adults who could read and yet they still could not perform metalinguistic tasks like that.

The controversial APD diagnosis created a misguided path to interventions that had little to no efficacy and prolonged the amount of time that children got the actual intervention that they needed. Sadly, many likely never received effective intervention at all. Audiologists coming into the profession for the last 10-15 years for the most part no longer specialize in APD. I had two audiologists explain the problems with the formal assessments, protocols, and even the definition of what APD even was. There was no consensus of what the diagnostic protocol should be, what the definition of APD entailed, or about what the tests were actualy measuring. Alas the damage was done and sadly there are still some audiologists out there giving the diagnosis and sending children and their families off to pay hundreds or thousands of dollars for ineffective intervention.

What do they need instead? Language intervention!

APD testing involves the processing of sounds, words and sentences so any deficits are linguistic and not auditory in nature. For example, auditory deficits such as Tolerance-Fading Memory (TFM) deficits are actually two skills that are often found together: “tolerance” – understanding speech in noise (processing of language) and “fading memory “or auditory short-term or working memory. However, memory is a higher-level cognitive skill rather than a purely auditory skill. Deficits in processing language in noisy environments are related to difficulty processing language and not auditory deficits.

Literacy skills are language skills, all of them. Dyslexic learners and learners who have other types of language disorders typically have other areas of language that need attention.

-Word finding
-vocabulary ( receptive and expressive)
-formulating syntactically correct sentences
-executive functioning
-putting their thoughts into writing
-using language to persuade, educate, describe, or define
-listening comprehension
-reading comprehension ( after they learn to read)
-spelling
-rote memorization ( doesn’t improve – needs alternative learning routes)

Placing the focus of diagnosis and intervention on auditory tasks wastes precious time that could be much better spend building the linguistic skills all learners need to develop to become successful communicators and to become fully literate. When you need a loaf of bread go to the baker. When your child has difficulty with language and literacy, go to a speech-language pathologist extensively trained in Structured Word Inquiry.

_{Cover Photo by Ivan Samkov: https://www.pexels.com/photo/photo-of-woman-taking-notes-4458554/}