Auditory processing disorder
Auditory Processing Disorder occurs when you have a client on your caseload who has trouble following directions, frequently asks you to repeat something you’ve said, and is having reading and writing difficulties.
According to the American Speech-Language Hearing Association, APD (also known as Central Auditory Processing Disorder, or CAPD), refers to:
“Deficits in the neural processing of auditory information in the CAND not due to higher order language or cognition.”
Children with auditory processing disorder do not have hearing loss. In APD, there is a discoordination of the brain and ears. That results in the individual having difficulty interpreting auditory input.
Most speech-language pathologists are somewhat familiar with auditory processing disorder, but it can present similarly to other speech, language and hearing disorders, so auditory processing disorder diagnosis can be somewhat difficult.
It’s important for SLPs to be familiar with the characteristics of auditory processing disorder. It can help guide treatment for a child who may or may not already have this diagnosis. Being able to recognize what auditory processing disorder looks like can also help SLPs use the most effective treatment techniques and develop appropriate, functional goals for the client.
Auditory processing disorder and potential causes
Common characteristics of auditory processing disorder include:
- Trouble detecting subtle differences between sounds (ex: pat and bat)
- More difficulty listening in the presence of background noise
- Frequently asking for repetitions of auditory information (ex: saying, “what?”, or “huh?” after being told something)
- Reduced phonological awareness skills (difficulty with tasks like rhyming or sound manipulation)
- Articulation difficulties (especially as in substituting closely related sounds, such as pronouncing as /t/ as a /d/)
- Trouble following spoken directions
- Difficulty comprehending information that is given from someone speaking quickly
- Difficulties with reading and spelling
- Delayed responses
- Trouble perceiving differences in the pitch or inflection of speech
What causes auditory processing disorder?
According to research, children who have experienced the following may be more likely to have APD:
- Frequent ear infections (Otitis Media)
- Seizures, lead poisoning
- Head trauma
In many cases, the cause of APD is unknown.
Auditory processing disorder testing
Audiologists test for and diagnose auditory processing disorder. Typically, the child must be at least 7 years old to be testing for CAPD. The audiologists will perform a battery of listening tests, such as temporal processing (recognizing differences in speech sounds) and auditory closure.
The speech-language pathologist plays an integral role on the team of professionals who should be involved in the diagnosis and treatment of auditory processing disorder for the individual.
First, the SLP should recommend that the child have his or her hearing assessed.
If the child has been found to have normal hearing acuity, the SLP should test these areas:
- Speech (articulation) skills (e.g., with a standardized test such as the Goldman Fristoe Test of Articulation, 3rd Edition (GFTA3))
- Expressive and Receptive Language (tests such as the Clinical Evaluation of Language Fundamentals, 5th Edition (CELF-5))
- Phonological Awareness
- Auditory Processing Checklist (for SLP and/or one designed for a teacher or parent to complete)
Prevalence of Auditory processing disorder
It’s estimated that 3% to 5% of school-aged children are affected by auditory processing disorder. One study found the prevalence of APD to be 1.94 per 1,000 children.
Auditory processing disorder is prevalent in certain populations, such as those with Fragile X syndrome and individuals with Autism.
Therapy strategies for auditory processing disorder
An important part of treatment for children with auditory processing disorder is educating the client about compensatory strategies.
These include:
- Asking others to speak slowly and possibly louder
- Reducing background noise
- Requesting repetition of information as needed
SLPs should also work with the client’s parents, teachers, and other professionals to bring their awareness to these helpful strategies.
The child may be taught certain therapy techniques, such as “chunking” to remember a long spoken direction. The client would break up what they heard into “chunks” of important information that can be easier for them to remember.
Goals of auditory processing disorder treatment
With intervention such as speech therapy, a child with auditory processing disorder can learn strategies for improving difficulties resulting from the disorder.
One main goal of treatment is to teach the child auditory memory strategies.
These include:
- Chunking (breaking auditory information into smaller parts)
- Visualization (picturing auditory information in their head)
- Rehearsal (repeating words, lists or phrases in your head over and over)
- Requesting repetition (asking others to repeat information when needed)
- Paraphrasing (identifying key words to remember instead of a longer piece of auditory information).
The SLP can also work with the child on improving other areas that may be affected by APD, such as phonological awareness (through sound manipulation activities), articulation, and expressive/receptive language skills.
Lifestyle changes with auditory processing disorder
In addition to implementing the strategies and environmental modifications reviewed, some lifestyle changes may be helpful for individuals with auditory processing disorder.
According to evidence, FM systems or remote microphone systems can benefit many children with auditory processing disorder academically and psychosocially. These systems can help improve speech perception abilities in a noisy environment such as school.
Carryover for school/home
Parents, teachers, and other professionals working with the child should be aware if the child has a diagnosis of auditory processing disorder.
Environmental modifications should be made as they are able to be, both at home and at school. Parents should be present during therapy sessions so that they can learn therapy techniques and carry them over into the home environment.
Effectiveness of auditory processing disorder treatment
More research is needed to measure the effectiveness of treatment for children with auditory processing disorder.
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For optimal outcomes, early detection and implementation of therapy strategies is recommended. Also, as in speech therapy for several other speech and language disorders, consistent attendance in therapy and carryover at home and school may result in increased improvements of skills.
According to the California board of Speech Language Pathology and Audiology, several evidence-based strategies and therapies have been shown to lead to “effective remediation of a number of functional deficits” seen in individuals with CAPD.
Billing/ICD10 Code
ICD-10CM code H93.25 should be used for a child with Auditory Processing Disorder (CAPD), also known as Auditory Processing Disorder (APD).
SLPs should remember that only an audiologist can give a diagnosis of APD. If the client has been tested and diagnosed with APD, then this ICD-10CM code is appropriate to be used for billing purposes.
A child with the ICD10 CM code H93.25 for APD may also have other ICD-10 codes for speech therapy. For example, R48.8 Other Symbolic Dysfunctions, for a child with speech and language deficits related to Autism, or F80.2 for a Mixed Receptive-Expressive Language Disorder.
If you’re not accepting health insurance in your practice yet but you’re considering it, you’ll find our Ultimate Insurance Billing Guide for Therapists helpful.
Resources
SLPs working with individuals who have a diagnosis of auditory processing disorder can utilize TheraPlatform for helpful resources. If you own a private practice or are considering starting a private practice, you can use TheraPlatform to manage several aspects of your practice, from documentation to financial organization and scheduling. TheraPlatform, an all-in-one EHR, practice management and teletherapy tool was built for therapists to help them save time on admin tasks. Consider starting with a free trial of TheraPlatform today.
More resources
- Guide to articulation therapy for SLPs
- Dynamic assessment
- Apraxia ICD-10
- CDC guidelines for speech development
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
