LM325 - Tools for your Toolbox: Recommendations for Children and Adults with Auditory Processing Disorder

Abstract:
Auditory processing disorder is an impairment in the central auditory nervous system’s ability to process auditory information. The audiologist is the professional responsible for rendering a diagnosis of APD and, when needed, for making individualized and appropriate management recommendations for patients. Recommendations are not “one size fits all” and instead, should be applied on an individual basis depending on test findings and the person’s functional difficulties. A discussion of common recommendations for the management of adult and pediatric auditory processing disorder will be discussed, along with evidence-based and clinical experiences to support them.

Summary:
Auditory processing disorder (APD) is an impairment in the central auditory nervous system’s ability to process auditory information that is not the result of peripheral hearing loss or higher-order language or cognitive difficulties (ASHA, n.d.). APD can affect children and adults, and its presentation varies across those affected. Common signs and symptoms of APD include: difficulties understanding speech in noise, impaired localization, frequent requests for repetitions, trouble understanding sarcasm, difficulties following directions, and distractibility, among others (AAA, 2010).

The audiologist is the professional tasked with the diagnosis of APD (AAA, 2010, ASHA, n.d.). Clinical practice guidelines for the assessment and diagnosis of APD exist; however, gold standard diagnostic tests do not (AAA, 2010). Since variability is inherent in the presentation, evaluation, and diagnosis of this disorder, it would be unreasonable to assume that a standardized set of recommendations could be applied to all patients. The audiologist must use their knowledge, expertise, counseling skills and patient feedback to make recommendations based on the pattern of test results and the functional impact APD is having on that individual’s life (AAA, 2010).

Recommendations for intervention and management of APD generally should encompass three areas: direct skills remediation, compensatory strategies, and environmental modifications (ASHA, n.d.; Ferre, 2006). Direct skills remediation aims to capitalize on neural plasticity and is typically completed through auditory training (including computer-based training programs, apps, and nontraditional therapies). Compensatory strategies include techniques aimed to improve listening skills, such as active listening and metamemory strategies. Environmental modifications include approaches to enhance the auditory signal via options such as remote microphone systems or low gain hearing aids, as well as the listening environment itself through acoustic modifications. Recommendations from all areas should be incorporated together in an attempt to maximize the benefit to each patient’s quality of life.

When considering the wide range of patients who can be assessed for auditory processing disorder and the vastly different listening environments in which they may find themselves, it can be a daunting task to consider all possible recommendations. Additionally posing a challenge is the task of evaluating the effectiveness of those options to help select the ones most likely to result in perceived or measurable benefit. The goal of this session is to compile well-known and innovative approaches to the management of adult and pediatric APD, and the published evidence or clinical experiences behind them, in hopes of adding them to the audiologist’s “toolbox”. Our patients and their needs are dynamic; whether the audiologist has years of experience related to APD or is newly interested in this specialty area, by sharing resources and ideas we all can better serve this population.