LM305 - Best Practices in Managing Auditory Processing Referrals: A View from Two Offices

Abstract:
Guidelines for the assessment and diagnosis of auditory processing disorder (APD) exist; however, a well-defined methodology does not. It is the responsibility of the audiologist to have a strong understanding of the central auditory nervous system and conditions that are known to coexist with, or be mistaken for, APD. With this understanding and taking into context input from related professionals, the audiologist can determine whether an evaluation for APD is warranted. Case studies of “appropriate” and “inappropriate” referrals based on current best practice will be discussed, along with challenges in assessment and rehabilitation that vary based on practice type.

Summary:
Literature relevant to auditory processing disorder (APD) is replete with controversy, including debate regarding the validity and clinical utility of the diagnosis. At present, the audiologist is the professional responsible for the diagnosis of APD and, as such, must determine the most appropriate way to manage these referrals—by defining candidacy criteria, developing an appropriate and efficient test battery, and selecting and defining diagnostic criteria. Guidelines for the assessment and diagnosis of APD (e.g., AAA, 2010) exist, but merely as such: to provide guidance. In large part, the recommendations leave much for the audiologist to interpret independently. A uniform, clear-cut methodology does not exist. Arguably, based on the nature and dynamic presentation of the disorder, including the non-modular nature of the brain, such regulations cannot exist.

Audiologists willing to take on this significant and somewhat personal responsibility to interpret current guidelines should have a strong understanding of the central auditory nervous system and conditions that are known to coexist with, or be mistaken for, APD. Audiologists have an obligation to evaluate the person in context. A proper understanding of the patient’s existing diagnoses, “red flags” generating this referral, and the patient’s functional deficits can help determine when evaluation is truly warranted. Specifically, in the case of pediatric referrals, audiologists often act as “gatekeepers” for services and interventions that could ultimately be beneficial for the child (Witton, 2010). It is important to acknowledge, however, that not all referrals are appropriate or warrant evaluation. Significantly, it is the audiologist’s responsibility to know what APD is and what APD is not. By carefully selecting the appropriate patients to assess, we can reduce the overdiagnosis of APD that is contributing to mistrust in this specialty area.

This presentation serves to reignite the conversation on APD. Rather than attempt to clear any sources of debate or points of contention, the authors will discuss a working definition of APD. This will include APD in the context of other diagnoses, such as learning disorders and language disabilities (Sharma et al., 2009; Witton, 2010). The authors will present current evidence-based approaches to the assessment of APD. These methodologies will be discussed in the context of the two vastly different clinical settings in which they are used (university clinic vs. hospital in different regions of the United States), and with regard to the unique needs of each setting’s population. The authors will also discuss their ideal test approach, in that an auditory processing evaluation should not necessarily be completed in isolation and without input from related professions. This comprehensive analysis of the patient will best allow audiologists to determine whether evaluation for APD is warranted. Case studies of referrals deemed “appropriate” and “inappropriate” will be presented and discussed, as well as the challenges in the assessment and rehabilitation of APD as they vary by practice type and location. With ongoing discussion, continued use of best-practice approaches, and acknowledging what we still must learn, we do our part in maintaining the integrity of the assessment and diagnosis of APD.