Central Auditory Processing
The term “central auditory processing” is used to describe what happens when the brain recognizes and interprets sounds that have been presented. The processing of language involves many elements, beginning at the point an individual initially hears another talking, all the way to ultimately understanding and retaining the information presented. A deficit in any of these elements can result in processing related difficulties.
What indicates that someone has a central auditory processing disorder (CAPD)? In general, if someone is experiencing difficulty understanding speech at home, school or work that are not due to hearing loss, a possible cause is a CAPD. The following are some difficulties that can occur:
- Difficulty understanding fast-rate speech (someone is speaking quickly)
- Difficulty comprehending information and/or struggling to answer questions
- Problems following sequences of directions, carrying out tasks, and/or organizing
- Forgetting what has been said
- Mixing up sounds, words, or other parts of speech
- Difficulty sustaining attention, daydreaming or distractibility
- Difficulty with reading comprehension
- Difficulty with spelling and phonics
Pediatric client wearing headphones during a hearing exam
Traditional Auditory Processing Testing
The traditional approach is a battery of auditory processing tests, which seeks to determine if a central auditory processing disorder is present and identify difficulties with specific aspects of auditory processing. This traditional approach is covered by many health insurance providers.
Prior to beginning the traditional central auditory processing evaluation, an intake process is completed. During this process we may collect relevant information in the following ways:
- Direct patient or guardian interview
- Completion of case history forms
- Completion of parent or teacher observation forms
- Standardized listening difficulty questionnaires | checklists
- Clinical files and histories review
- Academic records review, such as IEP and 504 plan documents
If not yet completed, an assessment of the peripheral hearing system and hearing sensitivity is conducted.
The central order processing evaluation takes approximately 1 1/2 to 3 hours. During this time a series of short tests are conducted to evaluate the client's strengths and weaknesses in a number of auditory skill areas. Performance in each area tested is then ranked and evaluated as compared to the average across a population set.
The diagnosis of an auditory processing disorder is made in accordance with the diagnostic criteria established by The American Speech-Language-Hearing Association and The American Academy of Audiology.
Following diagnosis, the clinician will meet with the client and/or guardian to determine an appropriate intervention and accommodation plan, while addressing each client’s professional, academic, and personal needs.
The Spoken-Language Processing Approach
The Spoken-Language Processing (S-LP) evaluation is based on a conceptual model developed by Larry Medwetsky, Ph.D. Dr. Medwetsky has presented on this topic at numerous national and regional conferences, published numerous chapters and articles on spoken-language processing, and has served on two national committees concerning central auditory processing.
Dr. Medwetsky’s approach envisions the intertwining of auditory, cognitive, and language processing skills, as well as their involvement with other systems, and has developed a testing approach based on this conceptualization. By determining the specific deficit that is present, Dr. Medwetsky derives a composite profile of the client’s processing strengths and weaknesses. The goal is to derive an understanding of why a child or adult is struggling at school, work, or home, and to provide individualized recommendations that will guide clients and those around them (teachers, parents, colleagues) on how to optimize spoken communication.
Pediatric client wearing headphones during a hearing exam
The various processes assessed during the evaluation are:
- Temporal resolution: The ability to detect rapid changes in the speech signal.
- Phonological Awareness: The awareness of and the ability to manipulate the speech sounds that make up words of a language.
- Phonemic Synthesis: The ability to blend individually presented speech sounds and derive the target whole word.
- Lexical decoding speed: The ability to process the words of speech quickly and accurately.
- Short-term/working memory span: The volume of information that can be retained in short-term/working memory.
- Auditory-linguistic integration: The ability to integrate information across different auditory/language processing regions.
- Sequencing: The ability to maintain speech sounds, words, or directions in correct order.
- Selective auditory attention: The ability to focus and recall target stimuli while blocking out competing stimuli.
- Divided auditory attention: The ability to recall both competing stimuli presented.
- Sustained auditory attention: The ability to maintain attention to verbal information over a period of time without a break (assessed, as needed).
The Spoken-Language Processing evaluation typically takes two visits for assessment and one for a review with the parent, guardian or adult client.
A hearing assessment must be conducted before an S-LP evaluation to ensure that hearing loss is not a factor. A hearing loss, even a minimal one, can cause or contribute to significant processing difficulties.
The following is an overview of the services provided:
First visit (1½ hours)
After completing various questionnaires, Dr. Medwetsky reviews with the adult client and/or guardian, the client’s medical/hearing history and any areas of difficulty in: (1) listening behaviors; (2) academic performance (such as spelling and reading); and (3) social behaviors and interactions. Also reviewed are any test or treatment findings from elsewhere. Initial tests are then conducted, beginning with tests where the client (and parent(s) or guardian[s]) is in the same room with Dr. Medwetsky, which helps the client become comfortable with the test environment. Subsequent testing is done in the test suite with earphones.
Second visit (1 hour)
The remainder of the test battery is conducted at this visit. Parents or guardians are able to observe pediatric testing at all times.
Third visit (approximately 1½ hours)
A report of all test results is reviewed in person with the adult client, child’s parent(s)s or guardian(s). This review details the implications of test results and the specific management recommendations based on the assessment.