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Auditory processing disorder
Classification and external resources
ICD-9	315.32, 388.45
MeSH	D001308

Auditory Processing Disorder (APD), also known as (Central) Auditory Processing Disorder ((C)APD) is an umbrella term for a variety of disorders^{[citation needed]} that affect the way the brain processes auditory information. It is not a sensory (inner ear) hearing impairment; individuals with APD usually have normal peripheral hearing ability. However, they cannot process the information they hear in the same way as others do, which leads to difficulties in recognizing and interpreting sounds, especially the sounds composing speech.

APD can affect both children and adults. Approximately 2-3% of children and 17-20% of adults have this disorder. Males are two times more likely to be affected by the disorder than females. ^{[1] [2]}

Contents [hide] 1 Definitions 2 Diagnosis 3 Causes 4 Characteristics 4.1 Secondary characteristics 5 Remediations and training 6 Relation to Specific language impairment 7 See also 8 References 9 External links

[edit] Definitions

The American Speech-Language-Hearing Association (ASHA) published "(Central) Auditory Processing Disorders" in January 2005 as an update to the "Central Auditory Processing: Current Status of Research and Implications for Clinical Practice (ASHA, 1996)",^[3] complementing the UK's Medical Research Council's ^[4] Auditory Processing Disorder (APD) pamphlet, Oct 2004.^[5]

Auditory processing disorder can be genetic or acquired. It may result from ear infections, head injuries or developmental delays that cause central nervous system difficulties that affect processing of auditory information. This can include problems with: "...sound localization and lateralization (see also binaural fusion); auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals."^[6]

The Committee of UK Medical Professionals Steering the UK Auditory Processing Disorder Research Program have developed the following working definition of Auditory Processing Disorder:

"APD results from impaired neural function and is characterized by poor recognition, discrimination, separation, grouping, localization, or ordering of speech sounds. It does not solely result from a deficit in general attention, language or other cognitive processes."^[7]

[edit] Diagnosis

As APD is one of the more difficult information processing disorders to detect and diagnose, it may sometimes be misdiagnosed as ADD/ADHD, Asperger syndrome and other forms of autism, but it may also be a comorbid aspect of those conditions if it is considered a significant part of the overall diagnostic picture. APD shares common symptoms in areas of overlap, such that professionals unfamiliar with APD might misdiagnose it as a condition they are aware of.

People with APD intermittently experience an inability to process verbal information. When people with APD have a processing failure, they do not process what is being said to them.

There are also many other hidden implications, which are not always apparent even to the person with the disability. For example, because people with APD are used to guessing to fill in the processing gaps, they may not even be aware that they have misunderstood something.

APD has been defined anatomically in terms of the integrity of the auditory nervous system,^[8] as "what we do with what we hear",^[9] and in terms of performances on a selected group of behavioral auditory tests (Task Force for the American Speech, Language, and Hearing Association; ASHA, 1994). The ASHA Task Force definition considered APD to be any observed deficits in one or more of these so-called "behaviors". Problems inherent in test validation by consensus are highlighted by the succession of task force reports that have appeared in recent years. The first of these occurred in 1996.^[3] This was followed by a conference organized by the American Academy of Audiology^[10] that explicitly embraced modality specificity as a defining characteristic of auditory processing disorders. Subsequently, an ASHA committee rejected modality specificity as a defining characteristic of auditory processing disorders.^[6]

There have been several commentaries questioning various aspects of these proposals.^[11][12] Additionally, Moore suggests that APD is primarily a difficulty in processing non-speech sounds and that a population-based approach should be taken to identify outlying performers.^[12] However, inclusive conceptualizations of APD have been criticized based on their lack of diagnostic specificity.^[13] Auditory processing disorder has been defined as a modality specific perceptual dysfunction that is not due to peripheral hearing loss.^[11][14] This viewpoint emphasizes the perceptual nature of auditory processing and asserts that the disorder should be conceptualized as being limited to problems in processing auditory material. Modality specificity has been advocated as a way to improve APD diagnosis.^[11][14] There are several limitations to the approach suggested by proponents of modality specificity testing, including: major differences between primary auditory and visual cortices in the way information is coded and processed, how such approaches would separate children with both visual and auditory processing deficits from children with supramodal deficits, cross modal test equivalence, clinical infeasibility of visual processing test administration, lack of appropriate visual analogs to be used by audiologists, redundancy of modality specificity testing with neuropsychological assessment, and non-modularity of the central nervous system, among others.

[edit] Causes

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The causes of APD are unknown. There is anecdotal evidence to suggest links to autistic spectrum disorder, dyslexia, middle ear infections and lack of oxygen at birth, as well as occurring in association with aniridia, (due to a PAX6 mutation) among other conditions.^{[citation needed]}

[edit] Characteristics

The National Institute on Deafness and Other Communication Disorders is the author of "Auditory Processing Disorder in Children". The National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/auditory.html.  Facilities, such as The Lewis School of Princeton, have specialists that can assist in determining the presence of this disorder. They state that children with Auditory Processing Disorder often:

• have trouble paying attention to and remembering information presented orally, and may cope better with visually acquired information
• have problems carrying out multi-step directions given orally; need to hear only one direction at a time
• have poor listening skills
• need more time to process information
• have low academic performance
• have behavior problems
• have language difficulties (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)
• have difficulty with reading, comprehension, spelling, and vocabulary

Other characteristics may include [citations needed]:

• needing people to speak slowly
• disliking locations with background noise such as bar, clubs or other social locations
• a preference for written communication (e.g. text chat)
• having trouble paying attention and remembering information when information is simultaneously presented in multiple modalities

APD can manifest as problems determining the direction of sounds, difficulty perceiving differences between speech sounds and the sequencing of these sounds into meaningful words, confusing similar sounds such as "hat" with "bat", "there" with "where", etc. Fewer words may be perceived than were actually said, as there can be problems detecting the gaps between words, creating the sense that someone is speaking unfamiliar or nonsense words. Those suffering from APD may have problems relating what has been said with its meaning, despite obvious recognition that a word has been said, as well as repetition of the word. Background noise, such as the sound of a radio, television or a noisy bar can make it difficult to impossible to understand speech, depending on the severity of the auditory processing disorder. Using a telephone can be problematic for someone with auditory processing disorder, in comparison with someone with normal auditory processing, due to low quality audio, poor signal, intermittent sounds and the chopping of words.^[6] Many who have auditory processing disorder subconsciously develop visual coping strategies, such as lip reading, reading body language, and eye contact, to compensate for their auditory deficit, and these coping strategies are not available when using a telephone.

[edit] Secondary characteristics

APD shares some of these signs with related disorders, which may have other overlap areas, such as acquired brain injury, attention deficits, dyslexia, learning difficulties, hearing loss, and psychologically-based behavioral problems.

APD may be related to cluttering,^[15] a fluency disorder marked by word and phrase repetitions.

[edit] Remediations and training

See also: Alternative therapies for developmental and learning disabilities

Recent research has shown that practice with basic auditory processing tasks (i.e. auditory training) may improve performance on auditory processing measures^[16][17] and phonemic awareness measures (Moore et al., 2005). These auditory training benefits have also been recorded at the physiological level (Russo et al., 2005; Alonso & Schochat, 2009). Many of these tasks are incorporated into computer based auditory training programs such as Earobics and Fast ForWord, an adaptive software available at home and in clinics worldwide.

There is no research supporting the following APD treatments:

• Auditory Integration Training typically involves a child attending two 30-minute sessions per day for ten days.^[18]
• Lindamood-Bell Learning Processes (particularly, the Visualizing and Verbalizing program)
• Physical activities that require frequent crossing of the midline (e.g., occupational therapy)
• Sound Field Amplification
• Neuro-Sensory Educational Therapy

[edit] Relation to Specific language impairment

APD can also be confused with Specific language impairment (SLI).

SLI is more specifically a problem associated with the linking of words, both written and spoken, to semantics (meaning) and someone can have both APD and SLI. Unlike those with SLI, those with APD can usually get the meaning of language from written words where those with SLI show problems with both heard and read words, demonstrating that the basic issue is not an auditory one.^{[dubious – discuss][original research?]}

Those with APD have auditory difficulty distinguishing sounds including speech from extraneous sounds, e.g. fans or other chatter. APD is purely about processing what you hear both verbal and non-verbal. For those who have SLI, difficulty processing verbal language is only one of many symptoms.

[edit] See also

• Active listening
• Asperger syndrome
• Attention-Deficit Hyperactivity Disorder
• Audiology
• Auditory scene analysis
• Cocktail party effect
• Cognitive science
• Echoic memory
• Language processing
• King-Kopetzky syndrome (now included in the UK Medical Research Councils definition of APD)
• Pure word deafness
• Spatial hearing loss

[edit] References

1. ^ La Trobe University. "(C)APD". http://www.latrobe.edu.au/hcs/resources/capd/capd/index.html. Retrieved 14 November 2010. 
2. ^ Musiek, Frank; Gail, Chermak (2007). Handbook of central auditory processing disorder [auditory neuroscience and diagnosis]. Plural Publishing. pp. 448. ISBN 1597560561. 
3. ^ ^{a b} "Central Auditory Processing: Current Status of Research and Implications for Clinical Practice. Technical Report, (1996)". Working Group on Auditory Processing Disorders. American Speech-Language-Hearing Association. http://www.asha.org/docs/html/TR1996-00241.html. 
4. ^ "MRC Institute of Hearing Research". Auditory Processing Disorder. http://www.ihr.mrc.ac.uk/research/apd.php/. 
5. ^ "Auditory Processing Disorder (APD). Pamphlet, (2004).". British Society of Audiology APD Special Interest Group. MRC Institute of Hearing Research. http://www.ihr.mrc.ac.uk/research/apd.php/apd.php?page=apd_docs. Retrieved 2008-01-15. 
6. ^ ^{a b c} "(Central) Auditory Processing Disorders. Technical Report, (2005).". Working Group on Auditory Processing Disorders.. American Speech-Language-Hearing Association.. http://www.asha.org/docs/html/TR2005-00043.html. 
7. ^ http://www.thebsa.org.uk/apd/Home.htm The British Society of Audiology and the UK APD Steering Group
8. ^ Rintelmann, W.F. (1985). "Monaural speech tests in the detection of central auditory disorders.". In Marilyn L Pinheiro and Frank E Musiek. Assessment of central auditory dysfunction : foundations and clinical correlates. Baltimore: Williams & Wilkins. pp. 173–200. ISBN 9780683068870. OCLC 11497885. 
9. ^ Katz, Jack (1992). "Classification of auditory processing disorders". In Jack Katz and Nancy Austin Stecker and Donald Henderson. Central auditory processing : a transdisciplinary view. St. Louis: Mosby Year Book. pp. 81–92. ISBN 9781556643729. OCLC 25877287. 
10. ^ Jerger J, Musiek F (October 2000). "Report of the Consensus Conference on the Diagnosis of Auditory Processing Disorders in School-Aged Children" (pdf). J Am Acad Audiol 11 (9): 467–74. PMID 11057730. http://www.taracentar.hr/download/diagnosis_apd_school.pdf. 
11. ^ ^{a b c} Cacace, Anthony T.; Dennis J. McFarland (2005-12). "The Importance of Modality Specificity in Diagnosing Central Auditory Processing Disorder". American Journal of Audiology 14 (2): 112–123. doi:10.1044/1059-0889(2005/012). PMID 16489868. http://aja.asha.org/cgi/content/short/14/2/112. Retrieved 2010-08-31. 
12. ^ ^{a b} Moore, David R. (2006-03). "Auditory processing disorder (APD): Definition, diagnosis, neural basis, and intervention". Audiological Medicine 4 (1): 4–11. doi:10.1080/16513860600568573. http://www.informaworld.com/smpp/content~content=a746030950~db=all. Retrieved 2010-08-31. 
13. ^ Cacace, Anthony T.; Dennis J. McFarland (1998-04). "Central Auditory Processing Disorder in School-Aged Children A Critical Review". Journal of Speech, Language, and Hearing Research 41 (2): 355–373. PMID 9570588. http://jslhr.asha.org/cgi/content/abstract/41/2/355. Retrieved 2010-08-31. 
14. ^ ^{a b} Cacace, Anthony T.; Dennis J. McFarland (1995-07). "Opening Pandora's Box: The Reliability of CAPD Tests". American Journal of Audiology 4 (2): 61–62. http://aja.asha.org/cgi/content/citation/4/2/61. Retrieved 2010-08-31. 
15. ^ William O. Haynes, Rebekah Hand Pindzola, Michael J. Moran, Communication Disorders in the Classroom: An Introduction for Professionals in School Settings, ISBN 0763727431, Jones & Bartlett Publishers (2006), p. 251
16. ^ Chermak GD, Silva ME, Nye J, Hasbrouck J, Musiek FE (May 2007). "An update on professional education and clinical practices in central auditory processing". J Am Acad Audiol 18 (5): 428–52; quiz 455. doi:10.3766/jaaa.18.5.7. PMID 17715652. 
17. ^ Moore DR (2007). "Auditory processing disorders: acquisition and treatment". J Commun Disord 40 (4): 295–304. doi:10.1016/j.jcomdis.2007.03.005. PMID 17467002. 
18. ^ Mudford OC, Cullen C (2004). "Auditory integration training: a critical review". In Jacobson JW, Foxx RM, Mulick JA (eds.). Controversial Therapies for Developmental Disabilities. Routledge. pp. 351–62. ISBN 080584192X. 

[edit] External links

• American Speech-Language-Hearing Association (ASHA)
• UK Medical Research Council Institute of Hearing Research)
• Auditory Processing Disorder in the Uk (APDUK)
• Support community for CAPD

[show]v · d · eAuditory and vestibular pathways Auditory inner ear: Hair cells → Spiral ganglion → Cochlear nerve VIII → pons: Cochlear nuclei (Anterior, Dorsal) → Trapezoid body → Superior olivary nuclei → midbrain: Lateral lemniscus → Inferior colliculi → thalamus: Medial geniculate nuclei → cerebrum: Acoustic radiation → Primary auditory cortex Vestibular inner ear: Vestibular nerve VIII → pons: Vestibular nuclei (Medial vestibular nucleus, Lateral vestibular nucleus) cerebellum: Flocculonodular lobe spinal cord: Vestibulospinal tract (Medial vestibulospinal tract, Lateral vestibulospinal tract) thalamus: Ventral posterolateral nucleus cerebrum: Vestibular cortex Vestibulo-oculomotor fibers M: EAR anat(e/p)/phys/devp noco/cong, epon proc, drug(S2)

[show]v · d · ePathology of the nervous system, primarily CNS (G04–G47, 323–349) Inflammation Brain Encephalitis (Viral encephalitis, Herpesviral encephalitis) · Cavernous sinus thrombosis · Brain abscess (Amoebic) Spinal cord Myelitis: Poliomyelitis · Demyelinating disease (Transverse myelitis) · Tropical spastic paraparesis · Epidural abscess Both/either Encephalomyelitis (Acute disseminated) Meningoencephalitis Brain/ encephalopathy Degenerative Extrapyramidal and movement disorders Basal ganglia disease: Parkinsonism (PD, Postencephalitic, NMS) · PKAN · Tauopathy (PSP) · Striatonigral degeneration · Hemiballismus · HD · OA Dyskinesia: Dystonia (Status dystonicus, Spasmodic torticollis, Meige's, Blepharospasm) · Chorea (Choreoathetosis) · Myoclonus (Myoclonic epilepsy) · Akathesia Tremor (Essential tremor, Intention tremor) · Restless legs · Stiff person Dementia Tauopathy: Alzheimer's (Early-onset) · Frontotemporal dementia/Frontotemporal lobar degeneration (Pick's, Dementia with Lewy bodies) Multi-infarct dementia Mitochondrial disease Leigh's Demyelinating autoimmune (Multiple sclerosis, Neuromyelitis optica, Schilder's disease) · hereditary (Adrenoleukodystrophy, Alexander, Canavan, Krabbe, ML, PMD, VWM, MFC, CAMFAK syndrome) · Central pontine myelinolysis · Marchiafava-Bignami disease · Alpers' disease Episodic/ paroxysmal Seizure/epilepsy Focal · Generalised · Status epilepticus · Myoclonic epilepsy Headache Migraine (Familial hemiplegic) · Cluster · Tension Cerebrovascular TIA (Amaurosis fugax, Transient global amnesia) Stroke (MCA, ACA, PCA, Foville's, Millard-Gubler, Lateral medullary, Weber's, Lacunar stroke) Sleep disorders Insomnia · Hypersomnia · Sleep apnea (Obstructive, Ondine's curse) · Narcolepsy · Cataplexy · Kleine-Levin · Circadian rhythm sleep disorder (Advanced sleep phase syndrome, Delayed sleep phase syndrome, Non-24-hour sleep-wake syndrome, Jet lag) CSF Intracranial hypertension (Hydrocephalus/NPH, Idiopathic intracranial hypertension) · Cerebral edema · Intracranial hypotension Other Brain herniation · Reye's · Hepatic encephalopathy · Toxic encephalopathy Spinal cord/ myelopathy Syringomyelia · Syringobulbia · Morvan's syndrome · Vascular myelopathy (Foix-Alajouanine syndrome) · Spinal cord compression Both/either Degenerative SA Friedreich's ataxia · Ataxia telangiectasia MND UMN only: PLS · PP · HSP LMN only: PMA · PBP (Fazio-Londe, Infantile progressive bulbar palsy) · SMA (SMN-linked, Kennedy disease, SMAX2, DSMA1) both: ALS M: CNS anat(n/s/m/p/4/e/b/d/c/a/f/l/g)/phys/devp noco(m/d/e/h/v/s)/cong/tumr, sysi/epon, injr proc, drug(N1A/2AB/C/3/4/7A/B/C/D)

[show]v · d · eDevelopmental disorders: Dyslexia and related specific developmental disorders (F80–F83, 315) General conditions Speech and language/ communication disorders Expressive language disorder · Aphasia/Dysphasia (Expressive aphasia, Receptive aphasia) · Landau–Kleffner syndrome · Lisp · Mixed receptive-expressive language disorder Scholastic skills/ learning disorder Dyslexia (Alexia (acquired dyslexia), Developmental dyslexia) · Dysgraphia (Disorder of written expression) · Dyscalculia (Gerstmann syndrome) Motor function Developmental dyspraxia Other Auditory processing disorder · Scotopic sensitivity syndrome Related topics Dyslexia research · Management of dyslexia/Dyslexia interventions · Reading acquisition · Writing system · Spelling · Literacy · Irlen filters · Recording for the Blind & Dyslexic · Neuropsychology Lists Languages by Writing System · People with dyslexia · Dyslexia in fiction M: PSO/PSI mepr dsrd (o, p, m, p, a, d, s), sysi/epon, spvo proc(eval/thrp), drug(N5A/5B/5C/6A/6B/6D)

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Categories: Neurological disorders | Audiology | Auditory perception | Dyslexia | Hearing | Learning disabilities | Oral communication | Phonology | Speech processing | Special education

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