How to Test for APD & Better Understand Your Child

The Multi-Disciplinary Path to an APD Diagnosis

A proper diagnosis of APD requires a multidisciplinary approach, involving input from an audiologist, speech-language pathologist, and other relevant healthcare professionals. They will consider the auditory processing disorder test results in conjunction with the individual’s symptoms and medical history to make an accurate diagnosis and develop an appropriate treatment plan.

As a reminder, Auditory Processing Disorder is a neurological condition that affects the way the brain interprets and understands auditory information. It does not affect the ability to hear but rather the ability to process and comprehend sound. More APD info here. People with APD may experience challenges such as difficulty in distinguishing similar-sounding words, following verbal instructions, discerning speech from background noise, or comprehending speech in noisy environments.  More info on the symptoms of APD here and the types of APD here.

It is important to note that many of these symptoms can be similar to other conditions, such as attention deficit hyperactivity disorder (ADHD), so it is essential to have a proper evaluation and diagnosis by an audiologist or other qualified healthcare professional. Treatment options for APD include speech therapy, listening therapy, and assistive devices such as FM systems.

Testing Approaches to Get a Full Picture

To conduct a scientific auditory processing disorder test, you would go to an audiologist.  Beyond APD testing by an audiologists, there are a number of different ways to screen out underlying issues and better understand your child.  So the list of APD test includes:

• Specific auditory processing disorder testing by an audiologist.
• Medical and hearing evaluations: A healthcare professional will conduct a thorough medical examination and hearing test to rule out any underlying medical or hearing conditions that may be causing the symptoms.
• Behavioral tests: A variety of behavioral tests can be used to assess an individual’s ability to process and interpret auditory information. These tests may include measures of speech perception, listening in noise, and temporal processing.
• Self-report measures: A healthcare professional may also use self-report measures such as questionnaires or interviews to gather information about an individual’s symptoms and experiences related to auditory processing.
• Educational and cognitive assessments: An individual’s educational and cognitive abilities may also be assessed to determine if there is any relationship between their APD symptoms and their performance in school or other daily activities.

Various tests can be used to detect and measure APD, and these tests can be divided into two main categories: behavioral and electrophysiological tests.

APD Test By An Audiologist

If you think your child is having trouble hearing or understanding when people talk, have an audiologist (hearing specialist) examine your child. Only audiologists can perform an auditory processing disorder test. The most common way to diagnose APD is to use a specific group of listening tests. Audiologist tests for APD look at these problem areas:

• Auditory figure-ground: This is when a child has trouble understanding speech when there is ambient noise in the background. Noisy, loosely structured or open-air classrooms can be very frustrating for a child with APD.
• Auditory closure: This is when a child can’t “fill in the gaps” of speech when it is more challenging. This can happen in a quieter situation but is more common when the speaker’s voice is too fast or is muffled, making it hard for the child to make sense of the sounds and words.
• Dichotic listening: This is when a child has trouble understanding competing, meaningful speech that happens at the same time. For example, if a teacher is talking on one side of the child and another student is talking on the other side, the child with APD cannot understand the speech of one or both of the speakers.
• Temporal processing: This is the timing of a child’s processing system, which helps them process at natural language speed, It’s how they recognize differences in speech sounds (such as met versus net). It also helps them understand pitch and intonation (for example, asking a question instead of giving a command), understand riddles and humor, and make inferences.
• Binaural interaction: This is the ability to know which side speech or sounds are coming from, and to localize sound in a room. Although less common, this problem happens in children with a history of brain trauma or seizure disorders.

In general, an auditory processing test should not be conducted until a child reaches 7 years old. That’s because processing skills don’t fully develop in children until then.

Newer electrophysiology tests (which use noninvasive electrodes to check the body’s response to speech) can give some early information about the central auditory system in kids younger than 7.

Medical Testing for APD

The main medical angle here for APD testing is to eliminate or identify hearing loss. There are several common methods used to test for hearing loss:

1. Pure-tone Audiometry: This is the most common test for hearing loss. It involves wearing headphones and listening to tones of different frequencies and volumes. The person being tested indicates when they can hear each tone, and the results are plotted on an audiogram, which helps determine the type and severity of hearing loss.
2. Speech Audiometry: This test evaluates how well a person can understand speech. The individual listens to and repeats words or sentences at different volumes and clarity levels.
3. Tympanometry: Tympanometry measures the movement of the eardrum in response to changes in air pressure. It helps identify problems with the middle ear, such as blockages or issues with the eardrum or the tiny bones of the middle ear.
4. Otoacoustic Emissions (OAE) Testing: OAE testing measures the sounds emitted by the inner ear (cochlea) in response to a stimulus. It can assess the health of the hair cells in the cochlea, which are essential for hearing.
5. Auditory Brainstem Response (ABR): ABR measures the electrical activity generated by the auditory nerve and brainstem in response to sound stimuli. It is often used for newborn hearing screenings or when testing individuals who cannot provide reliable responses, such as infants or people with certain disabilities.
6. Speech-in-Noise Testing: This type of testing assesses a person’s ability to understand speech in the presence of background noise. It helps determine how well someone can hear in real-world situations with competing sounds.

These tests are typically conducted by audiologists, who are specialized healthcare professionals trained in evaluating and treating hearing-related issues. The results of these tests, along with other factors such as medical history and symptoms, help determine the type, degree, and configuration of hearing loss, enabling appropriate treatment and management strategies to be implemented.

Behavioral Tests for APD

Behavioral tests evaluate an individual’s auditory processing abilities and how they respond to specific auditory stimuli. Here are a few examples of behavioral tests used for APD assessment:

1. Listening in Spatialized Noise-Sentences Test (LiSN-S): This test assesses the individual’s ability to understand speech in the presence of competing background noise. It evaluates spatial listening skills and the ability to separate speech from noise.
2. Dichotic Listening Tests: These tests involve presenting different sounds simultaneously to both ears and assessing the individual’s ability to attend to and process sounds presented to each ear separately. Examples include the Dichotic Digits Test or the Competing Sentences Test.
3. Auditory Figure-Ground Tests: These tests evaluate an individual’s ability to focus on a target sound while filtering out background noise. They assess the person’s ability to selectively attend to specific sounds in complex listening environments.
4. Pitch Pattern Sequence Test: This test examines the individual’s ability to detect and discriminate differences in pitch and tonal patterns. It assesses the auditory discrimination skills related to pitch perception.
5. Time Compressed Speech Test: This test measures the person’s ability to understand speech that has been sped up or time-compressed. It evaluates temporal processing abilities and the ability to process rapid auditory information.
6. Random Gap Detection Test: This test assesses the individual’s ability to detect brief silent gaps in a continuous sound. It evaluates temporal resolution and the ability to perceive temporal cues in auditory stimuli.
7. Sound localization and lateralization: This test measures an individual’s ability to locate the source of a sound. It can assess how well an individual can hear and understand speech in different environments.
8. Auditory memory tests: These tests measure an individual’s ability to remember auditory information.

These behavioral tests, along with other assessments like speech-in-noise testing, help identify specific auditory processing difficulties and guide the diagnosis of APD. It’s important to note that a comprehensive evaluation by a qualified healthcare professional, such as an audiologist or speech-language pathologist, is necessary to accurately diagnose APD and develop an appropriate treatment plan.

Some examples of behavioral tests include:

1. Speech audiometry: This test measures an individual’s ability to hear speech at different frequencies and intensities. It is typically used to establish a baseline for an individual’s hearing and to identify any potential hearing loss.
2. Pure-tone audiometry: This test measures an individual’s ability to hear different tones at different frequencies and intensities. It is typically used to identify hearing loss and to establish a baseline for an individual’s hearing.
3. Speech-in-noise tests: These tests measure an individual’s ability to understand speech in the presence of background noise. They can assess how well an individual can hear and understand speech in different environments, such as in a classroom or a busy street corner.
4. Sound localization and lateralization: This test measures an individual’s ability to locate the source of a sound. It can assess how well an individual can hear and understand speech in different environments.
5. Auditory figure-ground tests: This test measures an individual’s ability to focus on a specific sound in the presence of other sounds.
6. Auditory memory tests: These tests measure an individual’s ability to remember auditory information.

Electrophysiological Tests

Electrophysiological tests are designed to measure the electrical activity of the auditory system. These tests can be used to identify the presence of APD, differentiate between different types of APD, and monitor the effectiveness of treatment. Some examples of electrophysiological tests include:

1. Auditory brainstem response (ABR): This test measures the electrical activity of the auditory system in response to a sound. It can be used to identify the presence of APD and to differentiate between different types of APD.
2. Otoacoustic emissions (OAEs): This test measures the sound emitted by the ear in response to a stimulus.
3. Auditory steady-state response (ASSR): This test measures the electrical activity of the auditory system in response to a repeating sound. It can be used to identify the presence of APD and to monitor the effectiveness of treatment.
4. Electrocochleography (ECoG): This test measures the electrical activity of the inner ear in response to a sound.
5. Cortical Auditory Evoked Potential (CAEP): This test measures the electrical activity of the auditory system in response to a sound.

Final Note of APD Tests

It’s important to note that the diagnosis of APD is not solely based on the results of any test but rather a combination of results from multiple tests and other factors such as a patient’s history, observation, and referral from other specialists. Additionally, a multidisciplinary approach is typically used to identify and address the unique needs and goals of the patient.

It’s also worth mentioning that an individual’s results on these tests may not always be black and white, and some cases can be more complex to diagnose.  While some people may have apparent symptoms of APD that can be identified through testing, others may have more subtle symptoms that are harder to detect.  In such cases, a combination of tests and a comprehensive evaluation by a qualified professional are necessary to arrive at an accurate diagnosis.

It’s also crucial that the treatment of APD is approached in a multidisciplinary way and tailored to the specific needs and goals of the individual patient.

It’s APD, Now What?

Gemm Learning provides adaptive software at home to treat APD.  Learn more about what is now know about APD in this free reoort.