66
JCPSLP
Volume 16, Number 2 2014
Journal of Clinical Practice in Speech-Language Pathology
Policy and practice
KEYWORDS
ASSESSMENT
SCREENING
SPEECH
PATHOLOGY
(C)APD
SURVEY
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
Wendy L. Arnott
(top), Caroline A.
Henning (centre),
and Wayne J.
Wilson
an audiologist, only 4% were subsequently shown to have
a (C)APD only, whereas 10% were shown to have a (C)APD
and a reading disorder; 10% were shown to have a (C)APD
and a language impairment; and 47% were shown to have
a (C)APD, a reading disorder and a language impairment.
Despite the efforts of groups such as ASHA, the
diagnosis and treatment of (C)APD, and indeed the
existence of the disorder itself as a separate diagnostic
entity, continues to attract considerable controversy
(e.g., Dawes & Bishop, 2008; Fey et al., 2011, Kamhi,
2011; Wilson & Arnott, 2013). Caught in the centre of
this controversy is the speech language pathologist (SLP)
who must decide what role, if any, they should play in the
management of this disorder.
Current best practice guidelines according to the
ASHA (2005) support a multidisciplinary approach to
the differential diagnosis of (C)APD and recommend that
audiologists collaborate with SLPs to screen, differentially
diagnose, and manage auditory processing disorders when
there is evidence of language or cognitive communication
problems (ASHA, 2005). ASHA also acknowledges
that SLPs are “uniquely qualified” to delineate between
language/cognitive communication problems and auditory
processing deficits.
These ASHA best practice guidelines may not be
widely followed, however, with a recent survey of 195
audiologists in the United States by Emanuel, Ficca,
and Korczak (2011) showing that audiologists deemed
they are primarily responsible for (C)APD diagnosis and
recommending treatment/management, but this treatment/
management should primarily be provided by SLPs and
educators. Further confounding the implementation of the
ASHA (2005) guidelines is the current lack of compelling
evidence to suggest that auditory interventions for (C)APD
lead to any functional gains in language, literacy, or
academic function (Fey et al., 2011). This suggests the role
played by the SLP in the management of (C)APD should be
limited to the direct management of speech/language
disorders that might coexist with (C)APD rather than the
direct management of the (C)APD itself (Kamhi, 2011). This
position could be considered to be more consistent with
The Speech Pathology Australia Scope of Practice (2003),
which states that SLPs provide services such as hearing
screening, auditory training, speech-reading, interpretation
of audiological reports, and speech and language
intervention/rehabilitation secondary to hearing loss or
(C)APD (although Speech Pathology Australia does not
have a formal position statement on [C]APD).
Methods of screening and assessing for
(central) auditory processing disorder
([C]APD) continue to attract considerable
controversy. This article (the first in a two-
part series) surveyed 60 Queensland speech-
language pathologists (SLPs) on how they
screen and assess children suspected of
having (C)APD. The majority of participants
were found to favour using parent or teacher
reports as indicators for the need to refer a
child to audiology for a (C)APD assessment
while simultaneously assessing the child’s
speech and language. Most participants also
reported rarely being asked by audiologists
to contribute to (C)APD cases, although they
found audiologists’ reports to be useful for
diagnosing (C)APD. Overall, these results
highlight a need for better communication
between SLPs and audiologists if the
screening and assessment of children for
(C)APD in Queensland is to be improved.
T
he American Speech-Language-Hearing Association
(ASHA, 2005) states that (central) auditory
processing disorder or (C)APD refers to difficulties
in the perceptual processing of auditory information in the
central nervous system (CNS), as demonstrated by poor
performance in one or more of the following skills: sound
localisation and lateralisation; auditory discrimination;
auditory pattern recognition; temporal aspects of audition,
including temporal integration, temporal discrimination,
temporal ordering, and temporal masking; auditory
performance in competing acoustic signals; and auditory
performance with degraded acoustic signals. ASHA also
indicates that (C)APD may coexist with other disorders
(e.g., speech language deficit and learning disability) and
that (C)APD is not due to higher order language, cognitive,
or related factors but may lead to or be associated
with difficulties in higher order language, learning, and
communication functions. The potential for these disorders
to coexist appears to be high with Sharma, Purdy and
Kelly (2009) reporting that in their sample of 68 children
(aged 7 to 12 years) who either had (C)APD suspected by
teachers and/or parents or had a diagnosis of (C)APD by
Screening and assessing for
(central) auditory processing
disorder and the role of the
speech-language pathologist
A survey of Queensland clinicians
Wendy L. Arnott, Caroline A. Henning, and Wayne J. Wilson
