Deciphering auditory processing disorders in children

As a result of a recent consensus conference, the term auditory processing disorder (APD) has been recommended to replace the previous term, central auditory processing disorder (CAPD). In April 2000, 14 senior scientists and clinicians met at the Callier Center for Communication Disorders at the University of Texas at Dallas to reach consensus on issues related to diagnosing CAPDs in school-aged children. The so-called Bruton Conference offered recommendations regarding diagnosis of this disorder, and some new terminology. The consensus panel proposed that the term APD replace the older CAPD term in keeping with the goals of maintaining an operational definition that emphasizes the interactions of disorders at both peripheral and central sites and does not impute anatomic loci [1]. The definition that emerged from the Bruton Conference cast APD as a deficit in the processing of information, specific to the auditory modality, despite normal auditory thresholds [1]. Characteristically, the auditory processing deficit is exacerbated in unfavorable acoustic environments. Individuals with APD typically have difficulty listening in the presence of background noise, have difficulty understanding rapid or degraded speech, and have difficulty following oral instructions. APD may co-occur with peripheral hearing loss; however, peripheral hearing loss does not fully explain the range and degree of auditory performance deficits in such cases. APD may also be associated with difficulties in listening, speech understanding, language development, and learning [2]. APD is a complex and heterogeneous group of disorders usually associated with a range of listening and learning deficits [3,44]. Underlying APD is a deficit observed in one or more of the auditory processes responsible for generating the auditory-evoked potentials and the following behaviors: sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal resolution, temporal masking, temporal integration, and temporal ordering; auditory performance with competing acoustic signals; and auditory performance with degraded acoustic signals [2].