A pediatric audiologist disagrees with the general philosophy of waiting until a child turns 7 to evaluate for auditory processing disorder.

I’m often faced with parents of young children who struggle in their new school setting. Preschool and kindergarten classrooms started placing more importance on early literacy skills—as well as other academic, social and behavioral expectations—in the past decade or so. In 2005, for example, 43 states reported having early childhood standards using guidelines created by the National Association for the Education of Young Children.

Most children benefit from these expanded early curriculums, but not every child can cope with such intense academic rigor. Some students work much harder than their peers to keep up. A child’s self-concept begins to develop in their early school years, and the last thing we want are children who doubt their abilities. This early self-doubt can affect the rest of their school years.

Earlier diagnosis

When a child struggles in the classroom, many school professionals suggest auditory processing disorder (APD), also called central auditory processing disorder, to parents as a possible explanation. They often add, however, that the child is too young to diagnose. Audiologists and speech-language pathologists working with young children—preschool, kindergarten and first grade—often realize a child demonstrates signs of APD. Few actually refer for testing, however, due to a “truth” about not being able to test children younger than 7. This practice is linked to a general belief that processing skills can’t be evaluated until 7 or 8, despite the lack of valid research confirming such claims.

I want to help school teams get more comfortable and confident in providing a referral for APD at a younger age. Many diagnostic tests (see below) work for children as young as 4 or 5.

According to audiologist, SLP and research professor Jack Katz, auditory processing involves what we do with the information we hear. Do we understand clearly what we just heard and can we effectively use, remember, combine with visual inputs and maintain in sequence the information? Katz’s explanation helped me understand the domino effect occurring when this important auditory processing foundation is weak.

Over the 10 years I’ve practiced as a pediatric audiologist, I’ve diagnosed and provided intervention for numerous young children with auditory processing weakness. I prefer the term “weakness,” as a reference to something easily strengthened. If addressed early enough, treating APD allows the child to build a strong foundation to succeed in school and their everyday environment.

Health professionals working with children are taught the importance of early intervention. We should apply this philosophy across the board. APD affects a child’s educational and social success. And just as we diagnose and provide intervention for other communicative disorders—hearing loss, apraxia, articulation, stuttering and more—APD must become part of our practice scope. It’s unreasonable to let treating something as vital as the speed of a child’s ability to process auditory stimuli wait until they turn 7 or 8 years old.

Earlier intervention

So how do we change the culture of waiting? A collaborative approach with teachers and parents is vital. Audiologists and SLPs understand that APD symptoms present similarly to other disorders, including attention-deficit/hyperactivity disorder, dyslexia, language delay and pervasive developmental disorder. Treatment approaches vary, however. For this reason, we need to work with a child’s caregivers and educators to tease out underlying issues and work together on improving them.

Many educational audiologists and school-based SLPs recognize APD characteristics for children 7 and older, so let’s review some red flags for younger students (excerpted from Katz’s “APD: Characteristics in Young Children”):

• history of otitis media (ear fluid, infections, tubes)
• easily distracted or bothered by noise
• may be noisy when in noisy conditions
• difficulty locating source of sound
• does not remember simple directions
• difficulty with finger-play, such as “Itsy-Bitsy Spider”
• difficulty learning nursery rhymes
• poor language (receptive or expressive)
• poor articulation
• has/had sensory-integration or speech-language treatment

Several comprehensive APD evaluation tools are designed specifically for school settings. SLPs and educational audiologists can use Buffalo Model Questionnaire-Revised, APD Characteristics in Young Children or Fisher’s Auditory Problems Checklist. Submit results to an audiologist specializing in APD who can determine if the student needs further testing. Only trained audiologists can provide an official diagnosis, although a multidisciplinary team including an SLP, physician, psychologist and classroom teacher should also be involved in the diagnostic process for APD.

Additional screening tests include: The Auditory Skills Assessment by Donna Geffner and Ronald Goldman, SCAN-3C by Robert W. Keith, Katz’s Phonemic Synthesis Picture test, and the BKB Sin test. When choosing the appropriate assessment tools, I strongly recommend looking at the child’s overall history and areas of concern. These steps will enable professionals to set up the appropriate treatment plan and provide intervention as early as possible.

Depending on the identified weaknesses, SLPs, occupational therapists, vision therapists, special instruction teachers and audiologists can create collaborative treatment plans. If everyone works together, they give the child the best chance to strengthen their skills and set them up for success in educational and social environments.

Zhanneta Shapiro, AuD, CCC-A, is director of audiology and adjunct professor at Brooklyn College and co-founder of a private practice, Audiology Island.

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