Understanding the Differences Between Auditory Processing, Speech and Language Disorders, and Reading Disorders October 2014 INTRODUCTION revealed. Although not all students diagnosed This document has been prepared to provide with a communication disorder will develop an overview of the differences among a reading disorder, some may require auditory processing disorders, accommodations to enable them to benefit communication disorders, and reading from their education. disorders to clarify the need for accommodations for students with RECOMMENDATIONS communication and processing disorders. Based on the results of the GAO study, the The document is organized by definition of impact on student performance for those the disorder, treatment options, and students denied accommodations, and the accommodations, followed by results of a differentiation between the needs of students study that differentiates between reading and with communication disorders and those with language disorders. reading disorders, ASHA recommends that decisions about the need for accommodations A 2011 Government Accountability Office be made by reviewing the student’s history, (GAO) study recommended that the the accommodations that have been provided Department of Justice develop a systematic to the student throughout his or her school approach to ensuring that all eligible students years, and the recommendations of the receive accommodations. GAO further student’s educational team. As noted above, recommended that the decision to allow for no single criterion should be used to accommodations be based on the individual’s determine eligibility for testing history and the recommendations of teachers accommodations, and rules for and service providers and not on a single accommodations should be applied measure of performance. consistently across disability categories. This document includes study highlights, a DEFINITIONS link to the full study, and specific examples of the impact that lack of accommodations Auditory Processing Disorder has on individual student performance. Auditory processing disorders (ADP) are deficits in the information processing of STUDENT ELIGIBILITY FOR SPECIAL audible signals not attributed to impaired EDUCATION peripheral hearing sensitivity or intellectual Students are sometimes determined to be impairment. This information processing eligible for services based solely on their involves perceptual, cognitive, and linguistic communication disorders. Once identified as functions that, with appropriate interaction, eligible, these students have access to all result in effective receptive communication necessary services and supports. Because of auditorily presented stimuli. Specifically, they receive such supports and services, APD refers to limitations in the ongoing additional testing may not be performed and transmission, analysis, organization, a subsequent reading disorder may not be transformation, elaboration, storage, retrieval, and use of information contained in audible 2200 RESEARCH BOULEVARD • ROCKVILLE, MARYLAND 20850-3289 • 301-296-5700 VOICE OR TTY • www.asha.org signals. APD may involve the listener's active pushing a button, or in some other way. and passive (e.g., conscious and unconscious, Other tests that measure the auditory system's mediated and unmediated, controlled and physiologic responses to sound may also be automatic) ability to do the following: attend, administered. Most of the tests for APD discriminate, and identify acoustic signals; require that a child be at least 7 or 8 years of transform and continuously transmit age, because the variability in brain function information through both the peripheral and is so marked in younger children that test central nervous systems; filter, sort, and interpretation may not be possible. combine information at appropriate perceptual and conceptual levels; store and retrieve information efficiently; restore, Key Points: organize, and use retrieved information; APD is an auditory disorder that is not segment and decode acoustic stimuli using the result of higher-order, more global phonological, semantic, syntactic, and deficit, such as autism, mental pragmatic knowledge; and attach meaning to retardation, attention deficits, or similar a stream of acoustic signals through use of impairments. linguistic and nonlinguistic contexts. Not all learning, language, and communication deficits are due to Children with APD may exhibit a variety of APD. listening and related complaints. They may No matter how many symptoms of have difficulty understanding speech in noisy APD a child has, only careful and environments, following directions, and accurate diagnosis can determine if discriminating (or telling the difference APD is, indeed, present. between) similar-sounding speech sounds. Although a multidisciplinary team Sometimes they may behave as if a hearing approach is important in fully loss is present, often asking for repetition or understanding the cluster of problems clarification. In school, children with APD associated with APD, the diagnosis of may have difficulty with spelling, reading, APD can only be made by an and understanding information presented audiologist. verbally in the classroom. Often their Treatment of APD is highly performance in classes that don't rely heavily individualized. There is no one on listening is much better, and they typically treatment approach that is appropriate are able to complete a task independently for all children with APD. once they know what is expected of them. APD may co-exist with attention deficit hyperactivity disorder (ADHD) or other disorders. Treatment Treatment of APD generally focuses on three A multidisciplinary team approach is critical primary areas: changing the learning or to fully assess and understand the cluster of communication environment, recruiting problems exhibited by children with APD, higher-order skills to help compensate for the but the actual diagnosis of APD is made by disorder, and remediation of the auditory an audiologist, who administers a series of deficit itself. The primary purpose of tests in a sound-treated room. These tests environmental modifications is to improve require listeners to attend to a variety of access to auditorily presented information. signals and to respond to them via repetition, Suggestions may include use of electronic 2 devices that assist listening, teacher-oriented SPEECH AND LANGUAGE/ suggestions to improve delivery of COMMUNICATION DISORDERS information, and other methods of altering the learning environment so that the child Definitions with APD can focus his or her attention on Receptive/Expressive Language Disorder the message. A communication disorder is an impairment Accommodations in the ability to receive, send, process, and comprehend concepts or verbal, nonverbal, Environmental modifications include both and graphic symbol systems. A bottom-up (e.g., enhancement of the signal communication disorder may be evident in and listening environment) and top-down the processes of hearing, language, and/or (e.g., classroom, instructional, workplace, speech. A communication disorder may recreational, and home accommodations) range in severity from mild to profound. It management approaches designed to improve may be developmental or acquired. access to information presented in the Individuals may demonstrate one or any classroom, at work, or in other combination of communication disorders. A communicative settings. Environmental communication disorder may result in a accommodations to enhance the listening primary disability, or it may be secondary to environment may include but are not limited other disabilities. to preferential seating for the individual with APD to improve access to the acoustic (and A speech disorder is an impairment the visual) signal; use of visual aids; of the articulation of speech sounds, reduction of competing signals and fluency, and/or voice. reverberation time; use of assistive listening An articulation disorder is the systems; and advising speakers to speak more atypical production of speech sounds, slowly, pause more often, and emphasize key characterized by substitutions, words. Specific suggestions may include omissions, additions, or distortions support for focused listening (e.g., use of that may interfere with intelligibility. note takers, preview questions, organizers), A fluency disorder is an interruption redundancy (e.g., multisensory instruction, in the flow of speaking characterized computer mediation), and use of written by atypical rate, rhythm, and output (e.g., e-mail, mind maps) repetitions in sounds, syllables, There is no one treatment approach that is words, and phrases. This may be appropriate for all children with APD. The accompanied by excessive tension, type, frequency, and intensity of therapy, like struggle behavior, and secondary all aspects of APD intervention, should be mannerisms. highly individualized and programmed for A voice disorder is characterized by the specific type of auditory disorder that is the abnormal production and/or present. absences of vocal quality, pitch, loudness, resonance, and/or duration, For more information see: which is inappropriate for an www.asha.org/public/hearing/Understanding- individual's age and/or sex. Auditory-Processing-Disorders-in-Children/; A language disorder is impaired and www.asha.org/policy/TR2005- comprehension and/or use of spoken, 00043.htm#sec1.6. written, and/or other symbol systems. The disorder may involve (1) the 3 form of language