Auditory Processing Testing
At Auditory Processing Center, we believe that auditory processing disorder (APD) is complex and requires a comprehensive approach. Therefore, we do not limit ourselves to any one test battery or model. We understand that each individual’s difficulties in processing spoken language can be rooted in various underlying skills. That’s why our approach to APD evaluation is thorough and tailored to ensure we capture a complete picture. Unlike other clinics that allocate only a couple of hours for evaluations, we prioritize quality and dedicate an entire day to gaining a comprehensive understanding of each individual’s strengths, challenges, and potential areas of growth. We reserve the full day for each evaluation and provide extensive breaks so patients can relax or play in our playroom while assessments are being scored.
Instead of relying on a single model or categorization system, we use a comprehensive battery of tests to assess all the skills that might contribute to processing difficulties. Our evaluations are designed to identify strengths, weaknesses, and patterns that reveal how a person processes auditory information in real-world environments. We aim to understand not just what tasks are difficult but why they are difficult.
In our thorough evaluations, we use tests from the Buffalo Model, a well-known diagnostic tool for APD. However, the Buffalo Model is just one part of our evaluation process. It includes three tests: the Staggered Spondaic Words Test, Phonemic Synthesis, and the CID W-22 Word Recognition in quiet and noise. While these tests provide valuable insights, they don’t cover all the necessary auditory processing skills that may be contributing to someone’s difficulties. Many additional skills are tested to gain a complete picture of each individual’s strengths and weaknesses. Each skill contributes to how we process and understand sounds, and the interaction between these skills is often where APD-related difficulties arise. This comprehensive approach ensures we provide an accurate diagnosis and develop an effective, individualized treatment plan.
Comprehensive Hearing Evaluation
Hearing evaluations assess the peripheral auditory system’s outer, middle, and inner ear structures and function to rule out hearing loss. They include tympanometry, an acoustic reflex test battery, a pure tone air and bone conduction audiogram, speech recognition thresholds, and speech discrimination.
Skills Assessed in Our Auditory Processing Evaluations
These assessments test the ability to understand auditory messages in the presence of background noise or competing speech. This skill can be assessed monaurally (one ear at a time) or binaurally (both ears listening) and with either words or sentences. Some assessments can be used with children with severe articulation errors or limited expressive language by having the child point to pictures representing the stimuli heard. Word recognition in noise tests can compare performance in quiet conditions versus conditions with competing noise. This is a test of monaural low redundancy, because each ear is tested by itself with degraded speech. It provides information about how well each ear can perceive a word, even if some parts of that auditory pathway aren’t working perfectly. Comparing performance in quiet and noisy conditions helps control for overall poor discrimination by determining if there is a significant decrease in performance in noise. In some cases a binaural words in noise test may also be used if there are concerns about one ear interfering with the ability of both ears to hear well in noise. Sentences in noise tests are also used to determine a listener’s signal-to-noise ratio loss. This measures how much louder the primary voice (signal) must be above the background noise (noise) for the listener to understand sentences compared to typical listeners the same age. It is also helpful to determine how well the listener can understand sentences in noise versus recognizing single words when there are no context clues available to help figure out the word.
This assesses the ability of the listener to process different information presented to both ears simultaneously. If listeners have difficulty dividing their attention to different auditory inputs when there is more than one thing to listen to, it will affect their ability to integrate the information. A battery of three tests of binaural integration is typically administered: the Dichotic Words Test (DWT), Randomized Dichotic Digits Test (RDDT), and Staggered Spondaic Words Test (SSW), to look for consistency in performance between tests. Listeners can exhibit problems with binaural integration and fit different profiles, requiring different types of treatment. For example, individuals with amblyaudia (lazy ear) will have an abnormal interaural asymmetry consistently across tests (with much better performance in their dominant ear). Amblyaudia cannot be diagnosed from a single test of binaural integration. Some listeners may have overall poor performance in both ears without a significant difference, fitting a profile of dichotic dysaudia, and others may show a combination of poor overall performance along with significantly better scores in their dominant ear. These profiles cannot be distinguished unless multiple tests measuring the same skill show consistency. We must uncover the specific cause for similar symptoms (hearing in noise). Amblyaudia is one type of APD that typically responds quickly to ARIA treatment, often being corrected with just four therapy sessions.
Binaural separation refers to the ability to process a message presented to one ear while ignoring a message presented to the opposite ear simultaneously. A Competing Sentences Test is typically used to assess this skill. If listeners have difficulty separating different sound inputs, they may struggle to focus on one ear while ignoring sound occurring from the opposite side. This skill is often used when we are on the phone or when a teacher is moving from one side of the room to the other. This is just one possible reason children may struggle to ignore distracting noises from classmates or background noises. By including it as part of the test battery, it helps separate the causes of a similar symptom (listening in noise) to guide treatment recommendations.
Spatial processing refers to the functioning of the mechanisms in the low brainstem that use the spatial distribution of sound sources (location cues) to suppress unwanted sound and enable the listener to focus on sound coming from directly in front of them. Individuals who struggle with this have a spatial processing disorder. This is a type of APD where they cannot take advantage of the spatial separation of a talker they are trying to listen to and distractors. The Listening in Spatialized Noise-Sentences (LiSN-S) test is most often used to evaluate this skill. This also provides information about the listener’s ability to use differences in the vocal quality of different talkers. People who had chronic ear infections (otitis media) when they were young are at a higher risk for developing a spatial processing disorder. This can lead to symptoms such as difficulty hearing in noisy environments and struggling to concentrate on the teacher’s voice when there are other sounds in the classroom. Fortunately, this type of Auditory Processing Disorder (APD) can usually be completely remediated within a couple of months.
There are several subskills within this broad category of tests that assess timing aspects of auditory processing. Some tests measure Temporal Resolution, which refers to the ability to detect the brief time intervals between sequential speech sounds and rapid transitions. This skill is needed to recognize individual speech sounds that differ by their first few milliseconds (i.e. p/b/d), perceive the onset and offset of sounds when they quickly follow one another, hear all the sounds in a blend, and perceive the order of sounds. Gap Detection Testing and performance with Time Compressed Speech are sensitive to difficulties in this area. Additionally, Auditory Pattern Recognition involves determining similarities and differences in acoustic contours and patterns of sounds. A listener must be able to perceive the order of sounds in a pattern, such as patterns of sounds differing in pitch (Pitch Pattern Sequence Test) or sound patterns differing in duration (Duration Pattern Sequence Test). In addition to being able to discriminate different pitched sounds and perceive the contour, we test the listener’s ability to verbally describe the patterns of sounds with words. The listener’s performance in different conditions is analyzed to determine if there are prosodic deficits and to assess the efficiency of interhemispheric transfer of auditory and linguistic information.
refers to the ability to understand an auditory signal even when some information is distorted or missing. This may include tests evaluating the listener’s ability to recognize the whole message despite distortion from missing sound components. Filtered speech tests assess the ability to understand when high-pitched sounds have been removed, causing the words to sound muffled. Time-compressed speech tests are both a measure of auditory closure and temporal processing because they present words or sentences at a very rapid rate, making it difficult to hear the rapid transitions between individual speech sounds.
Phonemic synthesis is the ability to blend individual sounds (phonemes) to create words by listening (without visual cues). The Phonemic Synthesis Test is a key indicator of auditory decoding abilities as it directly assesses the brain’s capacity to process and integrate auditory information. It is a crucial skill for language development, closely connected to reading and spelling. Strong phonemic synthesis is crucial for early reading success, as it allows for the retention of sound sequences necessary for sounding out new words. Individuals with very poor phonemic synthesis have difficulty understanding what is said, making verbal associations, and with verbal recall.
The ability to maintain concentrated attention to sound for an appropriate length of time. If there are concerns about whether attention could be impacting test results auditory attention testing with an Auditory Continuous Performance Test can be performed to assess how well a listener can respond consistently to a target auditory stimulus over time. It enables the examiner to analyze inattentive errors, impulsive responses, and any decrement in performance. This can be useful to help differentiate auditory attention problems from central auditory processing disorders.
involves the listener’s ability to take in the information heard, process it, store it in their mind, and then recall what was heard. Auditory Short-Term Memory involves retaining what was just heard to immediately recall the details. Auditory Sequential Memory involves the ability to recall a sequence of auditory stimuli in the exact order they were presented. Rote-memory span is typically assessed with lists of digits and unrelated word recall. This can then be compared to memory for sentences, providing additional insight into sentence recall abilities compared to memory for lists. Auditory Working Memory refers to active processing. It involves the ability to hold information heard long enough to manipulate and use the auditory information just presented. Working memory is required for problem solving such as math calculations. When individuals with APD show a weaknesses in both auditory short-term memory and auditory figure-ground, this supports a profile of “tolerance-fading memory.” The word “tolerance” refers to low tolerance for background noise, and “fading memory” refers to short-term memory fading quickly due to the extra cognitive load imposed by filtering out background noise. Some listeners may also struggle with auditory organization, making it hard to maintain the proper sequence of information. This impacts their ability to store and remember what they hear in the correct sequence. Information must be stored in the correct order to be retrieved easily from long-term memory. Poor auditory organization can affect the speed of processing/retrieval of information.
We assess advanced auditory processing skills because listening comprehension goes beyond basic sound recognition. It involves the capacity to process, interpret, and understand spoken language in practical scenarios. Proficiency in understanding abstract concepts, making inferences, and following multi-step directions is crucial for effective communication. By evaluating auditory comprehension in noisy environments, we can pinpoint particular areas where individuals face difficulties and develop tailored interventions to enhance their overall listening comprehension.
Retained primitive reflexes can significantly affect auditory processing, yet many people have never heard of this. Primitive reflexes are automatic responses of the central nervous system to a specific stimulus that allow babies to make body movements before the brain cortex is fully mature. They serve for protection and survival in newborns until around 4 to 6 months of age as the brain matures. When primitive reflexes are integrated, they are replaced by voluntary motor activities, facilitating the development of advanced motor and cognitive abilities. However, in some cases, there can be an interruption in the normal development process, causing these reflexes to persist beyond infancy and even into adulthood. This may lead to developmental delays and learning disabilities impacting abilities such as balance, coordination, attention, cognitive functions, and sensory processing, including how we process auditory stimuli. Depending on which primitive reflexes are not fully integrated, auditory skills such as sound localization, discrimination, binaural interaction, and binaural integration can be affected, often leading to trouble filtering out background noise, sound sensitivity, anxiety, and emotional distress. It’s important to test for these reflexes because spotting them early and getting treatment can help improve sensory and cognitive functions. Screening for retained primitive reflexes is included in our auditory processing evaluations because it’s important to address this along with any auditory processing deficits when necessary. To learn more about primitive reflexes, Integrated Learning Strategies (ILS) offers comprehensive resources and online courses for parents, educators, and therapists on how to test and treat these reflexes, in addition to a wealth of articles, guides, videos, and many free resources on primitive reflexes. Click here to learn more.
Our testing protocol is tailored to meet the specific needs of each individual, taking into account their age, primary concerns, and any cognitive, developmental, or speech-language delays. We carefully consider each person’s unique circumstances, needs, and abilities. Early weaknesses in auditory processing skills can be identified in children as young as 3 years old using tests designed for this age group. Full auditory processing disorder evaluations are performed for children and adults ages 5 and above.
Some auditory processing tests can be administered to individuals with mild to moderate hearing loss. This can provide information on how well the individual can hear in noise with their hearing aids, yield useful information about individual’s need for remote microphone technology, and monitor the listener’s progress with auditory training.
This page includes an affiliate link to Integrated Learning Strategies (ILS).
