Subtypes of Auditory Processing Disorder (APD)

The following information is copied from an old article written by Jeanane Ferre, PhD. The article used to be housed on this website but is not longer live. Full credit for the following content is given to Jeanane Ferre, PhD.        

Primary and Secondary Subtypes

There are two groups of subtypes for APD: Primary and Secondary.

  • Primary subtypes: based upon presumed anatomical site of dysfunction include Auditory Decoding Deficit, Integration Deficit, and Prosodic Deficit.
  • Secondary subtypes: perhaps not appropriately termed "CAPD" but show unique test profiles include Auditory Association Deficit and Output-Organization Deficit.

Decoding Deficit

Poor discrimination of fine acoustic differences in speech. Likely site of dysfunction - primary auditory cortex. Signal distortion at point of neural representation.

Keyword: They do not "hear". The "what" kids.

Key CAF findings: poor auditory discrimination, closure, temporal resolution. Poor scores for degraded speech tasks, right ear often poorer than left. Errors are phonemically similar to target.

Key behaviors: difficulty in situations with reduced extemal redundancy - unfamiliar with vocabulary, few or no contextual or visual cues, excessive noise and/or reverberation, auditory chaos; in groups. Report "can't hear", "didn't hear". Mishears, needs repetition, SLOW &

INACCURATE. May have communicative problems in vocabulary, syntax, semantics, second language acquisition and/or academic problems in reading decoding, spelling, notetaking, direction following.

Other considerations: Wepman ADT - reliable screener for poor discrimination, memory tests - poor decoders rend to do more poorly on word memory tests than on sentence memory test, spelling - if you can spell it the "way it sounds" you probably have adequate

auditory decoding skills

Key managernent strategies:

  • preferential classroom seating that maximizes BOTH auditory and visual channels
  • reduction of extraneous
  • increased use of visual/contextual cues
  • improved signal-to-noise ratio usually via assistive listening technology
  • target repetition to improve acoustic clarity
  • target rephrasing to provide additional contextual/Iinguistic cues
  • substitute verbal foreign language requirement with sign language
  • adjust class schedule to minimize auditory overload
  • closed set tests
  • use of tape recorders
  • combination of speech-languagelaural rehabilitation therapy to work "top-down" skills and auditory training to work "bottom-up" skills
  • Commercial programs: Earobics, FAST ForWord, Sloan, LiPS, M3.
  • Games: diadokokinetic exercises, telephone game, direction following games, rhyming games, Word- A- Day, Start-stop games (also work on vigilance), ANY awareness, same-different, identification, or recognition sound game

Integration Deficit

Deficiency in the ability to perform tasks that require intersensory or interhemispheric communication. Reflects delayed or abnormal interhemispheric communication. Deficiency in ability to coordinate multimodal inputs.

Keyword: They do not "synthesize". "It's too much".

Key CAF findings: excessive left ear suppression on dichotic listening tasks, can't label auditory patterns but can mimic them.

Key behaviors: trouble knowing "how to" do some task, tends to "watch and wait", poor starter, poor transitions, needs more time; lots of "I don't know", "I don't get it" or "I have no idea". Variable trouble in noise. Variable impact on communication. Academic effects in reading recognition, spelling, writing skills, other integrative tasks.

Other considerations: spelling- tend to spell phonetically not by the rules, the alphabet - can "sing" the alphabet but struggles to "say" it, digit span tests- tend to have more trouble with digits reversed, memory tests- difficulty with sentences - better on word memory

Key management strategies:

  • child may perform MORE poorly when visual information is added, they may need to look OR listen or look THEN listen
  • DO make sure that visual cues MATCH the auditory target and DON'T compete with it
  • DON'T EVER rephrase to a child with Integration Deficit, it will just confuse them
  • DO repeat the information with an associated visual cues, demonstration, or model
  • bothered by "noise" as a function of the TASK DEMANDS, not necessarily the level of noise, so change demands or remove child to quieter environment, especially for tests
  • require an experiential, structured, "hands-on" environment, lots of examples, multimodal inputs given one at a time
  • must know task demands up front
  • untimed tests
  • NO ALDs
  • consider Latin or Hebrew for foreign language requirement
  • use tape recorder, notetakers, books on tape, study guides, CliTs Notes
  • intervention focuses on academic and speech-language impact as needed and appropriate remedial programs include Orton, Lindamood-Bell, Wilson, and similar
  • "Bottom-up'-type activities that enhance development of interhemispheric skills include those that stimulate transfer of function, ability to extract key information, do "parts-to- whole" (synthesize). Examples: dance, music, juggling, karate, gymnastics, Bopit, Scrabble, Boggle, UpWords, Rummy and other card games, Rummy-Q, Top it, Brain Warp, Simon and Simon Says, Chess, Video games with pattern puzzles, "feely bag"
  • Pair OT-type activities with verbal tasks

Prosodic Deficit

Deficiency in ability to use prosodic features of target. Believed to reflect inefficient right hemisphere function.

Keyword: Subtle problems. It's all "too fast". "blah, blah, blah, something".

Key CAF lindings: poor labelling AND mimicking of temporal patterns. Poor temporal integration. Reflects poor gestalt pattern recognition skills - unisensory in this case.

Key behaviors: pragmatic language problems including trouble with non-verbal cues, e.g., facial expressions, body language, gestures, sarcasm; heteronyms, expressive speech may be monotone, poor rhythm perception. Possible deficits in music. Variable academic impact. Part of the cohort of behaviors of nonverbal learning disability.

Other considerations: The Alphabet Song - song off-key or off-tempo music & musical cues - doesn't like music or can't "carry a tune"

multisyllabic production - "trips" over multisyllabic words or leaves syllables out

Key management strategies:

  • requires animated teacher with a melodic voice, lots of demonstration/examples, multisensory inputs and additional visual cues
  • change rate, pacing of speech, emphasis on key words
  • untimed tests
  • may require speech-language TX for pragmatic and nonverbal language, rhythm perception, prosody training
  • for academic intervention, consider Lindamood-Bell or Wilson
  • consider music TX and/or social work services (for social language)
  • use games/activities similar to those for poor integrator including singing, Math Rap, Schoolhouse Rock, Bopit, sing-along tapes/videos, books on tape, activities that work on pattern recognition (auditory, visual, or tactile) and symbolic language, listening to color, "soap" operas, dramatic arts.
  • Keep in mind: It's not just the perception of the timing cues for these children, it's what those cues MEAN.
  • Check for similar problems in other modalities - difficulty reading facial expressions or problems with tactile patterns
  • Check for NVLD

Associative Deficit (secondary subtype)

Not applying RULES of LANGUAGE to acoustic signal. Inefficient communication between primary and associative cortical regions (i.e. inefficient intrahemispheric cooperation).

Keyword: They do not "translate". The "huh" kids.

Key CAF results: bilaterally depressed scores on dichotic listening tasks. OK pitch pattern labelling.

Key behaviors: request clarification, saying "I don't know what you MEAN" or "I don't understand". Communicative problems in syntax, vocabulary, semantics, verbal and/or written expression, pragmatics, social communication, foreign language acquisition. Reading decoding OK but weak comprehension. Trouble with math word problems. Early academics may be OK but declines with increasing linguistic demands.

Other considerations: language-biased IQ tests - tend to underestimate true potential. Will get more reliable estimate with non language-biased instrument such as Leiter or TONI.

Key management strategies:

  • focus on "use of the rules"
  • needs an educational environment that is systematic, logical, multisensory, & rule- based
  • rephrase instead of repeating, emphasize linquistic clarity, avoid ambiguity
  • use multiple choice or closed set tests
  • waive foreign language
  • increase linguistic familiarity, books on tape, study guides, Clifs Notes
  • tell the rules up front
  • speech-language TX to build linguistic/metalinguistic and metacognitive skills
  • academic intervention may include Orton-based programs, Lindamood-Bell, Wilson
  • use games/activities that get you to OR let you think "outside the box" andlor build facility with vocabulary, (meta)Iinguistic rules or concepts (including problem solving): Catch Phrase, Scattergories, UpWords, Tabu, Clever Endeavor, Alphabet games, Plexers, Rebus games, Password, Boggle, Scrabble, Wheel of Fortune, Word-A-Day calendars, Word Jumble, Word Search Puzzles, words-from-a-word games, "It pays to increase your word power" - Readers' Digest, Change-a letter games, dramatic arts

Output-Organization Deficit (secondary subtype)

Deficiency in the ability to organize, sequence, plan, or recall appropriate responses. Difficulty on tasks requiring efficient motor path transmission/motor planning. May be behavioral manifestation of impaired efferent function or planning/executive function deficit.

Keyword: They can't "get it back out".

Key CAF results: poor performance in noise, target reversals, ordering problems, omission of target/substitution with previously heard word.

Key behaviors: disorganized, impulsive, poor planner. Deficits in expressive language, articulation, syntax. Educational problems: direction following, note-taking, remembering assignments.

Other considerations: free vs. directed recall tasks - tend to perform much better with free recall than with directed recall tasks

Key management strategies:

  • needs training and practice in the rules for organization
  • break info into smaller units, use tag words
  • use outlines, checklists, assignment notebooks, computers
  • use activities with specific order
  • teach verbal rehearsal, information chunking, use of mnemonics, metacognitive strategies, visual imagery and visualization.
  • may need speech-language intervention for expressive speech-language skills
  • may need academic TX for study, note-taking and test-taking strategies
  • consider ALD for attentiveness
  • use games that emphasize sequence, order, rules, planning: Alphabet games, drama, follow the leader, Bopit, Topit, Brain Warp, Freddie Fish, memory games, Scrabble, chess, Battleship, model building, cooking

APD Book Now Available!

41B1MaCKobL15 authors share their stories of living with auditory processing disorder. Their stories share the struggles and triumphs with diagnosis, accommodation and therapies that helped.

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