for the purpose are to be considered synonymous - PDF document

() for the purpose are to be considered synonymous. Technical Report ¥ (Central) Auditory Processing Disorders severe depres- 1977).ÊSince that time, many committees and confer- and Technical Report ¥ (Central) Auditory Processing Disordersproblems.ÊIt is important to note that this list is illus-characteristics are not exclusive to (C)APD.ÊOther 1.It is important that the audiologist, who has2.The test battery process should not be test3.Tests with good reliability and validity that4.A central auditory test battery should include5.Tests generally should include both nonver-6.The audiologist should be sensitive to at-7.The audiologist must review the test norma-8.The audiologist should be sensitive to the in- Technical Report ¥ (Central) Auditory Processing Disorders9.Test methods should be consistent with the10.

The duration of the test session should be ap-11.SLPs, psychologists, educators, and other12.In cases in which there is suspicion of speech13.Test results should be viewed as one part ofCentral auditory tests can be affected differen- of having central auditory dysfunction, Technical Report ¥ (Central) Auditory Processing DisordersSquires, & Emmerich, 1990; S. Jerger, Johnson,Ê &Loiselle, 1988; Rappaport et al., 1994).ÊFinally, thereFinally, there)underlie auditory behavior and listening, and whichrely on neural processing of auditory stimuli. Somecentral auditory tests may involve stimuli and/orpresentation features that span categories and exac-erbate challenges to the individualÕs CANS.ÊFor ex-1.Auditory discrimination tests: assess the abil-2.Auditory temporal processing and pattern-3.Dichotic speech tests: asses

s the ability to4.Monaural low-redundancy speech tests: as-Monaural low-redundancy speech tests: as-mance-intensity PI-PB functions]), speech-in-noise or speech-in-competition).5.Binaural interaction tests: assess binaural6.Electroacoustic measures: recordings ofto acoustic stimuli (e.g., OAEs, acoustic reflex7.Electrophysiologic measures: recordings of tivity, topographical mapping). The use ofelectrophysiologic measures may be particu-larly useful in cases in which behavioral pro-cedures are not feasible (e.g., infants and veryyoung children), when there is suspicion offrank neurologic disorder, when a confirma-tion of behavioral findings is needed, orwhen behavioral findings are inconclusive.Test InterpretationThere are several approaches audiologists mayuse to interpret results of diagnostic tests of (C)APD.While work co

ntinues to ascertain the gold standardagainst which (C)APD should be gauged, additionalapproaches to test interpretation will contribute toaccurate and meaningful analysis of an individualÕstest scores. In combination, these approaches assistaudiologists and related professionals in differen-tially diagnosing (C)APD from disorders havingoverlapping behavioral attributes (e.g., ADHD, lan-guage disorder, cognitive disorder, LD).Absolute or norm-based interpretation, probablythe most commonly used approach, involves judgingan individualÕs performance relative to group datafrom normal controls.Relative or patient-based interpretation refers tojudging an individualÕs performance on a given testrelative to his or her own baseline. Patient-based in-terpretation may include:¥Intratest analysis, which is the comparison of¥Intert

est analysis, which is the comparison of¥Cross-discipline analysis, which is the com- Technical Report ¥ (Central) Auditory Processing Disordersrelated language and learning disorders, it is espe-cially crucial that intervention be undertaken broadly American Speech-Language-Hearing Association12 / 2005tional, workplace, recreational, and home accommo-dations) management approaches designed to im-prove access to information presented in theclassroom, at work, or in other communicative set-Musiek, 1997; Hedu, Gagnon-Tuchon, & Bilideau,limited to preferential seating for the individual with(C)APD to improve access to the acoustic (and thevisual) signal; use of visual aids; reduction of com-peting signals and reverberation time; use of assistivelistening systems; and advising speakers to speakmore slowly, pause more often,

and emphasize keywords (ASHA, 2003b; Crandell & Smaldino, 2000,The first step in selecting appropriate bottom-upenvironmental modifications is to assess the acous-tic environment to determine the need for and bestmethods of improving the acoustics of the physicalspace. Classrooms, workplaces, and home environ-ments can be modified to reduce noise and reverbera-tion and improve the associated visible aspects of themay include decreasing reverberation by coveringreflective surfaces (e.g., black/white boards not inuse, linoleum or wood floors, untreated ceilings),using properly placed acoustic dividers, using otherabsorption materials throughout open or emptyspaces (e.g., unused coat areas), and/or changing thelocation of ÒstudyÓ sites. External noise sources canbe eliminated or moved away from the learning spacedoor or wall)

. ANSI Standard 12.60-2002, providesguidelines for acoustical performance and design cri-teria for school environments (ANSI, 2002).Accommodations that utilize technology to im-prove audibility and clarity of the acoustic signal it-self (assistive listening devices such as FM or infraredtechnology) may be indicated for some individualswith (C)APD. Recommendation of signal enhance-ment technology as a management strategy for indi-viduals with (C)APD should be based on theindividualÕs profile of auditory processing deficitsrather than as a general recommendation for all per-sons diagnosed with (C)APD. The strongest indica-tors for the use of personal FM as a managementspeech and dichotic speech tests (Bellis, 2003;Rosenberg, 2002). These listening tasks involve de-graded signals, figureÐground, or competing speechthat are si

milar to the effects of noise and reverbera-tion in classroom, home, and workplace environ-The benefits of personal FM and sound-field tech-nologies for the general population and individualsat risk for listening and learning are well docu-mented, but little data has been published document-ing the efficacy of personal FM as a managementstrategy for students with (C)APD (Rosenberg et al.,1999; Stach, Loiselle, Jerger, Mintz, & Taylor, 1987).For individuals with greater perceptual difficulties,such as auditory processing disorder, a body-wornor ear-level FM system should be considered initiallyas the accommodation strategy due to their signal-to-noise (S/N) enhancement capabilities (Crandell,Charlton, Kinder, & Kreisman, 2001). Fitting, select-ing, training, and monitoring of an assistive listeningdevice or system is a proces

s; each step must beimplemented to ensure the appropriateness and theeffectiveness of the management strategy (ASHA,2002a) and binaural listening remains the preferredgoal of this type of intervention. Newer technologybeing developed (e.g., signal manipulation, adaptivesignal processing) holds promise for additional im-provements in acoustic accessibility and speech per-When working with students with (C)APD, it isimportant to increase all team membersÕ awareness(including teachersÕ and parentsÕ) of the studentÕsspecific profile/deficits to assist in the implementa-tion of specific instructional accommodations andstrategies. Access to communication and learningwithin the classroom and at home becomes criticallyimportant to the success of the student. It is incum-bent upon audiologists or other professionals work-ing with

the classroom team to understand theinstructional style of the primary teachers and thecurriculum so that modifications that accommodatethe student with (C)APD can be arranged. Class-designed to increase the studentÕs ability to access theinformation and may include recommendations re-garding the manner or mode by which instructionalmaterial is presented, the management of the class-room, the structure of auditory information, and com-munication style. Specific suggestions may includesupport for focused listening (e.g., use of note-takers,preview questions, organizers), redundancy (e.g.,multisensory instruction, computer-mediation), anduse of written output (e.g., e-mail, mind-maps) (Bellis,2002, 2003; Chermak, 2002a, 2002b; Chermak &Musiek, 1997). Efforts to improve acoustic access andcommunication for individuals of any

age require ananalysis of functional deficits and specific recommen-dations for change in their everyday settings (e.g.,home, occupational, social, educational).The intervention plan must include measurableoutcomes to determine whether treatment goals and Technical Report ¥ (Central) Auditory Processing Disordersal., 1999; Tremblay & Kraus, 2002; Tremblay et al., American Speech-Language-Hearing Association14 / 2005erential seating, use of personal FM system) designedto improve skills and minimize the adverse effects ofthe (C)APD on the individualÕs communication, aca-demics, social skills, occupational function, and qual-ity of life. The professional team and family membersshould help those with (C)APD develop self-advo-cacy skills by demonstrating techniques, providingmaterials and resources, and offering reinforcement

that can empower them. This may take the form ofteaching the individual specific self-advocacy skillsor, in the case of children, providing parents withtechniques to teach these skills at home; sharingprinted materials that educate the individual withInternet information or product resources; and facili-tating access to appropriate related professionalsand/or support groups as needed.Service providers may choose to require paymentin full at the time services are rendered rather thanto accept third-party assignment. For those provid-ers who choose to accept third-party assignment,there is continuing frustration relative to fair reim-bursement for diagnosis, treatment, and managementof (C)APD. At the time of this writing, there is a lim-ited number of procedure codes in the Current Pro-cedural Terminology (CPT) guide (American

MedicalAssociation, 2004) available to the audiologist andSLP for billing purposes. These codes include thosedescribing specific diagnostic tests as well as so-calledÒbundledÓ codes that can include a variety of proce-dures (e.g., Central Auditory Function Tests, CPT92589; Evaluation of Auditory Processing, CPT92506). However, CPT procedures specific to audio-logical evaluation of central auditory function havebeen accepted by the CPT Editorial Panel and newbecame effective January 1, 2005. These codes include92620 (Evaluation of Central Auditory Processing,initial 60 minutes) and 92621 (Evaluation of CentralAuditory Processing, each additional 15 minutes). Atthe same time, the previous code, 92589 (CentralAuditory Function Tests) has been deleted. As thescope of audiologic rehabilitation is expanded, moretreatment codes

may become available, increasingopportunities for more exact reporting of procedures;however, it is important to note that, at the presenttime, audiologists are not considered eligible for re-imbursement by Medicare for audiologic rehabilita-tion, including (C)APD intervention, whereas SLPsmay bill for intervention under Medicare.ASHA and other related professional organiza-tions are currently seeking additional CPT codesthrough the Medicare system. The process for ex-panding procedural terminology is both time andlabor intensive, leaving providers in a Òwait and seeÓposition as to the introduction of new codes and re-imbursement values. Audiologists and SLPs shouldfamiliarize themselves with currently accepted pro-cedure and diagnosis codes used for third-party as-signment. Billing scenarios are available (Thompson,2002)

to assist service providers in obtaining reim-Further complicating the reimbursement processare the many variations among health plan carrierswith respect to description of services attached tospecific codes (despite the universal nature of the CPTreference book), type of provider eligible to use cer-tain codes, accepted forms of billing invoices, andcoverage eligibility and restrictions for their membersÒhearing testsÓ not a covered benefit). Clients and/or their families should be advised to contact theirhealth plan provider to clarify these issues, preferablyin writing, prior to evaluation or treatment. The spe-cifics of payment assignment to a third party otherthan a health plan (e.g., billing to a school district)should be clarified in writing prior to evaluation orFuture Research NeedsAs is true for most areas of pra

ctice within theprocessing and its disorders. There is a pressing needfor the development of testable models of auditoryprocessing disorder to resolve the controversy sur-rounding multimodality and supramodality concerns(McFarland & Cacace, 1995). Additional behavioraldiagnostic tests must be developed that are based onpsychophysical principles, that meet acceptable psy-chometric standards, that have been validated onknown dysfunction of the CANS, and that can bemade available through commercial venues for prac-ticing clinicians. Similarly, there is a need to developmore efficient screening tools to identify individualsat risk for (C)APD, as well as both screening and di-agnostic measures appropriate for multicultural/multilingual populations. The role of physiologic test-topic of differential diagnostic criteria for (C)APD.

Relationships among performance on various catego-ries of central auditory diagnostic tests and higherorder language, learning, or communication sequelaeneed to be examined in a systematic manner. How-ever, because of the complexity of auditory and re- Technical Report ¥ (Central) Auditory Processing Disorders .ÊMelville, NY: Author. ed.). Clifton Park, NY: Delmar Acta Technical Report ¥ (Central) Auditory Processing Disorders Volta Review, 101 (pp. 269Ð272). Baltimore: (pp. 540Ð563). Baltimore: Williams & Vol. (pp. 45Ð72). New York: (3 ed.). New York: Ox- Technical Report ¥ (Central) Auditory Processing DisordersThompson, M. (2002, May). Coding options for central (pp. 437Ð464). (pp. 43Ð72). New York: ¥Assessment: Formal and informal procedures¥Comorbidity: The coexistence of two or more¥Diagnosis: Identi

fication and categorization of¥Differential diagnosis: Distinguishing between¥Evaluation: Interpretation of assessment data,¥Intervention: Comprehensive, therapeutic¥Management: Procedures (e.g., compensatory¥Pansensory: Referring to higher level mecha-¥Prevention: Procedures targeted toward re-¥Reliability: The consistency, dependability,¥Remediation/treatment: Procedures targeted¥Screening: Procedures used to identify indi-¥Validity: The degree to which a test measures Technical Report ¥ (Central) Auditory Processing Disorders Index terms: auditory processing disorders, assessment, ()Working Group on Auditory Processing DisordersWorking Group members were selected to ensurethat broad experience, varied philosophies, and mul-tiple perspectives regarding (C)APD would be rep-resented. The charge to the Working Gr

oup onAuditory Processing Disorders was to review theASHA technical report, ÒCentral Auditory Process-ing: Current Status of Research and Implications forClinical PracticeÓ (ASHA, 1996) and determine thebest format for updating the topic for the member-ship. The decision was to write a new document inthe form of a technical report and to issue the posi-tion statement Ò(Central) Auditory Processing Disor-dersÑThe Role of the AudiologistÓ (ASHA, n.d.) asa companion document. Rather than replacing theprevious ASHA (1996) document, the present docu-ment was designed to augment and update the infor-mation presented therein, building on the cumulativescientific and professional advances over the pastdecade. Further, it was decided that the current setof documents would focus specifically on theaudiologistÕs role in (C)APD di

agnosis and interven-tion. Although speech-language pathologists (SLPs)are essential to the overall assessment and manage-ment of children and adults with (C)APD, specificallywith regard to delineation of and intervention forcognitive-communicative and/or language factorsthat may be associated with (C)APD, it was felt thatin-depth discussion of the role of the SLP and otherprofessionals was beyond the scope of this report. Itshould be emphasized, however, that the WorkingGroup embraced the concept that a multidisciplinaryteam approach to assessment, differential diagnosis,and intervention is imperative. The Working Groupalso considered the use of the term auditory process-ing disorder. The Bruton conference consensus paper(Jerger & Musiek, 2000) set forth the use of the termauditory processing disorder rather than the previo