Understanding the Differences Between Auditory Processing

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Understanding the Differences Between Auditory Processing,

Speech and Language Disorders, and Reading Disorders

October 2014

INTRODUCTION

This document has been prepared to provide

an overview of the differences among

auditory processing disorders,

communication disorders, and reading

disorders to clarify the need for

accommodations for students with

communication and processing disorders.

The document is organized by definition of

the disorder, treatment options, and

accommodations, followed by results of a

study that differentiates between reading and

language disorders.

A 2011 Government Accountability Office

(GAO) study recommended that the

Department of Justice develop a systematic

approach to ensuring that all eligible students

receive accommodations. GAO further

recommended that the decision to allow for

accommodations be based on the individual’s

history and the recommendations of teachers

and service providers and not on a single

measure of performance.

This document includes study highlights, a

link to the full study, and specific examples

of the impact that lack of accommodations

has on individual student performance.

STUDENT ELIGIBILITY FOR SPECIAL

EDUCATION

Students are sometimes determined to be

eligible for services based solely on their

communication disorders. Once identified as

eligible, these students have access to all

necessary services and supports. Because

they receive such supports and services,

additional testing may not be performed and

a subsequent reading disorder may not be

revealed. Although not all students diagnosed

with a communication disorder will develop

a reading disorder, some may require

accommodations to enable them to benefit

from their education.

RECOMMENDATIONS

Based on the results of the GAO study, the

impact on student performance for those

students denied accommodations, and the

differentiation between the needs of students

with communication disorders and those with

reading disorders, ASHA recommends that

decisions about the need for accommodations

be made by reviewing the student’s history,

the accommodations that have been provided

to the student throughout his or her school

years, and the recommendations of the

student’s educational team. As noted above,

no single criterion should be used to

determine eligibility for testing

accommodations, and rules for

accommodations should be applied

consistently across disability categories.

DEFINITIONS

Auditory Processing Disorder

Auditory processing disorders (ADP) are

deficits in the information processing of

audible signals not attributed to impaired

peripheral hearing sensitivity or intellectual

impairment. This information processing

involves perceptual, cognitive, and linguistic

functions that, with appropriate interaction,

result in effective receptive communication

of auditorily presented stimuli. Specifically,

APD refers to limitations in the ongoing

transmission, analysis, organization,

transformation, elaboration, storage, retrieval,

and use of information contained in audible

Key Points:



APD is an auditory disorder that is not

the result of higher-order, more global

deficit, such as autism, mental

retardation, attention deficits, or similar

impairments.



Not all learning, language, and

communication deficits are due to

APD.



No matter how many symptoms of

APD a child has, only careful and

accurate diagnosis can determine if

APD is, indeed, present.



Although a multidisciplinary team

approach is important in fully

understanding the cluster of problems

associated with APD, the diagnosis of

APD can only be made by an

audiologist.



Treatment of APD is highly

individualized. There is no one

treatment approach that is appropriate

for all children with APD.

signals. APD may involve the listener's active

and passive (e.g., conscious and unconscious,

mediated and unmediated, controlled and

automatic) ability to do the following: attend,

discriminate, and identify acoustic signals;

transform and continuously transmit

information through both the peripheral and

central nervous systems; filter, sort, and

combine information at appropriate

perceptual and conceptual levels; store and

retrieve information efficiently; restore,

organize, and use retrieved information;

segment and decode acoustic stimuli using

phonological, semantic, syntactic, and

pragmatic knowledge; and attach meaning to

a stream of acoustic signals through use of

linguistic and nonlinguistic contexts.

Children with APD may exhibit a variety of

listening and related complaints. They may

have difficulty understanding speech in noisy

environments, following directions, and

discriminating (or telling the difference

between) similar-sounding speech sounds.

Sometimes they may behave as if a hearing

loss is present, often asking for repetition or

clarification. In school, children with APD

may have difficulty with spelling, reading,

and understanding information presented

verbally in the classroom. Often their

performance in classes that don't rely heavily

on listening is much better, and they typically

are able to complete a task independently

once they know what is expected of them.

APD may co-exist with attention deficit

hyperactivity disorder (ADHD) or other

disorders.

A multidisciplinary team approach is critical

to fully assess and understand the cluster of

problems exhibited by children with APD,

but the actual diagnosis of APD is made by

an audiologist, who administers a series of

tests in a sound-treated room. These tests

require listeners to attend to a variety of

signals and to respond to them via repetition,

pushing a button, or in some other way.

Other tests that measure the auditory system's

physiologic responses to sound may also be

administered. Most of the tests for APD

require that a child be at least 7 or 8 years of

age, because the variability in brain function

is so marked in younger children that test

interpretation may not be possible.

Treatment

Treatment of APD generally focuses on three

primary areas: changing the learning or

communication environment, recruiting

higher-order skills to help compensate for the

disorder, and remediation of the auditory

deficit itself. The primary purpose of

environmental modifications is to improve

access to auditorily presented information.

Suggestions may include use of electronic

devices that assist listening, teacher-oriented

suggestions to improve delivery of

information, and other methods of altering

the learning environment so that the child

with APD can focus his or her attention on

the message.

Accommodations

Environmental modifications include both

bottom-up (e.g., enhancement of the signal

and listening environment) and top-down

(e.g., classroom, instructional, workplace,

recreational, and home accommodations)

management approaches designed to improve

access to information presented in the

classroom, at work, or in other

communicative settings. Environmental

accommodations to enhance the listening

environment may include but are not limited

to preferential seating for the individual with

APD to improve access to the acoustic (and

the visual) signal; use of visual aids;

reduction of competing signals and

reverberation time; use of assistive listening

systems; and advising speakers to speak more

slowly, pause more often, and emphasize key

words. Specific suggestions may include

support for focused listening (e.g., use of

note takers, preview questions, organizers),

redundancy (e.g., multisensory instruction,

computer mediation), and use of written

output (e.g., e-mail, mind maps)

There is no one treatment approach that is

appropriate for all children with APD. The

type, frequency, and intensity of therapy, like

all aspects of APD intervention, should be

highly individualized and programmed for

the specific type of auditory disorder that is

present.

For more information see:

www.asha.org/public/hearing/Understanding-

Auditory-Processing-Disorders-in-Children/;

and www.asha.org/policy/TR2005-

00043.htm#sec1.6.

SPEECH AND LANGUAGE/

COMMUNICATION DISORDERS

Definitions

Receptive/Expressive Language Disorder

A communication disorder is an impairment

in the ability to receive, send, process, and

comprehend concepts or verbal, nonverbal,

and graphic symbol systems. A

communication disorder may be evident in

the processes of hearing, language, and/or

speech. A communication disorder may

range in severity from mild to profound. It

may be developmental or acquired.

Individuals may demonstrate one or any

combination of communication disorders. A

communication disorder may result in a

primary disability, or it may be secondary to

other disabilities.

 A speech disorder is an impairment

of the articulation of speech sounds,

fluency, and/or voice.

 An articulation disorder is the

atypical production of speech sounds,

characterized by substitutions,

omissions, additions, or distortions

that may interfere with intelligibility.

 A fluency disorder is an interruption

in the flow of speaking characterized

by atypical rate, rhythm, and

repetitions in sounds, syllables,

words, and phrases. This may be

accompanied by excessive tension,

struggle behavior, and secondary

mannerisms.

 A voice disorder is characterized by

the abnormal production and/or

absences of vocal quality, pitch,

loudness, resonance, and/or duration,

which is inappropriate for an

individual's age and/or sex.

 A language disorder is impaired

comprehension and/or use of spoken,

written, and/or other symbol systems.

The disorder may involve (1) the

form of language (phonology,

morphology, syntax), (2) the content

of language (semantics), and/or (3)

the function of language in

communication (pragmatics) in any

combination.

Form of Language

 Phonology is the sound system of a

language and the rules that govern the

sound combinations.

 Morphology is the system that

governs the structure of words and the

construction of word forms.

 Syntax is the system governing the

order and combination of words to

form sentences and the relationships

among the elements within a

sentence.

Content of Language

 Semantics is the system that governs

the meanings of words and sentences.

Function of Language

 Pragmatics is the system that

combines the above language

components in functional and socially

appropriate communication.

Communication Variations

 Communication difference/dialect is a

variation of a symbol system used by

a group of individuals that reflects

and is determined by shared regional,

social, or cultural/ethnic factors. A

regional, social, or cultural/ethnic

variation of a symbol system should

not be considered a disorder of speech

or language.

Treatment

Speech Sound Disorders

Treatment for speech sound disorders may

focus on articulation production or

phonological/language-based intervention.

Most treatment approaches focus on three

phases: establishing target behaviors,

generalization or carryover of sound

production, and maintenance that involves

stabilization of target behaviors and self-

correction of errors. Further information on

treatment for sound production disorders can

be found on ASHA’s Practice Portal at

www.asha.org/PRPSpecificTopic.aspx?folder

id=8589935321&section=Treatment.

Language Disorders

The objective of language treatment is to

increase the frequency and quality of

language to age-appropriate levels. Speech-

language pathologists play a critical and

direct role in helping children with language

disorders learn to speak, listen, read and

write.

Treatment for young children may involve

improving intelligibility, increasing

phonological awareness, increasing

vocabulary and social communication skills,

and building emergent literacy skills.

The focus of language intervention for

elementary school children with language

difficulties is to help the child acquire the

language skills needed to learn and succeed

in a classroom environment. Interventions are

curriculum based, so that goals address

language needs within the context of the

curriculum.

Interventions may also address literacy skills

(e.g., improving decoding, reading

comprehension, and narrative and expository

writing), as well as metacognitive and

metalinguistic skills (e.g., increasing

awareness of rules and principles for use of

various language forms, improving the ability

to self-monitor and self-regulate) that are

critical for the development of higher-level

language skills.

Interventions for older students (adolescents)

tend to focus on teaching ways to compensate

for language deficits. Student involvement is

important at this age to foster a feeling of

collaboration and responsibility for

developing and achieving intervention goals

and to enable the student to learn self-

advocacy skills for the classroom.

Instructional strategies focus on teaching

rules, techniques, and principles to facilitate

acquisition and use of information across a

broad range of situations and settings.

Classroom assignments are often used to

teach strategies for learning academic

content.

Difficulties experienced by children and

adolescents with language impairment can

continue to impact functioning in post-

secondary education and vocational settings.

When compared with typically developing

peers, fewer individuals with language

impairment complete high school or receive

an undergraduate degree (Johnson,

Beitchman, & Brownlie, 2010). The data on

educational and vocational outcomes for

individuals with speech and language

disorders highlight the need for continued

support to facilitate a successful transition to

young adulthood. A formal transition plan

should be developed in high school and

include career goals and educational needs,

academic counseling (including discussion of

requirements for admission to post-secondary

schools), career counseling, opportunities to

gain work experience, and community

networking.

Goals for successful transitioning to post-

secondary school or employment may

include preparing a resume, completing a job

or college application, effectively presenting

skills and limitations during an interview,

expressing concerns to authority figures

about academic or job performance, and

stating or restating a position to effectively

self-advocate in academic and employment

settings.

Accommodations

Secondary school personnel can assist

students with language disorders through the

transition process by providing current

documentation needed to access services

(e.g., testing and academic accommodations

in a post-secondary setting) and helping

students identify and advocate for supports,

accommodations, and assistive technologies

as needed.

Individualized support for college-level

students may include accommodations, such

as extended time for tests and the use of

assistive technology (e.g., to help with

reading and writing tasks). Further

information on treatment for expressive

(spoken) language disorders can be found on

ASHA’s Practice Portal at

www.asha.org/Practice-Portal/Clinical-

Topics/Spoken-Language-Disorders/.

Additional definitions of communication

disorders can be accessed at

www.asha.org/policy/RP1993-00208.htm.

READING DISORDER

Definitions

A reading disorder is a learning disorder that

involves significant impairment of reading

accuracy, speed, or comprehension to the

extent that the impairment interferes with

academic achievement or activities of daily

life. People with reading disorders perform

reading tasks well below the levels one

would expect on the basis of their general

intelligence, educational opportunities, and

physical health. Reading disorders are most

commonly called dyslexia. Dyslexia usually

includes deficits in spelling and writing as

well as reading.

A reading disorder is a learning disorder

characterized by a significant disparity

between an individual's general intelligence

and his or her reading skills. Learning

disorders, formerly called academic skills

disorders, are disorders that account for

difficulty learning and poor academic

performance when low performance cannot

be attributed to mental retardation, low

intelligence, lack of learning opportunities, or

such specific physical problems as vision or

hearing deficits. Common learning

disabilities include reading disorder (often

called dyslexia), mathematics disorder,

disorder of written expression, and some

language processing disorders.

A reading disorder can cause severe

problems in reading, and consequently in

academic work, even in people with normal

intelligence, educational opportunities,

motivation to learn to read, and emotional

self-control. Reading disorder is different

from slowness in learning or mental

retardation. In a reading disorder, there is a

significant gap between the expected level of

performance and actual achievement.

Difficulties in reading can occur on many

levels and a reading disorder may have

several causes that manifest in different

ways.

90% of children diagnosed with a reading

disorder have other language deficits

(www.minddisorders.com/Py-Z/Reading-

disorder.html).

DIFFERENTIATING READING AND

LANGUAGE DISORDERS

In a study by Hugh Catts, University of

Kansas, published in the Journal of Speech

and Hearing Research (1993), kindergarten

students with speech-language impairments

were given a battery of speech-language tests

and measures of phonological awareness and

rapid naming. In second grade they were

given a test to measure written word

recognition and reading comprehension.

Researchers found that children with

semantic (language) impairments were at a

higher risk for a reading disability than were

those with articulation and phonological

disorders. Not all children with speech-

language impairments requiring speech-

language pathology services developed a

reading disorder. Standardized testing and

other reliable measures of semantic language

and phonological awareness can help predict

which students with speech-language

impairments will develop a reading disorder.

http://jslhr.pubs.asha.org/article.aspx?articlei

d=1779577

RESULTS OF 2011 GAO STUDY

The GAO study

(www.gao.gov/products/GAO-12-40 )

requested by Representatives George Miller

(D-CA), Pete Stark (D-CA), and Cathy

McMorris Rodgers (R-WA), examined the

process that testing companies use to render

decisions regarding testing accommodations

for students with disabilities, and how federal

agencies (including the Department of

Justice) enforce compliance with relevant

federal disability laws and regulations,

including the ADA. In its report, GAO

recommended that the Department of Justice

Common problems in people with a

reading disorder include:

• slow reading speed,

• poor comprehension when reading

material either aloud or silently,

• omission of words while reading,

• reversal of words or letters while

reading,

• difficulty decoding syllables or

single words and associating them

with specific sounds (phonics),

• limited sight word vocabulary.

develop a systematic approach to ensuring

that all eligible students receive appropriate

accommodations. The agency further

recommended that the decision to allow

accommodation requests should be based on

individual disability history rather than

diagnostic testing or other single criterion.

In other words, testing companies should rely

on the unique experiences of the individual

and the recommendations of teachers,

clinicians, and other providers. In the case of

individuals with speech-language

impairments, accommodation decisions

should be based on the history of

accommodations for test taking and other

activities and recommendations of the

individual’s IEP team and not on the arbitrary

criterion of whether or not the individual also

presents with a reading disorder.

We urge the Department of Justice to require

testing companies to be ADA compliant

when assessing the accommodation needs of

all students who require accommodations,

including students with speech and language

disorders absent a reading disorder.

SCENARIOS

Below are specific scenarios, written by

speech-language pathologists whose clients

with APD and language disorders needed

continued accommodations.

Student AB had been denied ACT

accommodations (twice), the first time 3

years prior. Following the denials, I had to

submit the attached letters to request

additional time, because ACT would not

recognize the diagnosis of Speech Language

Impairment as grounds for accommodations.

For students with a diagnosis of Specific

Learning Disabilities (SLD), I did not need to

send additional information; the SLD

diagnosis alone was sufficient justification.

Following graduation, AB attended Hesston

College, a 2-year college of the Mennonite

Church in Kansas. He ran cross country for

the college and studied youth ministry. He

graduated with his associate degree in May

2014 with a 2.27 GPA. While in college, he

received test accommodations of a separate

location and extended time for testing. AB

will be attending Greenville College in

Illinois this fall in order to obtain his

bachelor’s degree.

His areas of deficit are in expressive and

receptive language. His language deficits

cause him to process written and verbal

information much more slowly than does a

typically functioning student.

Receptively, AB has to reread information

multiple times in order to comprehend what

is being expressed or what a question is

asking. He will take longer to understand a

story, a question stem, or answer choices. He

will then take longer to make a decision and

choose the best answer, because he has to

reason through the information and the

related words in order to make that choice.

AB will take longer to complete the writing

portion of the ACT. He will need to process

the directions and the writing prompt. He will

then need time to formulate and organize his

written response. AB is slow and inaccurate

due to his word-finding deficit and will take

longer to select the appropriate words to

include in his written responses.

AB requires extended time on each test and

give authorization over multiple days. He

needs these accommodations due to his

receptive and expressive language deficits.

Student A had to take the ACT without

accommodations. She did not have a reading

disorder but had a language disorder. Her

disorder caused her to need additional time to

gather meaning from the text, although she

was a fluent reader. She had receptive

language and language memory deficits but

was competent in analyzing word (prefixes,

suffixes, root words) and context clues,

including sentence structure and related

words, to improve her comprehension. She

needed to read and reread passages for

understanding. The reading comprehension

portion of standardized academic

assessments, such as the Woodcock-Johnson,

is not timed. A student may take the time to

think through the passage, questions, and

answer choices. Student A used her skills and

time to formulate or choose correct answers.

All of this analysis took extra time, which

student A was not given on the ACT. She

graduated in May 2014 from Northern

Illinois University (NIU), where she was

admitted through a special program called

Chances. She had been denied regular

admission due to her ACT scores (14 and

15); she took the test twice with no

accommodations. Student A did extremely

well at NIU academically and with her

involvement on campus activities. She

graduated from the university in 4 years with

a 3.14 GPA.

Students with communication disorders may

be good readers and processors of

information, given sufficient time. These are

individuals who must work hard to process

and comprehend information.

CONTACT INFORMATION

For more information on practice related

issues, contact Deborah Dixon, ASHA's

director of school services, at 301 296-5690

or by e-mail at [email protected], or Janet

Deppe, ASHA's director of state advocacy, at

301-296-5668 or by e-mail at

[email protected].

For advocacy related issues contact Catherine

D. Clarke, ASHA's director of education and

regulatory advocacy, at 202- 624-5953 or by

e-mail at [email protected].