Profile and aetiology of children diagnosed with auditory processing disorder (APD)

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Summary

Objective

Auditory processing disorder (APD) is characterised by listening difficulties despite a normal audiogram. APD is becoming ever more widely diagnosed in children, though there is a controversy over definition, diagnosis and aetiology. This study sought to describe presenting features and investigate aeitological factors for children diagnosed with APD compared to those for whom APD was excluded.

Methods

Medical notes for children referred to a specialist hospital-based APD clinic were reviewed in relation to presenting features and potential aetiological factors.

Results

32 children diagnosed with APD and 57 non-APD children were compared. They reported similar symptoms and similarly had high rates of co-morbid learning problems. No aetiological factor (including history of otitis media, adverse obstetric history or familial history of listening problems) predicted APD group membership.

Conclusions

Children identified with APD on the basis of commonly used APD tests cannot be distinguished on the basis of presenting features or the aetiological factors examined here. One explanation is that learning problems exist independently of auditory processing difficulties and the aetiological factors do not have a strong causal role in APD. However, no gold standard for APD testing exists and an alternative explanation is that the commonly used APD tests used as selection criteria in this study may be unreliable.

Introduction

APD is diagnosed on the basis of difficulty in identifying or discriminating sounds despite normal peripheral hearing. Difficulty in understanding speech in noise is the most common manifestation. Although it does not feature in mainstream diagnostic classifications such as DSM-IV or ICD-10, APD is becoming more widely diagnosed. However, controversy exists over the definition of APD, diagnosis, association with learning problems and causation. We studied a sample of children referred to a specialist APD clinic to describe and compare the presenting features of APD and non-APD children as well as to examine the role of various possible aetiological factors in APD.

Chermak and Musiek [31] noted that ADP cases with an obvious neurological aetiology are in the minority (∼5%). For the remainder, the concept of ‘neuro-developmental disorder’ or ‘maturational lag’ is usually invoked, but the aetiology of this is not clear and there is little evidence for the role of any particular risk factor. Inherited factors and/or obstetric complications may relate to neuro-developmental auditory processing problems while auditory deprivation due to otitis media has been suggested to underlie a maturational delay [1]. Musiek et al. [2] reported that a genetic contribution was suspected for some children with APD of ‘neuro-developmental origin’, with many having family histories of learning disabilities. Note, however, that Musiek et al. did not distinguish between learning problems such as specific language impairment (SLI), for which there is good evidence for heritability [3] and more specific auditory problems.

The first part of this article seeks to characterise children diagnosed with APD in comparison to children for whom an APD diagnosis is excluded (non-APD) in terms of terms of age, sex, co-morbid conditions and reported symptoms. The second part explores factors that may be significant in the aetiology of auditory processing problems.

Section snippets

Methods

Data were analysed retrospectively from a research database containing demographic details, case history, symptoms, co-morbid conditions, audiological test results and suspected aetiology. Information was entered into the database from medical case notes.

Presenting features

Proportion of males and females and average age were not significantly different between groups. The average age of the APD children was 10.3 (S.D. 2.6) and 10.1 for the non-APD group (S.D. 2.0). Average SCAN composite scores, average parental Fisher's checklist percentile and average parental CHAPS scores are shown in Table 1. There was no significant difference between average percentile score on Fisher's checklist or on total CHAPS score between groups.

Symptoms

Table 2 contains a list of symptoms

Aetiological factors

For the aetiological analysis, two children with an identifiable neurological cause for their auditory processing problems (Landau-Kleffner syndrome and Gaucher-related brainstem abnormalities) were excluded from the APD group.

Discussion

Among children referred for investigation of APD, there were no differences between those who did and did not receive an APD diagnosis, either in symptoms or co-morbid conditions. The CHAPS and Fisher's APD screening questionnaires also did not differentiate between groups. A high proportion of both APD and non-APDs had co-morbid conditions, especially those related to language and literacy. Overall, non-APD and APD children did not differ in any respect apart from performance on tests of

Acknowledgement

This research was funded by Deafness Research, UK.

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