Auditory processing disorder

How Can I Tell If My Child Has Been Misdiagnosed With Auditory Processing Disorder?

By Ellen Koslo

How can I tell if my child has been misdiagnosed with auditory processing disorder?

Ellen Koslo

Associate Professor of Otolaryngology, Columbia University Medical Center

Auditory processing disorder (APD) is difficult to diagnose. It’s sometimes confused with attention-deficit hyperactivity disorder (ADHD). And it may share symptoms with other conditions. These include specific language impairment, Asperger’s syndrome and other autism spectrum disorders.

Hints of APD can appear as early as preschool. But most audiologists recommend waiting to test for APD until a child is 7 or 8 years old. That’s because young kids vary a lot in how quickly they pick up different skills. Those skills include making sense of the sounds we hear and learning to listen while ignoring background noise.

It takes time for the brain to develop and refine these and other abilities. And these developmental factors can lead to a misdiagnosis of APD.

For example, when very young children are tested for APD, factors such as lack of cooperation, lack of sustained attention and lack of understanding can all affect interpretation of the test results.

That’s why children who get a diagnosis of APD at age 6 or younger may need to be retested later on. Experts recommend doing this around age 12 to confirm the diagnosis. They will want to make sure it wasn’t ADHD or another issue that sometimes can look a lot like APD.

Diagnosing APD involves giving a sequence of tests, called a battery. The APD test battery looks for a mismatch between hearing ability (which is typically normal for kids with APD) and the ability to interpret or discriminate sounds.

Your child’s performance on these auditory tests can be affected by things like attention issues or problems with speech or language. Here are a few things you can do to try to prevent or correct a misdiagnosis.

Use the whole team. Any potential case of APD should be assessed by a team. Include an audiologist, a speech-language pathologist (SLP), a psychologist and an ear, nose and throat doctor.

Make sure the audiologist is familiar with APD. Not all audiologists are. Unless they’re specifically looking for APD, many audiologists will not refer a child for APD testing if tests show he has normal hearing. But if you describe your child’s symptoms clearly, most audiologists will know enough about the warning signs of APD.

Rule out other problems first. Before testing a child for APD, the audiologist should perform a hearing test to rule out hearing loss. The SLP should also assess any speech or language problems prior to the APD testing.

It’s also a good idea to have a psychologist see if your child has an attention deficit. If this turns out to be the case, and if you choose to give him medication for attention issues, it’s best to wait to do the APD testing until you’ve figured out the optimal dosage for managing his ADHD symptoms.

Don’t stop taking ADHD medication. If your child has an ADHD diagnosis and is on medication, be sure he keeps taking it during the APD testing. Stopping or changing the medication could affect the results of the APD testing.

Of course, many parents choose not to medicate for ADHD. In these cases, accurate APD testing will depend on the child’s ability to pay sufficient attention to the testing.

Take notes on the strategies you’re using. Keep track of which classroom accommodations seem to help and which ones don’t. Do the same with the strategies you’re trying at home. Taking notes and sharing your observations can be very helpful to clinicians.

About the Author

Portrait of Ellen Kolso

Ellen Koslo is an audiologist and associate professor of otolaryngology at Columbia University Medical Center.

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