A Little of This, A Little of That: (Central) Auditory Processing Disorder

Abstract

Victoria was unusually quiet as an infant, seldom cooing or babbling. She spoke her first words a bit late at 18 months and began combining two to three words at age 2½ years. Her speech was very difficult to understand, but her parents assumed that her pronunciation would improve with age. An evaluation conducted by the local school district to determine school readiness indicated that Victoria had profound delays in articulation and phonological skills. She was subsequently enrolled in a phonology program at age 4 years. The program was minimally effective; her speech remained 80–85% unintelligible to everyone except her immediate family. In kindergarten, Victoria struggled to learn letter sounds and seemed to have more difficulty than her peers with following directions and answering questions. Her classmates understood very little of what she said and constantly teased her because she sounded “like a baby.” Both Victoria's parents and teacher noticed that she seemed sad and withdrawn.

Victoria's speech was often monotone and she had a tendency to stress the wrong syllables of words. Her parents began to wonder about a hearing impairment. Shortly after her sixth birthday, Victoria was evaluated by an audiologist. Her peripheral and middle ear function were normal in both ears. However, further testing suggested that she had difficulty discriminating the subtle differences between sounds in words, especially in noisy environments. She also had difficulty understanding the meaning of words and phrases. Victoria was subsequently diagnosed with (central) auditory processing disorder ((C)APD). The audiologist provided detailed recommendations including the use of an FM system and referred Victoria to the school Individualized Education Program (IEP) team for an evaluation. The IEP team concluded that Victoria met eligibility criteria to receive special education services under the speech and language impairment classification. She began using an FM system and received pull-out speech and language therapy during the fourth quarter of her kindergarten year.