An opinion on the assessment of people who may have an auditory processing disorder

We need to rethink how we assess auditory processing disorder (APD). The current use of test batteries, while necessary and well accepted, is at risk of failing as the size of these batteries increases. To counter the statistical, fatigue, and clinical efficiency problems of large test batteries, we propose a hierarchical approach to APD assessment. This begins with an overall test of listening difficulty in which performance is measurably affected for anyone with an impaired ability to understand speech in difficult listening conditions. It proceeds with a master test battery containing a small number of single tests, each of which assesses a different group of skills necessary for understanding speech in difficult listening conditions. It ends with a detailed test battery, where the individual tests administered from this battery are only those that differentiate the skills assessed by the failed test(s) from the master test battery, so that the specific form of APD can be diagnosed. An example of how hierarchical interpretation of test results could be performed is illustrated using the Listening in Spatialized Noise-Sentences test (LiSN-S). Although consideration of what abilities fall within the realm of auditory processing should remain an important issue for research, we argue that patients will be best served by focusing on whether they have difficulty understanding speech, identifying the specific characteristics of this difficulty, and specifically remediating and/or managing those characteristics.