Many audiologists believe that we cannot and should not evaluate children for auditory processing disorders (APD) below 7 years of age. However, they usually do not present evidence to support this statement. Often, they state that this is what our professional associations say, but they do not cite from where they have read such statements. This article discusses what evidence exists to refute the argument that you must wait until age 7 to test children for APD. Citations from our professional associations, as well as from other publications, show that there is no evidence to support that children younger than age 7 cannot be evaluated for APD.

Opinion | April 2018 Hearing Review

By Jay R. Lucker, EdD

Parents and others are often told by audiologists that their child below age 7 cannot be evaluated for APD. In general, clinicians state that one must wait until the child is at least 7 years old before such testing can be completed. Even if there are concerns identified for the child related to possible auditory processing problems, many audiologists will contend that a younger child cannot be evaluated. However, professionals making such statements do not provide evidence-based references that support waiting until a specific age to test a child for APD. Often these professionals merely say this age limit has been established by our professional organizations.1-4

This brings up the question whether such evidence limiting the age for testing actually exists. Publications posing the idea of an age limit have been around for years. For example, a Q&A published in 2002 advises that audiologists can screen for possible APD in children below age 7; however, one might “strongly caution parents about being careful not to ‘overinterpret’ the results…If the score fell outside normal range for the child’s age, I would be hesitant to diagnose an auditory processing disorder.”5 

Yet, evidence from research may no longer support this approach. In more recent years, several publications have discussed the age limits surrounding APD testing.6-10 In fact, I have contended that there is no evidence for limiting the age to 7 years or older. A review of the AAA Guidelines,1 ASHA Technical Report,2 and EAA Position Statement4 reveals these professional organizations do indicate concern for all age levels if the person demonstrates inability to complete the auditory processing testing, but no age limit for evaluating APD has been established. 

For example, the ASHA Technical Report (2005)2 states that “…exceptions to the general care may occur following careful examination of the task’s requirements and the child’s capabilities and when using tests designed for use with young populations.” Thus, it implies we can test young children of any age so long as the children can handle the task and perform appropriately. So long as appropriate care is taken by the audiologist, children below age 7 can and should be evaluated for auditory processing problems.

Bellis11 states that caution must be taken in testing, but never says you cannot test children younger than 7 years old.  In an online publication, Bellis writes, “Most of the tests of 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.” Yet, when reading the AAA Guidelines (2010),1 they report a variety of tests with age norms below age 7, stating that these tests—including the Pediatric Speech Intelligibility Test,12 the SCAN-3:C,13 and the SSW test,14 among others15—can be used when evaluating auditory processing in young children. The Guidelines1 also state that checklists and other measures can be used to identify possible problems with auditory processing in young children.  

In addition to these measures of auditory processing that contain norms for children below age 7, there are other tests with young age norms, including Word Recognition in Quiet and Noise,16 Pitch Pattern Sequence Test,17 the Auditory Skills Assessment test,18,19 and others.  There are many measures that can be used with young children below 7 years of age.

The author believes the evidence supports that there should be no age limit for testing children for APD. There are tests which have norms for younger children, and many younger children can perform the tasks required for most, if not all, tests for auditory processing better than children above age 7. Therefore, if an audiologist asks if we can test a child of 5 or 6 years of age, the answer should be, “Yes, and outcomes can help provide appropriate interventions for the child,” rather than saying, “Sorry, you have to wait until the child is 7 years old.”

Correspondence can be addressed to HR or Dr Lucker at: [email protected]

Original citation for this article: Lucker JR. Evidence supports testing children younger than age 7 for Auditory Processing Disorders. Hearing Review. 2018;25(4):42.

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References 

  1. Frank E. Musiek, Jane A. Baran, Teri James Bellis, et al. American Academy of Audiology. Clinical Practice Guidelines for the Diagnosis, Treatment, and Management of Children and Adults with Central Auditory Processing Disorder (CAPD). http://audiology-web.s3.amazonaws.com/migrated/CAPD%20Guidelines%208-2010.pdf_539952af956c79.73897613.pdf. Published August, 2010.

  2. Teri James Bellis, Gail D. Chermak, Jeanane M. Ferre, et al. American Speech-Language-Hearing Association (ASHA). (Central) Auditory Processing Disorders [Technical Report]. www.asha.org/policy/tr2005-00043.htm. Published 2005.

  3. Teri James Bellis, Gail D. Chermak, Jeanane M. Ferre, et al. American Speech-Language-Hearing Association (ASHA). (Central) Auditory Processing Disorders—The Role of the Audiologist [Position Statement]. www.asha.org/policy/ps2005-00114.htm. Published 2005.

  4. Educational Audiology Association. Auditory processing assessment [Position Statement]. http://www.edaud.org/advocacy/16-advocacy-10-15.pdf. Published October, 2015.

  5. Beck B. CAPD/APD age restrictions. January 14, 2002. Available at: https://www.audiologyonline.com/ask-the-experts/capd-apd-age-restrictions-716

  6. Katz J. At what age?: Moral and ethical questions. SSW Reports. 2005;27(3):13-15.

  7. Lucker JR. At what age depends on your approach. SSW Reports. 2005;27(4):19-20.

  8. Lucker JR. Auditory processing abilities in children: When to test? Audiology Today. 2015;27(1):24-31.

  9. Lucker JR. How young is too young to evaluate children for auditory processing disorders? Canadian Audiologist. 2015;2(5). Available at: http://canadianaudiologist.ca/how-young-is-too-young-to-evaluate-children-for-auditory-processing-disorders

  10. Lucker JR, Katz J, Alexander, AL, et al. Testing young children for APD. ASHA Leader. 2017;22:4.

  11. Shapiro Z. Don’t wait to diagnose auditory processing disorder. ASHA Leader. 2016;21(12):34-35.

  12. Bellis TJ. Understanding auditory processing disorders in children. Available at: http://www.asha.org/public/hearing/Understanding-Auditory-Processing-Disorders-in-Children

  13. Jerger J and Jerger S.  Pediatric Speech Intelligibility Test. St Louis: Auditec;1984.

  14. Keith RW. SCAN-3:C Tests for Auditory Processing Disorders for Children. London, England: Pearson;2009.

  15. Katz J.  The Staggered Spondaic Word (SSW) Test. Vancouver, WA: Precision Acoustics;1962.

  16. Tillery KL. Five year olds–CAP test battery. SSW Reports. 2005;27(3):15-16.

  17. Bodkin K, Madell J, Rosenfeld R.  Word recognition in quiet and noise for normally developing children. Poster presented at: The Annual Convention of the American Academy of Audiology; 1999; Miami, Fl.

  18. Smart JL, Purdy SC, Leman KR. Evaluation of (central) auditory processing and phonological/phonemic awareness in 6-year-old children: A pilot study to determine test efficiency and inter-subject reliability. J Ed Audiol. 2012;18:14-23.

  19. Geffner D. Auditory Skills Assessment. SSW Reports. 2011;32(3):3-6.

  20. Geffner D, Goldman R. Auditory Skills Assessment( ASA). London, England:Pearson;2010.