Controversy is a good thing. I take that back – controversy with an open mind is a GREAT thing. It spawns evaluation of current information, a motivation for additional research, and a sharing of ideas. It forces us to evaluate our beliefs and come to understand new information. With this new information, we either solidify what we already believe or broaden our perspectives to new possibilities.
When I was in graduate school (2011-2013), there were 3 major areas of controversy in our field that we discussed in our classes. Apraxia of speech (I had 1 professor who believed apraxia of speech was a bunk diagnosis), Non-speech oral motor exercises as a treatment for speech disorders, and auditory processing disorder and treatment. Today, I’m going to focus on the latter – the controversy surrounding (C) APD.
(C) APD stands for (Central) Auditory Processing disorder and broadly refers to the central nervous system’s ability to process auditory information.(C) APD can only be diagnosed by an audiologist. Audiologists measure performance on a variety of tasks (including sound localization and lateralization; auditory discrimination; auditory performance with degraded acoustic signals, among others. See ASHA’s technical report for a full list of APD diagnostic tasks). A person is diagnosed with (C) APD if they perform less effectively or efficiently than a typically functioning person on these tasks. A child is often referred for evaluation with symptoms such as difficulty following directions, difficulty answering questions, difficulty understanding information presented out loud, etc. Here is the first part of the controversy – these symptoms could be indicative of a wide variety of difficulties, including learning disabilities, language disorders, ADHD, behavioral and/or social/emotional issues, and more. Differential diagnosis is further complicated by the fact that (C) APD can co-exist with one or more of the previously mentioned disorders. With so much overlap, some people argue (C) APD is not a unique diagnosis, but rather a set of symptoms that result from other causes.
There are many experts in the fields of speech-language pathology and audiology who feel strongly about this topic, and there are basically two schools of thought:
- (C) APD is a legitimate disorder
- (C) APD is not a valid disorder; any presenting difficulties are actually caused by something else
I’m not writing this post to take a stance on whether or not (C) APD exists. I’m writing this post with an open-mind, hoping to fuel discussion and learning, and I’m much more interested in effectively improving communication skills. More on that later. While I do believe accurate diagnosis is important, I also know that SLP’s are trained to be critical thinkers. We learn how to treat the symptoms of a disorder to facilitate the most functional outcomes.Whether or not someone has a diagnosis from a doctor, audiologist, or other professional, SLP’s should always do their own testing, observation, and analysis and create a treatment plan based on their own expertise. That is not to say that multi-disciplinary collaboration is not an important piece of the puzzle. If a student comes to me with a diagnosis from another professional, it is important to read their evaluations and recommendations and discuss their findings with them, but ultimately, it is best practice to use my own expertise in creating a treatment plan. While I may not choose to take a stance on the legitimacy of (C) APD as a diagnosis today, I do feel strongly about treatment choices.
There are many, many treatment options available for struggling learners. There are many products that claim to be a magical cure. There are many products and treatment choices available that are extremely costly and not extremely effective. In general, I believe if it sounds too good to be true, it probably is. I’m not discrediting the anecdotes from parents and professionals who claim a particular approach resulted in huge improvements. That is fantastic for that particular person. I think they should keep doing what they are doing, and if they want to recommend it to their family and friends, I have no problem with that. But, I do have a problem with companies taking anecdotes and making broad claims, preying on the vulnerability of parents who are willing to try anything to help their child. SLP’s with backgrounds in research design know that doing something is better than doing nothing, and doing something intensively will probably result in improvements, even if the actual treatment itself is no better than the other available options. Any seeming improvements may be simply because of the intensity of the treatment compared to no treatment at all. We have the background and education to evaluate the research, or lack of research, and make a educated appraisal before choosing a treatment option. Companies out to make profits can make claims about their products making them seem better than they actually are. I’m not saying some of the popular treatments are not worth trying. I’m just advocating that parents and professionals do their research and carefully consider their options before investing lots of time and money in “miracle-cures” that have poor research support.
And for the elephant in the room, what magical treatments am I talking about? In keeping with my own advice, I suggest you consult the research to determine whether or not some of these programs and approaches are effective for treating (C) APD and/or language impairment and/or learning disabilities. I’ve provided links from the Macquarie University Special Education Centre (MUSEC) Briefings and their appraisal of the treatment.
- Interactive Metronome© training – Not recommended
- Fast ForWord® Language – Not recommended
- Additionally, an article in Journal of Speech Language and Hearing Research has similar findings. The article is called “Effects of Computer-Based Intervention Through Acoustically Modified Speech (Fast ForWord) in Severe Mixed Receptive—Expressive Language Impairment: Outcomes From a Randomized Controlled Trial” by Wendy Cohen, Ann Hodson, Anne O’Hare, James Boyle, Tariq Durrani, Elspeth McCartney, Mike Mattey, Lionel Naftalin, and Jocelynne Watson.
- Strategic Use of Classroom Seating – Recommended
- The Listening Program – Not recommended
- Explicit Instruction for Students with Special Learning Needs – Recommended
- BrainGym – Not Proven
- Mnemonics – Recommended
I’d love to see briefings on some of the other treatment centers and techniques that have become popular – like Brain Balance and Brain Highways.
For more reading on the controversy surrounding (C) APD, check out these bloggers:
- The Speech Guy: I’LL HAVE A SAUSAGE AND PEOPLE PIZZA: THE CONTROVERSY OVER AUDITORY PROCESSING DISORDER
- Smart Speech Therapy LLC: Why (C) APD Diagnosis is NOT Valid!
Thanks for reading!