Auditory Processing

What is auditory processing?

According to ASHA, it is the efficiency and effectiveness of the central nervous system’s ability to use auditory information

What is central auditory processing disorder?

Limitations in the transmission, analysis, organization, transforming, elaboration, storage, retrieval, and use of auditory information

The Central Auditory System affects these processes:

Sound localization

Sound lateralization

Auditory discrimination

Auditory pattern recognition

Temporal aspects of audition

Auditory performance with competing acoustic signals

Auditory performance with degraded acoustic signals

*Task Force on CAP Consensus Development, ASHA 1996

What is the connection between APD and language?

Research suggests that people diagnosed with CAPD likely have deficits in other sensory processing modalities. This includes the cognitive and language mechanisms. 

*DeBonis, 2015; Medwetsky, 2011

What is language processing?

The ability to attach meaning to and use auditory information by perceiving, recognizing, understanding, and remembering sounds, words, and sentences

*Chris Dollaghan

Auditory processing and language processing work with one another but also independent of each other

*Kathy Fahey

Bottom-up Processing

Information is taken in and analyzed through the reception and processing of sensory information.


Top-down processing

Higher-order thinking is emphasized over perceptual analysis, with experiences and higher-order analysis makes predictions about sensory information.

Interactive processing models

Information is processed by sensory information and higher-order thinking in a parallel form, alongside active participation from the individual and clarity of linguistic and non-linguistic information. 

*Kathy Fahey


Notes on diagnosis

CAPD can only be diagnosed by an audiologist.

10% of children may have APD (Wilton, 2010), but the prevalence of APD in the absence of other disorders is likely lower (Sharma, et al, 2009)

CAPD tends to exist alongside dyslexia, attention deficits, reading deficits, and language deficits (Dawes & Bishop, 2009; Kelly et al, 2009; Ferguson et al, 2011; Wallach, 2011)

For the SLP, Geffner and Goldman’s Auditory Skills Assessment can be useful to screen possible deficits but not to diagnose.


From the available research:

Intervention should include activities of both top-down and bottom-up processing types. (DeBonis, 2015)

Auditory-only interventions may provide some benefit for for auditory function and phonemic awareness but not language skills or academic incomes. (Fey, et al, 2011)

SLPs should treat children diagnosed with CAPD as a child with a language or learning disability. (Kamhi, 2011)

Skills for intervention:

Auditory Figure Ground

Auditory Memory

Phonological Awareness



Figurative Language

Receptive Vocabulary

Binaural Integration

Auditory Figure Ground

Continuum of background noises

– White noise

– Non-lyrical music

– Lyrical music

– Verbal message

Continuum of tasks

– Minimal pairs

– Minimal pairs in phrases or sentences

– Recall words or phonemes

– Following directions 

Auditory Memory

Continuum of tasks

– Series of unrelated words

– Digits

– Functional word lists

– Phoneme series

– Story content

– Subordinated clauses or conditional commands

– Sentences with 3 attributes

– Story with 3-5 key components


– Chunking

– Visualization

– Repetition

– Key words

– Localization



Phonological Awareness

Continuum of tasks

– Syllable segmentation

– Phoneme segmentation 

– Phoneme isolation

– Phoneme deletion

– Phoneme manipulation

– Grapheme knowledge of diphthongs



Detection, discrimination, and vigilance of temporal aspects of audition.

Continuum of skills

– Discriminate between tones (incremental increases)

– Identify pitch patterns

– Identify pitch patterns with modulated pitch sweeps

– Increase gap detection (silence between sounds)



Continuum of skills

– Comprehend the meaning of emphasized keywords in reading or conversation 

– Comprehend inflectional cues in reading or conversation (questions, sarcasm, etc…)

– Identify gaps and its meaning when reading

– Use grammatical markers based on gap detection, word emphasis, inflectional cues (periods, exclamation points, question marks) when being read aloud to

– Use appropriate silence and pitch when reading aloud, based on grammatical markers

– Identify and use pitch cues and silence appropriately in conversation 

Figurative Language

Continuum of skills

– Match figurative language phrases to similar meanings

– Use figurative language phrases by completing sentences and paragraphs

Receptive Vocabulary

Continuum of skills

– Identify categories

– Identify the word that doesn’t belong

– Identify synonyms

– Identify target word given descriptive cues

– Describe a word for listener guessing using descriptive cues

– Use inferencing skills when reading a text

Binaural Integration

Continuum of skills

– Name objects by touch when felt with left hand

– Describe objects by touch when felt with left hand

– Describe simple pictures related to a heard story using 2-3 details



It is important to stay up-to-date and do your own reading on current research and reputable resources


– Options will be based on specific deficits (auditory or language)

– Accommodations in the classroom can be very useful, including reducing background noise, slowing rate of speech, providing visual cues, and using amplification. 

– Training in self-help techniques can help children improve their overall communication. 


Children younger than 8 years old who are suspected of having an APD should be involved in activities that promote auditory skills such as :

– selective listening during book reading (raise your hand each time you hear the word _____)

– games such as duck, duck, goose, simon says, or musical chairs

– interhemispheric exercises

– guessing emotion based on a speaker’s voice


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