Understanding the Differences Between Auditory Processing,  
                         Speech and Language Disorders, and Reading Disorders  
                                                     October 2014 
                                                            
               INTRODUCTION                                     revealed. Although not all students diagnosed 
               This document has been prepared to provide       with a communication disorder will develop 
               an overview of the differences among             a reading disorder, some may require 
               auditory processing disorders,                   accommodations to enable them to benefit 
               communication disorders, and reading             from their education.  
               disorders to clarify the need for                 
               accommodations for students with                 RECOMMENDATIONS 
               communication and processing disorders.          Based on the results of the GAO study, the 
               The document is organized by definition of       impact on student performance for those 
               the disorder, treatment options, and             students denied accommodations, and the 
               accommodations, followed by results of a         differentiation between the needs of students 
               study that differentiates between reading and    with communication disorders and those with 
               language disorders.                              reading disorders, ASHA recommends that 
                                                                decisions about the need for accommodations 
               A 2011 Government Accountability Office          be made by reviewing the student’s history, 
               (GAO) study recommended that the                 the accommodations that have been provided 
               Department of Justice develop a systematic       to the student throughout his or her school 
               approach to ensuring that all eligible students  years, and the recommendations of the 
               receive accommodations.   GAO further            student’s educational team. As noted above, 
               recommended that the decision to allow for       no single criterion should be used to 
               accommodations be based on the individual’s      determine eligibility for testing 
               history and the recommendations of teachers      accommodations, and rules for 
               and service providers and not on a single        accommodations should be applied 
               measure of performance.                          consistently across disability categories.  
                                                                 
               This document includes study highlights, a       DEFINITIONS 
               link to the full study, and specific examples     
               of the impact that lack of accommodations        Auditory Processing Disorder 
               has on individual student performance.           Auditory processing disorders (ADP) are 
                                                                deficits in the information processing of 
               STUDENT ELIGIBILITY FOR SPECIAL                  audible signals not attributed to impaired 
               EDUCATION                                        peripheral hearing sensitivity or intellectual 
               Students are sometimes determined to be          impairment. This information processing 
               eligible for services based solely on their      involves perceptual, cognitive, and linguistic 
               communication disorders. Once identified as      functions that, with appropriate interaction, 
               eligible, these students have access to all      result in effective receptive communication 
               necessary services and supports. Because         of auditorily presented stimuli. Specifically, 
               they receive such supports and services,         APD refers to limitations in the ongoing 
               additional testing may not be performed and      transmission, analysis, organization, 
               a subsequent reading disorder may not be         transformation, elaboration, storage, retrieval, 
                                                                and use of information contained in audible 
                                                            
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                signals. APD may involve the listener's active      pushing a button, or in some other way. 
                and passive (e.g., conscious and unconscious,       Other tests that measure the auditory system's 
                mediated and unmediated, controlled and             physiologic responses to sound may also be 
                automatic) ability to do the following: attend,     administered. Most of the tests for APD 
                discriminate, and identify acoustic signals;        require that a child be at least 7 or 8 years of 
                transform and continuously transmit                 age, because the variability in brain function 
                information through both the peripheral and         is so marked in younger children that test 
                central nervous systems; filter, sort, and          interpretation may not be possible.  
                combine information at appropriate                   
                perceptual and conceptual levels; store and          Key Points:  
                retrieve information efficiently; restore,              APD is an auditory disorder that is not 
                organize, and use retrieved information;                 the result of higher-order, more global 
                segment and decode acoustic stimuli using                deficit, such as autism, mental 
                phonological, semantic, syntactic, and                   retardation, attention deficits, or similar 
                pragmatic knowledge; and attach meaning to               impairments.  
                a stream of acoustic signals through use of             Not all learning, language, and 
                linguistic and nonlinguistic contexts.                   communication deficits are due to 
                                                                         APD. 
                Children with APD may exhibit a variety of              No matter how many symptoms of 
                listening and related complaints. They may               APD a child has, only careful and 
                have difficulty understanding speech in noisy            accurate diagnosis can determine if 
                environments, following directions, and                  APD is, indeed, present.  
                discriminating (or telling the difference               Although a multidisciplinary team 
                between) similar-sounding speech sounds.                 approach is important in fully 
                Sometimes they may behave as if a hearing                understanding the cluster of problems 
                loss is present, often asking for repetition or          associated with APD, the diagnosis of 
                clarification. In school, children with APD              APD can only be made by an 
                may have difficulty with spelling, reading,              audiologist.  
                and understanding information presented 
                verbally in the classroom. Often their                  Treatment of APD is highly 
                performance in classes that don't rely heavily           individualized. There is no one 
                on listening is much better, and they typically          treatment approach that is appropriate 
                are able to complete a task independently                for all children with APD.  
                once they know what is expected of them.                                     
                APD may co-exist with attention deficit              
                hyperactivity disorder (ADHD) or other               
                disorders.                                          Treatment 
                                                                    Treatment of APD generally focuses on three 
                A multidisciplinary team approach is critical       primary areas: changing the learning or 
                to fully assess and understand the cluster of       communication environment, recruiting 
                problems exhibited by children with APD,            higher-order skills to help compensate for the 
                but the actual diagnosis of APD is made by          disorder, and remediation of the auditory 
                an audiologist, who administers a series of         deficit itself. The primary purpose of 
                tests in a sound-treated room. These tests          environmental modifications is to improve 
                require listeners to attend to a variety of         access to auditorily presented information. 
                signals and to respond to them via repetition,      Suggestions may include use of electronic 
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                 devices that assist listening, teacher-oriented        SPEECH AND LANGUAGE/ 
                 suggestions to improve delivery of                     COMMUNICATION DISORDERS  
                 information, and other methods of altering              
                 the learning environment so that the child             Definitions 
                 with APD can focus his or her attention on             Receptive/Expressive Language Disorder 
                 the message.  
                                                                        A communication disorder is an impairment 
                 Accommodations                                         in the ability to receive, send, process, and 
                 Environmental modifications include both               comprehend concepts or verbal, nonverbal, 
                 bottom-up (e.g., enhancement of the signal             and graphic symbol systems. A 
                 and listening environment) and top-down                communication disorder may be evident in 
                 (e.g., classroom, instructional, workplace,            the processes of hearing, language, and/or 
                 recreational, and home accommodations)                 speech. A communication disorder may 
                 management approaches designed to improve              range in severity from mild to profound. It 
                 access to information presented in the                 may be developmental or acquired. 
                 classroom, at work, or in other                        Individuals may demonstrate one or any 
                 communicative settings. Environmental                  combination of communication disorders. A 
                 accommodations to enhance the listening                communication disorder may result in a 
                 environment may include but are not limited            primary disability, or it may be secondary to 
                 to preferential seating for the individual with        other disabilities.  
                 APD to improve access to the acoustic (and                    A speech disorder is an impairment 
                 the visual) signal; use of visual aids;                        of the articulation of speech sounds, 
                 reduction of competing signals and                             fluency, and/or voice.  
                 reverberation time; use of assistive listening                An articulation disorder is the 
                 systems; and advising speakers to speak more                   atypical production of speech sounds, 
                 slowly, pause more often, and emphasize key                    characterized by substitutions, 
                 words. Specific suggestions may include                        omissions, additions, or distortions 
                 support for focused listening (e.g., use of                    that may interfere with intelligibility.  
                 note takers, preview questions, organizers),                  A fluency disorder is an interruption 
                 redundancy (e.g., multisensory instruction,                    in the flow of speaking characterized 
                 computer mediation), and use of written                        by atypical rate, rhythm, and 
                 output (e.g., e-mail, mind maps)                               repetitions in sounds, syllables, 
                 There is no one treatment approach that is                     words, and phrases. This may be 
                 appropriate for all children with APD. The                     accompanied by excessive tension, 
                 type, frequency, and intensity of therapy, like                struggle behavior, and secondary 
                 all aspects of APD intervention, should be                     mannerisms.  
                 highly individualized and programmed for                      A voice disorder is characterized by 
                 the specific type of auditory disorder that is                 the abnormal production and/or 
                 present.                                                       absences of vocal quality, pitch, 
                                                                                loudness, resonance, and/or duration, 
                 For more information see:                                      which is inappropriate for an 
                 www.asha.org/public/hearing/Understanding-                     individual's age and/or sex.  
                 Auditory-Processing-Disorders-in-Children/;                   A language disorder is impaired 
                 and www.asha.org/policy/TR2005-                                comprehension and/or use of spoken, 
                 00043.htm#sec1.6.                                              written, and/or other symbol systems. 
                                                                                The disorder may involve (1) the 
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                      form of language (phonology,              phonological/language-based intervention. 
                      morphology, syntax), (2) the content      Most treatment approaches focus on three 
                      of language (semantics), and/or (3)       phases: establishing target behaviors, 
                      the function of language in               generalization or carryover of sound 
                      communication (pragmatics) in any         production, and maintenance that involves 
                      combination.                              stabilization of target behaviors and self-
                                                                correction of errors. Further information on 
                  Form of Language                              treatment for sound production disorders can 
                     Phonology is the sound system of a        be found on ASHA’s Practice Portal at 
                      language and the rules that govern the    www.asha.org/PRPSpecificTopic.aspx?folder
                      sound combinations.                       id=8589935321§ion=Treatment.  
                     Morphology is the system that              
                      governs the structure of words and the    Language Disorders 
                      construction of word forms.               The objective of language treatment is to 
                     Syntax is the system governing the        increase the frequency and quality of 
                      order and combination of words to         language to age-appropriate levels. Speech-
                      form sentences and the relationships      language pathologists play a critical and 
                      among the elements within a               direct role in helping children with language 
                      sentence.                                 disorders learn to speak, listen, read and 
                                                                write. 
                  Content of Language                            
                     Semantics is the system that governs      Treatment for young children may involve 
                      the meanings of words and sentences.      improving intelligibility, increasing 
                                                                phonological awareness, increasing 
                  Function of Language                          vocabulary and social communication skills, 
                     Pragmatics is the system that             and building emergent literacy skills.  
                      combines the above language                
                      components in functional and socially     The focus of language intervention for 
                      appropriate communication.                elementary school children with language 
                                                                difficulties is to help the child acquire the 
                  Communication Variations                      language skills needed to learn and succeed 
                     Communication difference/dialect is a     in a classroom environment. Interventions are 
                      variation of a symbol system used by      curriculum based, so that goals address 
                      a group of individuals that reflects      language needs within the context of the 
                      and is determined by shared regional,     curriculum.  
                      social, or cultural/ethnic factors. A      
                      regional, social, or cultural/ethnic      Interventions may also address literacy skills 
                      variation of a symbol system should       (e.g., improving decoding, reading 
                      not be considered a disorder of speech    comprehension, and narrative and expository 
                      or language.                              writing), as well as metacognitive and 
                                                                metalinguistic skills (e.g., increasing 
               Treatment                                        awareness of rules and principles for use of 
               Speech Sound Disorders                           various language forms, improving the ability 
               Treatment for speech sound disorders may         to self-monitor and self-regulate) that are 
               focus on articulation production or              critical for the development of higher-level 
                                                                language skills.  
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