The APD Diagnosis Trap: How a Controversial Label Harms Kids in Schools

Despite its clinical ring, “Auditory Processing Disorder” (APD) remains one of the most poorly defined, inconsistently diagnosed, and least useful labels used in school-aged populations. Not only is the diagnosis itself mired in scientific controversy, but its downstream effects in schools often do more harm than good.

Recently, I conducted a professional poll on social media asking: “When a student enters your school with an outside APD diagnosis, what typically happens next?”

With over 260 responses, the overwhelming answer was: confusion and delay.
Here are the most common outcomes reported by clinicians and educators:

• 28%: Services depend on team judgment, not on any clear APD guidance.
• 20%: The student is given an FM system as a “fix.”
• 18%: The diagnosis causes confusion with no clear plan or support.
• Only 1%: Receive direct SLP and special education services for language/literacy issues.
• Many commented that APD diagnoses delay effective language-literacy interventions.

These poll results confirm a troubling reality: APD is a diagnostic detour that wastes precious time and money while offering no path to functional academic support.

Why APD Is a Broken Diagnosis

Here’s what we now know, based on years of research and analysis:

1. There is no gold standard for diagnosing APD.
There is no agreed-upon test battery, diagnostic threshold, or performance criteria. As DeBonis (2015) explains, diagnosis often depends on which clinic you walk into, with rates varying from 7.3% to 96% across settings (Wilson & Arnott, 2013, as cited in DeBonis, 2015).

2. The tests confound language, memory, and cognition.
What’s being measured in most APD tests is not isolated auditory processing but rather language comprehension, working memory, or attention—all of which are far more relevant and treatable in school-based services.

3. There is no evidence-based treatment for APD.
Systematic reviews (Fey et al., 2011) found no compelling evidence that auditory training (e.g., dichotic listening, Fast ForWord®, Earobics) improves auditory skills, language, or academic outcomes. Even FM systems, frequently recommended, lack strong scientific support for children with APD (Lemos et al., 2009).

4. APD labels do not lead to services.
As documented by the poll and years of practice, students with APD diagnoses rarely receive targeted language therapy. Instead, they may be given vague accommodations (“preferential seating”) or told to use devices that don’t address the core problem.

5. The real problem is always language and/or literacy.
Children showing signs of APD, such as difficulty following directions, impaired auditory processing, and trouble in noisy environments, are overwhelmingly found to have oral language weaknesses, phonological weaknesses, or literacy deficits when tested appropriately.

The High Cost of a Diagnosis That Solves Nothing

Families often spend thousands on private APD evaluations, expecting meaningful answers. Instead, they are left with:

• A diagnosis that isn’t recognized under IDEA or even DSM-V.
• No clear plan for intervention.
• Vague suggestions like “reduce background noise.”
• No access to the services their child actually needs.

As one poll respondent put it: “The APD push only delays effective language-literacy intervention that kids actually need to see functional gains.”

This is not an exception. It’s the norm.

What Should Be Done Instead?

When a child presents with “APD-like” concerns:

• Do not refer them for APD testing.
• Instead, conduct a comprehensive language and literacy evaluation using high-quality tools (e.g., TILLS, CAPS, GORT, CELF-5:M, PAT-2:NU, etc.).
• Focus on areas such as phonological awareness, morphological knowledge, orthographic competence, syntax, vocabulary breadth and depth, narrative comprehension, pragmatic knowledge, and use as well as expository reasoning.
• Develop academic therapy goals that actually target deficits and support curriculum success (Kelley & Spencer, 2021).

Language, Literacy, and Cognition Are Intertwined

There are NO standalone auditory processing skills that we can fix in isolation! As many researchers have noted (Kamhi, Vermiglio, & Wallach, 2016; Wallach, 2014; Vermiglio, 2014, 2018), the very concept of APD as a distinct clinical entity lacks both definition and utility.

If it doesn’t guide instruction in speaking, reading, or writing, doesn’t inform intervention, and doesn’t predict positive academic outcomes, then why are we still diagnosing it?

Summary

The bottom line is: APD is not a diagnosis that helps kids in schools. It’s a diagnostic label that obscures the real issue: language and literacy. It misleads teams and delays the evidence-based intervention children urgently need.

We need to stop relying on trendy diagnoses and start providing evidence-based support that addresses students’ actual needs and moves them toward real academic success.

Useful Resources:

1. Deconstructing Auditory Processing Disorder (APD) for Parents and Professionals: Informational Handout
2. The Controversy of the Auditory Processing Disorder Diagnosis
3. Comprehensive Assessment of Elementary-Aged Children with Subtle Language and Literacy Deficits
4. Treatment of Children with “APD”: What SLPs Need to Know

References:

1. Beck, D. L., Clarke, J. L., & Moore, D. R. (2016). Contemporary issues in auditory processing disorders: 2016. The Hearing Review, 23(4), 36–40.
2. DeBonis, D. A. (2015) It Is Time to Rethink Central Auditory Processing Disorder Protocols for School-Aged Children. American Journal of Audiology. v. 24, 124-136.
3. DeBonis, D. A. (2016) Response to the Letter to the Editor From Iliadou, Sirimanna, and Bamiou Regarding DeBonis (2015). American Journal of Audiology, December, V. 25, 371-374.
4. de Wit, E., Visser-Bochane, M.I., Steenbergen, B., van Dijk, P., van der Schans, C.P., & Luinge, M.R. (2016). Characteristics of Auditory Processing Disorders: A Systematic Review. Journal of Speech, Language, and Hearing Research, 59, 384–413.
5. de Wit E, Steenbergen B, Visser-Bochane MI, et al. Response to the Letter to the Editor From Moncrieff (2017) Regarding de Wit et al. (2016), “Characteristics of Auditory Processing Disorders: A Systematic Review”. Journal of Speech, Language, and Hearing Research : Jslhr. 2018 Jun;61(6):1517-1519.
6. Fey, M. E., Richard, G. J., Geffner, D., Kamhi, A. G., Medwetsky, L., Paul, D., Schooling, T. (2011). Auditory processing disorder and auditory/language interventions: An evidence-based systematic review. Language, Speech and Hearing Services in Schools, 42, 246–264.
7. Hazan, V., Messaoud-Galusi, S., Rosen, S., Nouwens, S., Shakespeare, B. (2009). Speech perception abilities of adults with dyslexia: Is there any evidence for a true deficit?. Journal of Speech, Language, and Hearing Research. 52 1510–1529
8. Iliadou, V., Sirimanna, T., & Bamiou, D.-E. (2016). CAPD is classified in ICD-10 as H93.25 and hearing evaluation—not screening—should be implemented in children with verified communication and/or listening deficits. American Journal of Audiology. v. 25, 368-370
9. Kamhi, A, Vermiglio, A, & Wallach, G (2016) Never-Ending Controversies With CAPD: What Thinking SLPs and Audiologists Know. Presented at ASHA Annual Convention, Philadelphia, PA.
10. Kelley, E.S., & Spencer, T.D. (2021). Feasible and Effective Language Intervention Strategies that Accelerate Students’ Academic Achievement. Seminars in Speech and Language, 42, 101 – 116.
11. Norrix, L. W., & Faux, C. (2019). Comment on Yathiraj & Vanaja (2018), “Criteria to Classify Children as Having Auditory Processing Disorders”. American journal of audiology, 28(1), 144-146.
12. Stoody, T & Cottrell, C (2018) “The Effect of Presentation Level on the SCAN-3 in Children and Adults”. American Journal of Audiology. 27 (2): 238–245.
13. Vermiglio, A (2014) Application of a Medical Definition of the Clinical Entity to (C)APD. North Carolina Speech Language and Hearing Association
14. Vermiglio, A. J. (2014). On the clinical entity in audiology: (Central) auditory processing and speech recognition in noise disorders. Journal of American Academy of Audiology, 25, 904–917.
15. Vermiglio, A. J.  (2018).The gold standard and auditory processing disorder. SIG 6 Perspectives of the ASHA Special Interest Groups, 3(6), 6–17.
16. Wallach, Geraldine (2014) Improving Clinical Practice: A School-Age and School-Based Perspective. Language, Speech, and Hearing Services in Schools. Vol. 45, 127-136
17. Watson, C., Kidd, G. (2009). Associations between auditory abilities, reading, and other language skills in children and adults. Cacace, A., McFarland, D. Controversies in central auditory processing disorder.  218–242 San Diego, CA Plural.
18. Wilson, W.  (2018). Evolving the concept of APD. International Journal of Audiology, 57(4), 240–248.