Confounding Variables in the Evaluation of Auditory Processing

Confounding Variables in the Evaluation of Auditory Processing

Alternative Auditory Processing TestingIn the first installment of this series, we discussed Lucker’s Multi-System Integrative Model of Auditory Processing, detailing the six main systems involved in auditory processing, cognitive, executive functioning, auditory, language, behavioral and emotional, and sensory systems.

The most critical part of the evaluation of auditory processing and, thus, APD, is to control for confounding variables. Confounding variables are things that are hidden which actually cause the child to have problems. For example, too often speech-language pathologists and psychologists use language and cognitive based measures and diagnose the child as having an APD because the child failed one of these measures.

Consider the Following:
A speech-language pathologist or psychologist administers a test asking a child questions about stories read to the child. The questions are usually categorized as “WH” questions such as “Who is the story about?” and “Where did the person go?” Yet, think about what is involved in answering such “WH” questions. Refer to the six main systems mentioned in the first article – Auditory Processing – A Multi-System Approach.

You have to know linguistically that “Who” stands for the person or subject of the story. You have to have good language skills to know the rules for “subject of the story” to differentiate that subject from any other person in the story. You have to have good cognitive thinking skills to understand the question and remember (good cognitive memory) what was said by the evaluator when he or she read the story to you.

What Happens when you Fail the Test?
If the evaluator believes that it is a test of auditory processing, you are given the diagnosis of APD. However, could the problem be your memory abilities (a cognitive process) or your inability to think about the question (also a cognitive processing) or your lack of understanding of the linguistic rules for “subject” of the story (a language deficit), or, could the problem be that you have problems remembering all the information presented in the story so that your emotional system reacts negatively and shuts down so you did not actually get to hear and process the verbal information spoken by the evaluator?

Control for Confounding Variables
If the measures of auditory processing do not control for such confounding variables, a misdiagnosis can be made and you might be told to do auditory based training when the problem is really a cognitive, memory, language, or emotionally based problem.

Examples of the types of tests that do not control for confounding variables that many professionals use and call tests of auditory processing include the Test of Auditory Processing Skills – Third Edition or TAPS-3, the Auditory Processing Abilities Test or APAT, and similar measures.

Some psychologists may use the Woodcock-Johnson Tests of Cognitive Skills which has a section called “Auditory Processing” in which there are two sub-tests. One is a measure of blending speech sounds (phonemes) into words (a measure of one small area of auditory processing) and the other is a measure of auditory attention which is even called “Auditory Attention.”

Auditory attention involves the executive functioning system, the auditory system which hears the message, the emotional system (reacting to the distractions used during the attention test), and the cognitive system that makes the decision to respond to the target item. Yet, if a child failed the auditory attention sub-test and passed the word blending part, it is possible that the child would be found to have an auditory processing deficit by the psychologist even though the one measure of one factor of auditory processing (phonological blending) was normal.

The next installment in this series will begin to examine Different Categories or Types of APD and Treatment Recommendations for Each Type based upon Lucker’s Multi-System Integrative Model of Auditory Processing.


Lucker, J.R. (2008). What are auditory processing disorders? In, H. Edell, J.R. Lucker, & L.
Alderman. Don’t You Get It? Living With Auditory Learning Disabilities. Wood Dale,
IL.: Stoelting Co.

Lucker, J.R. (2013). Auditory hypersensitivity in children with autism spectrum disorder. Focus
On Autism and Other Developmental Disabilities, 20 (10), 1-8.

Lucker, J.R., Doman, A. (2012). Auditory hypersensitivity in children. Autism Science Digest, 4.