How Is Auditory Processing Disorder Tested? The Battery, and the Disagreement Behind It

Auditory processing disorder is tested by an audiologist, after a standard hearing test has come back normal, using a battery of listening tasks that degrade or compete with speech and sound: dichotic listening, temporal processing measures such as gaps-in-noise, frequency and duration pattern tests, masking level difference, speech-in-noise tests, and sometimes auditory brainstem response. No single test produces the diagnosis, and the criteria for calling the pattern a disorder are not agreed between the professional bodies that publish them.

The visual version of this idea, visual processing disorder, has a narrow and well-studied controversy about whether perceptual training improves reading. The auditory version has a wider one. Here the argument is about whether the disorder is separable from language impairment and attention impairment at all, and it is being conducted in print between national audiology bodies. This page covers what the battery contains, the order the testing has to happen in, who may administer and diagnose it, why the composition of the battery largely determines the answer, and where the disagreement currently sits.

A standard hearing test asks how quiet a tone can get before the listener stops hearing it. Someone referred for auditory processing testing has usually passed that test and still cannot follow speech in a classroom, mishears instructions, asks for repetition constantly, or appears not to be listening. The British Society of Audiology describes the typical presentation as listening difficulties and behaviours consistent with hearing loss despite a normal audiogram.

The construct is described as poor perception of speech and non-speech sounds originating in impaired neural function of the central auditory nervous system. The American Speech-Language-Hearing Association states that the disorder is not due to peripheral hearing loss, whether conductive or sensorineural, and not due to multilingualism. Two points about its formal status are worth having early.

• It is in the ICD but not in DSM-5-TR: central auditory processing disorder has carried the ICD-10-CM code H93.25 since the 2017 revision, which is what lets it be billed and recorded. DSM-5-TR contains no such diagnosis, so a psychiatric or psychological report will not produce one.

• The code does not settle the science: the ASHA practice portal opens its own page by noting "long-standing variation in perspectives within the professions of audiology and speech-language pathology regarding the diagnosis, assessment, and treatment" of the condition. A billing code records that a label is in use.

The sequence is not optional, because almost every finding in the battery can be produced by something upstream of it.

• Peripheral hearing is established first: the British Society of Audiology specifies pure-tone audiometry from 250 to 8000 Hz plus immittance testing including ipsilateral and contralateral reflexes, to identify hearing impairment and middle-ear pathology needing medical attention. A child with intermittent middle-ear fluid can look exactly like a child with a central problem.

• Existing hearing loss contaminates the central tests: the American Academy of Audiology's clinical practice guideline warns that peripheral hearing loss and linguistic background can confound results, and that where some loss is present the clinician should prefer tasks shown to be less affected by cochlear hearing loss. The guideline also notes that an absent pattern of central findings may simply reflect the peripheral loss.

• Age matters more than families expect: most behavioural central auditory tests require a developmental age of seven or eight years, because normative ranges in younger children carry very large standard deviations and produce floor or chance effects. The Academy's guideline advises that below that age, behavioural diagnostic testing "should be undertaken with extreme caution." Younger children get checklists, monitoring and follow-up rather than a diagnosis.

• Case history and a questionnaire come before the booth: the British guidance asks for a structured case history, a well-validated listening questionnaire and previous professional reports first, and asks the referrer to consider whether further testing will add anything to the support already in place.

An audiologist administers and interprets these tests, in a sound-treated room with calibrated equipment. The Academy of Audiology's position is explicit that because auditory processing is an aspect of hearing, audiologists are responsible for diagnosing the disorder. A psychologist does not administer this battery, and a speech-language pathologist's language testing sits alongside it rather than inside it.

• Dichotic listening: different material is presented to each ear at once and the listener reports one or both. Dichotic digits, competing sentences and competing words are the common forms, and the guideline describes dichotic tests as having a long record of sensitivity to central auditory dysfunction. Ear advantage matters as much as the raw score, since a typically developing listener shows a right-ear advantage that shrinks with maturation.

• Monaural low-redundancy speech: speech is degraded by filtering, time compression or background noise, and the listener identifies it. Filtered words and speech-in-noise measures such as the Words-in-Noise test, the Bamford-Kowal-Bench Speech-in-Noise test and the Listening in Spatialized Noise Sentences test belong here. The British guidance recommends these for their functional specificity while noting that every speech perception test recruits language, attention and working memory.

• Temporal processing: gaps-in-noise asks the listener to detect brief silent intervals inside a noise burst, and frequency and duration pattern tests ask for sequences of tones to be reported. The Gaps-in-Noise test was validated against confirmed central auditory nervous system involvement by Frank Musiek and colleagues in 2005.

• Binaural interaction: the masking level difference measures the improvement in detecting a signal in noise when the phase relationship between the ears changes, which indexes brainstem-level binaural processing rather than anything cortical.

• Electrophysiology: auditory brainstem response, middle latency and cortical responses are objective and do not require a behavioural answer. The Academy's guideline cautions that these responses "may be entirely normal in many cases," and the British guidance finds little evidence for including them when audiometry is normal, with one exception: auditory brainstem response combined with otoacoustic emissions or cochlear microphonic is needed to identify auditory neuropathy spectrum disorder.

Screening and skills batteries circulate alongside the clinical one and are frequently confused with it. Our articles on the SCAN-3 and the TAPS-4 cover what each of those contains and what its scores mean.

This is the structural problem with the whole enterprise, and it is not a fringe complaint. It appears in the guidelines themselves.

The published criteria work like this. The Academy of Audiology's guideline reports that experienced clinicians have independently converged on a score two standard deviations or more below the mean, in at least one ear, on at least two different behavioural central auditory tests. ASHA's portal gives the same two-test rule and adds that where only one test is failed, diagnosis may be withheld unless performance is at least three standard deviations below the mean. Both documents are explicit that a single abnormal result is not enough.

Now count the opportunities. A cut-off two standard deviations below the mean flags roughly the lowest two percent of a normal distribution, and each test is scored for each ear separately. Run six or seven tests and the number of chances to produce one abnormal ear-score climbs quickly, which is precisely why the two-test rule exists. The rule constrains the problem without dissolving it, because the clinician chooses how many tests to run and which ones.

Wayne Wilson and Wendy Arnott quantified the consequence. They reviewed files for 150 children aged 7.0 to 15.6 with normal peripheral hearing who had completed an assessment comprising low-pass filtered speech, competing sentences, two-pair dichotic digits, and frequency patterns with linguistic and non-linguistic report. Applying nine different sets of published diagnostic criteria to the same test results, they found rates of potential diagnosis ranging from 7.3 percent under the strictest criteria to 96.0 percent under the most lenient. Their recommendation was that any diagnosis be reported with an explicit statement of the criteria used.

ASHA's own portal notes a related failure mode in the other direction: pervasive deficits across every test in a battery may signal a cognitive deficit or another non-auditory confound rather than an auditory one. A child who fails everything is evidence against the specific diagnosis.

The disagreement is institutional, documented, and unresolved, and a reader deciding whether to pursue testing deserves to see it rather than a consensus that does not exist.

The American Academy of Audiology's 2010 clinical practice guideline treats the condition as a diagnosable entity within audiology's scope and sets out a battery and criteria for identifying it. The British Society of Audiology's 2018 position statement, lead-authored by David Moore and Nicole Campbell, starts from a different place. It states that there "continues to be no universally accepted diagnostic criteria or test batteries," that "most currently used tests of APD are primarily tests of language and auditory attention that lack sensitivity and specificity for deficits of auditory perception," and that while the condition may contribute to learning difficulties, "its status as a distinct learning disability is controversial" and other agreed diagnoses such as language impairment, dyslexia, attention-deficit/hyperactivity disorder and autism "should take diagnostic precedence." It adds that adherence to arbitrary criteria "has unfortunately contributed to much of the current controversy."

The peer-reviewed case for the sceptical position has three strands. Moore and colleagues tested 1,469 randomly chosen British children aged 6 to 11 and reported that presenting symptoms were largely unrelated to auditory sensory processing, with response variability and cognitive scores the best predictors of poor listening. Ellen de Wit and colleagues reviewed 48 studies, rated only one as methodologically strong, and concluded that the listening difficulties may follow from cognitive, language and attention issues rather than from bottom-up auditory processing. David DeBonis reviewed the literature and found support for the propositions that current testing is heavily influenced by memory, attention, language and executive function, that the lack of agreement on performance criteria is concerning, and that the contribution of auditory processing abilities to language and reading as currently measured is not significant. His conclusion was that routine use of the protocols cannot be supported.

There is also a long-running methodological argument about what would even count as evidence. Anthony Cacace and Dennis McFarland have argued since the 1990s that a genuine auditory processing disorder must be shown to be modality specific, meaning the deficit should not appear when the same demand is made of vision, and that batteries which do not test this cannot distinguish an auditory problem from a general one. Padraig Dawes and Dorothy Bishop's review set the diagnosis explicitly against developmental disorders of language, communication and attention and found the boundaries poorly drawn. From Australia, Wayne Wilson has argued for rebuilding the concept rather than defending the current one.

The empirical overlap is easy to demonstrate. Dimitra Stavrinos and colleagues gave attention tests and an auditory battery to 27 children referred for assessment and found divided auditory attention correlated with the dichotic digits test at r = 0.68, and divided auditory-visual attention at r = 0.76. Whatever the dichotic digits test measures, attention is a large part of it.

None of this means the listening difficulty is imaginary. It means the label is doing less explanatory work than its name promises, which is why the British guidance recommends describing the presenting listening problem and the support it needs instead of applying the label where a label is not required for funding. Where language is the likelier account, a language battery is the relevant measurement, and our article on the CELF-5 covers what one of those contains.

An audiologist, using calibrated equipment in a sound-treated room. Speech-language pathologists, psychologists and teachers contribute language, cognitive and classroom information that the interpretation depends on, and none of them administers the central auditory battery.

A full battery usually runs one to two hours, preceded by the audiological evaluation and the case history. Expect a separate appointment for results, because the interpretation depends on the language and attention information arriving as well.

Most behavioural tests need a developmental age of seven or eight years. Below that, norms are too variable to support a diagnosis, and the responsible path is screening, monitoring and a later reassessment.

No. Measures of attention correlate strongly with the dichotic listening tasks used in these batteries, which is a reason to assess attention separately rather than to treat an auditory result as evidence about it.

Not by itself. Federal special education categories are defined by educational need rather than by this label, and eligibility turns on whether the difficulty adversely affects educational performance. The practical gains are usually environmental, such as a remote microphone system and seating.

No. The batteries are listening measures and are not intelligence tests. Scores on them do correlate with cognitive measures, which is an argument for interpreting them alongside a proper cognitive assessment rather than instead of one.

An auditory processing disorder test is a battery, administered by an audiologist after normal peripheral hearing has been confirmed, built from dichotic listening, degraded-speech, temporal-processing, binaural-interaction and sometimes electrophysiological measures, and usable only from a developmental age of about seven. The criteria for converting its results into a diagnosis are published by more than one body and do not agree: applying nine sets of published criteria to the same 150 children produced diagnosis rates between 7.3 percent and 96.0 percent. The American Academy of Audiology's guideline treats the condition as a diagnosable entity audiologists own, while the British Society of Audiology's position statement holds that most current tests are primarily tests of language and auditory attention and that other diagnoses should take precedence. That disagreement is live and this page does not settle it. What follows practically is that a listening difficulty deserves careful description and real accommodations, and a test result deserves to be reported with the criteria that produced it. If you want a cognitive baseline to read alongside an audiological report, you can take a professionally developed IQ test and hand the score to the clinicians doing the interpretation.

1. American Speech-Language-Hearing Association. (2026). Central auditory processing disorder (Practice Portal). asha.org

2. American Academy of Audiology. (2010). Clinical practice guidelines: Diagnosis, treatment and management of children and adults with central auditory processing disorder. audiology.org

3. Moore, D. R., Campbell, N. G., Rosen, S., Bamiou, D.-E., Sirimanna, T., Grant, P., & Wakeham, K. (2018). Position statement and practice guidance: Auditory processing disorder (APD). British Society of Audiology. thebsa.org.uk

4. Moore, D. R., Ferguson, M. A., Edmondson-Jones, A. M., Ratib, S., & Riley, A. (2010). Nature of auditory processing disorder in children. Pediatrics, 126(2), e382-e390. doi.org

5. Wilson, W. J., & Arnott, W. (2013). Using different criteria to diagnose (central) auditory processing disorder: How big a difference does it make? Journal of Speech, Language, and Hearing Research, 56(1), 63-70. doi.org

6. DeBonis, D. A. (2015). It is time to rethink central auditory processing disorder protocols for school-aged children. American Journal of Audiology, 24(2), 124-136. doi.org

7. 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(2), 384-413. doi.org

8. Dawes, P., & Bishop, D. (2009). Auditory processing disorder in relation to developmental disorders of language, communication and attention: A review and critique. International Journal of Language and Communication Disorders, 44(4), 440-465. doi.org

9. Cacace, A. T., & McFarland, D. J. (2005). The importance of modality specificity in diagnosing central auditory processing disorder. American Journal of Audiology, 14(2), 112-123. doi.org

10. Wilson, W. J. (2018). Evolving the concept of APD. International Journal of Audiology, 57(4), 240-248. doi.org

11. Stavrinos, G., Iliadou, V.-M., Edwards, L., Sirimanna, T., & Bamiou, D.-E. (2018). The relationship between types of attention and auditory processing skills: Reconsidering auditory processing disorder diagnosis. Frontiers in Psychology, 9, 34. doi.org

12. Musiek, F. E., Shinn, J. B., Jirsa, R., Bamiou, D.-E., Baran, J. A., & Zaidan, E. (2005). GIN (Gaps-In-Noise) test performance in subjects with confirmed central auditory nervous system involvement. Ear and Hearing, 26(6), 608-618. doi.org

13. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). doi.org

Hero image: a 1960s clinical audiometer, released into the public domain by the photographer. Via Wikimedia Commons.