J Am Acad Audiol 2019; 30(08): 694-702
DOI: 10.3766/jaaa.17063
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Effect of Varying Test Administration and Scoring Procedures on Three Tests of (Central) Auditory Processing Disorder

Maria E. Pomponio
*   Towson University, Towson, MD
†   Weill Cornell Medicine, New York, NY
Stephanie Nagle
*   Towson University, Towson, MD
‡   Connecticut Children’s Medical Center, Hartford, CT
Jennifer L. Smart
*   Towson University, Towson, MD
Shannon Palmer
§   Central Michigan University, Mount Pleasant, MI
› Author Affiliations
Further Information

Publication History

25 April 2018

02 May 2018

Publication Date:
25 May 2020 (online)



There is currently no widely accepted objective method used to identify (central) auditory processing disorder ([C]APD). Audiologists often rely on behavioral test methods to diagnose (C)APD, which can be highly subjective. This is problematic in light of relevant literature that has reported a lack of adequate graduate-level preparation related to (C)APD. This is further complicated when exacerbated by the use of inconsistent test procedures from those used to standardize tests of (C)APD, resulting in higher test variability. The consequences of modifying test administration and scoring methods for tests of (C)APD are not currently documented in the literature.


This study aims to examine the effect of varying test administration and scoring procedures from those used to standardize tests of (C)APD on test outcome.

Research Design:

This study used a repeated-measures design in which all participants were evaluated in all test conditions. The effects of varying the number of test items administered and the use of repetitions of missed test items on the test outcome score were assessed for the frequency patterns test (FPT), competing sentences test (CST), and the low-pass filtered speech test (LPFST). For the CST only, two scoring methods were used (a strict and a lax criterion) to determine whether or not scoring method affected test outcome.

Study Sample:

Thirty-three native English-speaking adults served as participants. All participants had normal hearing (as defined by thresholds of 25-dB HL or better) at all octave band frequencies from 500 to 4000 Hz, with thresholds of 55-dB HL or better at 8000 Hz. All participants had normal cognitive function as assessed by the Mini-Mental State Examination.

Data Collection and Analysis:

Paired samples t-tests were used to evaluate the differences in test outcome when varying the CST scoring method. A 3 × 2 × 2 repeated-measures factorial analysis of variance (ANOVA) was used to determine the effects of test, length, and repetitions on outcome score for all three tests of auditory processing ability. Individual 2 × 2 repeated-measures two-way ANOVAs were subsequently conducted for each test to further evaluate interactions.


There was no effect of scoring method on the CST outcome. There was a significant main effect of repetition use for the FPT and LPFST, in that test scores were greater when corrected for repetitions. An interaction between test length and repetitions was found for the LPFST only, such that there was a greater effect of repetition use when a shorter test was administered compared with a longer test.


Test outcome may be affected when test administration procedures are varied from those used to standardize the test, lending itself to the broader possibility that the overall diagnosis of (C)APD may be subsequently affected.

Portions of this paper were presented as a poster session at the 2015 American Academy of Audiology AudiologyNOW! Conference in San Antonio, TX; the 2016 American Auditory Society Conference in Scottsdale, AZ; and the 2016 American Speech-Language-Hearing Association Convention in Philadelphia, PA.


  • American Academy of Audiology (AAA). 2010 Clinical Practice Guidelines: Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder. http://www.audiology.org/resources/ . Accessed June 12, 2012
  • American Speech-Language-Hearing Association (ASHA). 2005 (Central) auditory processing disorders [Technical Report]. www.asha.org/policy . Accessed June 12, 2012
  • Atcherson SR, Nagaraj NK, Kennett SEW, Levisee M. 2015; Overview of central auditory processing deficits in older adults. Semin Hear 36 (03) 150-161
  • Bellis TJ. 2003. Assessment and Management of Central Auditory Processing Disorders in the Educational Setting: From Science to Practice. 2nd ed. Clifton Park, NY: Delmar Cengage Learning;
  • Bellis TJ. 2006. Audiologic behavioral assessment of (C)APD. In: Parthasarathy TK. An Introduction to Auditory Processing Disorders in Children. New York, NY: Lawrence Erlbaum Associates; 63-80
  • British Society of Audiology (BSA) 2011 Position Statement on APD. http://www.thebsa.org.uk/ . Accessed May 17, 2017
  • Cacace AT, McFarland DJ. 2013; Factors influencing tests of auditory processing: a perspective on current issues and relevant concerns. J Am Acad Audiol 24 (07) 572-589
  • Chermak GD, Silva ME, Nye J, Hasbrouck J, Musiek FE. 2007; An update on professional education and clinical practices in central auditory processing. J Am Acad Audiol 18: 428-452
  • Chermak GD, Traynham WA, Seikel JA, Musiek FE. 1998; Professional education and assessment practices in central auditory processing. J Am Acad Audiol 9: 452-465
  • Chermak GD. 2016 20Q: (C)APD—Fundamentals. AudiologyOnline. Article #17765. http://www.audiologyonline.com/ . Accessed May 17, 2017
  • Cox LC, McCoy SL, Tun PA, Wingfield A. 2008; Monotic auditory processing disorder tests in the older adult population. J Am Acad Audiol 19 (04) 293-308
  • Dawes P, Bishop D. 2009; Auditory processing disorder in relation to developmental disorders of language, communication, and attention: a review and critique. Int J Lang Commun Disord 44 (04) 440-465
  • Emanuel DC, Ficca KN, Korczak P. 2011; Survey of the diagnosis and management of auditory processing disorder. Am J Audiol 20 (01) 48-60
  • Emanuel DC. 2002; The auditory processing battery: survey of common practices. J Am Acad Audiol 13: 93-117
  • Folstein MF, Folsetin SE, McHugh PR. 1975; “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12 (03) 189-198
  • Friberg JC, McNamara TL. 2010; Evaluating the reliability and validity of (central) auditory processing tests: a preliminary investigation. J Educ Audiol 16: 4-17
  • Golding M, Carter N, Mitchell P, Hood L. 2004; Prevalence of central auditory processing (CAP) abnormality in an older adult Australian population: the Blue Mountains hearing study. J Am Acad Audiol 15: 633-642
  • Hornsby B, Mueller HG. 2013 Monosyllabic word testing: five simple steps to improve accuracy and efficiency. AudiologyOnline, Article #11978. http://www.audiologyonline.com/ . Accessed May 17, 2017
  • Huff MJ, Meade ML, Hutchison KA. 2011; Age-related differences in guessing on free and forced recall tests. Memory 19 (04) 317-330
  • Katz J, Johnson CD, Tillery KL, Bradham T, Brandner S, Delagrange TN, Ferre JM, King J, Kossover-Wechter D, Lucker JR, Medwetsky L, Saul RS, Rosenberg GG, Stecker NA. 2002 Clinical and research concerns regarding Jerger & Musiek (2000) APD recommendations. AudiologyOnline, Article #1182. http://www.audiologyonline.com/ . Accessed June 12, 2012.
  • Kelly A. 2007; Normative data for behavioural tests of auditory processing for New Zealand school children aged 7 to 12 years. Aust N Z J Audiol 29: 60-64
  • McDermott EE, Smart JL, Boiano JA, Bragg LE, Colon TN, Hanson EM, Emanuel DC, Kelly AS. 2016; Assessing auditory processing abilities in typically developing school-aged children. J Am Acad Audiol 27 (02) 72-84
  • Musiek FE. 1994; Frequency (pitch) and duration pattern tests. J Am Acad Audiol 5 (04) 265-268
  • Musiek FE. 2002; The frequency pattern test: a guide. Hear J 55 (06) 58
  • Musiek FE, Chermak GD, Weihing J, Zappulla M, Nagle S. 2011; Diagnostic accuracy of established central auditory processing test batteries in patients with documented brain lesions. J Am Acad Audiol 22 (06) 342-358
  • Musiek FE, Pinheiro ML. 1985. Dichotic speech tests in the detection of central auditory dysfunction. In: Pinheiro M, Musiek F. Assessment of Central Auditory Dysfunction: Foundations and Clinical Correlates. Baltimore, MD: Williams & Wilkins; 201-218
  • Musiek FE, Pinheiro ML. 1987; Frequency patterns in cochlear, brainstem, and cerebral lesions. Audiology 26: 79-88
  • O’Beirne GA, McGaffin AJ, Rickard NA. 2012; Development of an adaptive low-pass filtered speech test for the identification of auditory processing disorders. Int J Pediatr Otorhinolaryngol 76: 777-782
  • Rowley GL, Traub RE. 1977; Formula scoring, number-right scoring, and test-taking strategy. J Educ Meas 14 (01) 15-22
  • Schoepflin JR. 2012 Back to basics: speech audiometry. AudiologyOnline, Article #6828. http://www.audiologyonline.com/ . Accessed May 17, 2017
  • Seashore HG, Wesman AG, Doppelt JE, Gelink M, Ricks JH Jr. 1954. The Correction for Guessing. Test Service Bulletin No. New York, NY: The Psychological Corporation;
  • Stach BA, Spretnjak ML, Jerger J. 1990; The prevalence of central presbycusis in a clinical population. J Am Acad Audiol 1 (02) 109-115
  • Stewart BS. 2003; The word intelligibility by picture identification test: a two-part study of familiarity and use. J Educ Audiol 11: 39-48
  • Sykes S, Tucker D, Herr D. 1997; Aural rehabilitation and graduate audiology programs. J Am Acad Audiol 8 (05) 314-321
  • Thornton A, Raffin M. 1978; Speech-discrimination scores modeled as a binomial variable. J Speech Hear Res 21 (03) 507-518
  • Tomlin D, Dillon H, Sharma M, Rance G. 2015; The impact of auditory processing and cognitive abilities in children. Ear Hear 36 (05) 527-542
  • Turner RG. 2013; Understanding protocol performance: impact of test performance. J Am Acad Audiol 24 (10) 909-919
  • Whitelaw GM. 2008. Assessment and management of auditory processing disorders in children. In: Madell JR, Flexer C. Pediatric Audiology: Diagnosis, Technology, and Management. New York, NY: Thieme Medical Publishers, Inc.; 145-155
  • Wiley TL, Stoppenbach DT, Feldhake LJ, Moss KA, Thordardottir ET. 1995; Audiologic practices: what is popular versus what is supported by evidence. Am J Audiol 4 (01) 26-34
  • Willeford JA, Burleigh JM. 1994. Sentence procedures in central testing. In: Katz J. Handbook of Clinical Audiology. 4th ed. Baltimore, MD: Williams & Wilkins; 256-268
  • Wilson WJ, Arnott W. 2013; Using different criteria to diagnose (central) auditory 67 processing disorder: how big a difference does it make?. J Speech Lang Hear Res 56: 63-70