Distorted sound waves around a child representing Auditory Processing Disorder

Is Your Child Misdiagnosed? Understanding Auditory Processing Disorder Criteria

Avery Sinclair in Health & Wellness November 2025 • 5 min read.

"New research highlights how different cutoff scores in central auditory processing tests can significantly impact diagnosis rates, potentially leading to over- or under-diagnosis."

Imagine your child struggling to follow instructions, having difficulty in noisy environments, or constantly asking you to repeat yourself. These could be signs of Auditory Processing Disorder (APD), a condition where the brain has trouble processing the sounds it hears. Identifying APD can be a challenge, and recent research sheds light on a critical factor affecting diagnosis: the criteria used to interpret test results.

APD, also known as Central Auditory Processing Disorder (CAPD), affects how the brain processes auditory information. Unlike hearing loss, where the ears don't receive sounds properly, APD involves the brain's ability to understand and interpret those sounds. This can lead to difficulties in understanding speech, following directions, and distinguishing between similar sounds, especially in noisy environments.

A new study published in Audiology Research examines how different cutoff scores on central auditory processing (CAP) tests influence the rate of APD diagnosis. The research highlights that the diagnostic rate can vary significantly depending on whether a 1 standard deviation (SD) or a 2 SD cutoff is used. Understanding these differences is crucial for parents, educators, and healthcare professionals to ensure accurate assessment and appropriate support for children with potential APD.

Decoding APD: Why Cutoff Scores Matter in Central Auditory Processing Tests

Distorted sound waves around a child representing Auditory Processing Disorder

Central Auditory Processing (CAP) tests aim to evaluate various auditory processes, including auditory discrimination, temporal aspects of audition, and performance in the presence of competing or degraded signals. These tests often involve a Central Test Battery (CTB), which typically includes tests like the Staggered Spondaic Word (SSW) test, Phonemic Synthesis (PS) test, and speech-in-noise (SN) test. The CTB helps audiologists assess how well a child processes auditory information under different conditions.

The challenge arises when interpreting the results of these tests. There isn't a universally agreed-upon standard for what constitutes a "significant" or abnormal test finding. Some clinicians and researchers advocate for using a cutoff score of 2 SDs below the mean, while others support using 1 SD below the mean. This difference in cutoff scores can lead to varying rates of APD diagnosis, potentially affecting the accuracy of identifying children who truly have APD.

1 SD Cutoff: Using 1 SD below the mean as a cutoff results in a higher failure rate, meaning more children are identified as potentially having APD. This approach may be more sensitive, capturing more children who might have subtle auditory processing difficulties.
2 SD Cutoff: A 2 SD cutoff, on the other hand, leads to a lower failure rate. This means fewer children are identified as having APD. This approach is more specific, reducing the likelihood of false positives but potentially missing some children who genuinely have the disorder.

The study in Audiology Research directly addresses this issue by quantifying how using these two different cutoff criteria affects the test failure rate and potential diagnosis of APD. By analyzing data from 98 children who underwent CAP assessments, the researchers found a significant difference in the rates of potential APD diagnosis based on the cutoff score used. Specifically, the rates ranged from 86.8% when a 1 SD cutoff was used to 66.2% when a 2 SD cutoff was applied. This 20% difference underscores the substantial impact of the chosen cutoff on diagnostic outcomes.

What This Means for Your Child's APD Assessment

The findings of this study have important implications for the diagnosis and management of APD in children. The significant difference in diagnostic rates based on cutoff criteria highlights the need for greater awareness and standardization in APD testing. It's crucial for audiologists, educators, and parents to understand the potential impact of these criteria on diagnostic outcomes.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4081/audiores.2016.158, Alternate LINK

Title: Impact Of Different Cutoff Criteria On Rate Of (Central) Auditory Processing Disorders Diagnosis Using The Central Test Battery

Subject: Otorhinolaryngology

Journal: Audiology Research

Publisher: MDPI AG

Authors: Mohsin Ahmed Shaikh, Lisa Fox-Thomas, Denise Tucker

Published: 2016-11-25

Everything You Need To Know

What is Auditory Processing Disorder (APD), and how does it differ from typical hearing loss?

Auditory Processing Disorder (APD), also known as Central Auditory Processing Disorder (CAPD), affects the brain's ability to process auditory information. This is different from hearing loss, where the ears don't receive sounds correctly. APD involves difficulties in understanding speech, following directions, and distinguishing between similar sounds, especially in noisy environments. A child with APD might struggle to follow instructions or constantly ask for repetitions.

What do Central Auditory Processing (CAP) tests measure, and what types of tests are commonly included in a Central Test Battery (CTB)?

Central Auditory Processing (CAP) tests evaluate various auditory processes, including auditory discrimination, temporal aspects of audition, and performance in the presence of competing or degraded signals. A Central Test Battery (CTB) typically includes tests like the Staggered Spondaic Word (SSW) test, Phonemic Synthesis (PS) test, and speech-in-noise (SN) test. These tests help audiologists assess how well a child processes auditory information under different conditions. However, there is no universally agreed-upon standard for interpreting the results of these tests.

In the context of central auditory processing tests, what is a cutoff score, and why is it important?

The cutoff score in Central Auditory Processing (CAP) tests refers to the threshold used to determine whether a child's test results are considered within the normal range or indicative of a potential Auditory Processing Disorder (APD). A 1 SD cutoff means that a child's score falling 1 standard deviation below the mean is considered a failure, leading to a higher rate of potential APD diagnosis. A 2 SD cutoff, on the other hand, requires a score 2 standard deviations below the mean for a failure, resulting in fewer children being identified as potentially having APD.

What are the implications of using a 1 SD cutoff versus a 2 SD cutoff when assessing Auditory Processing Disorder (APD)?

Using a 1 SD cutoff in Central Auditory Processing (CAP) tests can lead to a higher rate of potential Auditory Processing Disorder (APD) diagnosis because it is more sensitive, capturing more children who might have subtle auditory processing difficulties. While this approach may identify more children with potential issues, it also increases the likelihood of false positives, where children without APD are incorrectly identified. This impacts resources and interventions for children incorrectly identified. It is balanced against missing a child who needs help.

How much does the use of a 1 SD cutoff vs a 2 SD cutoff in Central Auditory Processing (CAP) tests impact potential diagnosis rates of Auditory Processing Disorder (APD)?

The choice between a 1 SD or 2 SD cutoff in Central Auditory Processing (CAP) tests significantly affects the rate of potential Auditory Processing Disorder (APD) diagnosis. Research indicates a notable difference in diagnostic rates depending on the chosen cutoff. A study in *Audiology Research* found rates ranged from 86.8% with a 1 SD cutoff to 66.2% with a 2 SD cutoff. This discrepancy underscores the importance of understanding the implications of each cutoff and the need for greater awareness and standardization in APD testing to ensure accurate assessment and appropriate support for children.