Professor Dorothy Bishop wrote recently on her personal blog (http://deevybee.blogspot.com/) about one of her current research topics; auditory processing problems (APD) in children with language difficulties. As Professor of Developmental Neuropsychology, she is particularly interested in developmental language disorders and has written extensively around the subject in peer-reviewed academic literature.
For more information about auditory processing disorder, see here: https://integratedtreatmentservices.co.uk/news/item/0/69/auditory-processing-disorder/. Briefly, children with APD have hearing skills within normal limits for their age (i.e. they will pass hearing tests as normal), but have difficulty making sense of, or understanding what they have heard.
Unusually, Professor Bishop’s post does not discuss the science of APD, but the politics surrounding it. She talks about APD on a global scale – and particularly how British thinking differs from American and Australian approaches, who may be more motivated by finances.
APD cannot be found in the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders), which is one of the ‘diagnostic bibles’ used by clinicians. However, it is described as code 388.40 in the World Health Organisation’s ICD-9-CM (International Classification of Diseases), along with a note that “388.40 is a billable ICD-9-CM medical code that can be used to specify a diagnosis on a reimbursement claim”.
Professor Bishop notes that APD is unusual in the fact that there are no agreed formal diagnostic tests for the assessment process. For this reason, some medical insurance companies in the USA are stating that, “diagnostic tests or treatments for the management of auditory processing disorder (APD)…are experimental and investigational because there is insufficient scientific evidence to support the validity of any diagnostic tests and the effectiveness of any treatment for APD.” In other words, they are refusing to pay out to families who have children with APD, as they say that there is not enough scientific evidence to support the diagnosis. In Britain, clinicians working for the NHS are not financially motivated, and have nothing to gain by making a diagnosis of APD.
As a final note, Professor Bishop points out that this big-business approach to medical diagnoses and insurance claims can only impact negatively on children with language difficulties around auditory problems. Ultimately, it is the children who will be affected most by financial decision-making.
Sarah Bennington March 2011
Written on behalf of Integrated Treatment Services. ITS is a private Speech and Language Therapy service based in Leicestershire and the East Midlands. It specialises in providing highly-skilled Speech and Language Therapists, but also associates with other therapeutic professionals, including Occupational Therapists, Physiotherapists, Psychologists and Arts Therapists.
