November 6, 2007 Features

Auditory Processing Disorder Evaluation

Using a Reinforcement Paradigm

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Many issues associated with auditory processing disorders (APDs) have been debated and researched. For the most part, however, the issue of testee motivation/reinforcement has been ignored except for an article by Silman and colleagues (2000) that demonstrated changes in APD test performance through the use of reinforcement.

During the last two years, I was asked to consult on the APD evaluation of two boys, ages 10 and 11. Each of these children had been diagnosed with a reading disorder, but had normal speech and language. The children's school system tested them for an APD with positive results. The testers' comments suggested poor motivation on the part of the two boys in performing the APD tests. The motivation issue was also noted in the teachers' comments, which characterized each child as not highly motivated. Recalling the article by Silman et al. (2000), I consulted with both sets of parents about the motivation issue and suggested that the two boys be retested using a reinforcement paradigm; the parents agreed.

During discussion with the parents, I asked about suitable reinforcement. By coincidence, both sets of parents said their sons were highly motivated to save money—one wanted to purchase a new skateboard and the other wanted to purchase upgrades for his BMX bicycle. Further, the parents volunteered to provide the reinforcement money.

The re-testing was conducted three to four weeks after the original testing, using the Filtered Speech Test (FST), the Dichotic Digits Test (DDT), and the Pitch Pattern Test (PPT), whose performance characteristics and norms I had previously investigated (Singer, Hurley & Preece, 1998). Each boy was told that he would receive 25 cents for each correct response. The results of these tests are presented in Figure 1, which compares the initial evaluation performance to the re-evaluation performance obtained using reinforcement. The test scores depicted in Figure 1 are composite scores, representing the average of the right and left ear scores, as the individual ear scores for each test were symmetrical. Each boy demonstrated enough improvement in each of the three APD tests using a reinforcement paradigm to move his performance from below normal to normal.

These results suggest that the original test may have been influenced by these children's low motivation. If these children truly had an APD, their performance should not have moved from below normal to normal with increased motivation, i.e., reinforcement. Arguably, the improved test performance may have been the result of a learning effect; however, the time between testing was three to four weeks and the improved performance was across all three tests. After an intensive remedial reading experience, both boys are reading at near grade level with no other reported academic problems.

The take-home messages from these case studies are: 1) motivation must be considered in APD evaluation, as children may be misdiagnosed as having an APD; and 2) motivation/reinforcement in APD assessment needs further study.

ASHA Special Interest Division 6, Hearing and Hearing Disorders: Research and Diagnostics contributed this article. The division offers affiliates the opportunity to earn CEUs through self-study of its peer-reviewed publication, Perspectives; an exclusive e-mail list and Web forum; and other benefits. To learn more, visit Division 6's Web page.

Raymond M. Hurley, is an associate professor in the Department of Communication Sciences and Disorders, University of South Florida, Tampa. Contact him at 

cite as: Hurley, R. M. (2007, November 06). Auditory Processing Disorder Evaluation : Using a Reinforcement Paradigm. The ASHA Leader.


Silman, S., Silverman, C. A., & Emmer, M. B. (2000). Central auditory processing disorders and reduced motivation: three case studies. Journal of the American Academy of Audiology, 11, 57-63.

Singer, J., Hurley, R. M., & Preece, J. (1998). Effectiveness of central auditory processing (CAP) tests with children. American Journal of Audiology, 7, 73‑84.


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