Auditory processing disorder: diagnosis, debate, and the Croatian perspective

Auditory Processing Disorder (APD) is recognized in the International Classification of Diseases (ICD) as a condition that affects central auditory processing despite normal peripheral hearing. However, its status as a distinct clinical entity is still widely debated—many of the symptoms associated with APD overlap with language, attention, and cognitive deficits (Seeto, Tomlin, & Dillon, 2021). The estimated prevalence is inconsistent because of the absence of universally accepted diagnostic criteria. Organizations such as the American Speech-Language-Hearing Association (ASHA), the American Academy of Audiology (AAA), and European expert groups define APD differently, relying on various behavioral and neurophysiological measures (Iliadou et al., 2017). Since many assessment tests use linguistic stimuli, it is often unclear whether poor performance results from an auditory or a language-processing deficit. These uncertainties have led some to question whether APD is a separate disorder or part of broader developmental conditions affecting language and cognition.

In Croatia, awareness of APD has increased, but clinical adoption and research on auditory processing remain inconsistent. A standardized diagnostic tool, The PSP1 test battery (Heđever, 2011), is available. PSP1 provides valuable insight into auditory processing but relies entirely on linguistic stimuli, making distinguishing auditory-specific deficits from language-related issues challenging. Currently, Croatia lacks standardized nonlinguistic auditory processing assessments, which limits alignment with European guidelines that emphasize using verbal and nonverbal tests to reduce linguistic bias. Additionally, APD assessments and research in Croatia are primarily conducted by speech-language pathologists, whereas international recommendations advocate for a multidisciplinary approach involving audiologists, psychologists, and other specialists.

This review examines the ongoing discussions over APD diagnosis, including inconsistent guidelines, difficulties in differentiating auditory and linguistic deficits, and limitations in current assessment methods. In Croatia, the absence of standardized nonlinguistic tests and limited multidisciplinary collaboration present significant challenges. Expanding multidisciplinary research efforts in the Croatian context could support a better understanding of auditory processing and its relationship to language development.