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Language and auditory processing disorders: literature review/ Alteracoes de linguagem e processamento auditivo: revisao de literatura.


Auditory processing is the ability of the Central Nervous System to receive, process and interpret sounds [1]. The proper development of this ability depends on factors such as the preservation of the peripheral hearing, the neurobiological maturation, environmental stimuli and cognitive skills, such as attention, memory and language [1-3]. The impairment of some of these aspects (or several of them together) can impair the physiological processing of sounds and lead to disorders of the auditory skills such as attention, discrimination, recognition and comprehension of the information [4].

On the other side, language constitutes the human ability to combine conventional symbols in order to transmit and understand information [5]. For that, the interaction of the environmental influence, biological processes and various cognitive and auditory skills is also decisive [4,6,7]. Otherwise, the language development will occur in an atypical way.

According to these considerations, it can be concluded that there is a relationship between the auditory and the language processes, and that the good performance of one of them contributes to the proper functioning of the other [4,8]. Therefore, the study of these aspects is of utmost importance for the understanding of their relationship. In addition, as the present study intends to raise studies that verify the relationship between language and auditory processing disorders, support is provided for health promotion strategies, guidance of family members and treatment planning.

The purpose of this study was to make a literature review based on national and international studies in a systematic way. Such review was made to verify the relationship between language and auditory processing disorders.


This is a systematic literature review based on national [9,10] and international [11] recommendations, which sought to answer the following question: "Which is the relationship between language and auditory processing disorders?".

The bibliographic search used as databases: Pubmed and Web of Science, from May to June 2014. DeCS (Descriptors in Health Sciences), and terms of the MeSH (Medical Subject Headings) of the National Library of Medicine were combined by the Boolean operators AND and OR. Thus, the following cross checks in English, Portuguese and Spanish were made: ("Auditory Perception" OR "Percepcion Auditiva" OR "Percepcao Auditiva" OR "Hearing Tests" OR "Pruebas Auditivas" OR "Testes Auditivos" OR "Processamento Auditivo" OR "Auditory Processing") AND ("Language Development Disorders" OR "Trastornos del Desarrollo del Lenguaje" OR "Transtornos do Desenvolvimento da Linguagem) and ("Auditory Processing" and "Phonological Awareness"); descriptors and free terms, respectively.

Regarding the selection criteria, two researchers independently searched for articles according to the inclusion and exclusion criteria. The texts with different answers of the researchers were grouped in a table presented later to a third appraiser in order to resolve the points of disagreement. Articles published in the last five years, i.e., from 2010 to 2014, were selected.

The inclusion criteria were: articles that answered the guiding question and were found through the descriptors used. Studies with animals, laboratory studies, opinion/authority articles, case series and reports, and cross-sectional studies were excluded [11].

In the Pubmed database, filters related to species (humans), language (English, Portuguese and Spanish) and year (2010-2014) were used. No filters were used in the Web of Science.

The data analysis was initially made through titles and abstracts of articles. Then, the full text of the selected articles was read. Only studies within the established criteria were used for the review.

The selection of articles was made through a protocol created for the elaboration of this study. For that, the following aspects were used: author, year, place, design, sample, age group, used tests and results. The data were summarized in a table in order to better visualize the results.


The search through free descriptors and terms revealed 254 articles in the pre-established database, 187 from Pubmed and 67 from Web of Science. Of the total, 156 were excluded by the title and abstract and 87 by the reading of the full text. This enabled the analysis of 10 articles.


As a wide variety of designs and criteria used for the elaboration of the results was found in the selected studies, such as sample, age group and used tests, it was not possible to make a statistical analysis. However, valid reflections can be drawn from this review.

Most of the selected articles were published in 2010, 2012 and 2013. No publications were found in 2011 and 2014.

Brazil and the United States were the countries with the largest number of selected studies related to the question of the review. The researches carried out in these countries, along with those of Mexico, highlight the predominance of studies that address this theme in the American continent. The other countries are located in Europe.

Regarding the design, the authors of the articles used in this review showed the need to make a comparison between typical and atypical development. It was made through the distribution of the population in groups of individuals with typical development and those with language or auditory processing disorders, or language and auditory processing disorders.

Therefore, the most commonly used design was control case. In addition, cohort, literature review and experimental type studies were found.

The samples of the selected studies had at least 20 and at most 88 individuals, and all selected studies were conducted with children and adolescents aged 3 to 13 years. The fact that these samples are composed of such age group suggests the importance of considering the maturation of the Central Nervous System in language and auditory processing studies. Most language and auditory processing disorders are identified in the childhood, as it is during this phase that the maturation of the Central Nervous System occurs [2,22,23].

In addition, this age group comprises the inclusion of the children in school, when linguistic and auditory demands increase. Thus, the difficulties become more evident, both for the professionals involved in the educational institution as for the health professionals [24,25].

The selected articles presented a wide range of tests that assess language and auditory processing, and their selection was done according to the purpose of the study. Regarding the auditory processing tests, it was observed that the Staggered Spondaic Word SSW [20,21] and Speech in Noise [15,19] were the most used tests. The Pediatrics Speech Intelligibility--PSI [19], Dichotic Digit [18,19], Frequency Standard [12] and Simplified Evaluation of Auditory Processing--ASPA [18,19] tests were also frequently used. Regarding the language tests, the Phonological Awareness Test [20] was the most used.

The predominant use of SSW and Speech in Noise tests demonstrates the interest of the authors in the further investigation of the binaural integration and auditory closure skills, respectively. Both are extremely important in the language development, especially with regard to reading and writing learning. It occurs in the school, frequently with a noisy environment that requires the proper functioning of these skills [4].

The fact that the Phonological Awareness Test is the most widely used may be related to its importance to the development of language. The acquisition of phonological awareness enables the development of oral language, communication, reading and writing [26]. A deficit in the mental organization and representation of speech sounds leads to alterations in the processes of perception, analysis and conscious manipulation of syllables [27].

The results varied according to the objectives and selected variables of the studies, but most of them showed the relationship between language and auditory processing disorders. Children with language disorders presented lower performance in the auditory tests compared to those with typical development. This finding may be explained by the fact that language and hearing development occurs simultaneously and they are interdependent [2,28].

The study of Murphy-Ruiz, Penaloza-Lopez et. al [12] showed that children with developmental dyslexia presented lower performance than children with typical development in all auditory processing tests. Such evidence corroborates the literature, as children with language disorders present alterations in the phonological processing related to an auditory processing disorder, in other words, children with dyslexia present changes in auditory skills [29].

In addition to original articles, a literature review with a sample of 16 articles, published in England in 2010 was found. The research reveals that the auditory training used in the studies had little effect on the language skills, therefore a strong relationship between language and auditory processing disorders could not be established. Although the language skills depend on the integrity and maturation of the Central Nervous System, the establishment of a relationship with auditory processing disorders requires studies with strong scientific designs, i.e., that enable higher level of scientific evidence, such as randomized clinical trials.

Through the analysis of the results of each article included in the review, in children with language disorders, the occurrence of changes in auditory tests involving temporal processing, dichotic hearing and speech perception can be verified. In addition, there was an association between auditory processing disorders with cognitive-linguistic factors and tasks involving phonological awareness.


This study showed that most of the research conducted in the last five years, published in the PubMed and Web of Science databases, revealed an association between language and auditory processing disorders. It was observed that children with language development disorders have lower performance in the auditory test compared to those with typical development.


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Marina Alves de Souza (1)

Nathalia de Jesus Silva Passaglio (1)

Stela Maris Aguiar Lemos (2)

(1) Universidade Federal de Minas Gerais-UFMG; Belo Horizonte, MG, Brasil.

(2) Departamento de Fonoaudiologia da Universidade Federal de Minas Gerais-UFMG - Belo Horizonte, MG, Brasil.

Sources of Support: National Council for Scientific and Technological Development (CNPq) and Fundacao de Amparo a Pesquisa do Estado de Minas Gerais FAPEMIG.

Notice 01/2013--universal demand

Universal Notice--14/2012

Conflict of interest: non-existent

Received on: October 06, 2015

Accepted on: December 21,2015

Mailing address:

Stela Maris Aguiar Lemos

Faculdade de Medicina da Universidade

Federal de Minas Gerais

Departamento de Fonoaudiologia

Av. Prof. Alfredo Balena, 190, sala 251

Belo Horizonte--MG--Brasil

CEP: 30130-100

Table 1. Results of the selected studies according to the variables

Author                 Year    Place         Design

Murphy PC-Ruiz,        2013   Mexico      Control Case
Penaloza YR-Lopez et
al. (12)

Schwartz RG,           2013     USA       Control Case
Scheffeler FLV,
Lopez K. (13)

Heim S, Keil A,        2013     USA       Experimental
Choudhury N et al.

Vandewalle E, Boets    2012   Belgium     Control Case
B, Ghesquiere P Zink
I. (15)

Vandermosten M,        2010   Belgium     Control case
Boets B, Luts H et
al. (16)

Muluk NB, Yalcinkaya   2010   Turkey      Control case
F, Keith RW. (17)

Attoni TM, Quintas     2010   Brazil      Control case
VG, Mota HB. (18)

Attoni TM, Quintas     2010   Brazil      Control case
VG, Mota HB. (19)

KH Corriveau, U        2010     USA          Coorte
Goswami, JM Thomson.

Loo JHY Bamiou DE,     2010   England   Literature review
Campbell N et al.

Author                        Sample             Age group

Murphy PC-Ruiz,        40 children. 20 with    Children aged
Penaloza YR-Lopez et   typical development    between 7 and 11
al. (12)                   and 20 with             years.

Schwartz RG,           25 children. 12 with    Children aged
Scheffeler FLV,         specific language     between 6 and 9
Lopez K. (13)          disorder and 13 with        years.
                       typical development.

Heim S, Keil A,        33 children. 21 with    Children aged
Choudhury N et al.      language learning     between 6 and 9
(14)                   disabilities and 12         years.
                           with typical

Vandewalle E, Boets     32 children. Group        6 years
B, Ghesquiere P Zink      case 1: 8 with
I. (15)                 specific language
                           disorder and
                         literacy delay.
                         Group case 2: 10
                          with specific
                        language disorder
                       and normal literacy.
                        Control group: 14
                           with typical
                         development and

Vandermosten M,         38 children. Group        11 years
Boets B, Luts H et      case: 13 dyslexic.
al. (16)                Control group: 25
                           with typical

Muluk NB, Yalcinkaya    22 children. Group     5 to 13 years
F, Keith RW. (17)      case: 12 with early
                        language delay and
                           speech sound
                       distortion. Control
                          group: 10 with
                         typical hearing,
                         development and

Attoni TM, Quintas      46 children. Group      5 to 7 years
VG, Mota HB. (18)         case: 22 with
                        disorders. Control
                          group: 24 with
                          typical speech

Attoni TM, Quintas      46 children. Group      5 to 7 years
VG, Mota HB. (19)         case: 22 with
                        disorders. Control
                          group: 24 with
                          typical speech

KH Corriveau, U            88 children          3 to 6 years
Goswami, JM Thomson.

Loo JHY Bamiou DE,         16 articles               --
Campbell N et al.

Author                      Used tests                Results

Murphy PC-Ruiz,         Informal assessment        Children with
Penaloza YR-Lopez et      of reading and           developmental
al. (12)                writing, Frequency     dyslexia showed lower
                        Standard, Duration       performance than
                             Standard,            children of the
                        Environmental Sound    control group in all
                          and Music Test.       auditory processing

Schwartz RG,           Questionnaire for the    Perceptual deficits
Scheffeler FLV,          parents, auditory      related to language
Lopez K. (13)              screening and         disorders suggest
                             Nonverbal             alteration in
                           Intelligence        cognitive-linguistic
                                                factors and not in
                                               auditory processing.

Heim S, Keil A,        Electroencephalogram,        Aspects of
Choudhury N et al.     Electrophysiological     ineffective sensory
(14)                   Assessment of Hearing    cortical processing
                              Events.            in children with
                                                 language learning
                                                 disabilities are
                                                  improved after

Vandewalle E, Boets    Frequency modulation,    Group case 1: worst
B, Ghesquiere P Zink       Gap Detection       performance in speech
I. (15)                Channels, Test Method    perception, but not
                           for Auditory        in temporal auditory
                         Processing Tasks,       processing. Group
                         Speech in Noise,       case 2 and Control
                            Categorical        group: no difference
                            perception,          regarding speech
                           Phonological           perception and
                         Awareness, Short-     auditory processing.
                        term Verbal Memory,
                         Rapid Automatized
                         Naming, Reading,
                       Standard Orthographic
                          Productive and
                          Receptive Oral

Vandermosten M,          Temporal and non-     Group case: children
Boets B, Luts H et      temporal contrasted    with less consistent
al. (16)                speech and temporal    sound classification
                       and non-temporal non-    (of speech or not).
                         contrasted speech

Muluk NB, Yalcinkaya   Scale-4 of Preschool     Group case: highest
F, Keith RW. (17)        Language, CELF-4,         average with
                            SSDT, RGDT.             statistical
                                               significance, of Gap
                                               Detection Thresholds
                                                in all frequencies:
                                               500Hz, 1000Hz, 2000Hz
                                                     e 4000Hz.

Attoni TM, Quintas     SSW, Dichotic Digit,      Group case: lower
VG, Mota HB. (18)      Simplified Evaluation   results in all tests
                            of Auditory             performed.
                          Processing and
                        Discrimination Test
                           with Figures.

Attoni TM, Quintas     Simplified evaluation   SSW--Group case: high
VG, Mota HB. (19)           of auditory         levels of exchanges
                         processing, Digit       and omissions and
                        dichotic, Speech in       longer time to
                         noise, SSW, PSI,       respond in the SSW.
                           Phonological          Digit dichotic--
                           Evaluation of        Group case: values
                           Children and         outside the normal
                         evaluation of the      range. Relationship
                         acoustic reflex.        between acoustic
                                                reflex and severity
                                                of the phonological
                                                 disorders: values
                                                with significance.

KH Corriveau, U        Auditory processing,         There is a
Goswami, JM Thomson.       Phonological        relationship between
(20)                    awareness, Reading     early acquisition of
                        skills and General     auditory sensitivity
                              skills.           and development of
                                                 awareness skills,
                                                 especially rhyme.

Loo JHY Bamiou DE,                               Auditory training
Campbell N et al.                                programs: little
(21)                                            effect on language,
                                               spelling and reading
                                               skills. Relationship
                                                 with phonological
                                                 awareness skills.
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Title Annotation:texto en ingles
Author:de Souza, Marina Alves; de Jesus Silva Passaglio, Nathalia; Lemos, Stela Maris Aguiar
Publication:Revista CEFAC: Atualizacao Cientifica em Fonoaudiologia e Educacao
Date:Mar 1, 2016
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