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All Disorders

(Central) Auditory Processing Disorder (CAPD) – Adult

What is (Central) Auditory Processing Disorder (CAPD)?

Auditory Processing Disorder (APD), often called Central Auditory Processing Disorder (CAPD), is a complex problem that is estimated to affect 2-3% of children and youth, but the incidence in the general population is most likely higher because adults may develop APD as a result of brain injury (stroke, traumatic brain injury, tumours, epilepsy), aging, or illness. Auditory processing problems occur when the auditory centers in the brain have difficulty processing the information perceived by the ears. This can cause a person with APD to have problems recognizing and interpreting sounds, especially in the presence of background noise. A person with APD may show a variety of problems; poor attention, difficulty following directions, forgetting or misunderstanding what was said, or difficulty remembering what has been learned through listening. The strain of maintaining attention to listen effectively may be exhausting and may make thinking and concentrating more challenging.

APD in children may contribute to a learning disability, attention deficit/hyperactivity disorder (ADHD) or speech and language problems. As children with APD grow into adulthood, some may show improvement in test scores and their language and literacy skills may move into the typical range, but for others these problems persist into adulthood.

What can professionals do to help?

An audiologist is the professional who will assess and make the diagnosis by performing auditory processing tests in addition to audiological (hearing) tests. The audiologist may make recommendations to improve the listening environment and may suggest a listening device which dampens background noise to make speech processing easier and help a person hear and understand auditory information in some settings.

Speech-language pathologists (SLP) work with individuals to improve speech, language and communication skills affected by strokes or other forms of brain injury, illness, or the ageing process. APD can interfere with a person’s communication abilities and be a strong compounding factor in a response to treatment. SLPs will implement strategies to address auditory processing problems in intervention planning.

(Central) Auditory Processing Disorder (CAPD) – Child

What is (Central) Auditory Processing Disorder (CAPD)?

Auditory Processing Disorder (APD), often called Central Auditory Processing Disorder (CAPD), is a complex problem that is estimated to affect 2-3% of children and youth. Children with APD have normal hearing but have difficulty processing and understanding what they hear. Children live and learn in a noisy world, and children with APD will have difficulty recognizing and interpreting sounds especially in the presence of background noise. They may show a variety of problems; poor attention, difficulty following directions, forgetting or misunderstanding what was said, or difficulty discriminating between speech sounds. Children with APD will often ask others to repeat or clarify what was said. These problems can significantly affect performance in school.

Auditory processing problems are often suspected early, but testing in children under age 7 years of age is often unreliable. APD is often not identified because the symptoms are very similar to those of other children with learning disability, attention deficit/hyperactivity disorder (ADHD) or speech and language problems. Although the profiles may be similar, the underlying cause is different.

A child with APD will typically pass a hearing screening and have a normal audiogram because their hearing sensitivity is usually normal and because these tests are conducted in a quiet environment. A child may do well on tasks if there are visuals, but they may have significant processing problems throughout the day when learning is primarily through listening. APD may be a source of speech, language and learning problems because the child is not receiving the same auditory and language input as his/her peers and, if not identified, the child may fall behind in his/her schoolwork.

What can professionals do to help?

An audiologist is the professional who will assess and make the diagnosis by performing auditory processing tests and other hearing evaluations. The audiologist will liaise with the speech-language pathologist and monitor hearing abilities because a child’s auditory system continues to develop through childhood and adolescence. The audiologist will make recommendations to improve the listening environment and may suggest a listening device to filter out background noise to make speech processing easier and help the child hear and understand auditory information in the classroom.

If the speech-language pathologist (SLP) working with a child suspects that there is an auditory processing problem underlying a student’s speech, language or learning problems, the SLP will make a referral to an audiologist for testing and diagnosis. After the diagnosis, the SLP can work with the child to develop speech, language, and literacy skills as well as providing the child with strategies to support listening and understanding. At the school level, the SLP is the professional most likely to work with parents and teachers to understand the challenges that the child is facing and discuss implementation of strategies to help the child learn, e.g. preferential seating, getting the child’s attention before giving instructions, providing a quiet space for school work, short simple instructions, or using writing or visual cues.

AAC (Alternative and Augmentative Communication) – Adult

What is AAC (Alternative and Augmentative Communication)?

AAC means Augmentative and Alternative Communication. Although not a disorder, AAC is mentioned here because it is a communication option for people who have difficulty speaking. Loss or absence of speech can have a significant effect on relationships and on quality of life. Using AAC to supplement or replace spoken language can help individuals to be more effective communicators, increase communication opportunities throughout the day with a wide range of people, reduce frustration, and improve independence.

Adults may use AAC to communicate if they were born with a developmental condition that affected speech and language abilities, such as cerebral palsy, cognitive challenges, or autism. AAC may also be used later in life if a person loses the ability to communicate due to acquired conditions such as ALS, Parkinson’s or Alzheimer’s disease, stroke, head injury or after surgery.

AAC can take many forms: objects, pictures, visual schedules, communication books or boards, sign language or voice output devices. The type of AAC used will depend on the person’s physical and language abilities and communication needs. For some, AAC will be used on a long-term basis to replace or supplement spoken language and help the individual communicate more effectively with friends and family or to be understood more fully in social situations. For others, AAC may be used on a temporary basis or to communicate with unfamiliar communication partners.

What can professionals do to help?

The speech-language pathologist (SLP) assesses the language and communication skills of the individual requiring AAC and makes recommendations on the best system or systems to help the person communicate more effectively. The SLP will also develop an intervention program to train the person how to use the AAC system and support communication partners to facilitate the use of the AAC system at home and in the community. The SLP is an important member of multidisciplinary teams which include the patient and family members and may include physiotherapists, occupational therapists, physicians, and other professionals.

AAC (Alternative and Augmentative Communication) – Child

What is AAC (Alternative and Augmentative Communication)?

AAC means Augmentative and Alternative Communication. Although not a disorder, AAC is used by many individuals who are unable to speak or have severe difficulty communicating with others. AAC can supplement or replace speech, writing, or nonverbal communication in individuals who have severe speech and language problems.

Vocalization, gestures, body language and facial expressions can all be used to express basic wants and needs, but without words, interaction with others can be very difficult. In order to communicate more effectively with others, signs or pictures can be introduced to add more information so others can understand.

AAC is used by children with a wide range of speech and language impairments, such as cerebral palsy, developmental delays, or autism. The goal initially will be to help the child communicate thoughts, ideas, and wishes with family members and friends. AAC will also help the child communicate with new or unfamiliar communication partners. AAC can not only improve communication but also participation in home and community life.

There are a wide variety of AAC options. Sign language is one option. The advantage of sign language is that there is no need for external tools or equipment, but communication partners have to know sign language. Some children require the use of external tools or equipment such as objects, pictures, visual schedules, communication books or boards, or voice output communication aids (VOCAS). VOCAS can be low-tech, such as single-switch devices, or high-tech devices with dynamic screen displays.

For some children, AAC can be a permanent replacement or supplement to spoken output. For others, it may be a bridge to developing functional speech. When using AAC to support the child’s communication, the goal is to increase social interaction with family and friends. When a child is unable to communicate thoughts, wishes, ideas and needs, social isolation, frustration, or challenging behaviours frequently occur. By promoting functional communication, the child will have more positive experiences with family and friends which in turn will encourage participation in school and promote literacy and academic success.

Although parents and caregivers are concerned that AAC will interfere with spoken output, research has shown that the use of AAC does not interfere with the development of spoken language.

What can professionals do to help?

Many children requiring AAC have complex developmental or neurological needs requiring the expertise of a team of professionals. The speech-language pathologist (SLP) is an important member of a multidisciplinary team including parents, physiotherapists, occupational therapists, educators, physicians, and other professionals. For school-aged children, the teachers and support staff are also important members.

The SLP will observe the child’s interactions with communication partners and determine the need for AAC by assessing the child’s language and communication skills. In consultation with other team members, the SLP will recommend the best system to promote the child’s communication now and in the future based on the child’s abilities and communication needs. The SLP will develop an intervention program to help the child learn and use the AAC system and train communication partners to help the child communicate throughout the day.

Accent Modification/Accent Reduction

What is Accent Modification/Accent Reduction?

Although accents are not a disorder, accent modification or accent reduction, which refers to teaching clients to speak with standard Canadian or American accents, is within the scope of practice of speech-language pathologists.

What can professionals do to help?

Speech-language pathologists (SLPs) have training in phonetics, phonology (sound patterns), and prosody (rhythm and stress or “melodies”) of language. SLPs also have extensive training and experience in teaching specific articulation of speech sounds and patterns. Some private practice SLPs offer accent modification or accent training services whereby they systematically analyze the speech of a client with a foreign or regional accent, and then instruct them in the production of a standard Canadian or American accent.

Alzheimer’s Disease

What is Alzheimer’s Disease?

Alzheimer’s disease is the most common form of dementia and is caused by plaques (deposits of protein fragments) in the brain. Dementia is an acquired progressive condition that affects many areas of cognitive function and has a major impact on communication skills.

What can professionals do to help?

For more information, please see our information on Dementia in this Disorders section of our website.


What is Aphasia?

Aphasia is a disorder caused by damage to the parts of the brain that contribute to the understanding or use of language. Aphasia usually occurs in adults who have had a stroke, a brain tumor, infection, brain injury or dementia. Someone with aphasia may find it hard to talk, understand spoken words, and/or read and write. The type or severity of the communication problem will depend on the part of the brain that is damaged and how much damage has occurred.

What can professionals do to help?

Speech-language pathologists (SLP) first assess to determine areas of strength and difficulties, then develop an intervention plan to improve listening, talking, reading and writing skills based on the needs of the individual. SLPs also work with the person’s family and friends to help them understand the nature of the language problems and educate them in ways to help the person with aphasia develop and use their communication skills.

Adults with aphasia often have difficulty dealing with the social and emotional issues that can occur when they lose their ability to communicate as they have in the past. SLPs often lead group therapy sessions to practice conversational skills with other persons with aphasia. These sessions provide support and encouragement to these adults.
Audiologists can assess the hearing of persons with aphasia to ensure that hearing loss or impairment is not a complication. If needed, the audiologist will help with hearing aids and aural rehabilitation to support the person’s ability to communicate.



What is Apraxia/Dyspraxia?

Apraxia is a general term that describes difficulties moving parts of the body. Apraxia of speech (AOS), sometimes called Acquired AOS to distinguish it from Childhood Apraxia of Speech, is a neurological disorder that may develop as a result of a stroke or a brain injury. In AOS, the injury happens to the part of the brain that is responsible for controlling the motor movements specifically needed to produce speech, despite the fact that the muscles themselves are still working. Pure AOS is rare and it often co-occurs with aphasia, which can result in additional speech andlanguage difficulties. AOS affects the person’s ability to purposefully produce speech sounds and may affect the rhythm and rate of speech.

People with AOS know exactly what they want to say, but the brain does not send out clear messages to the muscles in the mouth so the wrong word or a made-up word may result. This can make communication very difficult and lead to frustration. The person with AOS may be able to produce non-speech movements like spontaneously blowing out a match, coughing or whistling, but be unable to do so when asked or on command.

What can professionals do to help?

A speech-language pathologist (SLP) will assess the person with suspected apraxia to rule out difficulties with swallowing, muscle weakness or muscle control for speech, and language. The SLP will check speech sound production skills as well as determine the severity of the problem. An SLP will work with a person with apraxia to help them re-program how they make speech sounds and retrain brain pathways for sound sequences and word production. SLPs help individuals adjust their speech rate to allow more time for the motor pathways that translate thoughts into speech to be re-established. The SLP will also provide information and strategies to help reduce frustration and promote improved communication.

For more information

Articulation of Speech/Speech Sound Disorder

What is Articulation of Speech/Speech Sound Disorder?

Speech sound disorders refer to difficulties a person may have producing specific sounds of speech (articulation of speech) and/or speech sound patterns (phonological disorders). When a child does not say speech sounds at an expected age, he/she is said to have speech sound delay. Typically, children produce the sounds first that are easiest to see and say, then move on to making more difficult sounds:

  • By 2-3 years of age: p, b, m, h, w, and n;
  • By 3-4 years of age: k, g, t, d, and f;
  • By 6 years of age: y, l, sh, ch, v, and blends (st, pl, gr, etc);
  • By 8 years of age: s, z, j, th, and r.

Typical children will make mistakes as they learn to say and use sounds and sound patterns, for example “wun” for ‘run’ or “gog” for ‘dog’. Most children correct their speech and will sound almost like an adult by the age of 8. When children do not correct their mistakes, leave out sounds in words, substitute one sound for another, or make the sounds incorrectly (a ‘th’ sound for ‘s’ for example), they will be difficult to understand and may be frustrated as they try to communicate.

What can professionals do to help?

A speech-language pathologist (SLP) will provide a complete speech evaluation which helps determine appropriate treatment. As needed, the SLP will also make referrals to other health professionals, consult with medical, school, or behaviour teams, and provide treatment strategies and counseling to parents and caregivers.

A child with speech sound disorder or delay may be referred to an audiologist for a hearing screening or other testing. The audiologist can determine if the child’s hearing is affecting his/her ability to hear speech sounds clearly.

Autism Spectrum Disorders (ASD)

What is Autism Spectrum Disorders (ASD)?

Autism Spectrum Disorder or ASD is a complex developmental disorder that affects a child’s development. Characteristics of ASD include difficulty with developing social communication and social interaction skills, particularly in understanding and using nonverbal communication. Persons with ASD also exhibit restricted and repetitive behaviours and interests. ASD affects 1 in 68 children and is more common in boys than girls.

What can professionals do to help?

Speech-language pathologists (SLPs) are experts in communication development. SLPs are able to accurately assess the key areas of development affected by ASD; nonverbal communication skills such as joint attention, verbal communication skills, social development including emotion sharing, imitation, and play skills. Based on the assessment, SLPs work with parents to put together intervention goals and strategies to address areas of concern. SLPs work with parents in the home and with community professionals, such as daycare or preschool personnel, to facilitate learning across all environments. SLPs work jointly with other professionals, such as behaviour intervention teams, to coordinate services which best meet the needs of all areas of a child’s development. SLPs use a variety of intervention approaches that are evidence-based.