oa Editorial [Hot Topic: Auditory Processing Disorder (Guest Editors: Vasiliki Maria Iliadou)]

When a child is having difficulty listening in noisy situations e.g. classroom, a hearing test should be considered as a first diagnostic step. If however, the hearing test is normal and the symptom persists, the pediatrician should consider requesting an auditory processing assessment. Hearing loss in childhood is known to interfere with communication, learning, language acquisition, social life and academic achievements. Similarly Auditory Processing Disorder (APD) may affect a child's ability to communicate, normally acquire reading skills and it may interfere with social life and academic achievements. An estimated 5% of school aged children may be affected by the disorder, which in many cases remains undiagnosed. This is a monothematic issue on pediatric (Central) Auditory Processing Disorder (APD or CAPD). The word monothematic is compound and of Greek origin, “mono” meaning only one and “thematic” meaning topic. It focuses on raising awareness of this disorder and providing evidence and data on speech perception in noise, comorbidity of APD and reading disabilities (Dyslexia), the neural substrate of the disorder and objective biological measures as a supplement for assessment and monitoring of management outcome. The aim is to provide a well-structured overview of presenting symptomatology, comorbidity and neurobiological origin. It should be noted that APD is too complex for all its features and controversies to be presented in a single issue. Nevertheless, authors in this issue are presenting this disorder mainly from the clinician's point of view largely incorporating current research. The core deficit in APD is difficulty perceiving speech in noise in the presence of a normal hearing test (audiogram). A key point to be remembered by the general practice pediatrician is as Bantwal & Hall state “A normal audiogram does not rule out a hearing deficit. Indeed, we really hear with our brains, not our ears”. Both parental and child's concern about hearing should be adequately addressed. Diagnosis of normal hearing sensitivity does not exclude the possibility of APD being present. As a result of this core deficit a child's ability to communicate and learn may be impaired and comorbidity with reading disabilities may present. These impairments have been shown to be associated with anxiety, low self-esteem and difficulty in acquiring friends as possible presenting psychosocial problems and may ultimately lead to academic failure. 30-50% of children with reading disabilities and/or learning disorders present with APD. Causality of this comorbidity is not conclusively defined at the present time. In this issue, preliminary results by Veuillet, Bouilhol & Thai-Van, are presented showing on one end differences in developmental trajectories of auditory descending pathway function between normal reading and dyslexic children and on the other end deficient high level process. Hearing is a sensation requiring bottom-up functionality, which is information conveyed and decoded from the peripheral auditory organ to the central auditory nervous system and the brain cortex. However, cognitive elements play a significant role accelerating information processing and this is denoted as top-down functionality. Top-down and bottom-up functioning in the auditory system are synergistically processing information accomplishing auditory perception. Even though this mentioned relation exists, yet “Too rarely to this day, health professionals faced with children with learning difficulties ask whether an APD is present” as noted in the conclusion paragraph of Veuillet et al.....