Auditory Processing Disorders: An Update for Speech-Language Pathologists

There is a history of debate and controversy about the assessment and intervention of children diagnosed with auditory processing disorder (APD). Professionals in communication sciences and disorders view APD from different perspectives. Speech-language pathologists (SLPs) tend to view APD from the language and literacy perspective, or a top-down model, whereas audiologists tend to view APD from an auditory perception perspective, or a bottom-up model. Professionals who assess and treat children with APD need to bridge the gap and merge their different perspectives to plan effective intervention for children with APD. A panel of audiologists who demonstrated expertise in the area of Central Auditory Processing Disorders (CAPDs) developed The American Speech-Language-Hearing Association's (ASHA's) technical report on APDs (ASHA, 2005). This report was approved by ASHA's Executive board in 2005. In this report, central auditory processing refers to the efficiency and effectiveness by which the central nervous system uses auditory information. Central auditory processing includes the auditory mechanisms underlying the skills of sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination, temporal ordering, and temporal masking; auditory performance in competing acoustic signals; and auditory performance with degraded acoustic signals (ASHA, 1996; Bellis, 2003; Chermak & Musiek, 1997; Jerger, 2009). A CAPD is a deficit in processing auditory input that is not due to higher-order language, cognitive, or related factors (Musiek, Bellis, & Chermak, 2005; Musiek & Chermak, 2007). However, children diagnosed with CAPD may experience difficulties in academic learning, speech, language, social skills, and literacy (e.g., encoding, decoding, reading comprehension, reading fluency, and written language).

Introduction Mismatch negativity (MMN) represents a negative component of event-related potentials, which is mentioned by guidelines as an important tool to provide measurable data regarding the functionality of the auditory system in acoustic processing. However, the literature still lacks reliable data that can support the clinical use of this potential in the complementary diagnosis of central auditory processing (CAP) disorder (CAPD).Objectives To analyze whether MMN assessment might be associated with the CAP behavioral test battery, as well as to assess the effects of auditory ability deficits on MMN responses in the pediatric population.Methods In total, 45 age-matched children participated in the study. They were submitted to the CAP behavior assessment and to MMN. The children were tested with a combination of speech contrast consisting of acoustic syllables [da] versus [ta], governed by the oddball paradigm.Results Mismatch negativity did not show a direct association with a single test but with the combination of the four tests used as a behavioral test battery to identify CAPD. The results also indicated that the auditory ability deficits influenced the measurement of MMN latency (p = 0.003*), but not the amplitude (p = 0.857) or the area (p = 0.577).Conclusion Mismatch negativity was shown to be statistically associated with the battery of tests used to identify deficits in auditory abilities in the studied sample rather than with a single behavioral test. The deficits in auditory abilities were observed in the MMN latency. Mismatch negativity can be used to assess children with CAPD.

Redefining Auditory Processing Disorder: A Speech-Language Pathologist’s Perspective

You have accessThe ASHA LeaderFeature1 Apr 2011Auditory Remediation for Patients With Landau-Kleffner Syndrome Annette HurleyPhD, CCC-A Annette Hurley Google Scholar More articles by this author , PhD, CCC-A https://doi.org/10.1044/leader.FTR5.16042011.5 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In http://www.asha.org/Publications/leader/2011/110405/Auditory-Remediation-for-Patients-With-Landau-Kleffner-Syndrome.htm Landau-Kleffner syndrome (LKS) is a rare neurological disorder that affects children and is characterized by aphasia that can develop suddenly or over a period of time. Often the deterioration in language is rapid, but it also may decline over several months (Miller et al, 1984). Although there is a body of evidence to support medical treatment for LKS, there is limited information about the clinical management for the language disorder or acquired (central) auditory processing disorder [(C)APD]. The prognosis of a child with LKS is unpredictable due to variability in the time and amount of recovery and the severity of the disorder. Speech-language pathologists are often challenged with the task of maximizing language recovery. Treatment techniques have relied on visual aids such as graphic symbols and visual language systems, as well as cued speech (for a review of language treatment options, see Alpern, 2010). Thomas Gibson listens to dichotic sentences during his treatment session with SLP Kristen Beckner. It also is important for clinicians to recognize auditory processing deficits associated with the acquired (C)APD that results from LKS and to offer a deficit-specific remediation plan to improve the patient’s auditory processing ability. Previous reports of auditory processing deficits in LKS patients have cited difficulty listening in background noise or other degraded environments, challenges with auditory discrimination, and problems with dichotic listening tasks (Bamiou, Musiek, & Luxon, 2001). An assistive listening device such as an FM system may be useful to improve the signal-to-noise ratio. Speech-in-noise training may also improve the patient’s listening ability. Dichotic listening treatment is one type of direct remediation for (C)APD that takes advantage of the brain’s lifelong capacity for plasticity and adaptive reorganization (Musiek, Chermak, & Weihing, 2007). LKS patients have an abnormal electroencephalogram (EEG) typified by abnormal spike activity in the temporal and/or parietal regions (Deonna, Beaumanoir, Gaillard, & Assal, 1991). The abnormal EEG activity occurs predominantly in the left temporal lobe, but may be present in both temporal lobes (Deonna et al., 1991). From anatomical and physiologic dichotic listening modeling, it is reasonable that the only way to isolate the damaged auditory pathway is to force this auditory pathway to work by direct auditory stimulation—dichotic listening. In normal listening conditions, auditory information is conducted to the auditory cortex by both ipsilateral and contralateral auditory pathways; however, during controlled dichotic listening, the ipsilateral pathway is suppressed by the dominant contralateral pathway. This dominant contralateral model was first proposed by Kimura (1961), whose data led her to hypothesize that the contralateral pathway must have greater neuronal innervation that enables it to be dominant over the ipsilateral pathway. Early work in the 19th century noted that most aphasia is the result of lesions in the left cerebral hemisphere, leading to the conclusion that most people are left-hemisphere-dominant for expressive and receptive language. Further, a language-related auditory signal presented to the right ear travels from the dominant contralateral right auditory pathway directly to the left hemisphere. Conversely, a language-related auditory signal directed to the left ear is conducted to the right cortex, but must be transferred to the left hemisphere via corpus callosum in order for the person to repeat what was heard in the left ear. Thus, it is not surprising that there is a slight right-ear advantage for neurologically normal listeners when listening to dichotic tasks (Kimura, 1961; Lowe, Cullen, Berlin, Thompson, & Willett, 1970; Berlin, Lowe-Bell, Cullen & Thompson, 1973). When there is damage or a lesion in the auditory temporal lobe, the ear contralateral to the lesion will be affected in dichotic listening tasks, as the contralateral pathway is the dominant pathway. Because lesions often are found in the left temporal lobe in LKS patients, a right-ear deficit on dichotic testing is expected. Dichotic listening training is an innovative treatment for the remediation of the compromised central auditory pathway (Musiek et al., 2007). Dichotic interaural intensity difference (DIID) training uses dichotic listening tasks in which the signal intensity presented to the unimpaired pathway is first decreased and then slowly increased over time as the weaker, impaired pathway grows stronger. DIID training purports to target the deficit ear specifically, thus activating brain regions that receive auditory sensory input on the side of the lesion. Previous investigations have shown behavioral and electrophysiological evidence of improvement of the central auditory nervous system after DIID training (Musiek, Baran, & Shinn, 2004; Hurley & Billiet, 2007; for a complete review of the DIID procedure, see Musiek et al., 2007). Improvement after auditory rehabilitative dichotic listening in dichotic scores and language scores also were shown in a group of children with language disorders. Until recently, dichotic listening programs could be completed only in a controlled laboratory environment; now dichotic stimuli are available on compact discs. Dichotic exercises directly stimulate areas of the cortex, which in turn forces the auditory pathways to these areas to exercise and recruit existing neuronal connections or build new neural connections and pathways. As the integrity of these areas pathways is improved, speech stimuli can reach the language processing temporal lobe more efficiently, resulting in improvement of dichotic skills. Dichotic Training: Case Studies Two patients participated in dichotic listening training. “Michael” participated in dichotic listening therapy for two clinic semesters. “Thomas” lives in another state and participated in dichotic listening therapy with his speech-language pathologist. In dichotic training, stimuli are presented at different interaural intensities with a higher intensity directed to the poorer (dichotic scoring) and lower intensity directed to better (dichotic scoring) ear. Initial presentation level is at a comfortable level to the poorer scoring ear, and a soft level to the better (dichotic scoring) ear. When the individual’s target ear’s score reaches >70%, the intensity level delivered to the poorer ear is increased by 1, 2, or 5 dB. This continues until there are equal intensities presented to both ears. Because of the limited amount of dichotic listening materials, available, new recordings of digits, words, sentences, CVs and short stories were created and used in the training sessions. Case One: Michael Michael was the product of a normal pregnancy and birth. All developmental milestones were developing appropriately until the age of three. At that time, Michael’s speech and language skills began to decline. Initially, this decline in speech and language was attributed to sibling jealousy as this decline coincided with the birth of a younger sibling. Michael was sent for a hearing evaluation which established normal peripheral hearing. As Michael had a history of otitis media, the lack of progression in speech and language was next related to his history of ear infections. Subsequently, autism and pervasive developmental disorder were also erroneously diagnosed. With the onset of seizure activity at the age of three and a half years, the diagnosis of LKS was made after a characteristic spiking EEG. Nocturnal seizure activity continued until Michael was eleven years old, even though anticonvulsants were prescribed. At age 11, Michael had his first normal EEG. Our involvement with Michael began when he was 12.5 years old, as he was a subject in a study examining pre and post behavioral and electrophysiological measures after Fast ForWord® training, provided by Michael’s local school system. Approximately four weeks after Michael completed the Fast ForWord® program, Dichotic listening therapy began weekly for a total of twenty one hour dichotic listening training sessions. Post-testing showed improvement in dichotic scores after dichotic listening training, as well as improvements in electrophysiologic responses (auditory late response). In addition, unsolicited parental reports were positive. Extended family member, as well as Michael’s teachers, commented that his speech was improving and that he was speaking in complete sentences and thoughts, rather than in a telegraphic-type speech. They also reported that he rarely used signs. This cannot be validated, as we did not measure pre and post mean length utterance. Case Two: Thomas Thomas was the product of a normal pregnancy and birth history was normal. Gross motor development milestones were achieved at appropriate times. At age 3, Thomas had a speech-language evaluation to address articulation concerns. This assessment yielded normal results. Sleep concerns were noted as early as age 3 ½; at age 5 ½, a tonsillectomy/ adenoidectomy was performed for sleep apnea. Early behavioral, attention, language and hearing were first noted when Thomas was in pre-school. A speech-language assessment at that time (age 6.25) indicated a severe receptive language delay. Language regression and concerns continued over the next few years. Thomas had an abnormal EEG at age 8 years, 2 months indicated bilateral abnormalities, but left temporal lobe activity greater on the left side. Approximately six months later, an EEG indicated abnormalities on the right side, as well. Thomas is currently managed medically for his abnormal nocturnal EEG. In July, 2009, Thomas was formally diagnosed with Landau-Kleffner Syndrome (LKS). Thomas began dichotic listening in October, 2009. He was seen at the LSU Health Sciences Center in July, 2010. Because of the geographical distance, Thomas has been working with his speech language pathologist on dichotic listening via recorded compact discs. Training began 20 minutes, twice per week, and is now listening weekly. Although we do not have comprehensive pre and post (C)APD test results, we have dichotic test scores from an assessment in July, 2009. Scores previously abnormal are now within normal limits. Reference Alpern C. A. (2010). Identification and Treatment of Landau-Kleffner Syndrome. ASHA Leader, September 21, 34–35. Google Scholar Bamiou D. E., Musiek F. M., & Luxon L. M. (2001). Aetiology and clinical presentations of auditory processing disorders—a review.Archives of Disease in Children, 85, 361–365. Google Scholar Berlin C. I., Lowe-Bell S. S., Culen J. K., & Thompson C. L. (1973). Dichotic speech perception: an interpretation of right-ear advantage and temporal offset effects.Journal of the Acoustical Society of America, 53, 699–709. Google Scholar Berlin C. I., Lowe-Bell S. S., Jannetta P. J., & Kline D. G. (1972). Central auditory deficits after temporal lobectomy.Archives of Otolaryngology, 96, 4–10. Google Scholar Deonna T., Beaumanoir A., Gaillard F., Assal G. (1977). Acquired aphasia in childhood with seizure disorder: a heterogeneous syndrome.Neuropadiatrie, 8, 263–273. Google Scholar Hurley A., & Billiet C. (2009). Dichotic interaural intensity difference (DIID) training; auditory remediation after CVA.Poster Presentation at the annual ASHA Convention, Chicago, IL. Google Scholar Kimura D. (1961). Cerebral dominance and the perception of verbal stimuli.Canadian Journal of Psychology, 15, 166–171. CrossrefGoogle Scholar Lowe S. S., Cullen J. K., Berlin C. I., Thompson C. L., & Willett M. E. (1970). Perception of simultaneous dichotic and monotic monosyllables.Journal of Speech and Hearing Research, 13, 812–822. LinkGoogle Scholar Miller J. F., Campbell T. F., Chapman R. S., & Weismer S. E. (1984). Language behavior in acquired childhood aphasia.In Holland A. (Ed.), Language disorders in childhood: Recent advances (pp. 57–99). San Diego: College Hill Press. Google Scholar Musiek F. E., Chermak G., & Weihing J. (2007). Auditory training.In In. Musiek F.E. and Chermak G. D. (Eds.), Handbook of (Central) Auditory Processing Disorder: Comprehensive Intervention, (Vol II, pp. 77-106). San Diego: Plural Publishing, 2007. Google Scholar Musiek F. E., Baran J. A., & Shinn J. (2004). Assessment and remediation of an auditory processing disorder associated with head trauma.Journal of the American Academy of Audiology, 15, 117–132. CrossrefGoogle Scholar Author Notes is an assistant professor in the Department of Communication Sciences at Louisiana State University Health Sciences Center in New Orleans, La. Contact her at [email protected]. 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To consider whether auditory processing disorder (APD) is truly a distinct clinical entity or whether auditory problems are more appropriately viewed as a processing deficit that may occur with various developmental disorders. Theoretical and clinical factors associated with APD are critically evaluated. There are compelling theoretical and clinical reasons to question whether APD is in fact a distinct clinical entity. Not only is there little evidence that auditory perceptual impairments are a significant risk factor for language and academic performance (e.g., Hazan, Messaoud-Galusi, Rosan, Nouwens, & Shakespeare, 2009; Watson & Kidd, 2009), there is also no evidence that auditory interventions provide any unique benefit to auditory, language, or academic outcomes (Fey et al., 2011). Because there is no evidence that auditory interventions provide any unique therapeutic benefit (Fey et al., 2011), clinicians should treat children who have been diagnosed with APD the same way they treat children who have been diagnosed with language and learning disabilities. The theoretical and clinical problems associated with APD should encourage clinicians to consider viewing auditory deficits as a processing deficit that may occur with common developmental language and reading disabilities rather than as a distinct clinical entity.

Although central auditory processing disorder (CAPD) test battery performance has been examined in adults with neurologic lesions of the central auditory nervous system (CANS), similar data on children being referred for CAPD evaluations are sparse. This study characterizes CAPD test battery performance in children using tests commonly administered to diagnose the disorder. Specifically, this study describes failure rates for various test combinations, relationships between CAPD tests used in the battery, and the influence of cognitive function on CAPD test performance and CAPD diagnosis. A comparison is also made between the performance of children with CAPD and data from patients with neurologic lesions of the CANS. A retrospective study. Fifty-six pediatric patients were referred for CAPD testing. Participants were administered four CAPD tests, including frequency patterns (FP), low-pass filtered speech (LPFS), dichotic digits (DD), and competing sentences (CS). In addition, they were given the Wechsler Intelligence Scale for Children (WISC). Descriptive analyses examined the failure rates of various test combinations, as well as how often children with CAPD failed certain combinations when compared with adults with CANS lesions. A principal components analysis was performed to examine interrelationships between tests. Correlations and regressions were conducted to determine the relationship between CAPD test performance and the WISC. Results showed that the FP and LPFS tests were most commonly failed by children with CAPD. Two-test combinations that included one or both of these two tests and excluded DD tended to be failed more often. Including the DD and CS test in a battery benefited specificity. Tests thought to measure interhemispheric transfer tended to be correlated. Compared with adult patients with neurologic lesions, children with CAPD tended to fail LPFS more frequently and DD less frequently. Both groups failed FP with relatively equal frequency. The two-test combination that showed the highest failure rate for children with CAPD was LPFS-FP. Comparison with adults with CANS lesions, however, suggests that the mechanisms underlying LPFS performance in children need to be better understood. The two-test combination that showed the next highest failure rates among children with CAPD and did not include LPFS was CS-FP. If it is desirable to use a dichotic measure that has a lower linguistic load than CS then DD can be substituted for CS despite the slightly lower failure rate of the DD-FP battery.

One important type of speech sound disorders is articulation and phonological disorders that affect children of age between 2-8 years. All normally developing children follow a unique developmental timetable, table 1 in which they acquire articulation and phonological skills to correctly pronounce both consonants and vowels to make the sound patterns of their respective language. Previous statistics, table 2 show that the number of Arab children, in the age group 2-8 years, who suffer from articulation and phonological disorders, is significant. To be able to test, assess, and evaluate the effect of therapy on these disorders, there is need to conduct research and development that would culminate in the availability of speedy, versatile and interesting computerized tools for use by Speech and Language Therapist, SLPs in standardized test, assessment, and evaluation of articulation and phonology disorders among the children, figure 1. There are prerequisites to the development of these tools such as the development of a suitable phonetic and phonological vocabulary (see table 3) of Modern Standard Arabic, MSA that is spoken by such children and which will meet the test and assessment requirements for speech disorders. The vocabulary could then be used to create a speech corpus for children with normal speech who are in the same age group as the children with disordered speech. Such speech corpus could then be used as a frame of reference to set the standards and norms for children speech. The standards and norms can be used by SLPs to compare normal children against children suspected of having the disorder. The speech corpus could also be used by researchers to develop limited vocabulary, speaker-independent phonetic speech recognizers that would help SLPs during speech therapy and evaluation. To meet the ultimate goal of finally producing efficient and versatile computerized tools to assist SLPs in their mundane tasks of handling articulation and phonological deficits among children in an efficient manner, we envisage a project with the following objectives in mind: 1) develop a comprehensive articulation and phonology vocabulary that represent all the sounds of MSA spoken by the children in all their important articulation and phonological contexts, and 2) use the vocabulary to create a norm speech corpus that represent the articulation of all sounds for children with healthy speech production. The corpus should include significant quantities of speaker-dependent data for a significant number of children with normal speech and would be segmented, labeled and transcribed according to the standards used for such tasks. The development of test and assessment vocabulary and the creation of the speech corpus from such vocabulary are the prerequisites for any investigation on articulation and phonology disorders. Firstly they would help the research community to study the disorders and secondly, after the development of suitable computerized tools, they assist the SLPs to test, assess, and evaluate the effect of treatment for articulation and phonological disorders among children. In this article, we present the status of the research and outline a roadmap to achieve our objectives and ultimate goal.

No AccessPerspectives on Hearing and Hearing Disorders in ChildhoodArticle1 Oct 2002Interpreting Central Auditory Test Results: Implications for Management Jeanane M. Ferre Jeanane M. Ferre Private Practice, Oak Park, IL Google Scholar More articles by this author https://doi.org/10.1044/hhdc12.3.9 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationTrack Citations ShareFacebookTwitterLinked In References ASHA (1996). Central auditory processing: Current status of research and implications for clinical practice..American Journal of Audiology, 5 (2),41–54. Google Scholar Bellis, T. J. (1996). Assessment and management of central auditory processing disorders in the educational setting: From science to practice.: San Diego, CA: Singular Publishing Group. Google Scholar Bellis, T. J., & Ferre, J. M. (1999). Multidimensional approach to differential diagnosis of central auditory processing disorders in children..Journal of the American Academy of Audiology, 10 (6), 319–328. Google Scholar Cognitive (1997). Earobics—Auditory development and phonics program.: Evanston, IL: Cognitive Concepts. Google Scholar Cognitive Concepts (1998). Earobics— Step two auditory development and phonics program.: Evanston, IL: Cognitive Concepts. Google Scholar Ferre, J. M. (1997). Processing power: A guide to capd assessment and management.: San Antonio, TX: The Psychological Corporation. Google Scholar Ferre, J. M. (1998) The M3 model for treating CAPD..M. G. Masters, N. A.. Stecker, & J. Katz (Eds.), Central auditory processing disorders: Mostly management (pp. 103–115). Boston, MA: Allyn & Bacon. Google Scholar FerreJ. M. (2002a). Behavioral therapeutic approaches for central auditory problems..J. Katz (Ed.), Handbook of clinical audiology (5th ed., pp. 525–531). Philadelphia: Lippincott Williams & Wilkins. Google Scholar Ferre, J. M. (2002b, in press). Managing children’s central auditory processing deficits in the real world: what teachers and parents want to know..Seminars in Hearing. Google Scholar Ferre, J. M., & Wilber, L. A. (1986). Normal and learning disabled children’s central auditory processing skill: An experimental test battery..Ear and Hearing, 7 (5), 336–343. Google Scholar Jerger, J., & Musiek, F. (2000). Report on the consensus conference on the diagnosis of auditory processing disorders in school-age children..Journal of the American Academy of Audiology, 11 (9), 467–474. Google Scholar Jerger, S.,Martin, R. C., & Jerger, J. (1987). Specific auditory perceptual dysfunction in a learning disabled child..Ear and Hearing, 8 (2), 78–86. Google Scholar Katz, J. (1968). The SSW test: An interim report..Journal of Speech and Hearing Disorders, 33, 137–146. Google Scholar Keith, R. W. (2000). SCAN-C: Test for Auditory Processing Disorders in Children-Revised.: San Antonio, TX: The Psychological Corporation. Google Scholar Medwetsky, L. (2002). Central auditory processing testing: A battery approach..J. Katz (Ed.), Handbook of clinical audiology (5th ed., pp. 510-524). Philadelphia, PA: Lippincott, Williams & Wilkins. Google Scholar Musiek, F. E. (1983). Assessment of central auditory dysfunction: The dichotic digits test revisited..Ear and Hearing, 4 (2), 79–83. Google Scholar Pinheiro, M. L. (1977). Tests of central auditory function in children with learning disabilities..R. W. Keith (Ed.), Central auditory dysfunction (pp. 223–256). New York: Grune & Stratton. Google Scholar Scientific Learning Corporation. (1997). Fast ForWord training program for children. Procedure manual for professionals.: Berkeley, CA: Scientific Learning Corporation. Google Scholar Sloan, C. (1986). Treating auditory processing difficulties in children.: San Diego, CA: Singular Publishing Group. Google Scholar Tallal, P., & Piercy, M. (1974). Developmental aphasia: The perception of brief vowels and extended consonants..Neuropsychologia, 13, 69–74. Google Scholar Tillery, K. L.,Katz, J., & Keller, W. D. (2000) Effects of methylphenidate (Ritalin) on auditory performance in children with attention and auditory processing disorders..Journal of Speech Language Hearing Research, 43 (, 43 (4), 893–901. Google Scholar Willeford, J. (1977). Assessing central auditory behavior in children: A test battery approach..R. W. Keith (Ed.), Central auditory dysfunction (pp. 43–68). New York: Grune & Stratton. Google Scholar Willeford, J. (1980). Central auditory behaviors in learning disabled children..Seminars in Speech Language and Hearing, 1, 127–140. Google Scholar Additional Resources FiguresReferencesRelatedDetails Volume 12Issue 3October 2002Pages: 9-14 Get Permissions Add to your Mendeley library History Published in issue: Oct 1, 2002 Metrics Topicsasha-topicsasha-sigsasha-article-typesCopyright & Permissions© 2002 American Speech-Language-Hearing AssociationPDF downloadLoading ...

The long latency auditory evoked responses (LLAERs), originating in the auditory cortex, are often considered a biomarker for maturity in the central auditory system and may therefore be useful in the evaluation of children with central auditory processing disorder (CAPD). However, the characteristics of the LLAERs elicited in this population have not been widely described, and clinical applications remain unclear. The goal of this scoping review was to investigate if LLAERs can be used to identify children with CAPD. A systematic search strategy was used to identify studies that analyzed the latencies and amplitudes of P1, N1, P2, and N2 waveforms of the LLAERs. The online databases, including Embase, Web of Science, MEDLINE, PubMed, ProQuest, and CINAHL, as well as the gray literature were searched for papers published in English and French between January 1980 and May 2021. Seventeen papers met the eligibility criteria and were included in the study. Four papers had pre- and posttraining study designs, and the remaining studies were cross-sectional. Several studies reported significant differences in LLAERs between children with CAPD and their normal-hearing peers, and the results tended toward longer latencies and smaller amplitudes regardless of LLAER waves considered. N1 and/or N2 results were most likely to reveal significant differences between children with CAPD and normal-hearing controls and could potentially be considered a biomarker for CAPD. It seems that LLAER assessments, especially waves N1 and N2, might assist in better identification of CAPD children. However, considering heterogeneity in the methodology among the included studies, the results should be interpreted with caution. Well-designed studies on children with confirmed CAPD using standard diagnostic and assessment protocols are suggested.

Background: Subjects with (central) auditory processing disorder (C)APD may manifest a range of complaints including difficulty in spee­ch perception in noise, following directions, and discrimination of similar speech sounds. Other disorders may also have the same behavioral manifestations. The Case: Here we present an 8-year-old boy who was misdiagnosed and mismanaged as a child with learning disability. His speech, language and cognition problems at initial eva­luation included semantic problem, a short len­gth of speech, phonological sound disorder, and attention disorder. He showed abnormality in the dichotic digits test with free recall approach and monaural selective auditory attention test. Based on his performance and test results, he was suffering from (C)APD especially in dicho­tic listening and speech perception in com­petition. It was suggested that binaural hearing training with differential interaural intensity, informal localization training including loca­lization clock, and auditory training in noise be added to his classic auditory training program. Conclusion: Studying this subject was impor­tant because (C)APD diagnosis needs a team approach. Evidently, the parents, teacher and speech-language pathologist (SLP) did not seek a central auditory processing evaluations early enough but some of his behaviors could poten­tially be a red flag for (C)APD and could guide SLPs to refer him for central auditory testing. As we may not be able to evaluate central auditory processing in the early childhood, iden­tifying the possible (C)APD signs by a SLP may help them to plan a more suitable program even before reaching a definite diagnosis.

The theoretical issues surrounding central auditory processing disorders (CAPD) are reviewed here, especially with reference to the central auditory behavioral processes and the auditory test measures as prescribed in the ASHA (1996, American Journal of Audiology, 5(2), 41-54) statement on CAPD. A simplified nomenclature is recommended that directly relates process and test measure to facilitate the diagnostic process in CAPD. This new terminology closely follows the ASHA (1996, American Journal of Audiology, 5(2), 41-54) document, but provides some refinement based on recent research in CAPD. To support this recommendation, a confirmatory factor analysis (CFA) was applied to the findings of Domitz and Schow (2000, American Journal of Audiology), who proposed use of a battery of CAPD tests, the Multiple Auditory Processing Assessment (MAPA) for testing school children. The CFA was found to reinforce the four-factor model, which clearly emerged in the exploratory factor analysis of Domitz and Schow. The model was found to be reasonably consistent even when subtests from the SCAN were included in the analysis. Refinement and revision of ASHA (1996, American Journal of Audiology, 5(2), 41-54) is recommended to facilitate diagnosis, subclassification, and intervention for CAPD.

Auditory symptoms and psychological characteristics in adults with auditory processing disorders

You have accessThe ASHA LeaderFeature1 Nov 2007Auditory Processing Disorder Evaluation: Using a Reinforcement Paradigm Raymond M. Hurley Raymond M. Hurley Google Scholar https://doi.org/10.1044/leader.FTR1.12152007.5 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In 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. References 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. Google Scholar Singer J., Hurley R. M., & Preece J. (1998). Effectiveness of central auditory processing (CAP) tests with children.American Journal of Audiology, 7, 73–84. LinkGoogle Scholar Author Notes Raymond M. Hurley, is an associate professor in the Department of Communication Sciences and Disorders, University of South Florida, Tampa. Contact him at [email protected]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 12Issue 15November 2007 Get Permissions Add to your Mendeley library History Published in print: Nov 1, 2007 Metrics Downloaded 235 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2007 American Speech-Language-Hearing AssociationLoading ...

We respond to Bellis, Chermak, Weihing, and Musiek's (2012) criticisms of the evidence-based systematic review of Fey et al. (2011) on the effects of auditory training on auditory, spoken, and written language performance of children with auditory processing disorder or language impairment. In general, we argue that the conceptualizations and methods on which our review was based were well motivated, and that our original conclusions are valid given the limited evidence that is currently available from clinical studies of auditory training with school-age children with auditory processing disorder or language impairment.

An interdisciplinary research group was established to investigate current and future service provision for children with central auditory processing disorder ([C]APD) in the Republic of Ireland. The aim of Phase 1 was to identify current awareness and knowledge of (C)APD among the relevant professionals in Ireland, including level of service provision, if any, available for children with (C)APD. The aim of Phase 2 was to explore the initial steps required to develop an integrated service for children presenting with (C)APD. A quantitative design was used in Phase 1, and 520 surveys were distributed to speech and language therapists, audiologic scientists, and educational psychologists. A qualitative participative design was used in Phase 2. There was a 53% response rate to the survey. The main findings from Phase 1 were that all professional groups considered themselves to be inadequately informed and lacking in skills for (C)APD assessment or intervention. In Phase 2, 98 participants with backgrounds in speech and language therapy, audiologic science, educational psychology, and occupational therapy engaged in interdisciplinary discussions to identify the first steps required to develop a (C)APD service. All professional groups considered that they were inadequately informed about (C)APD, and the first steps required to develop services in Ireland include the promotion and development of interdisciplinary teamwork and education, a need for additional resources, a clearer understanding of the definition of (C)APD, and evidence-based assessment and management of this condition.