Speech and other central auditory processes: insights from cognitive neuroscience

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).

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.

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 ...

Objective: We wished to investigate central auditory processing in unilateral hearing loss (UHL), as little is discussed regarding its impact on auditory processing. Study design: Central auditory processing was evaluated in children with UHL using the P300 component of event related potentials. Speech and tone stimuli were used for eliciting P300 in three groups of children: group A (bilateral normal hearing children); group B (children with right UHL); and group C (children with left UHL). Results: In children with a right UHL, P300 amplitudes were significantly reduced in response to speech when compared to a tone stimulus. Comparing the speech-evoked P300 response revealed a significantly delayed latency in children with UHL compared to controls. Conclusion: Children with UHL showed central auditory processing defects that are more pronounced in children with right UHL. Speech processing is more vulnerable to the effect of UHL than simple stimuli.

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.

The purpose of this study was to quantify how the use of two different cutoff criteria affects the test failure rate and potential diagnosis of central auditory processing disorder ([C]APD) in a sample of children subjected to central auditory processing ([C]AP) assessment.Test failure rates for the central test battery (CTB) using two different cutoff criteria (1 and 2 SDs below the mean) were measured retrospectively for 98 children who completed (C)AP assessment. The rates of potential (C)APD diagnosis ranged from 86.8% [when a 1 standard deviation (SD) cutoff was used] to 66.2% (when a 2 SD cutoff was used). The current use of two different cutoffs for the CTB has a large impact on the diagnostic rate for (C)APD. These findings have clinical implications for the diagnosis of (C)APD due to the widespread use of the CTB in the United States for the assessment of (C)APD in children. Thus, it is important to create awareness among audiologists that use of the 2 SDs cutoff criterion is recommended for reducing false positives (error).

The objective of this study was to describe the auditory performance of patients deafened by meningitis in closed-set, open-set and language tests (Luria's test). Ten paediatric subjects deafened by meningitis were compared with a peer group of ten paediatric congenitally deaf subjects. All the subjects had a full insertion of a Nucleus device. Three of the subjects in each group had a longer follow-up period and were selected to perform the Luria test. The closed-set tests did not show statistically significant differences between the two groups (p < 0.21) but comparative results of open-set bisyllabic tests did show statistically significant differences (p < 0.003). It was concluded that meningitis might affect the central auditory processing and acquisition process of language. Copyright © 2009 John Wiley & Sons, Ltd.

IntroductionA number of studies have reported an association between peripheral hearing impairment, central auditory processing and Alzheimer’s disease (AD) and its preclinical stages. Both peripheral hearing impairment and central auditory...

IntroductionTraumatic brain injury can impair the central auditory pathways and auditory cortex. Hence, individuals who suffered a traumatic brain injury may be at risk of central auditory processing disorders, which can be identified with behavioral tests that assess central auditory function. ObjectiveTo characterize and compare the performance of children and adolescents with and without a history of traumatic brain injury in behavioral tests that assess central auditory processing. MethodThe sample comprised 8- to 18-year-old individuals of both sexes who suffered moderate or severe closed traumatic brain injury 3 to 24 months before their participation in the study and whose hearing thresholds were normal. These individuals were matched for sex and age with other subjects without a history of traumatic brain injury and submitted to behavioral assessment of the central auditory processing with special tests to assess hearing skills (namely, auditory closure, figure-ground, and temporal processing), selected according to their chronological age and response-ability. ResultsThe study group performed statistically worse than the comparison group in auditory closure, figure-ground in verbal dichotic listening, and temporal ordering. The central auditory processing tests with abnormal results in the comparison group were different from those in the study group. ConclusionCentral auditory processing disorders were identified in all subjects of the study group, especially involving auditory closure and temporal processing skills, in comparison with subjects without a history of traumatic brain injury.

Evaluate the effects of therapy with citalopram on the central auditory processing in the elderly measured by central auditory tests. Prospective, randomized, double-blind, placebo-controlled study. Tertiary referral center. Thirty-nine patients older than 60 years with normal hearing thresholds or symmetrical sensorineural hearing loss up to 70 dBHL, word-recognition score equal to or better than 70%, and diagnosed with central auditory processing disorders completed the study. They underwent the mini-mental state examination, as a way to screen those with the possibility of dementia; they also underwent the Beck depression inventory, for screening individuals with depression. Citalopram 20 mg/d or placebo for 6 months. The central auditory tests were applied to the selection of individuals with auditory processing disorders and repeated after 6 months' treatment. The tests were sound localization, speech in noise, dichotic digits test, pitch pattern sequence, duration pattern test, and gaps-in-noise. Comparisons of central auditory tests pre- and posttreatment in groups showed: sound localization (p = 0.022), pitch pattern sequence humming (p = 0.110), pitch pattern sequence nomination (p = 0.355), duration pattern test humming (p = 0.801), duration pattern test nomination (p = 0.614), and gaps-in-noise (p = 0.230). Dichotic tests in right and left ears respectively: speech in noise (p = 0.949; p = 0.722), dichotic digits test (p = 0.943; p = 0.513). There was no clinical effect with the use of citalopram in central auditory processing tests of the subjects.

Evaluation of central auditory processing in children with developmental dyslexia.

Children with Learning Disabilities with a positive Central Auditory Processing deficit diagnosis (CAP+); children with Learning Disabilities with a negative Central Auditory Processing diagnosis (CAP-); and children with no school problems and no difficulty with Central Auditory Processing were compared on measures of Intelligence, Language, Memory, Attention, Phonological Awareness, Reading and Spelling in order to elucidate the nature of CAP deficits. The differences found between the CAP+ and CAP- groups shed some light on the nature of a CAP deficit and the additional burden imposed on children with Learning Disabilities. The similarities raise important issues regarding remediation and assumptions regarding the effect of a CAP deficit on learning.

Objective: Peripheral hearing, central auditory processing (CAP) and cognition are all important for comprehension of speech and deteriorate with increased age. This study aimed to examine the relation between hearing impairment and cognitive impairment by assessing both peripheral hearing impairment and CAP ability.Design: Cognition was measured using the CogState Brief Battery (CSBB). Peripheral hearing was measured across eight frequencies (250 Hz–8000 Hz) using pure tone audiometry, and CAP was measured using the Listening in Spatialised Noise-Sentences test (LiSN-S) and the Dichotic Digits Test. Data were analysed using correlation and regression analyses.Study sample: Around 85 adults aged 60.33–83.08 years who attended the Melbourne Audiology clinic and had no previous diagnosis of dementia were included in the study.Results: A significant association was found between degree of peripheral hearing impairment and the cognitive skills of attention and executive function as measured by the CSBB. Additionally, CAP abilities as assessed using the LiSN-S test were significantly correlated with at least one cognitive measure.Conclusions: This study adds to the knowledge that peripheral hearing and CAP ability both share an association with cognition, specifically identifying cognitive skills and measures of “hearing” that mediate this relationship.

central auditory processing and exposure to metallic mercury. to evaluate the performance on tests of central auditory processing in adolescents exposed to metallic mercury. participants were 52 adolescents, of both genders, who presented hearing thresholds within normal limits. The study group (SG) was composed by 21 adolescents who worked on the burning of gold-mercury amalgams, on the re-burning of gold in stores that sell this metal or who lived next to gold mines or gold shops. The control group (CG) was composed by 31 adolescents who had no history of exposure to mercury. Investigation procedures included the application of a clinical, occupational and mercury exposure history questionnaire, basic audiometric assessment as well as central auditory processing tests. Statistical significant differences in the auditory processing tests of non-verbal sound sequence memory test (p = 0,001), frequency pattern test (p = 0,000), duration pattern test (p = 0,000) and SSW test in Portuguese (p = 0,006) were observed between SG and CG. adolescents exposed to metallic mercury presented a lower performance on most of the auditory processing tests when compared to those who had no history of exposure to mercury. The main deficit found in the study was related to difficulty in distinguishing successive brief sounds.

Estrogen has been identified as playing a key role in many organ systems. Recently, estrogen has been found to be produced in the human brain and is believed contribute to central auditory processing. After menopause, a low estrogen state, many women report hearing loss but demonstrate no deficits in peripheral hearing sensitivity, which support the notion that estrogen plays an effect on central auditory processing. Although animal research on estrogen and hearing loss is extensive, there is little in the literature on the human model. The aim of this study was to evaluate relationships between hormonal changes and hearing as it relates to higher auditory function in pre- and postmenopausal (Post-M) females. A prospective, group comparison study. Twenty eight women between the ages of 18 and 70 at the University of Kentucky were recruited. Participants were separated into premenopausal and peri-/Post-M groups. Participants had normal peripheral hearing sensitivity and underwent a behavioral auditory processing battery and electrophysiological evaluation. An analysis of variance was performed to address the aims of the study. Results from the study demonstrated statistically significant difference between groups, where Post-M females had difficulties in spatial hearing abilities as reflected on the Listening in Spatialized Noise Test-Sentences test. In addition, measures on the auditory brainstem response and the middle latency response reflected statistically significant differences between groups with Post-M females having longer latencies. Results from the present study demonstrated significant differences between groups, particularly listening in noise. Females who present with auditory complaints in spite of normal hearing thresholds should have a more extensive audiological evaluation to further evaluate possible central deficits.