1. An innovative approach to the remediation of Central Auditory Processing Disorder (CAPD) in children at Australian Hearing Karin Gillies 1, Sharon Cameron 2, Helen Glyde 2, Alison King 3 and Harvey Dillon 3. 1 Australian Hearing, Melbourne, Victoria, Australia 2 National Acoustic Laboratories, Macquarie University, NSW, Australia 3 Australian Hearing, Box Hill, Victoria, Australia Audiology Australia Conference, Melbourne, Australia - 2016

2. Background Home-based auditory training programs offer a convenient and cost-effective option for the remediation of specific listening deficits that come under the Central Auditory Processing Disorder (CAPD) umbrella. Two such programs are: LiSN & Learn for children with spatial processing disorder (Cameron & Dillon 2011, Cameron et al. 2012) Memory Booster for children with a verbal memory deficit (St Clair-Thompson et al 2010)

3. LiSN-S High Cue Number Memory Forward & Number Memory Reversed Screening audiometry Dichotic Digits Full LiSN-S <-1 SD Intake questionnaire Fail SPD Fail Fail LC or Pass ≥-1 SD Full audiogram Mild cond. HL Discontinue CAPD testing Goal setting (COSI-C), strategies & recommendations re L&L / FM Goal setting (COSI-C), strategies & recommendations re MB / FM Pass Fail Goal setting (COSI-C), strategies & recommendations re FM Pass Goal setting (COSI-C), strategies & recommendations re L&L / FM Goal setting (COSI-C), strategies & recommendations re MB / FM

4. Clinical population Auditory training program Number of children Age range LiSN & Learn696:0 to 13:0 Memory Booster 526:1 to 13:3

5. Methods Auditory training program Home-based training regime Remote clinical support during training Post-training evaluation LiSN & Learn 2 games a day, 5 days a week, over 10 weeks Email progress report end of 1 st, 5 th and 10 th weeks Repeat LiSN S, review COSI-C and Teacher LIFE Memory Booster 20 minutes of training a day, 5 days a week, over 8 weeks Email progress report end of 1 st, 4 th and 8 th weeks Repeat NMF/ NMR, review COSI-C and Teacher LIFE

6. L&LMB The child listens to the target sentence with competing speech at ± 90 O under headphones and selects one of 4 pictures on the screen The child is taught memory strategies and listens to the target phrase and selects from the pictures on the screen The program adapts in difficulty Rewards are incorporated into the software program

7. Results Completion of the LiSN &Learn (N=69)

8. Results Completion of the Memory Booster (N=52)

9. Results Time to complete training program Auditory training program Expected time to complete training Actual time to complete training AverageRange L&L (N=40)10 weeks20.2 weeks10.7 – 43.6 weeks MB (N=30)8 weeks16.3 weeks7.8 – 36.1 weeks

10. Results Post-training evaluation for LiSN S (N=33) Significant improvements on all spatially-separated conditions of LiSN-S (high cue SRT, spatial, total advantage; each p < 0.00001) and on low cue SRT (p < 0.0005). 27 (82%) children showed normal results on the LiSN-S test. 30 (91%) children showed an improvement on the LiSN S test. 30 (91%) children reported real-life improvement on the COSI-C. 15 LIFE questionnaires were returned. The mean score was 19 (range -1 to 35).

11. Results Post-training evaluation for NMF/ NMR (N=30) Significant improvement on both mean scaled score of NMF (n=17*, p=0.003) and NMR (n=18*, p=0.002). 11 children (65%) were within the normal range and 14 children (82%) showed improvement post-training on the NMF. 11 children (61%) were within the normal range and 14 children (78%) showed improvement post-training on the NMR. 22 out of 26 children (85%) reported real life improvements on the COSI-C. 12 LIFE questionnaires were returned. The mean score was 15 (range -2 to 32). * results incl. only for children who failed that test pre-training

12. Summary Post-training evaluation showed significant improvement on diagnostic assessment results and on real life outcomes measures. Of the children who undertook to complete a home- based auditory training program, 60% completed their program. A small number of children abandoned training because of technical, family or health issues. Outcomes could not be verified for all families.

13. Conclusions Home-based auditory training programs can be an effective option for the remediation of specific listening deficits in a clinical CAPD service. Factors for successful completion of training are: o identifying and addressing technical, family or health issues that may delay or disrupt training o providing strategies to keep the child motivated to continue the training o maintaining contact with families whose children commence training

14. New developments In March 2016, LiSN & Learn was superseded by Sound Storm Sound Storm is an app for iPads that uses the same auditory training stimuli and adaptive algorithms, set in a more engaging space fantasy game

15. References Cameron, S., Glyde, H., Dillon, H., King, A., & Gillies, K. (2015). Results from a national central auditory processing disorder service: A "real world" assessment of diagnostic practices and remediation for CAPD. Seminars in Hearing, 36 (4), 216-236. Cameron, S., Glyde, H. & Dillon, H. (2012). Efficacy of the LiSN & Learn auditory training software: Randomized blinded controlled study. Audiology Research, 2:e15. Cameron, S., & Dillon, H. (2011). Development and Evaluation of the LiSN & Learn Auditory Training Software for Deficit-Specific Remediation of Binaural Processing Deficits in Children: Preliminary Findings. Journal of the American Academy of Audiology, 22(10), 678-696. St Clair-Thompson, H., Stevens, R., Hunt, A., & Bolder, E. (2010) Improving children’s working memory and classroom performance. Educational Psychology, 30, 203-219.

16. Thank you for listening For more information: http://www.hearing.com.au http://capd.nal.gov.au

17. LiSN & Learn Post-Training Results (for n = 33) * p < 0.00001 * * * 82% of children had results within normal limits on the LiSN-S test post-training 17

18. 18 LiSN & Learn Post-Training Questionnaire Ratings 91% of children reported real-life improvement on COSI-C. 15 LIFE Teacher questionnaires returned: mean score was 19 (range -1 to 35).

19. Memory Booster Post-Training Results (for n = 29) * * p < 0.003, n=18 * * p < 0.002, n=17 61% of children were within normal range post-training on the NMF 65% of children were within normal range post-training on the NMR 19

20. 20 Memory Booster Post-Training Questionnaire Ratings 85% of children reported real life improvements on COSI-C. 12 LIFE Teacher questionnaires returned. Mean score was 15 (range -2 to 32).