Presentation on theme: "Testing for Central Auditory Processing Disorders"— Presentation transcript:
1 Testing for Central Auditory Processing Disorders Harvey DillonWith thanks to:Sharon CameronHelen GlydeDani TomlinPiaGyldenkaerneMridula SharmaWayne Wilson
2 On the basis of evidence, what should CAPD testing and remediation services consist of?
3 Defining CAPD Do researchers need to define CAPD? Yes, ……. but a means not an endDo clinicians need to determine if a client has CAPD?No, concept too broad to be useful,Answer will change each time researchers change the definitionWhat question should clinicians ask?Helps the discussion about how sounds are processed within the brainConsider implications for a clinician when the definition is changed …. Has to phone all past clients to let some know they are now no long have CAPD, and that others have acquired it!!!!!
4 A clinician’s question Does this child have a problem hearing or understanding sound that adversely affects him or her, and that I or anyone else can do something about?What is the specific nature of the problem?Is there a specific remediation for that problem?What general management techniques will minimize its effects?What tests should I use to determine the child’s problems?
5 Problems with current definitions Requirement for modality specificity and absence of other problems.Auditory processing neuronsDeficient auditory skillLife consequencesConsequent disabilitiesTrauma or failure to developHearing lossLanguage processing neuronsDeficient language skillLife consequencesVisual processing neuronsDeficient visual skillLife consequences
6 Problems with current definitions 2. Arbitrariness of fail criterionWhich tests to include in battery?How many tests have to be failed, in how many ears, in what combinations?What is a fail on each test?
7 Impact of criterion on diagnosis of CAPD Binaural failMonaural failWayne Wilson
8 Problems with a Large Test Battery Impact on child’s attention(The tests are often very boring!!)Relevance of the normative dataStatistical implications of presenting multiple tests - inflating Type II error rate.So …. how do we solve this problem??
9 Possible, but not very good, solutions…. 1. Tighten the pass-fail criteria on each test (e.g. 3 SD): have to be very aberrant to fail2. Require that the individual fail more than one test: Only logical if CAPD is a “generalized disorder”3. Repeat any test that produces a failed result: Not consistent with normative data An inefficient use of time
10 Current approach to CAPD testing HistoryAudiometryIs there a problemthat CAPDmight explain?Exclude CAPD;Refer elsewhereNoDetailed test batteryYesTest result interpretationNon-specific remediationand management:Classroom placementFM useInstruction styleSoundfield amplificationAuditory training software
11 Dealing with problems in understanding speech Questionnaire / historyAudiometryMeasured disabilityIs there a problemthat CAPDmight explain?Exclude CAPD;Refer elsewhereNoMaster test batteryYesNon-specific remediationand management:Classroom placementFM useInstruction styleSoundfield amplificationDetailed test batteryTest result interpretation leading toa disorder-specific diagnosisDisorder-specific remediation
12 Dealing with problems in understanding speech Questionnaire / historyAudiometryMeasured disabilityIs there a problemthat CAPDmight explain?Exclude CAPD;Refer elsewhereNoMaster test batteryYesNon-specific remediationand management:Classroom placementFM useInstruction styleSoundfield amplificationFPTVerbalSPINHi ContLiSN-SHigh CueDetailed test batteryFPTHumSPINLo ContLiSN-SSpatialAdvantageTalkerLow CueTest result interpretation leading toa disorder-specific diagnosis?ClosureskilldeficitsUndiag-noseddeficitSPDPitchdeficitDisorder-specific remediation?Top-downtrainingLiSN& Learn
13 What is a fail on one test? Proportion of childrenTest scoreZ-score
14 Test score sensitivity relative to functional listening ability Can estimate from correlation between test scores and functional abilityQuestionnaire scores of listening abilityEducational attainment scoresTest ATest B
15 Test score sensitivity relative to functional ability: Test ATest B
16 Criteria for adopting a CAPD test Test is associated with variation in functional abilityHigh sensitivity (= ∆ 𝐹𝑢𝑛𝑐𝑡𝑖𝑜𝑛𝑎𝑙 𝑧−𝑠𝑐𝑜𝑟𝑒 ∆ 𝐶𝐴𝑃𝐷 𝑧−𝑠𝑐𝑜𝑟𝑒 )Deviant results common in clinical populationAttributes tested minimally shared with other tests in batteryTest result indicates specific remediation necessary (and remediation affects real life)Time taken is smallTest is minimally affected by attention, intelligence, motivation, working memoryAssociated with a known anatomical site and neural mechanism
17 Experiment 1 Dani Tomlin current PhD study Two subject recruitment groups:Children referred to Uni of Melbourne Audiology Clinic due to suspected APD (n=65)Teachers, parent, speech pathologist referralNormative group (n=47)School enrolment, open invitationAge range of 7–12 yearsBoth groups to complete full test batteryResults converted to Z scores (derived using age specific norms)
18 Measures obtainedDichotic Digits Test (DDT): Binaural integration (Musiek, 1993)Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990)Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005)MLD: Binaural interaction (Bellis, 2003)LiSN-S: Binaural integration – spatial listening ability (Cameron & Dillon, 2006)Memory CELF-4: Forward and reverse digitsAttention: BrainTrain®: Continuous Performance Test: Sustained auditory and visual attentionCognition -TONI-4: Nonverbal cognitive assessmentQuestionnaires and interview:Child completed LIFE questionnaire & recorded interviewParent completed Fisher checklist & written interviewTeacher Evaluation of Auditory Performance (TEAP) & written interviewAcademic Performance - NAPLAN & WARP (reading fluency)
19 Relations between questionnaires Listening Capabilities Score
35 Importance of presenting symptoms MANOVA analysis: p=0.94
36 Importance of presenting symptoms Response by childInterpretation by observerEventActs (inappropriately) based on what was heardIs not very smartCan’t follow instructionsChild fails to understand an instructionAsks for repetition of instructionPoor concentrationDoes nothingDaydreamsMisbehavesBadly behaved
37 Experiment 2Pia Gyldenkaerne current PhD studyChildren referred to Macquarie Uni Audiology Clinic due to suspected APD (n=119)Teachers, parent, speech pathologist referralAge range of 7–13 years
38 Measures obtainedDichotic Digits Test (DDT): Binaural integration (Musiek, 1993)Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990)Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005)MLD: Binaural interaction (Bellis, 2003)Memory CELF-4: Forward and reverse digitsAttention: BrainTrain®: Continuous Performance Test: Sustained auditory and visual attentionCognition -TONI-4: Nonverbal cognitive assessmentQuestionnaire:Purpose designed – yes/no answers to 18 questions asking about difficulties in listening and its possible consequencesAcademic Performance: WARP (reading fluency)
39 Test score sensitivity relative to functional ability: Reported difficulties and reading fluency Dichotic digits - leftDichotic digits - rightFreq pattern - leftFreq pattern - rightReading speedPia Gyldenkaerne and Mridula Sharma
40 Test score sensitivity relative to functional ability: Reported difficulties and reading speed Gaps in noise - rightBrain Train attention quotientBrain Train response control quotientBinaural masking level differenceReading speedPia Gyldenkaerne and Mridula Sharma
42 Simple correlation matrix – outcome scores and test scores Reported DifficultiesWARPL DDTR DDL FPTR FPTR GINMLDTONIBT Attention Quotient--0.57-0.49-0.24-0.42-0.440.280.11-0.55-0.350.410.200.35-0.33-0.070.500.430.420.49-0.200.010.310.36R DDT0.220.23-0.11-0.000.070.270.86-0.28-0.050.34-0.060.330.26-0.020.120.04
43 Reported Difficulties No. of predictorsDDT_L_SDDDT_R_SDFPT_L_SDFPT_R_SDMLD_SDGIN_RBT.AttQuot1*234567No. of predictorsDDT_L_SDDDT_R_SDFPT_L_SDFPT_R_SDMLD_SDGIN_RBT.AttQuotTONI.Quot1*2345678
44 Criteria for adopting a CAPD test Test is associated with variation in functional abilityHigh sensitivity (= ∆ 𝐹𝑢𝑛𝑐𝑡𝑖𝑜𝑛𝑎𝑙 𝑧−𝑠𝑐𝑜𝑟𝑒 ∆ 𝐶𝐴𝑃𝐷 𝑧−𝑠𝑐𝑜𝑟𝑒 )Deviant results common in clinical populationAttributes tested minimally shared with other tests in batteryLeads to a specific diagnosis, for which remediation exists, and remediation affects real life functional abilityTime taken is smallTest is minimally affected by attention, intelligence, motivation, working memory, and language abilityKnown high reliability and critical differencesAssociated with a known anatomical site and/or neural mechanism
45 Comparison of tests against criteria LiSN-S LC/SADichotic digitsFreq Patt TestGINDigit span fwdDigit span reverseMLDSens: slope re functional43256Sens: deviant results common7Uniqueness re other tests6.52.512Specific diagnosis leading to effective proven remediation0/10Time takenMinimal effect of attention, working memory, intelligence, motivation, language ability5/151625Known high reliability and small critical differences10?Known anatomical site and neural mechanism1
46 Diagnosis and intervention Spatial processing disorder LiSN & LearnAuditory working memory (digit span fwd and reverse) Memory booster or Cog MedAny other disorder causing speech in noise difficulties dichotic digits Remote microphone hearing aids (Hornickel and Krauss), dichotic training (DIID or ARIA)