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Testing for Central Auditory Processing Disorders Harvey Dillon With thanks to: Sharon Cameron Helen Glyde Wayne Wilson Pia Gyldenkaerne Mridula Sharma.

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Presentation on theme: "Testing for Central Auditory Processing Disorders Harvey Dillon With thanks to: Sharon Cameron Helen Glyde Wayne Wilson Pia Gyldenkaerne Mridula Sharma."— Presentation transcript:

1 Testing for Central Auditory Processing Disorders Harvey Dillon With thanks to: Sharon Cameron Helen Glyde Wayne Wilson Pia Gyldenkaerne Mridula Sharma Dani Tomlin 1

2 On the basis of evidence, what should CAPD testing and remediation services consist of? 2

3 Defining CAPD Do researchers need to define CAPD? – Yes, ……. but a means not an end Do clinicians need to determine if a client has CAPD? – No, concept too broad to be useful, – Answer will change each time researchers change the definition What question should clinicians ask? 3

4 A clinicians 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 childs problems? 4

5 Problems with current definitions 1.Requirement for modality specificity and absence of other problems. Auditory processing neurons Deficient auditory skill Life consequences Trauma or failure to develop Visual processing neurons Deficient visual skill Life consequences Consequent disabilities Hearing loss Language processing neurons Deficient language skill Life consequences 5

6 Problems with current definitions 2. Arbitrariness of fail criterion – Which 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? 6

7 Impact of criterion on diagnosis of CAPD Binaural fail Monaural fail Wayne Wilson 7

8 Problems with a Large Test Battery Impact on childs attention (The tests are often very boring!!) Relevance of the normative data Statistical implications of presenting multiple tests - inflating Type II error rate. So …. how do we solve this problem?? 8

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 fail 2. 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 9

10 History Audiometry Is there a problem that CAPD might explain? Exclude CAPD; Refer elsewhere No Current approach to CAPD testing Detailed test battery Yes Test result interpretation Non-specific remediation and management: Classroom placement FM use Instruction style Soundfield amplification Auditory training software

11 Questionnaire / history AudiometryMeasured disability Is there a problem that CAPD might explain? Detailed test battery Exclude CAPD; Refer elsewhere No Dealing with problems in understanding speech Master test battery Yes Non-specific remediation and management: Classroom placement FM use Instruction style Soundfield amplification Test result interpretation leading to a disorder-specific diagnosis Disorder-specific remediation

12 Questionnaire / history AudiometryMeasured disability Is there a problem that CAPD might explain? Detailed test battery Exclude CAPD; Refer elsewhere No Dealing with problems in understanding speech Master test battery Yes Non-specific remediation and management: Classroom placement FM use Instruction style Soundfield amplification Test result interpretation leading to a disorder-specific diagnosis Disorder-specific remediation LiSN & Learn LiSN-S High Cue LiSN-S Spatial Advantage LiSN-S Talker Advantage LiSN-S Low Cue SPD Undiag- nosed deficit Pitch deficit FPT Verbal FPT Hum SPIN Hi Cont SPIN Lo Cont Closure skill deficits ? Top-down training ?

13 What is a fail on one test? Z-score Proportion of children Test score 13

14 Test score sensitivity relative to functional listening ability Can estimate from correlation between test scores and functional ability – Questionnaire scores of listening ability – Educational attainment scores Test A Test B 14

15 Test score sensitivity relative to functional ability: 15 Test A Test B

16 Criteria for adopting a CAPD test 16

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 referral – Normative group (n=47) School enrolment, open invitation Age range of 7–12 years Both groups to complete full test battery Results converted to Z scores (derived using age specific norms) 17

18 Measures obtained Dichotic 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 digits Attention: BrainTrain®: Continuous Performance Test: Sustained auditory and visual attention Cognition -TONI-4: Nonverbal cognitive assessment Questionnaires and interview: – Child completed LIFE questionnaire & recorded interview – Parent completed Fisher checklist & written interview – Teacher Evaluation of Auditory Performance (TEAP) & written interview Academic Performance - NAPLAN & WARP (reading fluency) 18

19 Relations between questionnaires Listening Capabilities Score 19

20 Relations between outcome variables 20

21 Test score sensitivity relative to functional abilities Dichotic digits - left Listening capabilities Dani Tomlin

22 Test score sensitivity relative to functional abilities Dichotic digits - left Listening capabilities Dani Tomlin

23 Test score sensitivity relative to functional abilities Dichotic digits - left Listening capabilities Dani Tomlin Reading fluency Literacy Dichotic digits - right Freq pattern - left Freq pattern - right 23

24 Test score sensitivity relative to functional abilities Gaps in noise - leftGaps in noise - right Digit span - Forward Digit span - Reversed Listening capabilities Reading fluency Dani Tomlin Literacy 24

25 Test score sensitivity relative to functional abilities LiSN-S Low CueLiSN-S High cueattention Listening capabilities Reading fluency Dani Tomlin Literacy MLD z score 25

26 Sensitivity: Effect on outcome variable of being 1 SD below the mean on test score 26

27 FPT results highly correlated between ears 27

28 Dichotic digit results less correlated 28

29 Relationships between test scores 29

30 Correlations – outcomes and test scores Liter acy WAR P Liste n Cap L DDR DDL FPT R FPT MLDL GIN R GIN LiSN LC LiSN HC LiSN SA DS Fwd DS Rev TONIAtt Literacy WARP Listening Cap L DD R DD L FPT R FPT MLD L GIN R GIN LiSN LC LiSN HC LiSN SA DS Fwd DS Rev TONI Attention P<

31 NAPLAN literacy L DD*********** R DD****** L FPT******** R FPT********* MLD* L GIN**** R GIN********** DS Fwd** DS Rev************ LiSN LC***** LiSN HC***** LiSN SA***** 31

32 What is affecting listening capabilities? TONI DS Fwd DS Rev Att LDD Listening capabilities N=59 Adj R 2 = 0.31

33 What is affecting literacy? TONI DS Fwd DS Rev Att LDD NAPLAN Literacy But only 14 clinic participants with NAPLAN so far. 33 N=35 Adj R 2 = 0.64

34 Importance of the presenting symptoms? 34

35 Importance of presenting symptoms MANOVA analysis: p=

36 Importance of presenting symptoms Child fails to understand an instruction Acts (inappropriately) based on what was heard Asks for repetition of instruction Does nothing Misbehaves Event Response by child Interpretation by observer Daydreams Badly behaved Cant follow instructions Is not very smart Poor concentration 36

37 Experiment 2 Pia Gyldenkaerne current PhD study Children referred to Macquarie Uni Audiology Clinic due to suspected APD (n=119) Teachers, parent, speech pathologist referral Age range of 7–13 years 37

38 Measures obtained Dichotic 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 digits Attention: BrainTrain®: Continuous Performance Test: Sustained auditory and visual attention Cognition -TONI-4: Nonverbal cognitive assessment Questionnaire: – Purpose designed – yes/no answers to 18 questions asking about difficulties in listening and its possible consequences Academic Performance : WARP (reading fluency) 38

39 Test score sensitivity relative to functional ability: Reported difficulties and reading fluency Dichotic digits - leftDichotic digits - right Freq pattern - left Freq pattern - right Reported difficulties Reading speed Pia Gyldenkaerne and Mridula Sharma 39

40 Test score sensitivity relative to functional ability: Reported difficulties and reading speed Gaps in noise - right Binaural masking level difference Brain Train attention quotient Brain Train response control quotient Reported difficulties Reading speed Pia Gyldenkaerne and Mridula Sharma 40

41 r > 0.40; p< r > 0.25; p <

42 Simple correlation matrix – outcome scores and test scores Reported Difficulties WARPL DDTR DDL FPTR FPTR GINMLDTONI BT Attention Quotient Reported Difficulties WARP L DDT R DDT L FPT R FPT R GIN MLD TONI BT Attention Quotient P<

43 No. of predictors DDT_L_SD DDT_R_SD FPT_L_SD FPT_R_SD MLD_SD GIN_R BT.AttQuot TONI.Quot 1 * 2* * 3* * * 4* ** * 5* *** * 6* ***** 7* ****** 8******** No. of predictors DDT_L_SD DDT_R_SD FPT_L_SD FPT_R_SD MLD_SD GIN_R BT.AttQuot 1* 2* * 3* * * 4* * ** 5* **** 6** **** 7******* Reported Difficulties 43

44 Criteria for adopting a CAPD test 44

45 Comparison of tests against criteria LiSN-S LC/SA Dichotic digits Freq Patt Test GINDigit span fwd Digit span reverse MLD Sens: slope re functional Sens: deviant results common Uniqueness re other tests Specific diagnosis leading to effective proven remediation 0/ Time taken Minimal effect of attention, working memory, intelligence, motivation, language ability 5/ Known high reliability and small critical differences 10?????? Known anatomical site and neural mechanism

46 Diagnosis and intervention Spatial processing disorder LiSN & Learn Auditory working memory (digit span fwd and reverse) Memory booster or Cog Med Any other disorder causing speech in noise difficulties dichotic digits Remote microphone hearing aids (Hornickel and Krauss), dichotic training (DIID or ARIA) 46

47 Thanks for listening 47


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