Auditory Processing Disorder (APD) - PowerPoint Presentation

Slide1

Auditory Processing Disorder (APD)

Amy Akiba, Elijah Balancio, Marissa Martinez, & Keala Sheets

What is APD?

History

Helmer

Mykleburst

(1954) was the first to note the symptoms of APD. He was the first to characterize symptoms. Since the time APD symptoms were first articulated, APD has not been properly, nor clearly defined because it is difficult to diagnose. Many researchers have found contradicting information on what defines the disorder. For now, APD is categorized into three types known as: Secondary APD, Acquired APD, and Developmental APD. 

Secondary APD involves genetic or hearing impairments. 

Acquired APD is associated with the event of neurological trauma. 

 Developmental APD is when an individual is born with normal audiometry without any other known etiology. 

There are several suggestions on the etiology neurochemically, neuroanatomically, and genetically, however, it is difficult to find supportive internal validity for APD. Additionally, APD does not satisfy the criteria for being considered a disorder, especially since the issues are not limited to connecting with the central auditory system. Difficulty defining the nature of APD contributes to the difficulty in maintaining and helping combat the negative symptoms from the disorder. (Moore, 2019)

Symptoms

This symptoms figure from Dawes et al. (2008) represents the processes involved with APD. It is difficult to find significant factors of causation of APD because it is hard to deny a possible third variable at play that influences the internal validity of the study. Many commonly used APD tests cannot make clear the etiological factors that might cause learning problems. 

Listening difficulties caused by impaired higher-level bottom-up processing of sounds and top-down processing of listening by the brain; for individuals with more impaired AP is

is

possible sensation and sound does predict cognitive listening skills. There is evidence that supports a close relationship between AP performance and intrinsic attention (Moore et al., 2010)

Micallef states, "

There is no gold standard investigation for APD and no standardized criteria for diagnosis

”. The neurodevelopmental disorder has the following auditory deficits: “Sound localization, auditory pattern recognition, auditory discrimination, temporal processing, processing of degraded signals and processing of auditory signals when embedded in competing acoustic signals [Bamiou et al., 2001].” (Micallef, 2015)

Symptoms

The following are deficits are associated with APD (not every person with APD exhibits these symptoms): 

Difficulty listening or learning auditorily

Problems with perceiving speech

Problems following multi-step directions

Difficulty reading 

Difficulty spelling

Problems filtering background noise (sound discrimination)

Hyper-

ro

hypo-sensitivity to noise

Frequent mishearing or misunderstanding

Difficulty with memory of what was heard

Issues with localizing sound

Difficulty organizing verbal information

Problems with oral and written expression

Poor handwriting

Difficulty understanding a fast speaker

structuring a sentence

Impaired auditory sensations

Difficulty maintaining attention 

Difficulty learning a new words or a foreign language

Etiology: Nurture

Developmentally, APD in children is primarily a result of poor engagement with sounds rather than having impaired hearing. (Moore et al, 2010)

Possible childhood birth defects include sickness and/or malnutrition during infancy or throughout childhood.

Dawes states that it is difficult to find significant factors of causation of APD because it is hard to deny a possible third variable at play that influences the internal validity of the study. Many commonly used APD tests cannot make clear the etiological factors that might cause learning problems (Dawes et al., 2008) 

Etiology:

Brain Structure

& Cognitive Pathways

CAPD is a primary characteristic of ASD.

 Thus, possible issues with cognitive structures may contribute to a degree of ADP deficits.

Histopathological evidence of a consistent and significant decrease in the number of superior olivary complex neurons in the autistic brain, which suggests a possible pathology at the brainstem level. (

Ocak

et al, 2018).

Central auditory neural pathways are: 

Medial Geniculate Nucleus (MGN, auditory nucleus of the thalamus)

Ventral Subdivision of the Cochlear Nucleus (VCN)

Dorsal Subdivision of the Cochlear Nucleus (DCN). 

If a child suffers from sickness early on, and the central auditory system brain areas are not being stimulated, fluctuated hearing loss may affect the susceptibility of children contracting otitis media with effusion (OME). Children with OME often suffer from APD to some degree (

Khaavaghazalani

et al., 2016)

Etiology: Nature

The same neural pathways that process speech use the same cognitive mechanisms to process music.

Truong et al. conducted a study on mice with ASD and have a

contactin

-associated protein-like gene called CNTNAP2. This gene is present with the disorder, and the researchers hypothesized that both factors contribute to anomalous language phenotype. They found that in the medial geniculate nucelus (MGN) had significantly less of a neuron count. However, in the

spectrotemporal

silent gap detections tasks they found that the mice had enhanced tone frequency discrimination abilities. These atypical music abilities might support the evidence of a slight savant syndrome in individualswith ASD who signs of CAPD.

This is support that a child with APD can improve language development and cognitive abilities from music training. Music trains the same acoustic pathways that the brain processes speech. (

Scheffner

, Vorwerk, & Vorwerk 2017;

Tallal

and

Gaab

, 2006)

The figure represent the relationship between msuical training and auditory processes.

Physiological Effects

Lesions found in the corresponding areas – Test used to measure responses – Deficiencies

1

. Auditory Nerve (AN-part of cranial nerve VIII) - Audiometry -  Sensorineural hearing loss

2. Cochlear Nucleus (CN- consists of primarily three nuclei located in the pons) - Acoustic Startle Reflex (a non-quantitative behavioral test for hearing in infants)

. 

3. Superior Olivary Complex (SOC-caudal pons’ auditory region)- Auditory Figure-Ground, Speech-in-Noise Masking Level Differences (MLD) -  Difficulties in localization. Difficulties hearing speech in noise (Cocktail Party Effect)

4. Inferior colliculus (IC)-Gap Detection, (Interaural Intensity (IID) Differences)-Marked decrease in ability to localize and track sound; Problems hearing in noise; With some lesions, central deafness.

5.

Insula - Dichotic Rhyme - Phonological difficulties Central Deafness with bilateral lesion

6. Auditory Cortex - Gap Detection Auditory figure-ground Pattern Recognition-Poor Frequency discrimination Auditory Agnosia

Long-term Social Effects

Intervening processes

Auditory Processing Disorder’s main deficit, especially in children, is that of the sensory temporal process. This results in the dysfunction of sensory input needed for the proper phonological coding, a cornerstone for the ability to read (

Mody, 2003). This intervention prevents the child from learning the relationships between written letters versus the speech sounds that they create. The negative effects are only increased with the presence of background noise (Bellis, 1996).consequences

These disabilities impact not only a child's academic success, but also their ability to socialize properly. APD prevents a child from following peer conversation, making it so that by the time the child comprehends what is said, his peers have responded and moved onto the next topic. This causes the tendency to hover and avoid participation, ultimately creating an attitude of discouragement from making friends. These qualities may follow an individual with APD into adolescence, young adulthood, and even much later in life (Giraud et al, 2005).

Treatment

ADP is a sensory disorder. Thus, for individuals without known neurologic lesions with AP issues should be redefined as a cognitive disorder. This will help with identifying proper treatments. (Moore et al, 2010)

Brain images to compare PET scans and fMRI studies have allowed researchers to find how information is encoded. This can be seen from brain images showing higher activity in the left auditory cortex than in the right auditory cortex can be associated with attentive listening and processing of phonetic information. Meanwhile the opposite is true for musical information. This supports the prevalence that information is shared through lateralization between the neural mechanisms for phonetic and mystical information. The automatic repetition from memory-based processing . of potential musical skills in children with ASD. (

Tervaniemi

 et al, 2000; 

Trallal

 and 

Gaab

 2006; 

Scheffner

, Vorwerk, & Vorwerk, 2017)

To diagnose the patient and see what would be the appropriate treatment, the proper tests need to be administered to the client/child/individual. An example of this is the Auditory Processing Domains Questionnaire (APTDQ). The APTDQ uses

a Children’s Auditory Performance Scale and an Applied  Children’s Auditory Processing Performance Scale. 

This questionnaire follows the guidelines and descriptions of ADP from several associations that make sure practitioners are follow ethical rules. Some of these associations include the: American Academy of Audiology (AAA), American Speech-Language-Hearing Association (ASHA), British Society of Audiology (BSA), & American Psychiatric Association (APA).

These organizations have varying definitions of APD, so it can be quite difficult to diagnose and treat a fitting diagnosis (O’Hara and 

Mealings

). A functional analysis of the client's deficits should be conducted in order to target therapy for specific issues. Speech pathologists and psychologists are the type of practitioners that typically diagnose and treat APD.

While

there may be issues with memory and attention in individuals w/APD, those features cannot be attributable to APD. Rather, it is highly likely attention issues that are prevalent in other disorders are the cause of the issue, such as a child w/ADHD and APD. (

Barlet

et al, 2017) 

Children with functional hearing loss and ASD deficits are also often comorbid to having APD. Thus, it is important to distinguish between which symptoms in order to expand upon finding a proper therapy. Some of these tasks include improving memory, enhancing attention skills, quickening processing rate and helping the child with organizing their thoughts when communicating.

APD cannot be treated with medication. Treatment is some form of therapy that involve a prompt and practicing repetitious and continuous academic and therapeutic techniques that will improve symptoms of the disorder.

Conclusion

APD is an LLI that is characterized by impaired cognitive language processing. Symptoms include issues with understanding auditory information and communicating thoughts or ideas coherently. APD is categorized by how its etiology. Each client should be treated differently depending on the type of APD (secondary, acquired, or developmental) that was acquired, they specific symptoms that are unique to the client, and what issues need to be improved upon or changed. Language is a cognitive process that uses many cognitive mechanisms including the auditory nerve (Cranial nerve viii), cochlear nucleus, superior olivary complex, the inferior chocoholics, the insula, and the auditory cortex. Many of the symptoms of APD that exist in individuals also have other disorders that may be comorbid. Thus, if a cognitive mechanism is impaired, then other disorder deficits may be present. This may lead to a wrongful diagnosis of APD or improper treatment of APD deficits because they were a part of a different disorder. Finding internal validity on the etiology of APD is imperative for treatment to follow the guidelines made by established professional associations. After an official and proper diagnosis from a practitioner, then practitioner should suggest a proper treatment that will target the symptoms of APD. Treatment of APD typically involves tasks that require a prompt and repetitious and continuous practice of therapeutic techniques.

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