Harvey Dillon Helen Glyde Sharon Cameron Disclosure The National Acoustic Laboratories is a division of Australian Hearing a Statutory Authority of the Australian Government NAL licences the ID: 910377
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Slide1
Central auditory processing disorders in children
Harvey Dillon
Helen
Glyde
Sharon Cameron
Slide2Disclosure
The
National Acoustic Laboratories is a division of Australian Hearing, a Statutory Authority of the Australian
Government. NAL licences the
LiSN-S test to Phonak, and is paid a royalty
on sales. NAL
directly sells the LiSN & Learn training package through its web site and Sound Storm through iTunes.
2
Slide3Presentation Overview
Diagnosing, Treating and Managing CAPD
Spatial processing disorder (SPD)
What is
it?How does it relate to CAPD?
Diagnosis with the LiSN-S.
Link to chronic otitis media.Remediation with the LiSN & Learn and Sound Storm.
Dichotic
digits
testing
Principles for test battery construction
Impact of cognitive deficits
3
Slide4An Auditory Processing Disorder (APD)
is a deficit in the way the neural representations of sounds are processed by the brain
Central Auditory Processing Disorder (CAPD)
Slide5APD creates difficulty in
listeningi
.e. hearing with intent to extract information
difficulty understanding speech in the presence of competing background noise or in reverberant acoustic environments
difficulty hearing on the phone
inconsistent or inappropriate responses to requests for information
difficulty following rapid speech
frequent requests for repetition and/or rephrasing of information
difficulty following directions
difficulty learning a foreign language or novel speech materials, especially technical language
problems with the ability to localize the source of a signal
difficulty or inability to detect the subtle changes in prosody that underlie
humor
and sarcasm
difficulty maintaining attention
a tendency to be easily distracted
poor singing, musical ability, and/or appreciation of music
academic difficulties, including reading, spelling and/or learning problems
AAA (2010)
Slide6Disorders other than APD (e.g. language disorders) can also create difficulty in listening
Language disorders
Attention deficit disorderAuditory working memory deficitExecutive function deficit
Autism spectrum disorderLow IQ
Slide7Diagnosis treatment and management of Auditory Processing Disorder
:
Slide8Deficits (various) in auditory processing
Deficits (various) in cognition
Listening difficulties
Performance on tests of APD
Deficits in language
Why diagnosing auditory processing disorders is complicated
Slide9Can CAPD be defined as a set of:
Symptoms?Difficulty understanding in noise
Difficulty understanding rapid speech Seeking repetitionEasily distracted…………
Performance on a test battery?Which tests in battery?What cut-off criteria?How many fails?What else causes test failures?
Also caused by other deficits
Diagnosis !!!
Slide10Child fails to understand an instruction
Event
Acts (inappropriately) based on what was heard
Asks for repetition of
instruction
Does
nothingMisbehaves
Response by child
Interpretation by observer
Daydreams
Badly behaved
Can’t follow instructions
Is not very smart
Poor concentration
10
Questionnaires
(or other ways to gather symptoms) might be able to confirm there is a problem, but can’t tell us the cause.
Diagnosing CAPD by symptoms?
Cognition
Language
Auditory processing
Slide11Why diagnose CAPD at all?
To Manage
it?To Treat it?
(i.e. remediate, cure)
To
Compensate
for it?
(i.e. train some useful skill)
Slide12How is Management guided by a diagnosis?
It’s not!
Parent complains that child has difficulty hearing in the classroom or other noisy place
Administer a test battery
Analyse test battery results
Write a report
Commence management
Sit at front of class
Fit wireless remote microphone system
Recommend clinician’s favourite training program
Refer to a “therapist”
Caveats:
Diagnosis may be needed to get the funding needed for management
Diagnosis may help teachers and/or parents “understand” reason for problems
Slide13How is Treatment guided by diagnosis?
It can be:
Example 1: Spatial processing disorder (LiSN-S) spatial processing training (LiSN & Learn)
Example 2: Dichotic deficit dichotic training Dichotic
Interaural Intensity Difference (DIID)Auditory Rehabilitation for Interaural
Asymmetry (ARIA)
Deficit in some specific ability diagnosed
Train that specific ability
Specific ability improved
Training generalises to real-life listening in challenging situations
Deficit-specific training
should
be the most efficient
Non-specific training
may
also be effective
compensation
Slide14What should the diagnosis be based on?
Speech-based tests
but… language disorder, or attention deficit, or working memory deficit, can cause low scoresThis can be solved with differential testing, as with LiSN-S
Non-speech (psychoacoustic) testsbut …. how good does one have to be in real life?
cognitive deficits can cause low scoresAre the right psychoacoustic abilities being measured?
Slide15Does any speech-in-noise test reveal a real-life deficit in speech understanding?
Not necessarily ….
Deficit may be in:
Spatial processing
Vocabulary to achieve closure at word level
Syntax or semantic knowledge, or working memory to achieve closure at sentence level
Temporal processing to accurately parse speech in reverberation
Speech in noise test
Slide16The elusive gold standard for CAPD?
Give up, because:CAPD has
multiple causes, which very likely cannot be detected with a single test.Speech tests can have poor scores because of reasons other than CAPDNon-speech tests
:are unlikely to assess all the skills needed to decode speech in challenging situationsmay assess skills not needed to decode speech in challenging situations
Questionnaires can confirm difficulty in understanding, but not identify why the difficulty exists – type of CAPD, whether CAPD or something else.
Slide17Spatial Processing Disorder
:
Diagnosis, cause, remediation
Slide18Spatial Processing Disorder –
Unique amongst CAPD because we:
Know its major causeCan diagnose it, unrelated to cognitive abilityHave extensive normative and reliability data
Can remediate it (blinded, randomized trial)Remediation generalizes to real life
18
Slide19Spatial Processing Disorder
Noise
Noise
Noise
Noise
Speech
19
APD battery
Slide20SPD is a deficiency in the ability to use binaural cues to selectively attend to sounds arriving from one direction while suppressing sounds arriving from other directions.
One type of CAPD.
A major cause of difficulty understanding speech in noise in a percentage of children with normal thresholds
(Cameron & Dillon, 2008).
Children with SPD need higher signal-to-noise ratios to understand speech in noise.
What is Spatial Processing
Disorder (SPD)?
20
Slide21Assessing Spatial
P
rocessing
A
bility
21
Slide22LiSN
-S
Adaptive speech-in-noise
test.
Virtual
auditory environment under headphones.
Target sentences
from 0°.
Distracter stories at 55
dB(A) SPL
from either 0º or ± 90º.
Stops when SE < 1.0 dB, or max of 30 sentences.
22
Slide23LiSN
-S Measurement Screen
23
Two Distracters at 55 dB
A SPL
Level of Target (adaptive)
SRT
≡ average SNR
Version 2.4
Slide24Same
D
irection
Different
D
irections
Different
Voices
Four
LiSN
-S Conditions
Same
Voice
T
D1
D2
T
D1
D2
T
D1
D2
Low Cue
SRT
Spatial Advantage
Talker
Advantage
D1
D2
T
High Cue
SRT
Total
Advantage
24
Difference measures !
Slide25LiSN-S Normative & Retest Data
Normative data specific to language version of test:
Australian norms: 202 people aged between 6 & 60 years
. Cameron et al (2011)North American
norms: 192 people aged between 6 & 30 years. Brown et al (2010)
Test-Retest reliability data provides a guide to whether performance at one test truly differs from retest.
One-sided critical difference scores in dB used to determine whether an individual has genuinely improved on the LISN-S on retest taking into account mean practice effects and day-to-day fluctuations in performance.
25
Lots!!
Slide26High Cue SRT
Better
p
<
0.001
26
Cameron et al. 2011
Slide27Spatial Advantage
(≡ Spatial Release from Masking)
Better
Australia
Nth America
Slide28LiSN-S Cut-off Scores
28
Cameron et al. 2011
Better
Level below which performance on a LiSN-S measure is
considered outside
normal limits.
Two
or
three-part regression equations fitted to account for improvement with age
min
(intercept +
B-value
* age, c
)
–
(
2 * SDs of the residuals from the age-corrected trend lines)
Slide29LiSN-S results profile: spatial processing disorder
29
Slide30Explanation Screen
Performance on
LiSN-S consistent with spatial processing disorder as determined by pattern measure.
30
Slide31Clinical study:
Children with spatial processing disorder
Slide32LiSN-S CAPD Study
(Cameron & Dillon, 2008)
Nine children aged 6 to 11 years, who had no language, learning or attention disorder, but were experiencing listening difficulties in the classroom
relative to peers (SusCAPD group).
Eleven children with confirmed learning or attention disorders (LD group).Assessed on LISN-S and results compared to 70 age-matched controls.
Assessed with a traditional APD test battery.
32
Slide33Cameron & Dillon (2008)
LiSN-S vs. Traditional Battery (LD Group)
Slide34LiSN-S vs. Traditional Battery – SusAPD Group
Cameron & Dillon (2008)
LiSN-S vs.Traditional Battery (sus CAPD Group)
Slide35Better
(LD)
SusCAPD
vs. LD vs. Controls – Co-located
Kruskal
-Wallis H Test
p = 0.978
35
Slide36SusCAPD
vs. LD vs. Controls – Spatially Separated
Better
Pairwise Comparison:
LD
vs
Control: p = 0.983
APD
vs
Control:
p < 0.0001
APD
vs
LD:
p = 0.003
Allocated to LD Group due to low-average working memory on WISC-III.
However……
Repeated episodes of otitis media.
Ventilation tubes fitted on four occasions.
36
Slide37APD
SPD
?
?
?
Slide38Link between SPD and
Chronic Otitis Media (COM)
38
Slide3939
Interpretation Based on Numerous Studies
Chronic otitis media
Fluctuating access to binaural cues
reduced
effectiveness in better-ear glimpsing
Slide4040
SPD and chronic otitis media (COM)
50% of children
diagnosed with SPD
at NAL reported a history of COM.
(Dillon et al., 2012).
20% of children
previously diagnosed with COM
at University of Melbourne were diagnosed with SPD.
(
Graydon
&
Rance
, ongoing).
Degree of spatial loss at primary school age increases with
degree of threshold elevation
due to COM in infancy. (
Gradyon
et al, 2015)
Spatial processing deficit
worse for early onset age and longer duration
of COM (n=35; Tomlin &
Rance
, 2014).
6
yo
children with history of COM have
below average spatial advantage
(n=17; z= -1.0) (Kapadia et al, 2012).
13-17
yo
adolescents with history of
COM have
below average spatial advantage
(n=20; z= -0.75)
(Kapadia et al,
2014).
10%
of a
population sample
(9/90) of Aboriginal children
from remote Australia
diagnosed with SPD.
(Unpublished data).
7% of a
population sample
(10/144) of
Aboriginal children from regional Australia diagnosed with SPD.
(Cameron et al., in review).
To OME summary
Slide4141
Kapadia
et al. (2012)
N = 17 children aged 6 years with history of OME requiring ventilation tubes.
Hearing thresholds within normal limits at time of testing.
No indication of middle ear infection at time of testing.
No history of cognitive delay or neurological disorders.
LiSN
-S results compared to age-adjusted normative data.
p = 0.43
Co-located
p = 0.012
Spatially Separated
Slide4242
Tomlin & Rance (2015)
N = 35 children aged 6-12 years with documented history of OME (≥ 3 episodes).
N = 35 age-matched controls.
Hearing thresholds within normal limits at time of testing.
No indication of middle ear infection at time of testing.
Groups matched for socio-economic status.
LiSN
-S results compared to age-adjusted normative data.
p = 54
p < 0.001
p < 0.001
Co-located
Spatially Separated
Spatially Separated
Slide43Impact of otitis media
Source: Tomlin &
Rance (submitted)
Slide44Remediation of SPD:
The
LiSN
& Learn Auditory Training Software
44
Slide45LiSN
& Learn
Deficit-specific remediation for SPD.
Trains children to attend to a frontal target stimulus and filter out distracting talkers from left and right.
Adapts to 70% performance level.Used in the home or schools/clinics).
Provides detailed feedback, analysis and reporting.
45
Slide46Description of LISN & Learn
Five
games presented on PC over
headphones.
Target sentences at 0º
azimuth.
Competing stories - same voice at ±90º
-
(55 dB SPL
).
Weighted up-down
adaption of target level.
SRT calculated over 40
sentences.
131,220 unique
sentences.
50
training sessions (2 games x 5 days
p/w x 10 weeks).
Reward system.
46
Slide47LISN & Learn Game
Target at 0˚:
Slide48Target: The horse kicked six wet
shoes
Slide4949
LiSN & Learn- Reporting
Slide50Method
9 children (6 to 11 years) - LISN-S SA >2SD
CAPD Pediatric SSQ
LISN & Learn - 15 minutes per day; 5 days per week; over 12 weeks (120 games)
Re-evaluate post-training; 3 months post-training
Slide51LiSN
& Learn – Preliminary Study
9 children with SPD (6 to 11 years)
LiSN & Learn – 2 games/day, 5 days/week, 12 weeks
LiSN
& Learn SRT (dB)
Better
Game Number
10 dB
Cameron & Dillon (2011
)
Average SRT
First
vs
Last 30 Days
p
=
0.000052
51
Slide52LC SRT
p = 0.158
Talker Advantage p = 0.981HC SRT p = 0.0002
Spatial Advantage p = 0.0002
Total Advantage p = 0.001
LiSN
-S
Results - Pre- vs.
Post-Training
Cameron & Dillon (2011
)
52
Slide53Self-Report
Questionnaire - Pre- vs. Post-Training
Very Hard
Hard
OK
Easy
Very Easy
SSQ –
Listening in Noise:
Pre
vs
Post -
p = 0.0002 *
Post
vs
3MP - p = 0.397
SSQ –
Listening in Quiet:
Pre
vs
Post - p =
0.103
Post
vs
3MP - p = 0.529
Cameron & Dillon (2011
)
53
Slide5454
Blinded Randomized Control Study
10
children
(aged 6
yrs
0
mths
to 9
yrs
, 9
mths
) diagnosed with
LiSN
-S as having SPD:
5
x
LiSN
& Learn
(experimental group)
5
x
Earobics
(control group)
Questionnaires
Participant (LIFE)
Parent (Fishers)
Teacher (LIFE)
LiSN
& Learn
or
Earobics
training –
15 minutes
p/d x 60 sessions
Re-evaluate
LiSN
-S and questionnaires post-training
Class 1 evidence
Slide55LiSN-S Results – Pre vs. Post Training
Earobics (n = 5)
Lisn
&
Learn (n = 5)
55
Cameron,
Glyde
& Dillon (2012
)
p = 0.5 to 0.7
p =
0.03 to 0.0008
Slide56Slide57Questionnaires – Post Training Improvements
Teachers
Children
57
Parents
L&L = 22%;
Earobics
= 9%
L&L = 31%;
Earobics
= 9% (p = 0.028)
L&L = 15.8
pts
;
Earobics
= 6.6
pts
where 0
pts
= “no improvement”.
Skip
quizz
Slide58Time for quick check: True or false?
The
LiSN-S test:Detects all forms of CAPD (T/F ?)
Is suitable for children down to the age of 4 yearsCan detect spatial processing disorder in children and adults
Gives much better scores on retest than on initial testMust be performed in an echo-free sound environment
Gives several sub-scores some of which may be affected by language disorders, attention, and cognition, and some of which shouldn’t.Detects spatial processing disorder, which causes most cases of CAPD
Reliably tests localization of speech sounds.Is a validated intervention tool.
Slide59Time for quick check: True or false?
The
LiSN-S test:Detects all forms of CAPD - False
Is suitable for children down to the age of 4 years - False
Can detect spatial processing disorder in children and adults - TrueGives much better scores on retest than on initial test - False
Must be performed in an echo-free sound environment - FalseGives several sub-scores some of which should be affected by language disorders, attention, and cognition, and some of which shouldn’t - True
Detects spatial processing disorder, which causes most cases of CAPD - FalseReliably tests localization of speech sounds - False
Is
a validated intervention
tool - False
Slide60In review
Spatial processing disorder (SPD) can unambiguously be diagnosedSPD is very often caused by protracted otitis media in infancyGeneralized auditory training appears to be much less effective than deficit specific training for SPD
SPD can be remediated … but boring!
Slide61LiSN & Learn Soundstorm
An app for tablet devices
Slide62Slide63Your turn
Spatial processing disorder:Is caused by chronic otitis media and cannot be overcome through training.
Is different from CAPD.Is remediable in children aged 6 to 12 years of age.
63
Slide64What causes fails in dichotic testing?
… and how should dichotic deficits best be remediated or managed?
… and how do they impact on real life listening ability?
Slide6565
Existing dichotic tests
Dichotic paradigms are the most commonly used tests of CAPD.
Intended to assess binaural interactions
Dichotic Digits Test (DDT) results correlated with academic outcomes and listening difficulty.
1, 8
2, 4
1, 2, 4,
8
Slide6666
So what’s the problem?
DDT is affected by more than binaural interactions
Dichotic free recall scores correlate with:
non-verbal intelligence (r = 0.49;
Tomlin et al., 2015
)
attention (r = 0.36;
Cameron et al., 2016
)
working memory (r = 0.38;
Cameron et al., 2016
)
Failing DDT doesn’t tell us what the problem is, only that a problem exists.
Slide6767
The Dichotic Digits difference Test (
DDdT
)
Modified version of the DDT
Four different test paradigms:
Dichotic integration
Dichotic directed left & right
Diotic
Computer scored
Norms based on exact age
Slide681, 8
2, 4
1, 2, 4,
8
68
Dichotic Free Recall Paradigm
Slide692, 4
1, 8
2, 4
1, 8
2,4,1,8
69
Diotic
Paradigm
Slide7070
DDdT
– computer-based testing
Plug headphones directly into laptop.
Enter client name & DOB.
Enter 4FAHLs if known.
To calibrate select measure threshold.
Slide7171
N=70
Slide72Dichotic
vs
diotic perception
72
R=
0.69
Dichotic presentation
Dichotic ability
Auditory working memory
Attention
IQ
Diotic
condition
Auditory working memory
Attention
IQ
N=112
Slide73Dichotic
vs
diotic perception
73
R=
0.71
Dichotic presentation
Dichotic ability
Auditory working memory
Attention
IQ
Diotic condition
Auditory working memory
Attention
IQ
N=139
Slide74Correlations – DDDT and cognition
74
Dichotic
Diotic
Attention
-
Prudence0.37
0.32
Attention - Vigilance
0.34
0.24
Number memory forward
0.35
0.41
Number memory reverse
0.34
0.47
Non-verbal IQ
0.26
0.26
Slide75Diotic
Free Recall
75
Interpreting results
1, 8
2, 4
1, 2, 4,
8
Dichotic Free Recall
2, 4, 1, 8
2, 4, 1, 8
1, 2, 4,
8
1, 8
2, 4
1, 8
Dichotic Directed Left
1, 8
2, 4
2, 4
Dichotic Directed Right
Attention Advantage
Right ear advantage (free)
Dichotic advantage
Right ear advantage (
dir
)
Slide7676
DDDT report
Slide7777
Normal spread of right ear advantage
Slide78Normal spread of right ear advantage
78
Slide79Conclusions – dichotic testing
None yet, but some observations ….Dichotic scores related to attention and memory (and NVIQ)Dichotic scores strongly related to
diotic scoresDDdT provides a basis for separating dichotic factors from other factors affecting dichotic scores79
Slide80Principles for test battery construction
80
Slide81Principles in constructing a test battery
Keep the battery as short as possible
Attention
Accumulating type I error
Include tests for which:
suitable normative data and reliability measures exist
poor results are associated with poor listening in real life
evidence-based remediation exists
81
NAL position statement on CAPD
: www.CAPD.NAL.gov.au
Slide82Questionnaire / history
Audiometry
Measured 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
Test result interpretation leading to
a disorder-specific diagnosis
Disorder-specific remediation
Slide83Questionnaire / history
Audiometry
Measured 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
?
DDDT
Dichotic
DDDT
Diotic
Integration
Deficit
ARIA /
DIID
Slide84Clinical results from the Australian Hearing
CAPD Service
84
Slide85Australian Hearing’s CAPD Service
Operating in 42 Australian Hearing centers around Australia since May 2012.
Diagnosis, assessment and management of specific aspects of CAPD.
Recruitment targets children experiencing difficulty hearing in background noise.
Tests are chosen which:
Have been shown to be associated with difficulties in real life.
Are reliable, repeatable and relatively quick to administer.
Lead to remediation that is backed by research evidence.
85
Slide86Age Distribution
N=618
86
Slide87Test structure
LiSN
-S high cue
Auditory memory(digits forward and reverse)
Dichotic digits
LiSN
-S
Remediate
(Memory booster)
Remediate
(FM …..)
Remediate
(L&L)
Slide88Hearing screening
LiSN
- HC
LiSN
Memory
Age
DDT
666
4
636
Pass
Z < -1
Z ≥ -1
317
Fail
Pass (not SPD) 219
Pass 362
< 7 years
77
≥ 7
yrs
285
Pass 181
Goal setting and recommendations
Testing discontinued
Goal setting and recommendations
Goal setting and recommendations
Fail 174
349
130
20%
26%
16%
27%
Sensorineural
loss
Mild conductive
26
Fail 104
11%
Cameron et al (2015)
Sem
in Hearing
Wireless remote mic
LiSN
& Learn
Memory Booster
Slide89National CAPD service results: LiSN & Learn effects
N=41
Slide90LiSN & Learn training: COSI results
N = 34
Slide91Effect of Memory Booster training
91
N=29
Slide92COSI scores for Memory Booster training
N=25
Slide93Addition to structure: Questionnaire
Auditory processing disorder questionnaire (APDQ)Brian O’Hara
52-item questionnaireMostly APD, short subscales for autism, attentionFor exampleHas no problem hearing your words clearly when paying close attention in noisy conditions.Does not say “huh?” “what?” or need “repeats” when conversing (with interest) in a quiet
place.Does not “mishear” and mistake similar sounding words (“fifty-fifteen,” “thirsty-Thursday”, "ships-chips")
Norwegian?
Slide94Current research
Auditory processing disorders and dyslexia
Slide95Auditory processing and dyslexia
Syllable segmentation
Consonant categorical perception
Non-word (phonetic) reading ability
Brain-wave oscillations
Auditory processing ability
To cognitive effects
To mechanisms
To cognitive conclusions
Cont
to
ephys
Slide96Locus of Spatial processing
Slide9719 September 2016
Sharon Cameron
97
Cortical Auditory Evoked Potential Study
Slide9819 September 2016
Sharon Cameron
98
Adult Control Group – Active Task
N1 and P2 to Standard Stimulus at
Cz
ms
-200.0
50.0
300.0
550.0
800.0
µV
0.0
2.5
5.0
7.5
10.0
-2.5
-5.0
-7.5
-10.0
-6.4
μ
V
2.9
μ
V
-4.6
μ
V
___
2.1
μ
V
Background Noise
_______ 0
˚
_______ ±90˚
Slide9919 September 2016
Sharon Cameron
99
Age Matched Control - Passive Task
N1 and P2 to Standard Stimulus at
Cz
ms
-200.0
50.0
300.0
550.0
800.0
µV
0.0
2.5
5.0
7.5
10.0
-2.5
-5.0
-7.5
-10.0
-9.1
μ
V
5.9
μ
V
-7.8
μ
V
___
1.7
μ
V
Background Noise
_______ 0
˚
_______ ±90˚
Slide100Frequency following response
Krishnan et al 2012
Slide101MECHANISMS IN Spatial processing AND ITS DISORDERS
Slide102Relative importance of ILD and ITD cues?
Better
Slide103Signal
Spatial processing mechanisms
+
Left
Right
+
ILDs
ITDs
SNR differences
Reduced energetic masking
Reduced informational masking
Slide104How do APD scores, cognitive abilities and reported listening capability connect?
Caution: heterogeneous!
Slide105Causation …….. unknown
Auditory processing abilities
Language abilities
Cognitive abilities
Academic abilities
Reported listening ability
Slide106Relation between APD and Attention Disorder
106
Auditory attention disorder
51
Auditory processing disorder
58
Visual attention disorder
25
19
13
2
20
14
5
4
24
No disorder
Gyldenkaerne
et al. (2015)
101 children with listening difficulties
Slide107Subjects
Clinical Group: (n=105)
Children
referred for clinical AP assessment Aged
7.0 to 12.9 years (Mean Age 8.9 yrs, ± 1.5)
Control group: (n=50)
No reported auditory, listening or academic difficulties Aged 7.0 to 12.2 years (Mean age 9.1
yrs.
±
1.4)
Peripheral hearing assessments all normal
Dani
Tomlin
Slide108Measures obtained
AP Frequency Pattern Test
(%)Dichotic Digits Test (%)Gaps In Noise
(msec)Listening in Spatialised
Noise Sentences test (LiSN-S) (dB)Masking Level Differences
(dB)Cognition
Non verbal IQAuditory Working Memory Sustained Attention
(
Quotient Scores)
Academic Results
Reading Fluency –WARP
NAPLAN
(
Numerical scores)
Listening Ability
Questionnaires:
LIFE (child)
Fisher
(Parent)
TEAP (Teacher) (Total item scores)
Results need to allow
for
development & comparison of measures
z scores
Source:
Dani
Tomlin
Slide109Relationships between variables
in different domains
Path analysis
Slide110DDT
avg
FPT
avg
GIN
avg
LiSNavg
Mem
avg
Atten
avg
NVIQ
Listening ability
Reading fluency
Path analysis
(model; no latent variable)
Slide111DDT
avg
FPT
avg
GIN
avg
LiSNavg
Mem
avg
Atten
avg
NVIQ
66%
Listening ability
Reading fluency
Path analysis
(results; no latent variable)
P=0.12
Most metrics OK
49%
76%
88%
97%
77%
Slide112DDT
avg
FPT
avg
GIN
avg
LiSNavg
Mem
avg
Atten
avg
NVIQ
Reading fluency
Listening ability
Path analysis (delete link from AP to Listening ability)
P=0.19
All metrics OK
Deletion causes no sig change in fit
66%
49%
76%
88%
97%
77%
Slide113DDT
avg
FPT
avg
GIN
avg
LiSNavg
Mem
avg
Atten
avg
NVIQ
Reading fluency
Listening ability
Path analysis
(reverse listening ability to reading fluency)
P=0.11
Most metrics OK
66%
49%
76%
88%
97%
77%
Slide114Conclusions
Performance on many AP tests affected by cognitive abilities (caution … causation!).
Teacher & parent reports of listening problems much more related to cognitive ability and academic performance than to auditory processing test scores.Need for auditory processing tests less affected by cognitive abilities.
114
Difference tests
Intervention studies
Slide115Conclusions … for the moment
A score on a CAPD test reflects more than just the child’s auditory processing ability.
Limiting the size of test batteries limits the chances of spurious test results.
Select tests that are minimally affected by higher order cognitive factors.Select tests that have evidence-based remediation available.
Stay up-to-date with literature as recommendations will continue to change!
115
Slide116116
References & Resources
http://capd.nal.gov.au
https://www.phonakpro.com/
lisn
-s
References
Brown, D., Cameron, S. Martin, J., Watson, C., & Dillon, H. (2010). The North American Listening in
Spatialized
Noise – Sentences Test (NA
LiSN
-S): Normative data and test-retest reliability studies for adolescents and young adults.
J
Amer
Acad
Audiol
,
21
(10), 629-641
.
Buchholz, J., Dillon, H., & Cameron, S. (2013). Toward a listening in
spatialized
noise test using complex tones.
Proceeding on Meetings of Acoustics, 19,
050047,
1-7.
Cameron ,S.,
Brown, D., Keith, R., Martin, J., Watson, C., & Dillon, H. (2009). Development of the North American Listening in
Spatialized
Noise - Sentences Test (NA LISN-S): Sentence equivalence, normative data and test-retest reliability studies.
Journal of the American Academy of Audiology
,
20
(2), 128-146.
Cameron, S., & Dillon, H. (2013). Remediation of spa
tial
processing issues in CAPD.
In
G. D.
Chermak
& Frank E.
Musiek
(Eds.)
Handbook of Central Auditory Processing
Disord
ers
. Comprehensive Intervention
(Vol.
II
, pp. 201-224).
San Diego
, CA
: Plural Publishing.
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.
J
Amer
Acad
Audiol
22
(10): 678-696
.
Cameron, S., & Dillon, H. (2012).
LISN & Learn Auditory Training Software
(Version 3.0.0) [Computer software]. Sydney, NSW: National Acoustic Laboratories
.
Cameron S, Dillon H. (2009)
Listening in Spatialized Noise – Sentences test (LISN-S)
(Version 2.2) [Computer software].
Murten
, Switzerland:
Phonak
Communications AG.
Cameron, S. & Dillon, H. (2008). The Listening in
Spatialized
Noise – Sentences Test: Comparison to prototype LISN test and results from children with either a suspected (central) auditory processing disorder of a confirmed language disorder.
Journal of the American Academy of Audiology
,
19
(5), 377-391.
Slide117117
References
(Continued)
Cameron
, S. & Dillon, H. (2008). Spatial hearing deficits as a major cause of auditory processing disorders: Diagnosis with the LISN-S and management options. In R.
Seewald
& J.
Bamford
, eds.
A Sound Foundation Through Early Amplification 2007. Proceedings of the Fourth International Conference
:
Phonak
AG, Switzerland, 235-241.
Cameron
, S. & Dillon, H. (2007). Development of the Listening in
Spatialized
Noise - Sentences Test (LISN-S).
Ear and Hearing, 28(2),
196-211.
Cameron
, S. & Dillon, H. (2007). The Listening in
Spatialized
Noise - Sentences Test (LISN-S): Test-retest reliability study.
International Journal of Audiology,
46
, 145-153
.
Cameron, S.,
Glyde
, H., Dillon, H.,
Kanthan
, S., &
Kania
, A. (2014). Prevalence and remediation of spatial processing disorder (SPD) in Indigenous children in regional Australia.
International Journal of Audiology.
Early Online:
1–10.
Cameron
, S.,
Glyde
, H., & Dillon, H., (2012) Efficacy of the
LiSN
& Learn auditory training software: Randomized blinded controlled study.
Audiol
Res 2
(1): e15.
Cameron, S.,
Glyde
, H. & Dillon, H. (2011).
Listening in Spatialized Noise- Sentences Test (LiSN-S): Normative and retest reliability data for adolescents and adults up to 60 years of age.
J
Amer
Acad
Audiol
, 22
(10), 697-709
.
Dillon, H., Cameron, S.,
Glyde
, H., Wilson, W., & Tomlin, D. (2012). Opinion: Re-designing the process of assessing people suspected of having central auditory processing disorders.
Journal of the American Academy of Audiology
,
23
, 97-105.
Glyde
, H., Cameron, S., Dillon, H.,
Hickson
, L. &
Seeto
, M. (2013) The effects of hearing impairment and aging on spatial processing.
Ear Hear, 34
(1), 15-28.
Glyde
, H.V. (2013)
The effects of ageing and hearing impairment on spatial processing.
(Doctoral dissertation, University of Queensland, 2013).
Kapalia
, S., Godden, D., Harvey, J.,
Satyanarayana
, N. & Morley, A. (2012). Spatial listening in children with a history of otitis media with effusion. Poster presentation.
Global Perspectives on CAPD. American
Acadamy
of Audiology Conference, Boston.
Tomlin, D., &
Rance
, G. (Under Review). Long-term hearing deficits following childhood middle-ear disease.
Developmental Medicine & Child Neurology.
Slide118118
www.CAPD.NAL.gov.au
Additional resources & references
Any questions?
Slide119Sophie’s story
CAPD.NAL.gov.auSpatial processing disorder on Catalyst
Slide120SPD in Other Populations
120
Slide121Friedreich
Ataxia Rating Scale
vs
LiSN
-S spatial advantage
Source:
Rance
(Neuroscience, 2012)
Slide122LiSN
-S Prescribed Gain Amplifier
122
Slide123Better
Changes in LiSN-S scores with hearing loss
Glyde et al (2013)
Ear Hear