hearing and auditory processing in school-age children

B R A D L E Y M C P H E R S O N

D I V I S I O N O F S P E E C H A N D H E A R I N G S C I E N C E S

U N I V E R S I T Y O F H O N G K O N G

Hearing and Auditory Processing in School-age Children

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DAHK May 2012 Meeting

Hearing Disorders

Outline

1. Hearing disorders in children

explained

2. Assessment for hearing loss

3. Management for hearing loss


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Hearing Disorders


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Hearing Disorders

Hearing loss can occur due to problems:

in the outer ear

in the middle ear

in the inner ear


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Hearing Disorders

Common hearing disorders in children are:

Impacted ear wax

Middle ear disease (“glue ear”)

Congenital hearing loss – problem from birth (includes many cases of genetic hearing loss)

Middle ear disease – about 50% of all children will get 1 or more episodes of this by age 5

Congenital hearing loss – much rarer, 1 or 2 cases for every 1,000 births


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Hearing Disorders

Hearing tactics such as positioning, preferential seating, visual supplements

Lip-reading

Amplification: hearing aids


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Auditory Processing Disorders

Outline

1. Auditory processing disorders

explained

2. APD assessment

3. APD management

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Also known as:

Central auditory

dysfunction

Central auditory

processing disorder

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Auditory Processing 9


Auditory Processing 10


Auditory Processing Disorders 11

APD is an auditory disorder that results from deficits in central auditory nervous system function

American Speech, Language, Hearing Association definition of auditory processing:

“…perceptual processing of auditory information in the CNS and the neurobiological activity that underlies that processing…”


APD behavioural processes

Central auditory processes are the auditory system mechanisms and processes responsible for the following behaviours:

1. Sound localization and lateralization

2. Auditory discrimination

3. Auditory pattern recognition

4. Temporal aspects of audition including: temporal resolution, temporal masking, temporal integration and temporal ordering.

5. Auditory performance with competing acoustic signals

6. Auditory performance with degraded signals

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APD behavioural processes

CAPD is an observed deficiency in one or more of the ASHA listed behaviours

CAPD can result directly from dysfunctional auditory processes or from more global deficits (e.g., language deficits, memory deficits, attention deficits)

The prevalence of CAPD in children is estimated to be between 2 and 3%

Twice as prevalent in male children

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Clinically, APD usually involves:

Speech-in-noise problems

Dichotic (different sounds to different ears) deficits

Temporal processing disorders

Usually CAPD is idiopathic (unknown cause)

In children it can be associated with mild developmental delay, or with PDD (pervasive developmental delay), or ADD (attention deficit disorder), or LD (learning disorders)

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APD is not...

Receptive language processing disorder

Poor language processing skills that affect language comprehension and vocabulary development — linguistic disorder

Neuropsychological disorder

Auditory attention or auditory memory problems — cognitive disorders

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Or other learning disabilities…

Learning disabled children

Have average to superior IQ

Serious learning deficits

Generally working 2 years or greater below grade level

Learning skill areas

Visual Perception

Visual Memory

Auditory Perception

Auditory Memory

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Auditory memory disorders

Listening (processing and storing)

Recall

ADD (Attention Deficit Disorder), ADHD (Attention Deficit Hyperactivity Disorder) children often have deficits in this area

Difficulty developing good understanding of orally presented material

Vocabulary and meanings

Remembering facts in history and science

Following oral directions

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APD is...

Impaired ability to process

acoustic information that is

not due to impaired hearing

sensitivity, impaired language

or impaired cognitive

function

Usually effects are most

apparent in poor acoustic

environments with low

“signal to noise ratio”

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APD and dyslexia

Dyslexia: difficulties in learning to read and write despite “adequate cognitive ability, motivation, access to instruction, and intact peripheral sensory mechanisms.”

At least a sub-group (around 40%) of individuals with dyslexia have auditory processing problems

Often these problems relate to processing small differences in sound pitch and small changes in sound intensity

Unknown whether these problems cause dyslexia or are unrelated


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Everyday behaviours associated with APD

1. Difficulty hearing in noisy situations

2. Difficulty following long conversations

3. Difficulty hearing conversations on the telephone

4. Difficulty learning a foreign language or challenging vocabulary words

5. Difficulty remembering spoken information (i.e., auditory memory deficits)

6. Difficulty taking notes

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Everyday behaviours associated with APD

7. Difficulty maintaining focus on an activity if other sounds are present —child is easily distracted by other sounds in the environment

8. Difficulty with organizational skills

9. Difficulty following multi-step directions

10. Difficulty in directing, sustaining, or dividing attention

11. Difficulty with reading and/or spelling

12. Difficulty processing nonverbal information (e.g., lack of music appreciation)


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APD assessment

No consensus on the ideal tests

Case history results* often show:

1. Poor educational achievement

2. Need for repetition

3. Failure to follow instructions

4. Difficulties in background noise or groups

5. Behavioural problems

Conventional audiometry results are normal

Speech understanding tests often used: in quiet and in noise

Specialised CAPD tests

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*Behavioural checklists useful: • Children’s Auditory

Performance Scale (CHAPS) • Fisher Auditory Problems

Checklist • Screening Identification for

Targeting Educational Risk (SIFTER)


APD assessment

May be difficult to interpret CAPD tests

ADD children, PDD children, etc., may show reduced scores because of non-auditory problems

Some audiology material may fail to distinguish CAPD from children with other problems

However, only 1 behaviour common to both CAPD and ADHD

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APD assessment 24


ADHD APD

1. Inattentive 1. Difficulty hearing in background noise

2. Distracted 2. Difficulty following oral instructions

3. Hyperactive 3. Poor listening skills

4. Restless 4. Academic difficulties

5. Hasty/impulsive 5. Poor auditory association skills

6. Interrupts/intrudes 6. Distracted

APD assessment

SCAN-C Test: Screening Test for Auditory Processing Disorders

1. Filtered Words

2. Auditory Figure-Ground

3. Competing Words

4. Competing Sentences

For children 5 - 11 years

High false positive rate

Best used as part of a test battery

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APD assessment 26


APD assessment

Diagnostic approach rather than a screening approach is preferred

Many other tests used: cover localization/ lateralization, discrimination, pattern recognition, temporal processing, competing acoustic signals, degraded speech signals

Speech tests: Staggered Spondaic Word Test (SSW)

Dichotic Digit Test (DD)

Low-Pass/High Pass Filtered Speech Test (Binaural fusion: BF)

Time Compressed Speech Test (TC)

Speech-in-Noise tests (such as HINT)

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APD assessment

Non-speech tests:

Pitch Pattern Sequence Test (PPS)

Random Gap Detection Test (RGD) or Gaps in Noise Test (GIN)

Duration Pattern Sequence Test (DPS)

Electrophysiological tests:

Auditory brain response tests

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APD management

Improving signal quality

Primary aim is to increase child’s ability to use sound information

Learning environment needs to be changed:

1. Environment modifications

2. Preferential seating

3. FM listening device

4. Pre-teaching, visual support, checks on understanding (repeat and rephrase)

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APD management 30

Assistive Listening Device fitting

Need for counselling and monitoring of children, parents and teachers


APD management


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APD management

Auditory training

Concept of auditory plasticity – neural connections can be modified and improved over time with training

Programs usually intensive – 1 hour or more, several times per week, for months

Programs progressively increase listening task difficulty

Programs target specific auditory processes

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APD management

Basic discrimination deficits: training in speech and non-speech discrimination tasks

Temporal processing deficits: training in sequencing tasks, rhythm training, poetry reading, directions learning

Perception of speech in noise deficits: vocabulary building and listening practice

Binaural listening deficits: Dichotic listening tasks

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APD management

Training materials

Katz, J. (2009) Therapy for auditory processing disorders: Simple effective procedures. Westminster, CO: Educational Audiology Association.

Earobics - http://www.earobics.com/

FastForWord - http://www.scilearnglobal.com/

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APD management

Other strategies

Equip children with tools to cope with APD

Motivational training

Cognitive behaviour modification to promote active listening

Assertiveness training

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Resources

Bellis, T.J. (2002). When the Brain Can’t Hear: Unraveling the Mystery of Auditory Processing Disorder. NY: Atria Books.

Heymann, L.K. (2010). The Sound of Hope. NY: Ballantine Books.


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hearing and auditory processing in school-age children

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