the auditory processing battery: survey of common … · the auditory processing battery: survey of...

J Am Acad Audiol 13 : 93-117 (2002)

The Auditory Processing Battery: Survey of Common Practices Diana C . Emanuel*

Abstract

A survey of auditory processing (AP) diagnostic practices was mailed to all licensed audiologists in the State of Maryland and sent as an electronic mail attachment to the American Speech-

Language-Hearing Association and Educational Audiology Association Internet forums. Common AP protocols (25 from the Internet, 28 from audiologists in Maryland) included requiring basic audi-

ologic testing, using questionnaires, and administering dichotic listening, monaural low-redundancy

speech, temporal processing, and electrophysiologic tests . Some audiologists also administer bin-

aural interaction, attention, memory, and speech-language/psychological/educational tests and

incorporate a classroom observation . The various AP batteries presently administered appear to be based on the availability of AP tests with well-documented normative data . Resources for obtain-ing AP tests are listed .

Key Words : Attention, auditory processing, binaural interaction, central auditory processing, dichotic listening, memory, monaural low redundancy speech, temporal processing

Abbreviations : ABR = auditory brainstem response ; ACPT = Auditory Continuous Performance Test ; ADHD = attention-deficit hyperactivity disorder ; AFG = Auditory Figure Ground ; AFT -R =

Auditory Fusion Test-Revised ; ALR = auditory late response ; AMLR = auditory middle latency response ; AP = auditory processing ; APD = auditory processing disorder ; ARID = acoustic reflex

decay ; ART = acoustic reflex threshold ; ASHA = American Speech-Language-Hearing Association ;

CAP = central auditory processing ; CAPD = central auditory processing disorder ; CHAPS = Children's

Auditory Performance Scale ; CS = Competing Sentences ; CW = Competing Words ; DPT = Duration Pattern Test; FW = Filtered Words ; MLD = masking level difference ; MLR = middle latency response ;

MMN = mismatched negativity ; OAE = otoacoustic emission ; NU-6 = Northwestern University

Auditory Test No . 6 ; PBKN = Phonetically Balanced Kindergarten in Noise ; PIPB = Performance Intensity for Phonetically Balanced Words ; PPS = pitch pattern sequence ; PSI = Pediatric Speech

Intelligibility Test ; RASP = Rapidly Alternating Speech Perception ; SCAN = Screening Test for

Auditory Processing Disorders ; SCAN-A = A Test for Auditory Processing Disorders in Adolescents and Adults ; SCAN-C = Test for Auditory Processing Disorders in Children-Revised ; SIFTER = Screening Identification for Targeting Educational Risk ; SIN = speech in noise ; SSI-CCM = Synthetic

Sentence Identification with Contralateral Competing Message ; SSI-ICM = Synthetic Sentence

Identification with Ipsilateral Competing Message ; SSW = staggered spondaic word ; TAPS-R =Test of Auditory Perception Skills ; TTFC = Token Test for Children ; WRS = word recognition score

Sumario

Una encuesta sobre practicas diagn6sticas de procesamiento auditivo (auditory processing : AP) fue enviada por correo a todos los audi6logos con licencia de ejercicio en el estado de Maryland,

y enviada tambien como archivo de correo electr6nico a la American Speech-Language-Hearing

Association y a los foros de internet de la Asociaci6n de Audiologia Educacional . Los protocolos

de AP recolectados (25 de internet y 20 de audiologos en Maryland) incluyeron elementos en

comun, como evaluaci6n audiol6gica basica, el use de cuestionarios y la administraci6n de prue-

bas auditivas dic6ticas, lenguaje monoaural de baja redundancia, procesamiento temporal, y pruebas electrofisiol6gicas . Algunos audiologos tambien administran pruebas de interacci6n bin-

aural, atenci6n, memoria, y pruebas de habla-lenguaje, psicol6gicas y educacionales, e incorporan

una observaci6n en el aula de clase . Las diferentes baterias AP actualmente utilizadas parecen

estar basadas en la disponibilidad de pruebas AP con informaci6n normativa bien documentada .

Se enlistan recursos para obtener [as pruebas AP.

Palabras Clave : Atenci6n, procesamiento auditivo, interacci6n binaural, procesamiento auditivo cen-

tral, memoria, auditivas dic6ticas, lenguaje monoaural de baja redundancia, procesamiento temporal

*Department of Communication Sciences and Disorders, Towson University, Towson, Maryland Reprint requests : Diana C . Emanuel, Department of Communication Sciences and Disorders, Towson University, 8000

York Road, Towson, MD 21252-0001

93

Journal of the American Academy of Audiology/Volume 13, Number 2, February 2002

Abreviaturas : ABR = respuestas auditivas de tallo cerebral ; ACPT = Prueba de Ejecuci6n Auditiva Continua ; ADHD = trastorno de deficiencia atencional con hiperactividad ; AFG = figura fondo auditiva ; AFTR = Prueba Revisada de Fusion Auditiva ; ALR = respuesta auditiva tardia ; AMLR = respuesta auditiva de latencia media ; AP = procesamiento auditivo ; APD = trastorno de procesamiento auditivo ; ARID = fatiga del reflejo acustico estapedial ; ART = umbral del reflejo acustico estapedial ; ASHA = Asociacion Americana de Habla-Lenguaje-Audicion ; CAP = proce-samiento auditivo central ; CHAPS = Escala de Rendimiento Auditivo en Ninos ; CS = Oraciones en Competencia ; CW = Palabras en Competencia ; DPT = Prueba de Patron de Duracion ; FW = pal-abras filtradas ; MLD = nivel diferencial de enmascaramiento ; MLR = respuesta de latencia media ; MMN = negatividad desigual ; OAE = emision otoacustica ; UN-6 = Prueba Auditiva No. 6 de la Universidad Northwestern ; PBKN = Prueba de Palabras Foneticamente Balanceadas en Ruido para Ninos Pre-escolares ; PIPB = Prueba de Rendimiento/Intensidad para Palabras Foneticamente Balanceadas ; PPS = secuencia de patron tonal ; PSI = Prueba de Inteligibilidad de Lenguaje Pediatrico ; RASP = Prueba de Percepcion de Lenguaje Rapidamente Alternante ; SCAN = Prueba de Tamizaje para Trastornos de Procesamiento Auditivo ; SCAN-A = Prueba para Trastornos de Procesamiento Auditivo en Adolescentes y Adultos ; SCAN-C = Prueba Revisada para Trastornos de Procesamiento Auditivo en Ninos ; SIFTER= Identificacion por Tam izaje para Encontrar Riesgos Educacionales ; SIN = lenguaje en ruido ; SSI-CCM = Prueba de Identificacion de Frases Sinteticas con Mensaje Competitivo Contralateral ; SSI-ICM = Prueba de Identificacion de Frases Sinteticas con Mensaje Competitivo Ipsilateral ; SSW = palabras espondaicas traslapadas ;TAPS-R = Prueba Revisada de Habilidad Perceptuales Auditivas ; TTFC = Prueba de TOKEN para Ninos ; WRS = Puntaje de Reconocimiento de Palabras

T

he topic of auditory processing (AP), also called central auditory processing (CAP) and central hearing loss, has been

discussed in the professional literature since the 1950s (Mylkebust, 1954) . Within the past decade, a renewed interest in the topic has emerged, including an emphasis on defining, diagnosing, and managing disorders of the cen-tral auditory system . In 1995, an American Speech-Language-Hearing Association (ASHA) Task Force on central auditory processing dis-orders (CAPDs) developed a technical report titled "Central Auditory Processing: Current Status of Research and Implications for Clini-cal Practice" (ASHA, 1996) . The task force defined central auditory processes as

the auditory system mechanisms and processes responsible for the following behavioral phenomena: sound localization and lateralization ; auditory discrimination ; auditory pattern recognition; temporal aspects of audition, including-temporal resolution, temporal masking, temporal integration, temporal ordering ; auditory performance decrements with competing acoustic signals; and auditory performance decrements with degraded acoustic signals.

CAPD was defined as "an observed defi-ciency in one or more of the above-listed behav-iors ." One recommendation of this task force was the development of a minimal test battery

for assessment of CAPD using physiologic and behavioral tests.

In October 2000, a consensus statement was published on the diagnosis of auditory pro-cessing disorders (APDs) in school-aged chil-dren (Jerger and Musiek, 2000). The consensus statement included a recommendation to change the traditional label "central auditory process-ing disorder" to "auditory processing disorder" to emphasize the interactions between the peripheral and central auditory systems . In addition, the consensus statement recommended APD screening procedures and a minimum test battery to differentially diagnose APD in school-aged children .

The recommended minimum test battery included pure-tone audiometry, performance-intensity functions for word recognition, a dichotic task, duration pattern sequence testing, temporal gap detection, immittance audiometry, otoacoustic emissions (OAEs), auditory brain-stem response (ABR), and middle latency response (MLR). Optional procedures included comparing auditory and visual continuous per-formance measures and conducting cortical event-related evoked potential testing.

The publication of minimal test batteries for identifying APD in children is not new (Willeford, 1977 ; Musiek and Chermak, 1994). In 1994, Musiek and Chermak recommended several first-order tests, including dichotic digits, com-peting sentences, frequency patterns, and the

94

Auditory Processing Battery/Emanuel

Pediatric Speech Intelligibility test (PSI) (Jerger and Jerger, 1984), and second-order tests, includ-

ing the MLR, the staggered spondaic word (SSW)

test (Katz, 1962 ; Katz et al, 1963), Tallal's tests (Tallal and Percy, 1974), and compressed speech

with acoustic modifications, which should be used in diagnosing APD. Similarly, Bellis and Ferre (1999) wrote that "a behavioral [AP] test

battery should include at least the following : dichotic speech tasks, monaural low-redundancy speech tasks, tests of temporal patterning, and

binaural interaction tasks" (p . 320) . More recently, Neijenhuis and colleagues (2001) sug-gested a seven-test AP battery including words in noise, filtered speech, binaural fusion, sen-tences in noise, dichotic digits, frequency and duration patterns, and backward masking in

addition to the use of a questionnaire . Musiek

and colleagues (1982) examined the performance of children with APD on a battery of tests and found that four tests-competing sentences, fre-

quency patterns, dichotic digits, and the SSW-were better at detecting auditory perceptual dysfunction than the Rapidly Alternating Speech

Perception (RASP) test (Ivey, 1969; Willeford 1977, 1978), low-pass filtered speech, and bin-aural fusion .

Individual clinicians often establish site-specific, or individual-specific, protocols . Oliver (1987, cited in Chermak et al, 1998) found that

the most commonly reported AP tests for chil-

dren were the SSW, Willeford Battery (Willeford,

1977) (i.e ., competing speech, filtered speech, bin-

aural fusion, and rapidly alternating speech), and

speech in noise . Chermak and colleagues (1998)

found that the Screening Test for Auditory Pro-cessing Disorders (SCAN) (Keith, 1986), acoustic

reflex threshold (ART), and ABR were reported as the three most frequently used AP proce-

dures . Martin and colleagues (1998) found that

the most commonly reported tests included the

SCAN, speech in noise, SSW, and performance-intensity function for phonetically balanced

words (PIPB) . The purpose of this study was to investigate

common AP diagnostic practices following the publication of the APD consensus statement. A mixed survey (closed- and open-set response for-mat) was developed requesting information on

behavioral and physiologic tests used as part of the AP battery in addition to the use of checklists, classroom observation, and tests of memory, atten-tion, and speech-language/psychological/educa-tional ability. The survey was sent via the Internet to audiologists outside Maryland and mailed to all audiologists licensed in the State of Mary-

land to determine routine AP assessment prac-tices and conformity with the APD consensus

statement .

METHOD

T he survey, titled "Survey of Audiologists' Central Auditory Processing (Auditory Pro-

cessing) Assessment Battery for Children (Preschool to Age 18)," was posted on the ASHA (<[email protected]>) and Educa-tion Audiology Association (EAA) (<eaa-list @lists .duq.edu>) Internet forums and mailed,

with a postage-paid envelope, to all 352 audiol-ogists licensed by the Maryland State Board of Examiners . This survey (Appendix A) included many of the commonly available behavioral AP tests as well as physiologic tests used to iden-tify AP disorders . The behavioral tests were grouped into the following categories : monaural

low-redundancy speech, dichotic speech, tempo-

ral processing, and binaural interaction (Bellis, 1996 ; Chermak and Musiek, 1997) . Physiologic

tests included the immittance battery, OAE, and electrophysiologic tests to examine brainstem and cortical systems . Electrophysiologic tests

included the ABR, auditory middle latency response (AMLR), auditory late response (ALR), mismatched negativity (MMN), and P300 . Addi-

tional survey questions included the use of

behavioral checklists, physiologic assessment, auditory attention, classroom observation, audi-

tory memory, speech-language/psychologicaVedu-cational assessments, and test results from other

professionals via referral or on-site team testing . The respondents' task was to indicate the

protocol they use to evaluate AP for their pedi-

atric population (preschool to 18 years old) . Each

question consisted of a closed set of response

options and an open-set response item labeled "other, please specify" because of the large num-ber and diversity of commercially marketed and

research tools that can be used as part of the AP battery.

The original intention of the study was to sur-vey audiologists only in the author's home state; however, posting the survey to the Internet allowed for comparison of this localized group with a larger population . Data were not col-lapsed across the Maryland and Internet groups because of the different sampling procedures and diversity of populations. Responses from the ASHA and EAA Internet forums were col-lapsed for analysis because the responses were not always identified by group (ASHA vs EAA),

95


0 20 40 60 80 100 Questionnaire ` Monaural Low

Dichotic ' d Temporal 0 Binaural Inl a N

Electrophys

Attention c Obsenetion a U d Memory a

Basic Audio . SLP/P Tests

Other Prof.

O Internet

E Maryland

Figure l Auditory processing battery reported by audi-ologists via the Internet (n = 25) and audiologists in the State of Maryland (n = 28) via regular mail . Monaural Low = monaural low-redundancy speech ; Dichotic = dichotic listening; Temporal = temporal processing; Bin-aural Int = binaural interaction; Electrophys = electro-physiologic tests; Basic Audio. = basic audiologic assessment ; SLP/P = speech-language/psychoeducational tests; Other Prof. = other professionals.

and some respondents may have received the posting on both forums or via forwarded mail from colleagues .

RESULTS

A total of 192 responses (55% response rate) were received from surveys mailed to audi-

ologists licensed in the State of Maryland, and 28 of these (15%) indicated that the respondent completing the survey conducted AP testing. Twenty-seven surveys were received in response to the Internet posting, and 25 responses indi-cated that the respondent conducted AP testing. The 25 Internet responses summarized for this study were received from the following states/ province : Texas (3), Connecticut (1), North Caro-lina (2), New York (2), Georgia (1), Idaho (1), Col-orado (1), Tennessee (1), North Dakota (2), Louisiana (1), Nebraska (1), Florida (1), Illinois (1), Ontario (1), and unknown (6).

All respondents who conduct testing indi-cated that they were certified and/or licensed in audiology. In addition, eight respondents were also certified and/or licensed in speech-language pathology, one was certified in auditory verbal therapy, and one was certified in deaf education.

General Profile of Test Battery

Figure 1 illustrates responses to survey questions 3 to 14 for both groups and indicates that the general profile of the AP test battery was similar. All of the respondents administer dichotic speech tests and require a basic audio-

Percent

0 20 40 60 80

Figure 2 Questionnaires used as part of the auditory processing battery. CHAPS = Children's Auditory Per-formance Scale; Fisher = Fisher Auditory Problems Checklist; SIFTER = Screening Identification for Tar-geting Education Risk ; P = preschool.

logic assessment prior to AP testing, and 96 percent administer monaural low-redundancy speech tests. In addition, over 60 percent of the respondents from both groups reported the use of questionnaires, temporal processing tests, and information from other professional evalu-ations (via referral or on-site team) as part of the AP diagnostic protocol . Sixty-four percent of Internet respondents and 46 percent of Maryland respondents indicated that electrophysiologic tests are used in some capacity for AP assess-ment as part of the standard test battery or as needed . Fewer than 50 percent from either group included binaural interaction, attention, class-room observation, memory, and speech-lan-guage/psychoeducational tests as part of their assessment protocol .

The subsequent sections will detail the results of the survey regarding the individual components of the AP test battery. These com-ponents include the questionnaire; audiology evaluation ; behavioral AP test battery; physio-logic test battery; and the findings of the survey regarding assessment of a child's attention, memory, and speech-language, psychological, and educational abilities. A list of all of the AP tests included in the survey, in addition to the AP and speech-language tests provided by respondents, is included as Appendix B along with the current distributors of these tests.

Questionnaire

Most respondents reported that they com-plete questionnaires as part of the AP battery, although the Internet group used questionnaires more frequently than the Maryland group (84% Internet ; 68% Maryland). Figure 2 illustrates that the most popular questionnaires were the

96

Percent

0 20 40 60 80 100

Otosc

PT

SRT

WRS

o, Sentence

6 c Q

NS

Plfz

Tyrnp

Other

ci Internet

0Mary land

Figure 3 Basic audiologic tests required prior to the

auditory processing battery. Otosc = otoscopy ; PT = pure-tone testing; SRT = speech recognition threshold; WRS = word recognition score; NS = nonsense syllable recog-

nition ; PI fx = performance-intensity function; Tymp = tympanometry.

Children's Auditory Performance Scale (CHAPS) (Smoski et al, 1998), Fisher Auditory Problems Checklist (Fisher, 1976), and the Screening Iden-tification for Targeting Educational Risk (SIFTER) (Anderson, 1989). Responses in the "other" category included the Kelly checklists (Kelly, 1995), Listening Inventory for Educa-tion (Anderson and Smaldino, 1996), and check-lists developed by individual testing facilities .

Basic Audiologic Evaluation

All of the respondents indicated that basic audiometric results were required prior to AP testing. Figure 3 summarizes the most fre-

Percent

0 20 40 60 80

rc TC+R

Ivey SIN

t-

PBKN SSI-ICM

SCAN-A_'

.

SCAN-C-FW

SCAN-C-AFG SCAN-A-AFG

SCAN FW SCAN AFG

LPFS PSI

Other

0lnternet " Maryland

Figure 4 Monaural low-redundancy (LR) speech tests

used as part of the auditory processing battery. TIC = time

compression; TIC + R = time compression plus reverber-ation; Ivey = Ivey filtered speech ; SIN = speech in noise;

PBKN = Phonetically Balanced Kindergarten in Noise;

SSI-ICM = Synthetic Sentence Identification with Ipsi-

lateral Competing Message; SCAN-C = Test for Auditory

Processing Disorders in Children-Revised ; FW = Filtered

Words; SCAN-A= Test for Auditory Processing Disorders

in Adolescents and Adults ; AFG =Auditory Figure Ground ;

SCAN = Screening Test for Auditory Processing Disorders;

LPFS = low-pass filtered speech ; PSI = Pediatric Speech Intelligibility.


Percent

0 20 40 60 80

DD SSW CST

Dichotic CV SSI-CCM

DSI SCAN-C-CW SCAN-A-CW SCAN-C-CS SCAN-A-CS SCAN-CW

DIRT Other

F. -Internet ] 0 Maryland

Figure 5 Dichotic speech tests used as part of the

auditory processing battery. DD = dichotic digits ; SSW

= Staggered Spondaic Word; CST = Competing Sentence Test ; CV = consonant vowel; SSI-CCM = Synthetic Sen-tence Identification with Ipsilateral Competing Message;

DSI = Dichotic Sentence Identification ; SCAN-C = Test for Auditory Processing Disorders in Children-Revised ;

CW = Competing Words; SCAN-A = Test for Auditory Pro-

cessing Disorders in Adolescents and Adults ; CS = Com-

peting Sentences; DRT = Dichotic Rhyme Test .

quently reported components of the basic audi-

ologic battery. All of the respondents required

pure-tone testing and tympanometry. Over 80

percent reported otoscopic examination, word recognition score (WRS), and speech recogni-

tion threshold . Only 24 percent (Internet) and

12 percent (Maryland) of the respondents indi-

cated that a performance-intensity function was required, and less than 10 percent from either

group reported sentence or nonsense syllable

recognition testing .

Monaural Low-Redundancy Speech Tests

The most commonly reported tests of monau-ral low-redundancy speech tests for both groups, illustrated in Figure 4, were the Filtered Word (FW) and Auditory Figure Ground (AFG) sub-tests of the Test for Auditory Processing Disor-ders in Children-Revised (SCAN-C) (Keith, 2000) and Test for Auditory Processing Disorders in Adolescents and Adults (SCAN-A) (Keith 1994a) . The reported use of these tests ranged from 54 to 68 percent. The FW and AFG subtests of the Screening Test for Auditory Processing Disorders (SCAN) (Keith, 1986) were reported for 43 per-

cent of the Maryland group but for less than 25 percent of the Internet group. Other reported tests of monaural low-redundancy speech, employed less frequently (< 40°/c of the time), include the Phonetically Balanced Kindergarten (PBK) test (Haskins, 1949) administered in noise, low-pass filtered speech test (e .g ., Rin-telmann, 1985), Speech in Noise (SIN) test (Fikret-Pasa, 1993; Killion and Villchur, 1993),

97


Percent 0 20 40 60 80

n N F

PPS

DPT

Int Pat

d c Gap Det

A

plnternet

1m Maryland AFT-R

`o E PPDT F

Other

Figure 6 Temporal processing tests used as part of the auditory processing battery. PPS = Pitch Pattern Sequence ; DPT = Duration Pattern Test ; Int Pat = Inten-sity Pattern Sequence Test; Gap Det = gap detection; AFT-R = Auditory Fusion Test ; PPDT = psychoacoustic pattern discrimination test .

time-compressed speech test Northwestern Uni-versity Auditory Test No . 6 (NU-6), Synthetic Sentence Identification test with Ipsilateral Competing Message (SSI-ICM) (Speaks and Jerger, 1965), PSI, and Ivey filtered speech test (Ivey, 1969). Approximately 15 percent of the respondents reported using "other" tests such as word recognition in various backgrounds, "tests measuring language processing at a phoneme, word, sentence and extended discourse level," time-compressed PBKs ; "quick" SIN; Hearing in Noise Test (Nilsson et al, 1994, 1996); and sound-field WRS with +5 and 0 dB signal-to-noise ratio with four-talker babble .

Dichotic Listening

The results of the survey indicated that the most commonly reported dichotic tests for both groups, illustrated in Figure 5, were the SSW and the Competing Words (CW) and Competing Sentences (CS) subtests of the SCAN-A and SCAN-C. The SSW was reported by 76 percent of Internet respondents and 57 percent of Mary-land respondents. The CW and CS subtests of the SCAN-A were reported by 56 to 64 percent of respondents. The CW and CS subtests of the SCAN-C were also frequently reported, with the Internet respondents more likely to use the CW (60%) and CS (56%) subtests of this test than the Maryland group (50% CW 43% CS). The SCAN (CW only) was reported by 43 percent of the Maryland group but only 24 percent of the Internet group (34%). The use of dichotic digit testing was common for the Internet group (60%) but much less frequently reported by the Mary-land group (18%).

Less frequently administered tests of dichotic listening (< 40%) included the Competing Sen-tence Test (Willeford, 1978), Synthetic Sentence Identification Test with Contralateral Compet-ing Message (SSI-CCM) (Speaks and Jerger, 1965), Dichotic Sentence Identification (Fifer et al, 1983), dichotic consonant vowels (Berlin et al, 1968), and the Dichotic Rhyme Test (Wexler and Halwes, 1983 ; Musiek et al, 1989). Fewer than 10 percent of the respondents indicated the use of "other" tests, including the Competing Envi-ronmental Sounds test (Katz et al, 1975; Arnst and Katz, 1982) and PSI dichotic sentences.

Temporal Processing

Temporal processing involves the perception of a sequence of acoustic events . The consensus statement has recommended that temporal pro-cessing be evaluated both in terms of temporal ordering/sequencing (frequency pattern, dura-tion pattern) and gap detection abilities.

The most commonly reported test of tem-poral ordering, illustrated in Figure 6, was the Pitch Pattern Sequence Test (PPS) (Pinheiro, 1977), which was reported by 76 percent of the Internet respondents and 61 percent of the Maryland respondents. The Duration Pattern Test (DPT) (Musiek et al, 1990) was also com-monly part of the AP battery for Internet respon-dents (44%) but was less frequently used by the Maryland group (11%).

The most frequently reported test of gap detection in the current study was the Auditory Fusion Test-Revised (AFT-R) (McCrosky and Keith, 1996) . It is almost exclusively employed by a small group of Internet respondents (28%), with very few reported from the Maryland group (4%) . Less than 20 percent of the respondents reported conducting any other listed test . "Other" reported tests in this category included the Screening Test for Auditory Perception (Kimmell and Wahl, 1970).

Binaural Interaction

Figure 7 illustrates that Internet respon-dents were almost twice as likely to include bin-aural interaction tests in their battery than Maryland respondents. The RASP (Ivey, 1969 ; Willford, 1977, 1978) and masking level differ-ence (MLD) (e .g., Hirsh, 1948 ; Licklider 1948) were the most commonly reported tests of bin-aural interaction by Internet respondents; how-ever, these tests were reported less than 25 percent of the time . Less frequently listed tests

98


Percent

0 5 10 15 20 25 30

p Internet

0 Maryland

Figure 7 Binaural interaction tests used as part of the auditory processing battery. RASP = Rapidly Alter-nating Speech Perception; BF = binaural fusion ; MLD =

masking level difference ; NU-6 = Northwestern Univer-sity Auditory Test No . 6; CVC Fus = consonant-vowel-con-sonant fusion ; Loc/Lat = localization/] ateralization.

Physiologic Tests

included binaural fusion (Ivey, 1969 ; Willeford 1977, 1978), segmented-alternated consonant-vowel-consonant fusion (Wilson et al, 1984, Wil-son, 1994), and binaural fusion (band-passed)

NU-6 (Wilson and Mueller, 1984) . The respon-dents were also asked to indicate if they assess the localization and lateralization abilities of their subjects . Twelve percent of the Internet group and 14 percent of the Maryland group indicated that they assess localization and lat-eralization abilities, but only four respondents indicated how the test was performed . These four respondents indicated that they asked the patient to point to the speaker from which a signal was heard . In addition, one of these respondents indicated that she asked the par-ents about the child's localization ability.

ACPT

m Conners N d

Percent

0 10 20 30 40 50

I

p Internet

EMary land

Figure 9 Attention tests used as part of the auditory

processing battery. ACPT = Auditory Continuous Per-formance Test ; Conners = Conners' Continuous Perfor-

mance Test ; Vigil = Vigil Continuous Performance Test ; SAAT = Selective Auditory Attention Test.

The consensus statement recommended a minimal AP test battery that included both behavioral and physiologic assessments designed to target both the peripheral and central audi-tory systems.

Figure 8 illustrates that the most common physiologic test administered as part of the stan-dard AP battery was immittance (79% Maryland, 92% Internet), with 71 percent (Maryland) and 76 percent (Internet) reporting the ART test,

specifically, as part of the standard battery. Less than 40 percent of respondents indicated that they conduct acoustic reflex decay (ARD) test-ing . Less than 50 percent of respondents reported including OAEs as part of the standard AP bat-

tery (46% Maryland, 44% Internet), but most

Internet respondents included OAEs as part of

either their standard or their extended test bat-

tery. "Other" responses from the survey included the use of ipsilateral and contralateral sup-

pression of OAEs as part of the AP battery. Electrophysiologic tests were reported as

part of the standard AP battery for less than 15 percent of respondents ; however, many of the electrophysiologic tests were reported as part of the extended test battery. The ABR was the most frequently reported electrophysiologic test, with 64 percent (Internet) and 46 percent (Mary-land) reporting that ABR was part of either the standard or the extended test battery. AMLR was rarely part of the standard test battery (4% Internet, 7% Maryland) but was more frequently included as part of the extended test battery (36% Internet, 18% Maryland), especially for Internet respondents. Fewer than 35 percent of respondents included any cortical event-related potentials (ALR, MMN, P300), even in

Percent

ABR

OAE ART

ARD

AMLR

ALR

MMN

P300

Y

Other

r- I"

plnternet std

EInternet ext

[]Maryland std

;~ Maryland ext

Figure 8 Physiologic tests used as part of the standard (std) or extended (ext) auditory processing battery. ABR

= auditory brainstem response ; CIAE = otoacoustic emis-sion ; ART = acoustic reflex threshold; ARD = acoustic

reflex decay; AMLR = auditory middle latency response ; ALR = auditory late response ; MMN = mismatched neg-ativity ; P300 = P300 auditory evoked response potential;

I = immittance audiometry.

99


Percent

0 5 10 15 20 25

TAPS TAPS GFW LAC

13 GFW N

d ADT m

~ TALC-3 Z DAPST 1 [1 Internet O

w T Token

E d

E Maryland a Flowers M AMST H Woodcock

CELF-3 Other Phon Aware

Other

Figure 10 Memory tests used as part of the auditory processing battery. TAPS = Test of Auditory Perceptual Skills ; GFW = Goldman-Fristoe-Woodcock Auditory Mem-ory Test ; DAPST = Denver Auditory Phoneme Sequenc-ing Test ; AMST = Auditory Sequential Memory Test.

the extended test battery, with the Internet respondents much more likely to conduct these tests than the Maryland group.

Auditory Attention

Based on this survey, 40 percent of Internet and 32 percent of Maryland respondents conduct an attention assessment. Examination of Figure 9 indicates that the most commonly reported attention assessment for both groups was the Auditory Continuous Performance Test (ACPT) by Keith (1994b). This test was reported for 40 percent of the Internet group and 18 percent of the Maryland group.

Other tests of attention reported less than 15 percent of the time include the Conners' Con-tinuous Performance Test (Conners, 1994), Vigil Continuous Performance Test (Vigil, 1996), and Selective Auditory Attention Test (Cherry, 1980). One "other" response included "a test of Execu-tive Function to rule out [attention-deficit hyper-activity disorder] ADHD." Executive function is "a component of metacognition that refers to a set of general control processes that ensure that an individual's behavior is adaptive, consistent with some goal and beneficial to the individ-ual"(Chermak and Musiek, 1997, p. 16-17) . However, the respondent did not include a description of the procedures used to assess executive function .

Classroom Observation

Less than one-third of the respondents indi-cated that they routinely performed a classroom observation/assessment . Reported observation protocol included site-specific checklists ; obser-vations by a teacher, social worker, or counselor;

Percent

0 5 10 15 20 25 30

Ip Internet

0 Maryland '

Figure 11 Speech-language/psychoeducational tests used as part of the auditory processing battery. TAPS = Test ofAuditory Perceptual Skills ; GFW = Goldman-Fris-toe-Woodcock Auditory Memory Test ; LAC = Lindamood Auditory Conceptualization; ADT = Auditory Discrimi-nation Test ; TACL-3 = Test for Auditory Comprehension of Language-3 ; Token = Token Test for Children ; Flowers

Flowers-Costello Test of Central Auditory Abilities; Woodcock = Woodcock-Johnson Psychoeducational Battery-Revised; CELF-3 = Clinical Evaluation of Language Fun-damentals; Phon Aware = phonologic awareness.

and forms from the Educational Audiology Hand-book by DeConde Johnson and colleagues (2001) .

Memory

Auditory memory was assessed by just over 20 percent of each group. Figure 10 indicates that the most commonly reported test for auditory memory was the Test of Auditory Perceptual Skills (TAPS-R) (Gardner, 1997), with 21 percent of Maryland respondents and 16 percent of Inter-net respondents listing this test . Less than 5 per-cent of respondents reported using the Denver Auditory Phoneme Sequencing Test (DAPST) (Aten, 1979). "Other" reported tests for assess-ing memory included the Token Test for Children (TTFC) (DiSimoni, 1978), Detroit Test of Learn-ing Aptitude (Hammill, 1998), "memory for sen-tences from several sources," and "digit span" (presumably, the Visual Aural Digit Span test by Koppitz, 1975).

Speech-Language and Psychoeducational Testing

Thirty-two percent (Internet) and 19 percent (Maryland) of the respondents reported incor-porating speech-language/psychoeducational tests as part of their assessment protocol . Of the respondents conducting speech-language/psy-choeducational tests, 50 percent (Internet) and 20 percent (Maryland) were dually certified in audiology and speech-language pathology. Fig-ure 11 illustrates that the tests reported most frequently by the Internet group included the

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Psyc

Educat

SLP

Otolaryn

Neurol

Other

Percent

0 20 40 60 80

0 Internet std

W Internet ext

p Maryland std

0 Maryland ext

Figure 12 Other professional evaluations used as part of the standard (std) or extended (ext) auditory process-ing battery. Psych = psychologist ; Educat = educational assessment ; SLP = speech-language pathologist ; Oto-laryn = otolaryngologist ; Neurol = neurologist .

Lindamood Auditory Conceptualization Test (Lindamood and Lindamood, 1979), by 28 per-cent of Internet respondents, and the Clinical Evaluation of Language Fundamentals (Semel et al, 1995), by 20 percent of Internet respon-dents. Maryland respondents most frequently reported the TAPS (18%), which was also reported by 16 percent of the Internet group . Other tests reported by less than 20 percent of respondents included the TTFC, Phonological Awareness Test (Robertson and Salter, 1997), Woodcock-Johnson Psychoeducational Battery-Revised (Woodcock and Johnson, 1989), Test for Auditory Comprehension of Language-3 (Car-row-Woolfolk, 1999b), and Auditory Discrimi-nation Test (Reynolds, 1994). "Other" reported tests included the Comprehensive Test of Phono-logical Processing (Wagner et al, 1999), Photo Articulation Test (Lippke et al, 1997), Peabody Picture Vocabulary Test-Revised (Dunn and Dunn, 1981), Expressive One-Word Picture Vocabulary Test (Brownell, 1990), Test of Phono-logicalAwareness (Torgesen and Bryant, 1994), Phono-Graphic pretest (McGuinness et al, 1996), Oral and Written Language Scales (Carrow-Woolfolk, 1996), Comprehensive Assessment of Spoken Language (Carrow-Woolfolk, 1999a), Slosson Oral Reading Test (Nicholson, 1990), Gray Oral Reading Test (Wiederholt and Bryant, 2001), Test of Word Finding (German, 1991), and the Test of Written Language (Hammill and Larson, 1996).

Other Professional Evaluations as Part of the AP Protocol

Figure 12 indicates that the most common referral/team assessments reported as part of the standard AP protocol or extended battery were

a speech-language evaluation (92% Internet, 75% Maryland), an educational evaluation (76% Internet, 72% Maryland), and a psychological evaluation (76% Internet, 72% Maryland) . Approximately 40 percent of both groups also reported an educational and psychological assess-ment as part of the standard protocol for AP

assessment . Evaluation by other professionals (otolaryngologist, neurologist) was rarely reported as part of the standard battery but was reported on an "as needed" basis by more than 50 percent of respondents . "Other" responses included assessments by a counselor, developmental pediatrician, and neuropsychol-ogist and input from a parent interview.

Test Battery

Each survey was examined to determine if the individual respondent followed the mini-mum behavioral and physiologic test battery suggested by the APD consensus statement . Specifically, each response was examined to determine if the respondent included pure-tone audiometry, a performance-intensity function, a dichotic task, duration pattern sequence testing, temporal gap detection (either "gap detection" generically or the AFT), immittance audiometry, OAEs, ABR, and AMLR tests .

None of the respondents listed all of the tests suggested by the APD consensus statement minimum test protocol . All of the respondents reported using dichotic tests, pure-tone audiom-etry, and some portion of the immittance battery, and over 60 percent of the respondents reported temporal processing tests; however, less than 50 percent reported conducting a DPT or a gap detection test, with the Internet group more likely to conduct these tests. Only 24 percent (Internet) and 12 percent (Maryland) of the respondents indicated that a performance-inten-sity function was required . In addition, less than 30 percent of respondents indicated that they administered the SSI-ICM or PSI, two tests that can be administered in a performance-intensity format for synthetic sentences (SSI-ICM), mean-ingful sentences (PSI), or words (PSI).

DISCUSSION

Questionnaire

Questionnaires are given to parents, care givers, and teachers to assess observed behav-iors and competencies in children suspected of APD . The CHAPS, the Fisher, and the SIFTER

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provide information regarding the specific type of functional difficulties the child is experi-encing . In addition, responses can be tallied to indicate if the child is below normal or at risk academically. Most of the respondents from both the Internet and Maryland groups reported using questionnaires as part of the AP battery.

The most commonly reported questionnaire, the CHAPS, was created to "systematically col-lect and quantify the observed listening behav-iors of children . . . [and] can be useful in prescribing therapeutic intervention and/or the need for classroom accommodations" by having an observer (such as the child's teacher) answer questions across six conditions, including quiet, ideal, multiple inputs, noise, auditory mem-ory/sequencing, and auditory attention span (Smoski et al, 1998) . The CHAPS manual includes the results of a study of 64 children with APD (Smoski et al, 1992), test-retest reliability data for 20 of these children, and normative data based on 20 non-APD children of similar age and background. A reported case study using the CHAPS (Garstecki et al, 1990) showed an improvement in CHAPS score and in CAP diag-nostic tests following auditory processing ther-apy, suggesting that the CHAPS may be a useful tool as part of the diagnosis and management protocol for children with APD.

The SIFTER, the second most commonly reported test from the current study, is broken down into five categories : academics, attention, communication, class participation, and school behavior. Normative data provided with the SIFTER include a much larger sample size (530 impaired, 50 typical). Although it was the sec-ond most commonly reported test in the cur-rent study, a limitation of this test is that it was designed for and tested on children with peripheral hearing loss rather than APD (Ander-son, 1989; Dancer, 1995 ; Wray et al, 1997).

The Fisher includes a broad range of gen-eral items such as "has a history of hearing loss" and "has difficulty with phonics" ; however, the items are not classified into specific categories, which makes it somewhat more limited for use in the AP battery than the CHAPS and SIFTER .

Basic Audiologic Evaluation

The current study indicated that 100 percent of respondents required a pure-tone test and tympanometry and close to 100 percent required a WRS prior to AP testing; however, less than 25 percent were conducting performance-intensity

functions. This is consistent with trends in audi-ologic testing reported by Martin et al (1998), who found that PIPB testing decreased significantly from approximately 72 percent (1989) to 44 per-cent (1992) to 26 percent (1997) . However, in the Martin et al study, PIPB was presumably used for retrocochlear diagnosis rather than for AP assessment . Performance-intensity functions in the AP battery can also be useful for examin-ing word recognition performance between ears, across presentation level, and with various stim-uli for children .

AP is generally assessed in children with normal peripheral hearing sensitivity. According to ASHA (1996), there is little systematic research on the effect of peripheral hearing loss on AP tests, and few tests are available to separate the effects of central versus peripheral pathology. ASHA (1996) suggested that AP testing could be administered with a peripheral hearing loss if the results are viewed with caution, tests are selected that are minimally impacted by peripheral hear-ing loss (such as dichotic digits, CS, MLR, and P300), and the effects of the peripheral hearing loss are taken into account in the interpretation of the AP tests. The importance of assessing peripheral hearing sensitivity was also empha-sized by the APD consensus statement, which suggested that a minimal test battery include pure-tone audiometry, performance-intensity functions for word recognition, and immittance audiometry. With the exception of performance-intensity functions, respondents from the current study were following suggested guidelines for assessing peripheral hearing sensitivity prior to AP assessment .

Monaural Low-Redundancy Speech Tests

Monaural low-redundancy speech tests deliver auditory stimuli, to one ear at a time, that have been altered with techniques such as fil-tering, time compression, and background noise to reduce the inherent redundancy in the speech signal to make it more difficult for a disordered central auditory nervous system to decode the signal .

The most popular tests in this category were the FW and AFG subtests of the SCAN, SCAN-A, and SCAN-C. Although other subtests (CW CS) are listed under the dichotic portion of this article, the general test will be described here .

The SCAN was originally marketed as an AP screening battery that could be administered via standard cassette player in a quiet room or via clinical audiometer in a sound booth; how-

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ever, Emerson et al (1997) found that SCAN scores obtained in a quiet school setting were markedly different from scores obtained in a

sound booth . The SCAN has been criticized as an AP assessment tool because of the absence of a temporal processing measure (Bellis, 1996), limited normative data sample for 3 to 4 year olds (Chermak and Musiek, 1997), and questionable reliability (Amos and Humes, 1998) .

The SCAN-A was developed to extend this battery of AP tests to adolescents and to adults . In addition to the three-subtest format used in the SCAN (FW AFG, and CW), it includes a fourth subtest of CS . The word "screening" does not appear in the title of the SCAN-A . It is sim-ply "A Test for Auditory Processing Disorders in Adolescents and Adults ."

The SCAN-C is a revision of the SCAN and is designed for children 5 years of age to 11 years, 11 months of age . Significant changes from the original SCAN include the use of the four-sub-test format (FW AFG, CW CS) similar to the SCAN-A; a change in the title, omitting the term "screening" and calling the instrument "Test for Auditory Processing Disorders in Children-Revised" ; providing the test on compact disc rather than cassette ; improving the test instruc-tions to the child ; and eliminating normative data for 3- and 4-year-old children .

The use of the SCAN-C, SCAN-A, and SCAN as part of a diagnostic battery remains the sub-ject of debate, with some asserting that it is a screening test (Medwetsky, 1994 ; Hall, 1999) and clinicians relying on it as part of their test battery based on findings from the current study and the results of the Martin et al (1998) and Chermak et al (1998) studies .

Dichotic Listening

Dichotic listening tasks involve present-ing two different stimuli, one to each ear, simul-taneously. The listener is required to repeat or identify stimuli from one or both ears . The SSW, SCAN-C, and SCAN-A (CW and CS sub-tests) were three of the most popular tests according to this survey. An advantage to using the SSW for assessment of AP is that studies of the SSW are prevalent in the professional lit-

erature for children (Myrick, 1965 ; Stubble-field and Young, 1975 ; White, 1977; Johnson and Sherman, 1979 ; Johnson et al, 1981 ; Berrick et al, 1984; Windham, 1985 ; Windham et al, 1986) and adults (Katz et al, 1963 ; Arnst and Katz, 1982) . Similarly, the SCAN-C and SCAN-A provide detailed information regard-

ing administration and interpretation for adults and children and are prevalent in the literature (Keith, 1994a, 2000).

Dichotic digits (Musiek, 1983) were also fre-quently reported by the Internet group but rarely by the Maryland group . Dichotic digits tests are easy to obtain but come with sparse documen-tation for test administration and interpretation . Reports of performance on dichotic digit tests for adults and children are available in the litera-ture (Musiek and Geurkink, 1980 ; Musiek, 1983 ; Musiek and Pinheiro, 1985 ; Musiek et al, 1991 ;

Jirsa, 2001) . Clinicians should be aware that nor-mative data available in the professional liter-ature may be specific to a particular recording and that clinicians should collect their own nor-mative data (Musiek, personal communication, July 17, 2001) .

Temporal Processing

The consensus statement stressed the importance of temporal processing tests by rec-ommending that the minimal battery include three tests specifically designed to target tem-poral processing : duration patterns, frequency patterns, and gap detection. More than 60 per-cent of all respondents indicated that they con-duct frequency pattern tests, but few indicated the use of a duration pattern test or a test of gap detection.

Research in auditory perception has indi-cated some basic characteristics of temporal processing ability in humans, including the fol-lowing : sounds separated by an interval less than 2 msec are perceptually fused by the lis-tener ; as the interval between sounds increases beyond about 2 msec, a listener can identify the presence of the interval, and this interval has to be 15 to 20 msec for a listener to accurately report which of the sounds occurred first (Hirsh, 1959) . Accuracy of detecting order of presenta-tion is crucial in speech discrimination . A lin-guistic example of the importance of accuracy in ordering of information includes perceiving the "t" prior to the "s" for accurate perception of the word "fits" rather than the word "fist." Hirsh (1959) asserted that the large temporal interval required for accurate identification of temporal

order suggested that anatomic and physiologic systems beyond the peripheral auditory system must be involved in judgment of these acoustic events . Every central auditory nucleus within the central nervous system up to and including the auditory cortex has been found to be sensitive to the effects of time (Pinheiro and Musiek,

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1985). The ability of humans to speak and under-stand language is dependent on the sensitivity of the central auditory nervous system to process sound sequences, and difficulty with temporal processing of auditory signals has been associ-ated with language impairment (Tallal 1980; Tallal et al, 1993 ; Phillips, 1999 ; Chestnik and Jerger, 2000).

Temporal ordering/sequencing tests involve a behavioral ordering (e.g., verbal labeling, hum-ming) of acoustic stimuli (e.g ., noise, tones, clicks, speech) that vary in intensity, frequency, and/or duration (Pinheiro and Musiek, 1985). Commercially available tests include both fre-quency pattern and duration pattern sequences. Although both frequency and duration pattern sequence tests yield bilateral deficits in response to unilateral central lesions, performance for these two tests has been shown to differ markedly for subjects with central lesions and therefore appears to involve different auditory processes (Musiek et al, 1990).

Frequency pattern tests were reported more than any other temporal processing test. These tests are commercially available from three sources : Auditec, Audiology Illustrated, and the Veterans' Administration . The PPS test, avail-able from Auditec, has child (6-9 years) and adult (age 9 to adult) versions, with identical scoring sheets . The listener is required to hum or verbally label tones from a three-tone series as "low" or "high." The children's version by Auditec includes increased tone duration, inter-burst interval, and interpattern interval com-pared with the adult version. The scoring information provided with the Auditec child ver-sion includes means and ranges for children in three age categories with no other references or other normative data. The adult version from Auditec includes means and ranges for 9 to 10 year olds and for adults with no additional nor-mative data or references . The Audiology Illus-trated version (Frequency Pattern Test) includes a one-page instruction sheet listing normal scores for each year from 8 to 11 and 12 to adult norms. In addition, two references are included (Musiek and Pinheiro, 1987; Musiek, 1994). The Veterans' Administration (1992) DPT is not accompanied by supporting literature . Norma-tive data can be found in the literature for adults (Musiek, 1994).

The Audiology Illustrated frequency pat-tern test instructions, unlike the Auditec test instructions, do not include reversals (e.g., low high low for high low high) as normal . Musiek (1994) pointed out that although a certain num-

ber of reversals are seen for normal-hearing subjects, subjects with brain abnormalities have a large number of reversals, and they should be considered incorrect for frequency pattern tests . Normative data for these tests do not separate "hummed" and "verbal" response norms . This may be useful information for test distributors to provide considering the different performances seen for children with APD for hummed versus verbal response (Jirsa, 2001) . Musiek and col-leagues (1980) found that split-brain patients could not accurately report a frequency pattern verbally; however, hummed responses were nor-mal or near normal for the subjects they stud-ied. They suggested that these findings indicate that both hemispheres and the corpus callosum were required to decode a frequency pattern and report the results verbally, presumably the right for decoding spectral content and the left for speech-language and temporal ordering .

DPTs are also available from Audiology Illustrated, Auditec, and the Veterans' Admin-istration. This test requires the listener to iden-tify each element in a three-tone series as "long" or "short." The Audiology Illustrated version comes with one page of instructions and back-ground information. Specifically, it states that 70 percent and above is normal for adults, and there are no child normative values. References are included (Musiek et al, 1990 ; Musiek, 1994), and it is recommended that clinicians establish their own normative values . The Duration Pat-tern Sequence Test (Auditec) comes with a one-page instruction sheet and states that scores below 67 percent should be considered abnormal. One reference is provided (Musiek et al, 1990), and the age range for this test is not given. Nor-mative data for adults on the Veterans' Admin-istration DPT are available from Musiek (1994) .

Additional information regarding frequency and DPTs is available in the literature for chil-dren and adults (e.g ., Pinheiro and Ptacek, 1971 ; Ptacek and Pinheiro, 1971 ; Musiek and Geurkink, 1980 ; Pinheiro and Musiek, 1985; Musiek and Pinheiro, 1987 ; Phillips, 1999; Jirsa, 2001). At present, further study of duration pat-tern testing in children is needed.

Gap detection tests were reported infre-quently in the current study. A gap detection task involves identifying the presence of a brief silent period between two bursts of sound. Lis-teners may be required to identify which of two sounds contains a gap or to indicate if a gap was present in a single stimulus . The smallest discernible silent period is called the gap detec-tion threshold. Gap detection threshold varies

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based on test paradigm, with the lowest gap detection thresholds associated with broad-

band signals . High-frequency narrow-band sig-

nals yield lower gap detection thresholds than

low-frequency narrow-band signals, and within-

channel paradigms are associated with smaller gap detection thresholds than between-channel designs (Phillips, 1999) . According to Jerger and Musiek (2000), the recommended gap detec-

tion test is one in which a "short silent gap is

inserted in a burst of broad-band noise." This

type of test, however, is not commercially avail-

able at present (Musiek, personal communica-tion, July 17, 2001) .

Of the less than 30 percent of respondents who indicated that they conduct gap detection

testing, the most frequently reported test was the AFT-R. The AFT-R does not meet the exact

description of a gap detection test specified by

Jerger and Musiek (2000) ; however, it requires

listeners to identify the presence of a silent gap

(interpulse interval) occurring between two tone

pulses and thus would fall into the general cat-

egory of gap detection tasks . The listener must

identify if he/she hears one tone or two in a

series of ascending and descending interpulse

interval trials . An advantage of this test is that

it is commercially available and can be admin-

istered to adults and children as young as 3

years, assuming that the listener understands the difference between "one" and "two ." A dis-advantage of this test is the testing paradigm,

which includes predictable ascending and

descending interpulse interval trials of 0 to 40

msec (40-300 msec for the expanded test) . A

modification of the AFT-R, the Random Gap

Detection Test, was recently developed by Keith .

This modification uses random interpulse inter-

vals rather than a series of ascending and

descending interpulse interval trials .

Binaural Interaction

Specific tests of binaural interaction, includ-ing tests that require a listener to combine sep-arate but simultaneously presented information

to each ear (binaural fusion, RASP) and tests that determine auditory threshold for binau-rally presented stimuli in background noise

before and after the phase shift of the stimulus or noise (MLD), were reported by less than 25 percent of respondents. In addition, localization and lateralization tests were infrequently reported in the current study. This is not sur-prising, considering that commercially avail-able tests of localization/lateralization are not


available at this time . However, there are pub-lished methodologies for testing (Cranford et al, 1990 ; Besing and Koehnke, 1995; Abouchacra et al, 1998), and a virtual localization test that can be administered via compact disc, currently still in laboratory trials, may be released for clinical use shortly (Besing, personal commu-nication, July 24, 2001).

Physiologic Tests

Many of the respondents indicated that they include ART tests as part of their AP battery. Pre-sumably, audiologists are attempting to elimi-nate the possibility of peripheral, cranial nerve VIII, or low brainstem pathology as a cause of AP difficulties prior to examination of more cen-tral involvement. This test can be useful for AP testing, as shown by a case study reported by Lenhardt (1981) of a child with APD caused by a low brainstem dysfunction that was investi-gated only because of absent acoustic reflexes during an audiologic examination.

Few respondents indicated that they conduct ARD testing. This is not surprising, considering the limited additional value of ARD testing for AP diagnosis compared with the possibility of inducing tinnitus and hearing threshold shift with high-intensity stimuli during this test (Hunter et al, 1999).

OAE testing was reported by just over 40 percent of the respondents from each group as part of the standard battery but by almost 80 per-cent of the Internet group as part of the standard or extended battery. OAEs are specified by the consensus statement as "useful in ruling out inner ear disorders" (p . 471) . Presumably, OAEs as part of the AP battery are used to' further investigate the peripheral auditory system including comparison of OAE results with ABR results to rule out auditory neuropathy (Hood, 1998). Surprisingly, only one respondent indi-cated the use of an OAE suppression test using ipsilateral and contralateral noise . This test has been shown to identify problems with the effer-ent auditory system (Hall, 2000).

Although less than 15 percent of respon-dents indicated using the ABR as part of their standard AP test battery, 64 percent (Internet) and 46 percent (Maryland) reported using it as part of either their standard or their extended test battery. These results are similar to the findings of Chermak et al (1998), who found 59 percent of respondents administered ABR with a rating from 4 to 6 (0 = never, 1= least, 6 = most used), with only a few respondents reporting

105


the use of any other electrophysiologic test (MLR and P300). Later evoked potentials were reported infrequently in the current study, although much more frequently for the Internet group com-pared with the Maryland group. Although the Maryland group represents an attempt to sam-ple an entire population, the Internet group most likely represents an unusually technolog-ically savvy group of audiologists based on the way the survey was distributed (via Internet forum and the need to open and save the attached file, complete the survey, and attach the survey to a return e-mail message) .

ABR has been established as an efficient instrument for assessing the vestibulocochlear nerve and brain stem ; however, its usefulness for upper brainstem and cortical assessment is lim-ited (Jirsa and Clontz, 1990). Other electro-physiologic tests, which extend beyond the latency of ABR, show promise in the AP diag-nostic process (Kurtzberg, 1989), and their underuse may be based on lack of familiarity with longer latency test paradigms and the applicability of test results to APD diagnosis and management .

Studies of later potentials have shown changes in these potentials following AP inter-vention and have found differences between chil-dren with APD and non-APD children . For example, a study by Jirsa and Clontz (1990) found significantly longer latency for late evoked poten-tials in children with APD compared with a nor-mal control group. Jirsa (1992) compared normal children with children diagnosed with APD and found a significant difference between the ampli-tude and latency of the P3 between the normal controls and the children with APD. Half of the APD group participated in a 14-week program of intense listening exercises for auditory memory, language comprehension, auditory discrimina-tion, attention, and interpretation of auditory directions . Following the treatment, there was a significant change in the P3 amplitude and latency for the treatment group compared with the APD control group. Kraus and McGee (1994) suggested that the diagnostic implications of the MMN include providing an objective measure of audi-tory discrimination as part of the AP battery. They presented a series of case studies in which the MMN was useful in the diagnostic battery to detect deficits in cortical level processing of audi-tory discrimination tasks.

Attention

ADHD is diagnosed by a psychiatrist or psy-chologist based on comparing characteristics displayed by the child with published criteria (e .g ., Diagnostic and Statistical Manual of Men-tal Disorders, Fourth Edition; American Psy-chiatric Association, 1994). The child may fall into one of three subtypes, including the pre-dominantly inattentive type, predominantly hyperactive-impulsive type, or a combination of the two. It is important for audiologists involved in the diagnosis ofAPD to consider the possibility of ADHD during AP assessment as these two disorders may be comorbid or may be difficult to diagnose differentially (Moss and Sheiffele, 1994).

According to ASHA (1996), "For some per-sons, APD is presumed to result from the dys-function of processes and mechanisms dedicated to audition; for others, APD may stem from some more general dysfunction, such as an atten-tion deficit or neural timing deficit, that affects performance across modalities . It is also possi-ble for APD to reflect coexisting dysfunctions of both sorts" (p . 41). Children diagnosed with ADHD and APD may display overlapping behav-iors, including difficulty following directions, asking for directions to be repeated, performing inconsistently in school, and having difficulty lis-tening, although peripheral hearing sensitivity is normal . Despite the overlap in behavioral profiles, Chermak et al (1999) argued that APD and ADHD are distinct clinical entities that may sometimes coexist based on neuroanatomic causes and the possibility that auditory per-ceptual deficits may trigger attention deficits .

The most commonly reported test of audi-tory attention for the 30 to 40 percent of respon-dents who conduct attention tests was the ACPT. The ACPT reported by 40 percent of Internet respondents and 18 percent of Maryland respon-dents, is an auditory vigilance task requiring the child to listen to a list of words and raise his/her thumb in response to every presentation of the word "dog ." The validity of the ACPT has been examined by comparing differences in perfor-mance between children with ADHD with and without medication (Keith and Engineer, 1991; Tillery et al, 2000) and comparing differences in performance between children with ADHD and children without ADHD (Keith, 1994b; Riccio et al, 1996a) .

Keith and Engineer (1991) found a signifi-cant improvement in ACPT performance when children with ADHD were medicated with

106


methylphenidate compared with the nonmed-icated condition; however, they also found improvements in performance on the SCAN and Token Tests for children between the two con-ditions . Their study failed to control for order effects in that only 1 of their 20 subjects was tested in the medicated condition first . A later study that used a counterbalanced design to control for order effects was conducted by Tillery et al (2000) . They found that scores on three AP tests, the SSW, phonemic synthesis (Katz and Harmon, 1982), and SIN (Mueller et al, 1987), were not significantly different when children with ADHD and APD were medicated with methylphenidate (Ritalin) compared with the nonmedication condition; however, ACPT scores were significantly different between groups, indicating that the medication affected audi-tory attention but not auditory processing. Ric-cio et al (1996a) found that children with APD scored higher than children diagnosed with APD plus ADHD, but the difference did not reach significance for this sample . This is in contrast to an earlier study that showed significant dif-ferences between groups (Keith, 1994b) . The Riccio et al (1996a) study diagnosed APD based only on the SSW test . This may be a critical flaw since scores on the SSW may (Gascon et al, 1986; Cook et al, 1993) or may not (Riccio et al,

1996b) be affected by attention. The less frequently reported Vigil and Con-

ners tests are computer-based tests that include nonverbal stimuli (Vigil includes auditory and visual) . With current emphasis on the impor-

tance of multimodality testing (Hall, 1999 ; Jerger and Musiek, 2000), these two tests may warrant

further study for use with AP testing.

Multidisciplinary Assessment

The best practice for assessment and man-agement of APD is a team assessment or col-laborative approach (ASHA, 1996). The APD consensus statement recommended that the team include an audiologist and speech-language pathologist at a minimum. The responses to this survey indicated that a majority of audiol-ogists include professional assessments from other disciplines as part of their assessment protocol for AP Although it may not be possible for an audiologist to perform an on-site obser-vation, the use of questionnaires (previously discussed), reports from school officials, or com-munication with the child's teacher regarding classroom acoustics and format were reported and can be used in developing recommenda-

tions for children with APD. Auditory memory tests are infrequently administered by audiol-ogists, presumably because these tests are com-monly administered by speech-language pathologists and psychologists. The most com-mon referral in either the standard or extended battery from 92 percent of the Internet group and 73 percent of the Maryland group was for a speech-language evaluation followed by the psy-chological (76% Internet, 72% Maryland) and educational evaluations (76% Internet, 72% Maryland), indicating the importance placed on the need for an interdisciplinary assessment team in the assessment and management of children with difficulties associated with AP.

Test Battery

The results of the survey indicated that

none of the respondents completed all of the tests recommended by the consensus statement. There are a number of possible reasons why clinicians are not following the APD consensus

statement protocol, including the following:

1. Some tests are not commercially available (e.g ., gap detection tests using white noise, localization) . Protocols exist in the pub-lished literature but require clinicians to

develop test materials. 2 . Although many AP tests are easily obtain-

able, many come with little supporting doc-

umentation for administration and

interpretation . Normative data may need to

be developed by individual testing facilities

to account for differences in regional dialect,

or normative data may be specific to a par-

ticular version of the test (Musiek, personal

communication, July 17, 2001) . Distribu-

tors of AP tests often include a disclaimer

with their tests, indicating that adminis-

tration and scoring information are limited

(or not provided at all) and that purchasers

of AP tests should obtain further informa-

tion from the literature and/or seminars

(e.g ., Auditec, 1998) . Although it is true that clinicians who

administer AP tests must have both theo-retical and practical knowledge of AP (ASHA, 1996), it is not surprising that one

of the most commonly reported AP tests from this and other studies (e.g., Chermak et al, 1998) is the SCAN (or SCAN-A or SCAN-C)-a professionally packaged and marketed test including instructions for administration and scoring.

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3. Another potential reason for the differences in test protocol is the heterogeneity of the population of children with APD. A diverse and flexible test battery, rather than the same battery for every child, is essential in appropriate assessment and management of these children (Pinheiro and Musiek, 1985; Bellis and Ferre, 1999). Traditional AP test-ing for adults followed the medical model of diagnosis to identify pathology. This is evi-denced by examining some of the traditional AP tests, such as the SSW, which includes extensive documentation for localization of site of lesion . Many of the reported studies ofAP test sensitivity and specificity compare results to a radiologically or surgically diag-nosed brainstem and/or cortical pathology (e.g., Pinheiro, 1976; Hurley and Musiek, 1997 ; Musiek et al, 1980; Musiek and Pin-heiro, 1987). Although APD has been attrib-uted to neurophysiologic disorder (such as polymicrogyri and heterotopias), neuro-maturational differences, neurologic pathol-ogy, and trauma (Chermak and Musiek, 1997), many causes of functional deficits cannot be attributed to a specific pathol-ogy. The focus for AP assessment with chil-dren should be to determine if the functional deficits in listening and learning experi-enced by the child can be attributed to the auditory system and, if so, how these deficits can be remediated or managed. The cur-rent battery of tests for most clinicians includes many tests of peripheral and lower brainstem function, including immittance, OAE, ABR, and PIPB functions. In contrast, some of the most exciting research over the past few decades has focused on cortical processing; however, these tests are rarely reported as part of the AP battery.

4. Electrophysiologic tests may not be available at some audiologic facilities that conduct AP tests. For example, in a public school sys-tem, obtaining electrophysiologic equip-ment, or referral to an outside agency for expensive electrophysiologic testing, may not be considered warranted by the ARD team, especially considering that APD is not classified as a disability under the Indi-viduals with Disabilities Education Act as of the writing of this article. Perhaps more research on the relationship between elec-trophysiologic diagnosis and management outcomes and greater advocacy within the school system by audiologists performing AP testing may lead to the evolution of AP

testing toward more electrophysiologic test-ing, including later cortical event-related potentials .

5. Another potential reason for clinicians not following the APD consensus statement pro-tocol is the audiologist's prerogative to deter-mine the test protocol that will best benefit the child based on a review of the literature and clinical experience . Jerger (1998) indi-cated in an editorial that he became "extremely depressed" by the Martin et al (1998) findings of current audiologic prac-tices. Miller (1998) responded to Jerger's editorial with the following statement: "There is a considerable time gap between publication of new data and their accep-tance on the clinical level. Perhaps this is not ,all bad' since it gives us an opportunity to evaluate what is new (which is not always good) and to preserve what is old (not always bad)" (p . 311) . The autonomy of audiologists relies on our ability to independently con-sider the merits of our test protocol . Some audiologists may argue that they do not agree with the protocol outlined by the Jerger and Musiek (2000), whereas others may counter that the use of tests that are convenient, but do not follow best practices, is not an example of professional autonomy but professional inertia (Jerger, 1998).

6. According to Sykes et al (1997), 88 percent of on-campus clinics in graduate audiology programs offer APD evaluations; however, Chermak et al (1998) suggested that uni-versity training programs do not adequately prepare students to assess the central audi-tory nervous system . Audiologists may not be using best-practice models of assessment because of poor training during their grad-uate education program.

SUMMARY

1. The typical AP test battery consists of dichotic speech tests, monaural low-redundancy speech tests, and question-naires . All audiologists require a basic audiologic evaluation prior to AP testing, and most include information from other professional evaluations (via referral or on-site team) as part of the APD diagnos-tic protocol . More than half of the audiol-ogists include temporal processing tests, and many include ABR as part of their standard and/or extended test battery, but few include longer latency potentials .

108


2.

3 .

4.

None of the audiologists in this survey reported using a protocol that met APD

consensus statement guidelines for mini-

mum APD testing . The most often omitted

tests included AMLR, duration pattern,

performance-intensity function, and gap

detection testing . Tests that are commercially packaged and accompanied by detailed instructions and

interpretation guidelines (including nor-mative data) such as the SCAN, SCAN-A, SCAN-C, and ACPT are often the most

widely clinically used tests of APD in each category. Many tests are available from commercial and research facilities or from individual

researchers ; however, the quality of sup-porting materials varies, and some tests

lack normative and reliability data, espe-cially for children (McFarland and Cacace,

1995). In some cases, published studies are applicable only to specific versions of the test, adult listeners, or subjects with a specific

pathology. Individual testing facilities may need to develop their own normative data and, in some cases, their own tests to con-duct the entire APD battery.

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Auditec. (1998) . Central auditory processing . Available at : http://www.auditec.com/central .htp, Accessed July 17, 2001 .

Acknowledgment. The author would like to thank

Dr. Barbara Laufer and Dr. Peggy Oates for their review

of the manuscript and Patricia Lucas for her assistance

during the development of the survey.

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APPENDIX A

Survey of Audiologists' Central Auditory Processing (Auditory Processing') Assessment Battery for Children (Preschool to Age 18)

1. Do you conduct auditory processing asses-sments? Yes No If no, please stop here and return the sur-vey. Thank you!

2. Please check your area(s) of certification and/or licensure.

Audiology Speech-language pathology Psychology

_Education Other. Please specify:

3. Do you usually have a parent, teacher, and/or client (if age appropriate) complete a questionnaire for AP evaluations? Yes No If yes, which ones?

"AP" seems to be more appropriate than "CAP" based

on "goals of maintaining operational definitions, avoiding

the imputation of anatomic loci, and emphasizing the inter-

actions of disorders (Jerger and Musiek, 2000). However,

clinical use of "CAP' is still common . For this survey, we

did not wish to confuse clinicians who use the traditional

"CAP" label.

4. Do you administer monaural low-redundancy speech tests? Yes No Please check all you commonly use as part of your test battery. Time-compressed speech test, NU-6

Time-compressed speech test plus rever-

beration, NU-6 Ivey filtered speech test (Willeford Cen-tral Test Battery) Speech in noise word recognition test Discrimination of Phonetically Balanced Kindergarten in Noise Synthetic Sentence Identification test with Ipsilateral Competing Message SCAN-C, Filtered Words SCAN-A, Filtered Words SCAN-C, Auditory Figure Ground SCAN-A, Auditory Figure Ground

-SCAN, Filtered Words SCAN, Auditory Figure Ground Low-pass filtered speech test Pediatric Speech Intelligibility test Other. Please specify :

5. Do you assess dichotic listening? Yes No Please check all you commonly use as part of your test battery.

Dichotic Digits test Staggered Spondiac Words test Competing Sentences test

_Dichotic Consonant Vowel test Synthetic Sentence Identification test with Contralateral Competing Message

_Dichotic Sentence Identification SCAN-C, Competing Words SCAN-A, Competing Words SCAN-C, Competing Sentences SCAN-A, Competing Sentences SCAN, Competing Words Dichotic Rhyme test Other. Please specify:

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8 . Do you administer electrophysiologic tests as part of your AP battery? Yes No Please check tests used as part of the standard test battery and as part of the extended test bat-tery (based on individual client needs) .

Electrophysiologic Tests Part of Standard

Test Battery As Needed, Based on

Individual Case Auditory brainstem response

Otoacoustic emissions

Acoustic reflex threshold

Acoustic reflex decay

Auditory middle latency response

Auditory late response

Mismatched negativity response

P300

Immittance audiometry

Other. Please specify:

6. Do you test temporal processing (e.g ., tem-poral ordering, gap detection)? Yes No Please check all you use as part of your test battery.

Pitch Pattern Sequence Pitch Pattern Sequence-Child Version

Duration Pattern Test Intensity Pattern Sequence Test Gap detection test

Auditory Fusion Test Psychoacoustic Pattern Discrimination

Test Other. Please specify:

7. Do you assess binaural interaction? Yes No Please check all you use as part of your test battery. Rapidly Alternating Speech Perception

Binaural Fusion Test (Willeford Central Test Battery) Masking level difference Binaural Fusion (bandpassed), NU-6

Segmented-alternated consonant-vowel-consonant fusion test


Do you assess localization and/or lateralization? Yes No How?

9. Do you assess auditory attention? Yes No Please check all you use as part of your test battery.

Auditory Continuous Performance Test Conners' Continuous Performance Test

Vigil Continuous Performance Test Selective Auditory Attention Test


10 . Do you routinely perform a classroom observation/assessment? Yes No If yes, do you fill out an evaluation as part of the observation/assessment? Yes No What type of evaluation do you com-plete?

11 . Do you assess memory? Yes No Please check all you use as part of your test battery.

Test of Auditory-Perceptual Skills-Revised Auditory Number Memory Auditory Number-Reverse Memory

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Auditory Sentence Memory Auditory Word Memory

Goldman-Fristoe-Woodcock Auditory Memory Test Recognition Memory Memory for Content Memory for Sequence Denver Auditory Phoneme Sequencing Auditory Sequential Memory Test Other. Please specify:

12 . Do you require a basic audiologic assess-ment prior to AP testing? Yes No Please check all you require prior to (or dur-ing) AP assessment .

Otoscopic evaluation Pure-tone air-conducted/bone-conducted evaluation Speech recognition threshold Word recognition Sentence recognition Nonsense syllable recognition Performance-intensity function Tympanometry Other. Please specify:

Lindamood Auditory Conceptualization Test Isolated Sounds in Sequence Sounds within a Syllable Pattern Auditory Discrimination Test Test for Auditory Comprehension of Language-3

Vocabulary Grammatical Morphemes Elaborated Phrases and Sentences Token Test for Children Part I-two critical elements Part II-four critical elements Part III-three critical elements Part IV-six critical elements

-Part V-linguistic concepts Flowers-Costello Test of Central Audi-tory Abilities Woodcock-Johnson Psychoeducational Battery-Revised

Clinical Evaluation of Language Fun-damentals-Revised Phonological Awareness Screen Other. Please specify:

15 . Would you like a copy of the results of this survey? Yes No

13 . Do you administer speech-language and/or psychoeducational tests as part of your AP test battery? Yes No Please check all you use as part of your test battery.

Test of Auditory Perceptual Skills Auditory Interpretation of Directions Auditory Word Discrimination Auditory Processing Goldman-Fristoe-Woodcock Auditory Skills Battery

-Quiet Subtest Noise Subtest

14 .

Thank you for your time . Please return the completed survey in the enclosed SASE or mail to Dr. Diana Emanuel, Department of Commu-nication Sciences and Disorders, Towson Uni-versity, 8000 York Rd., Towson, MD 21252-0001 . If you receive this survey electronically, please attach your response and send it to [email protected] .

What other evaluations (via referral or on-site team) are part of your AP diagnostic protocol?

Type of Evaluation Psychological Educational Speech-language Otolaryngology Neurologic

Part of Standard Test Battery I As Needed, Based on Individual Case


Journal of the American Academy of Audiology/Volume ~13, Number 2, February 2002

APPENDIX B2

American Guidance Service 4201 Woodland Road P.O . Box 99 Circle Pines, MN 55014-1796 800-328-2560 www.agsnet.com

0 Comprehensive Assessment of Spoken Lan-guage

" Goldman-Fristoe-Woodcock Test ofAuditory Discrimination

" Oral and Written Language Scales " Peabody Picture Vocabulary Test-III

Audiology Illustrated, LLC 111 Lyme Road Hanover, NH 03755 603-643-9705

" Dichotic Digits " Frequency Patterns " Duration Patterns

Auditec of St . Louis 2515 S. Big Bend Blvd . St . Louis, MO 63143 314-781-8890 800-669-9065 www. auditec. com

" Auditory Fusion Test-Revised " Competing Sentences " Dichotic CV " Dichotic Digits " Dichotic Sentence Identification " Dichotic Word Listening Test " Discrimination of Phonetically Balanced

Kindergarten in Noise Duration Pattern Sequence (DPS) Low-pass filtered lists; NU-6, PBK-50, Word Intelligibility by Picture Identification

" NU-6 with various competitions " Pediatric Speech Intelligibility Test " Pitch Pattern Sequence " Random Gap Detection Test " Rapid Alternating Speech " Selective Auditory Attention Test " Speech in Noise " Spondee Binaural Fusion " Synthetic Sentence Identification with Con-

tralateral Competition " Synthetic Sentence Identification with Ipsi-

lateral Competition

2 Many of the speech-language tests are available from multiple distributors but are only listed once .

" Time-compressed speech (several standard word recognition score lists including WIPI)

Educational Audiology Association 4319 Ehrlich Rd . Tampa, FL 33624 www.edaud.org 800-460-7EAA

Children's Auditory Performance Scale Fisher Auditory Problems Checklist Listening Inventory for Education Screening Identification for Targeting Edu-cational Risk

Etymotic Research 61 Martin Lane Elk Grove Village, IL 60007 847-228-0006

" Quick SIN

Linguisystems 3100 4th Avenue R O. Box 747 East Moline, IL 61244-0747 www.linguisystems.com 800-776-4332 Fax: 800-577-4555

" Phonological Awareness Test

Maico Diagnostics 9675 West 76th Street Eden Prairie, MN 55344 952-941-4201 Fax: 952-903-4200 www.maico-diagnosties .com

" Hearing in Noise Test

Precision Acoustics 411 NE 87th Avenue, Suite B Vancouver, WA 98664 360-892-9367

" Competing Environmental Sounds " Phonemic Synthesis " Phonemic Synthesis Picture " Staggered Spondaic Word

Pro-Ed 8700 Shoal Creek Boulevard Austin, TX 78757-6893 800-897-3202 Fax: 800-397-7633 www.proedinc.com

" Comprehensive Test of Phonological Pro-cessing

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Detroit Test of Learning Aptitude-Fourth Edition Expressive One Word Picture Vocabulary Test-2000 Edition Gray Oral Reading Tests-Fourth Edition Lindamood Auditory Conceptualization Test Test for Auditory Comprehension and Lan-guage, Third Edition Test of Auditory Perceptual Skills-Revised Test of Phonological Awareness Test of Word Finding, Second Edition Test of Written Language, Third Edition Token Test for Children

800-323-9540 http://www.riverpub.com

The Psychological Corporation 555 Academic Court San Antonio, TX 78204-2498 800-872-1726 www.psychcorp .com

" Vigil Continuous Performance Test (Psy-

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chological Corporation, 1996) Conners' Continuous Performance Test (Con-ners, 1994) Auditory Continuous Performance Test (ACPT) (Keith, 1994b) SCAN-C : Test for Auditory Processing Dis-orders in Children (Keith, 2000) SCAN-A : A Test for Auditory Processing Disorders in Adolescents and Adults (Keith, 1994a) SCANWARE (Software) Test of Phonological Awareness Clinical Evaluation of Language Funda-mentals, Third Edition Photo Articulation Test, Third Edition

Read America Box 1246 Mount Dora, FL 32756 352-735-9292 Fax: 001-352-735-9294 www.ReadAmerica .net [email protected]

" Phono-Grapix

Riverside Publishing Company 425 Spring Lake Drive Itasca, IL 60143-2079

" Test of Word Finding in Discourse

Slosson Educational Products P.O . Box 280 East Aurora, NY 14052-0280 888-756-7766 800-655-3840

" Slosson Oral Reading Test

Western Psychological Services 12031 Wilshire Boulevard Los Angeles, CA 90025-1251 310-478-2061 www.wpspublish.com

" Auditory Discrimination Test

Richard Wilson, PhD Chief, Audiology James H. Quillen VA Medical Center Mountain Home, TN 37684 www.va.gov/621quillen/clinics/asp (Use this Web site to download word lists for the

compact disc .) Richard.Wilson2Qmed.va.gov

Tonal and Speech Materials for Auditory Per- ceptual Assessment Dichotic Digits Dichotic Consonant Vowels Dichotic synthetic sentences NU-6 high-pass filter Frequency patterns NU-6 compression + reverberation Spondaic words masking level difference

Speech Recognition and Identification Materials

" Competing Sentences " NU-6 in babble " SSI-ICM

Jack A. Willeford, PhD 4603A E. 2nd Street Tucson, AZ 85711 520-290-0158

0 Willeford Battery

the auditory processing battery: survey of common … · the auditory processing battery: survey of...

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