A. Hurley, PhD
Definition What we do as audiologists? Glimpse into the Future
ASHA (2005) cited (C)APD as referring to the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information. (C)APD refers to difficulties in the perceptual processing of auditory information in the CNS as demonstrated by poor performance in one or more of the following skills:
Bob Keith (C)APD is a deficit in the auditory pathways of the brain that results in inability to listen to or to comprehend auditory information accurately even though normal intelligence and hearing sensitivity are documented (1986). Jack Katz What we do with what we hear.
Sound localization Sound lateralization Auditory discrimination Auditory pattern recognition Temporal resolution Integration and ordering of auditory information Difficulty with degraded or competing signals
Difficulty hearing in noisy backgrounds Difficulty localizing the sound source Difficulty learning a foreign language Often asks for repetition Difficulty processing fast speech Inability to detect humor or sarcasm (prosody) Inappropriate responses Easily distracted by external stimuli Difficulty maintaining attention Difficulty following direction Poor musical ability Reading, spelling, and or learning problems.
Does it truly exist? Modality Specific? Is the brain modality specific? Who can diagnosis CAPD? No gold standard for assessment No gold standard for interpretation What constitutes a deficit?
Medical Site of Lesion Site of Lesion/Site of Dysfunction Lag of Maturation of the CANS Morphological Dysfunction Neurologic Disease & Insult Acquired CAPD TBI CVA Educational Auditory, Language, Reading and Learning Disorders
Development Education Difficulties Coordination Language Temperament Other.
Often there are co morbid conditions Difficulty with communication Academic Difficulties (ADHD/ADD) Language Disorders Learning Disorders Reading Disorders (dyslexia) Other Related Difficulties Acquired (CAPD) TBI
We are testing the auditory system at the acoustic level. The CAPD may not alone be the reason for the academic failure. Often see very bright individuals with CAPD-- may have learned to compensate for their difficulties. Often we see CAPD in existence with language processing, phonological disorders or dyslexia. We know that training can improve deficits noted in the auditory system.
Who? Parents SLP.Teacher Why? Academic Difficulties When? Family History
Peripheral Hearing!! Age of the child (Chronological and Mental) Cognitive capacity Linguistic Capacity (native language) Attention Native Language Memory Motivation
Medical History (Pre, peri, & postnatal development) Developmental milestones General Health Family History Psychological Factors Communication, Listening and Auditory Skills History of OME History of jaundice/hyperbilirubinemia
Screening Tests SCAN-3 (Adults and Children) Normed for ages 5- adult Screening and Diagnostic Portions CD player (Stereo earphones) Fisher s Auditory Processing Checklist Children s Auditory Performance Scale Evaluation of Classroom Listening Behavior Children s Home Inventory for Listening Difficulties (CHILD)
Ages 5-12 children; 13-50 adult Approximately 10-25 minutes. Administration for the diagnostic and supplementary tests is 20-30 minutes. Gap Detection Test Filtered Words 750 Hz low pass Auditory Figure Ground at various SNR levels (all have option of 0, 8, & 12 db SNR) Competing Words Free Recall Competing Sentences Time Compressed Speech (60%)
I. Monaural Low Redundancy Degraded Acoustic Signals Background noise Filtered Speech Time Compressed Speech II. Temporal Pattern Tests Discrimination and Patterning Frequency Pattern/Ordering Tests Duration Pattern/Ordering Tests
III. Binaural Tests Binaural Separation/Integration Dichotic (Different)Tests Binaural Interaction Rapidly Alternating Speech Perception Masking Level Difference
Electrophysiologic data validates the results of behavioral data when abnormalities are shown in both behavioral and electrophysiological tests Auditory Brainstem Response Auditory Middle Latency Response Auditory Late Response (P300 & MMN) cmark: an ABR to Speech Approximately 30% of children with a language based learning disability have an abnormal BioMARK recording. Normed for ages 3-4; 5-12; 18-28
It is the PATTERN of findings across measures of central auditory function and cognitive, language, and learning testing that will determine whether a CAPD exists, the specific type(s) of CAPD that is/are present, and the direction that management should take (Bellis,2003).
Identify the presence or absence of auditory processing skill weaknesses Identify specific auditory processing skill weaknesses (auditory discrimination, or auditory memory) Determining the effects of the weakness spelling, following directions, etc Determining which treatment/interventions will be beneficial
ACCURATE DIAGNOSIS!
Remember other skills may improve due to the nature of training! Intervention should be both bottom-up (auditory training) but also include some top-down instructional approaches.
1. Environmental Modifications Enhance access to auditory information. Increase opportunity for effective listening. 2. Compensatory Strategies (top down) Metacognition, metamemory, metalingustic To overcome secondary associated motivational related deficits.
Direct Remediation Techniques Improve auditory performance by altering the way the brain processes sound Involves targeted activities that maximize neuroplasticity. Define Neuroplasticity Alterations of nerve cells due to experience or learning.
Auditory training activities must be: Frequent Intense Challenging Involve active participation Include salient reinforcement
There is no one size fits all for (C)APD intervention!
1. Identify the auditory weakness/dysfunction. 2. Relate auditory deficits to language, learning, and communication. 3. Select appropriate treatment and management strategies. 4. Monitor the efficacy of treatment/management and adjust as needed.
Wall Spear Snake Tree Fan Rope
Auditory Processing Language Processing Transition Area Both Auditory & Language Processing Reception Discrimination Interpretation
Heschl s Gyrus Wernicke s Angular Gyrus Peripheral Auditory System CANS Transition Area Broca and Frontal Lobe Response Primary Secondary Tertiary Central Auditory Processing BOTH AUD and LANG Language Processing
THE BRAIN HAS TO.. Be aware that a sound was made Find where the sound came from Pay attention to the sound Separate the sound from background noise Decide if the sound is speech or not Figure out which speech sound was made Understand the tonal and stress patterns Understand each part of the word Create words out of sounds Create sentences out of words Create thoughts out of sentences Remember all of the sounds, words, sentences and thoughts
instruction because the signal was blocked by a sudden, loud noise outside the room (i.e., competing signal that interfered with primary stimulus). instruction because it was presented in a language or linguistic code that was unfamiliar (i.e. foreign language). he or she chose not to comply (i.e. choice he or she could not remember it long enough to comply (i.e. memory)
he or she was not sure what the instruction meant (i.e. language). the acoustic signal was not received (i.e., audibility, deaf, HOH) because he or she was thinking about something else (i.e. attention deficit).
the acoustic signal was not received (i.e., audibility, deaf, HOH). The individual ignored the instruction because he or she was thinking about something else (i.e. attention deficit).
Experiences word-finding problems Difficulty remembering lengthy directions Has pronounced differences between measures of verbal and performance abilities
Audiologists are responsible for evaluating and diagnosing problems in the reception and/or transference of an acoustic signal in the peripheral auditory system and central auditory nervous system. SLPS are responsible for evaluating and diagnosing problems in analyzing an acoustic signal in phonological awareness and/or linguistic interpretation. Treatment for processing disorders cannot be effective unless the specific skills in deficit are carefully differentiated.
Generic term used to describe a variety of communication disorders: language processing, language perception, sensory processing, central auditory processing. Audiologists, SLPs, and OTs?
Understanding speech, Noise tolerance, Temporal processing difficulties, Ear deficits on dichotic speech tasks
Abnormal Auditory Evoked Potentials Structural Brain Differences A decrease in size may lead to a decreased number of axons transversing the CC. Optimal and efficient processing occurs when the two hemispheres interact. Abnormalities of cortical connectivity lead to a disruption of integrative and interhemispheric processing.
At the end of each intervention session, 10 language processing probes were delivered to the child Percent correct responses to probes was tracked to determine if DL training was improving Language Processing
SA Total Correct for Language Probes 10 8 6 4 2 0 10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 SB Total Correct for Language Probes 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 SC Total Correct for Language Probes 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Parental Reports were positive Increase in spontaneous language More engaging