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J AmAcadAudi ol 11 : 467- 474 ( 2000)

Report of t he Consensus Conferenceon theD agnosi s of Audi tory Processi ngD sorders i n School -Aged Chi l drenJ ams Jerger*FrankMusi ck'

BACKGROUNDAgroup of 14 seni or sci enti sts and c l i ni c ians mt at the Cal l i er Center i n Dal l as over the2-dayper i od, Apri l 27-28, 2000, i n an attemt t o reach aconsensus on the probl emof di agnosingaudi tory processi ng di sorders i n school -aged chi l dren . Theconferencewas organi zedbyJ ams Jerger andFrankMusi ek The f ol l ow ng i ndi vi dual s parti c i pated :SharonAbel , PhDJ ane Baran, PhDAnthonyCacace, PhDGai l Chermk, PhD$SusanDal ebout, PhDJ ayHal l 111, PhDLi ndaHood, PhDLi saHunter, PhDJ ams erger, PhDSusan erger, PhDRobert Kei t h, PhDFrankMusi ek, PhDRoss Roeser, PhDChri sti ne Sl oan, PhD

Uni versi ty of Toronto, Toronto, ONUni versi ty of Massachusetts, Amerst ,MAAl bany Medi cal Col l ege, Al bany, NYWshi ngton State Uni versi t y, Pul l mn, WUni versi ty of Vi rgi ni a, Charl ottesvi l l e, VAUni versi ty of Fl or i da, Gai nesvi l l e, FLLoui si anaStateUni versi ty Medi cal Center, NewOrl eans, LAUni versi ty of Mnnesota, Mnneapol i s,MNUni versi ty of Texas at Dal l as, Dal l as, TXUni versi ty of Texas at Dal l as, Dal l as, TXUni versi ty of C ncinnati , C ncinnati , OHDartmuth-H tchcockMedi cal Center, Hanover, NHUni versi ty of Texas at Dal l as, Dal l as, TXAnnapol i s Val l ey Regi onal School Board Berw ck, NS

Meeti ngboth as separate groups and n pl enary sessi on, the conferees reached the consensus summri zedbelow

INTRODUCTION

Some school -aged chi l dren appear t o haveheari ng probl em. They are descri bedbythei r parents andt eacher s as chi l drenwho are

*The Uni versi ty of Texas at Dal l as, Ri chardson, TexastDartmuth-H tchcock Medi cal Center , Hanover, NewHamshi re

tDr Chermk was unabl e t o com t o Dal l as f or t hemeeti ng but parti ci pated vi a t el ephone l i n k .

The Bruton Conference was hel d Apri l 27- 29, 2000,at t he Cal l i er Center f or Commni cati on D sorders, TheUni versi ty of Texas at Dal l as .

Thi s report has been accepted as an o f f i c i a l docu-mnt by the Amri can Academ of Audi ol ogy.Repr i nt requests : J ams J erger, 2612 Prai r i e CreekDr . East, Ri chardson, TX75080-2679

uncertai nabout what they hear, have d i f f i c u l t yl i s teni ng i n the presence of background noi se,have d i f f i c u l t y f o l l ow ng oral i nstr ucti ons, andhave d i f f i c u l t yunderstandi ngrapi d or degradedspeech Som of thesechi l drenw l l have a si g-ni f i cant l oss i n peri pheral heari ng sensi t i vi ty I nothers, however, audi tory thresholds w l l bewt hi n norml l i m t s . I t i s assumd hat, i n a s i g-ni f i cant proport i on of the atter group of chi l dren,the l i s teni ng probl em resul t f roman audi toryprocessi ng defi cit , the def ecti ve processi ng ofaudi tory i nf ormti on n spi te of norml audi torythresholds . I nthepast , chi l drenw th suchprob-l em have been l abeled as havi ng "central audi -tory processi ng di sorder" (CAPD I n keepi ngw th the goal s of mi ntai ni ngoperati onal def i -ni ti ons, avoi di ng the i mutati on of anatomc

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l o c i , andemphasi zi ng the i nt er acti ons of di sor-ders at bothperi pheral andcentral sit es, however , i t seem more appropri ate t o l abel suchprobl em as "aud tory processi ng d sorder"(APD) .

AnAPDmaybebroad ydef i nedas adef i ci ti n the processi ng of i nformti on that s speci f i ct o the audi tory mdal i ty Theprobl emmaybeexacerbatedi n unfavorabl e acousti c envi ron-ments . I t mybe associ ated wth di f f i cul t i es i nl i steni ng, speechunderstand ng, l anguagedevel -opment , and earni ng I n i t s pure form however,i t i s conceptual i zed as a def i c i t i n the process-i ngof audi tory i nput.

Thedi agnosi s of APDs presentl ycompl i -catedbythree f actors :

Oher types of chi l dhooddi sorders my xhi bi tsiml ar behavi ors Exampl es are attenti ondef ic i t hyperacti vi ty di sorder (ADHD), l an-guage i mpai rment, read ng di sabi l i ty , l ear n-i ng di sabi l i ty , aut i s t i c spectrumdi sorders,andreducedi nt el l ectual functi oni ng

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" Some of thea li d t lo ogi c proce ures presen yusedt o evaluatechi l dren suspectedofAPDai lt o di f ferent i ate themadequatelyfromchi l drenwth other probl em . Test procedures requi r-i ng thec hi l d t o respondbehavioral l ymaybesubj ect t o t hi s cr i t i ci smI n assessi ngchi l drensuspectedof havi nganAPD one i s l i k e l y t o encounter other pr ocessesandfuncti ons that confoundthe i nt erpreta-ti on of t est resul ts . Exampl es are l ackof moti -vat i on, l ack of sustained at t ent i on, l ack ofcooperat i on, and ack of understand ng I t i svi t al t o ensure that suchconfound ng f actorsdo not l ead t o the erroneous di agnosi s of anaud toryprobl em

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Becauseof these compl i cat i ons, thed i f f e r -ent i al di agnosi sof APDs r equi r es thesystemati cacqui si t i on of abody of data suf f i c i ent t o i den-t i f y an audi tory- speci f i c perceptual def i ci t . Thepurposeof thepresent document i s t o assembl eabodyof recommendat i ons di rected towardthatgoal .Thedel i ber at i ons of thegrouparesumm-ri zedunder f our head ngs :

" Mni mal Test Batt ery-aproposedmni maltest batteryf or theaudi ol ogi cal di agnosi s ofAPD

" D r ec t i ons f or Future Research

SCREENNGFORAPD

Sreeni ng f or APDs i n school chi l dren i s notcurr entl y addressedi nanypol i cy statementbynati onal prof essi onal organi zati ons .Aumber of checkli sts andquesti onnaires havebeenusedf or thepurposes of scr eeni ng, but there i sa l ack of consensus onhowthe i deal screeningprocedure shoul dbe structured andwhat tasksi t shoul d contai n Moreover, these checkl i stsand questi onnaires are not hi ghl y specif i c toAPD Performance s of ten i nf l uenced bynonau-di t o r y factors ( e . g . , l anguage, memory), resul t -i ng i n over- ref err al of chi l dren wt hnonaud toryprobl em f or APDassessment . Thepresent doc-ument suggests met hods f or mni mzi ng theseconfounds i n order t o i mprove screeni ng f orAPD

I t i s i mportant t o d sti ngui sh betweenscreeni ngtests anddi agnost i c tests. I nthepast ,screeni ng test outcomes have somet i mes beenused t o i dent i f y andl abel chi l drenas havi nganAPD Thi s i s an i nappropri ateuseof screeningtool s . Thegoal of anyscreeni ngprocedure i s t oi dent i f y chi l drenwhomayhave anAPD Chi l -drenwhoare so i dent i f i ed shoul dbereferred t oan audi ol ogi st f or di agnost i c eval uati on S ncethegoal of screening s t o i dent i f y asmnych i l -drenas possi bl e who myhaveAPD screeni ngtests are purposel y desi gned f or maxi mal sen-s i t i v i t y . Such sens i t i vi t y i s usual l yachi evedatthe expense of l ack of spec i f i c i t y Thus, ahi ghf al se- pos i t i ve rate i s common, i ndeedexpected,fromaproperl y desi gnedscreeni ngprocedure Wensuchscreeni ngdata areusedt o i dent i f yrather than t o refer, theresul t i s anabundanceof f al se-posit i ve i denti f i cati ons, l eadi ng nevi t abl yto l oss of cr edi bi l i t y amngparents andamngprofessi onal s i n related speci al t i es .I n vi ewof the l i m t at i ons of exi st i ng screen-i ngtool s, i t seem appropri ate that anewscr een-i ng procedure be devel oped andval i dated f orschool - aged chi l dren . The ol l ow ng pri nci pl es aret o be fol l owed i nthedesi gnof anyAPDscreen-i ngprocedure

" Screeningf or APDarevi ewof basi cpr i nc i -pl es rel evant t o screeni ngchi l dren f or APD

" D f fe r ent i al Dagnosi s of APDarevi ewofbasi c pr i nc ip l es rel evant t o the di f f erenti aldi agnosi s of th is compl exdi sorder

" Screeni ng questi onnai res and i nstrumentsshoul demphasi ze the tasks essent i al t o theprocessi ng of compl exaudi toryst i mul i . Exampl es of such processes i ncl ude, but are not

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" Som of the audi ol ogi c procedures presentl yused t o eval uate chi l drenwho"donot seemt o hear wel l " f a i l t o di f f erent i ate chi l drenw thaudi toryversus nonaudi tory prob em.

" I n assessi ngchi l dren suspectedof havinganAPD one s l i k e l y t o encounter other processesand functi ons that mayconfound the i nter-pretati on of test resul t s .I n order to eff ecti vel y di f f erenti at e APDf romother di sorders w th si m l ar symtom-t ol ogy, the examner mst consi der the f ol l ow-

ingrelevant l i stener vari abl es :AtentionAudi toryneuropathy (Appendix A)FatigueHeari ngsensi t i vi ty (AppendixB)I nt el l ectual anddevelopmntal ageMedicationsMotivationMotor s k i l l sNative l anguage, l anguage experi ence, l an-guageage

" Response str at egi es anddecisi on-mkingsty l e" Vi sual acui t y

Thedesign of ef f ect i ve test instrumntsrequires consi deration of the fol l owng taskvari abl es :

Cognitivedemnds (mmry, at t ent i on)Fl oor andcei l i ng effectsLearningand/or pract i ce effectsLi ngui s t i c demndsResponse mde

t o those that systemati cal l y mnipul ate l i n -gui st i c vari abl es . The i ngui st i c paramtersshoul dbe clear l y speci f i ed These st rat egi esw l l assi st i n di f f erent i at i ng APDf rompoorperformnce rel atedt o l anguage di f f i c u l t ie s ." I t i s im r t t t to an o use con emorary psy-chophysi cal mthods that permt thecont r olof sti ml us presentationandresponse sel ec-

t i on andal l owthe f l exi bi l i t y t o eml oyavar i -ety of feedback opti ons .I t i s imortant t o mnimze memoryl oad I fa test depends onremmberi ng nformati on,poor performncemaybe theresul t of amemory defi cit rather thananaudi tory processi ngdef i ci t . For examl e, def i ci t s i n memoryprocesses have been i dent i f i ed i n chi l dren

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wth l earni ngdi sabi l i t i es and n chi l drenwthattenti on def i c i t s ." I t i s imortant to eml oy a si ml e responsemde i n order t o mnimze the confoundingeffects onaudi tory processi ng of sensori m-tor imai rmnts, speech production di sor-ders, andprobem i n mtor l earning " Comuter-control l edadapti vepsychophysi cal

procedures arerecommnded Theuseof suchtechni ques mximzes test ef f i ci ency andmn-i mzes f l oor andcei l i ng effects ." Aeamapproacht o assessmnt provi des fur-ther val i dat i on of the di f f erenti al di agnosi s .Moreover, i t i s imortant f or mnagemnt

planning At a mni mm the teamshoul dinclude an audi ol ogi st and speech-l anguagepathol ogi st al ongw thparents andteachers .Oher speci al i sts canbeconsultedas needed MNMALAPDTESTBATTERY

A though a number of diagnostic proce-dures are i n current use, manyhave probembecause l i stener andtask vari abl esare not sat-is fa ct o r i l y cont rol l ed . The fol l owngpri nci pl esshoul dbe consideredt o imrove str at egi es i nAPDassessmnt :

I t i s imortant t o comare analogous tasksf romml ti pl e sensorymodal i t i es . For exampl e, a chi l dw th anAPDmght performpoorl yon an auditory task but not a vi sual task,whereas achi l dwth bothaudi toryandvi sualprocessi ng def i ci ts mght performpoorl y onbothtasks. Som chi l dren wthei t her reducedi ntel l ectual f uncti on or ADHDmght al so per-formpoorl y onboth tasks .

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" I t i s imortant o eml oy test mteri al s thatcont r ol for l i ngui s t i c var i abl es, rangingfromtasks w thmniml or no l i ngui s t ic demnd

T ere are threepossi bl e approaches t o theconstr ucti on of amni ml test battery f orAPDi n school chi l dren ( 1) behavioral tests,( 2) el ect rophysi ol ogi c andel ectr oacoust i c tests,and ( 3) neuroimging st udi es .

Behavioral tests havetheadvantageof beingwdel y avai l abl e and relat i vel y easy and i nex-pensi ve t o admnister There i s al so a body ofinformtionrel at i ve t o performncecharact er-i s t i cs . There i s a disadvantage, however, thatresul t s maybe easi l y confoundedbyextraneousvari abl es ( see above) .

El ectr ophysi ol ogi c andel ect roacoust i c testshave theadvantageof beingi nf l uenced l ess byextraneous vari abl es . The disadvantage, how-ever, i s that they aremretimconsumngandmre expensi ve t o admnister. Moreover, f a c i l i -t i es f or suchtesti ngare not wdel y avai l abl e . I t

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i s noteworthy, nonethe ess, that mnybehavi oraltest paradi gm canbe i ncorporated wthi nel ec-trophysio ogi c procedures, thus provi dingbothperformnce masures andgross si te -specif i ci nformti on f romthesamtest sessi on

Neuroi mgi nghol ds great promseas a oolf or the assessmnt of audi tory processi ng Anumer of the tasks that have beendefi ned i nthe behavi oral domi nare al ready i n cl i ni caluse i n i mgi ng l aborator i es, wth wel l - def i nednorm Others, part i cul ar l y tasks i nvol vi ng di s -cri mnati onparadi gm, areevol vi ngtoward c l i n -i c a l appl i cabi l i ty Al l of thesetasks have beenapp i ed i n ei t her cl i ni ca l or experi mntal s e t -t i ngs . I t i s thecase, however, that neuro mgingshares wth el ectr ophysi ol ogi c testi ng the di s -advantage of rel at i vel y hi gh cost and l i mtedavai l abi l i ty .

Thi s sai d, the parti cipants f e l t that anapproach f ocusi ngonbehavi oral tests andsup-p emnted by el ectr ophysi ol ogi c and el ectr oa-cousti c testi ng hel d thegreatest promseas a estbattery or APDs

Potent i al behavi oral masures i ncl ude0Measures of detecti on ( e. g , the pure-toneaudiogramandtemporal i ntegrati on tasks) ;Measures of suprathresho d di scri mnati on( e . g , di fferencel i mns for frequency, ntensi ty,and/or durati on temporal orderi ng/ sequenc-i ng tasks ; temporal reso uti on tasks; back-ward/ forward msking tasks ; msking l eveldi fferenceLMLD1) ; soundl ateral i zati on andspati al l ocal i zati on andMeasures of i dent i f i ca t i on ( e . g , the r ecogni -t i o n of phonems, syl l abl es, words, phrases,and sentences) .

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Therearethree possi bl e mdes i nwhi chaudi -tory tasks canbe presented

Parti ci pants consi dered the f ol l ow ng po-tenti al el ectr ophysi ol ogi c and el ectroacousti cprocedures:

" Otoacousti cemssi ons" Immttance audiomtry" Audi tory brainstemresponse (ABR)" Audi tory mddl e l atency response(AMLR)" Audi tory l a te response (ALR)" Msmtched negati vi ty response(MMNR)" Event-re ated responses (ERP)

Fromthi s poo of potenti al test procedures,the parti cipants created twoenti ti es ( 1) themnmmtest battery necessary t o arri veat adi f ferent i a l diagnosi s ofAPD n schoo -aged chi l -dren and (2) opti onal procedures potenti al l yusefu i nstrengthen ng thedi agnosi s .

Mnm Test BatteryThef ol l ow ng test battery s recommnded

i n order t o provide themnmmamunt ofi nformti onnecessary or thediagnosi sofAPDi n schoo -aged chi l dren Some cl i ni ci ans mychooset o carryout addi ti onal t esti ng ; however,the set of procedures l i s ted be ow s suggestedas themnmmnecessary test batteryBehavi oral Measures

Pure-toneaudiomtry-essenti al f or assess-i ngpresence anddegree of peri pheral hear-i ng l oss ( see Appendi x B) .Performnce-i ntensi ty functi ons f or wordrecognti on-essenti al f or theexpl orati on ofwordrecogni ti onover awderangeof speechl evel s and or compari ngperformnceonthetwoears .Ai chot i c task (e .g , di choti c di gi ts, di choti cwords, or di choti c sentences)-a sensi t i vei ndi cator of anaudi tory processingproblemDurati onpatternsequencetest-a key ma-sure of audi torytemporal processi ng Temporal gapdetecti on-a key masureofaudi tory temporal processi ng

Monoti c, st i m us t o each ear separate yD oti c, samsti m us to both ears si m ta-neousl yD chot i c , di f f erent sti mul i t o the two earssim taneously

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Thereare di f f er i ngci rcumtances i n whi cheach of thesedel i very mdes i s mst appropri -at e . I n the case of di choti c t e s t s , thedi choti c mdei s obviousl yessenti al . However, mnoti c assess-mnt s a lso essenti al t o ensurethat si gni f i cantear asymmtri es are detected Somemasures( e . g . , tests of spati al l oca l i zat i on) myentai ldi ot i c sti mul ati on Final l y, somtasks e . g . , temporal orderi ng) mybe presentedi n al l threemdes

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El ectroacousti c andEl ectrophysi ol ogi c Measures

I mmttance audiomtry-essenti al t o rul eout mddl e ear di sorder andto i denti fyacousti c ref l ex abnorml i ti es Otoacousti c emssi ons-usefu i n rul i ng outi nner ear di sorder s .

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" Audi tory brainstemresponse and mddl el atencyresponse-keymasures of thestatusof audi tory structures at brainstemandcor-t i cal l evel s .

I f a chi l d f ai l s a screen f or APD he/sheshouldbereferr ed t o anaudi ol ogi st or audi ol ogi ctesti ng f aci l i t y wth the capabi l i ty t o provideeachof theseessent i al procedures and o i nter-pret thei r resul ts .Thepart i ci pants acknowedgethat thi s mn-iml test battery acks animortant dimnsioni n rel at i on t o the prob emof di f f erent i at i ng anaudi tory -speci f i c di sorder fromother di sordersthat mayimact auditory processing There sacl ear andpressingneed f or analogousbehav-i oral and/or el ectrophysi ol ogi c test procedures i nanonauditorymdal i ty (e .g , vi si on) . Unti l suchmasures arewdelyavai l abl e, themni ml estbattery summri zed above represents a rea-sonab e comromse Theopt i onal proceduresdescribedi n the fol l ow ng secti on suggest pos-si bl e future approaches t o the ssue of mdal i tyspeci f i ci ty .Opti onal Procedures

I norder t o demnstrate that theprocess-i ngdisorder i s speci f i c to the audi tory mdal -i t y , i t i s desi rabl e t o comareperformnces onanalogous audi tory andvi sual tasks Onepos-si bl e approach i s t o comare behavi oral per-formnce scores on comarab e audi tory andvi sual continuous performnce masures . Forexamle, duration patterns of l ong and shortl i ght f l ashes mght becomaredwthanalogous

durati on patterns of ongandshort noi se bursts .Another potential l y useful approach i s theevent-rel atedevoked potent i al . Anexamle sthe Ps oo event-related response i n the f aml i ar"oddbal l " paradigm Onemght, f or examl e,structure analogous audi tory andvi sual temporal processing tasks i n order t o test whetheradef i ci t i s present nbothmodal i t i es or i s con-f i ned t o the audi torymdal i ty

FUTURE RESEARCHNEEDS

Tere i s acl ear need f or further research t oaddress0

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Thenorml psychophysi cal devel opmnt ofthe di scr i mnat i on, recogni t i on, and recal lof vi sual andaudi tory i nformati on,Thepr eval ence of APDn chi l dren,Theappropriateageat which o beginAPDscr eeni ng,The ageat which di agnosti c tests f or APDcanbe used rel i abl y,

" Performncecharacteri sti cs of exi st i ngtestsi n di f f erent cl i ni cal groups," Adaptati on of psychophysical di scri mna-t i o n paradigmt o thecl i ni cal eval uationofAPD" Therelationship betweenAPDtest out-

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APPENDXAAudi toryNeuropathy

Oneaudi t ory di sorder t hat canexhi bi t sym-tomtol ogy si ml ar t o mre centr al l y basedAPDsi s thedi sorder presentl yreferr ed t o as "audi t oryneuropathy " Auditory neuropathy i s charac-ter i zedbynorml cochl ear functi on at the l evelof theouter hai r cel l s but dysynchronous audi -tory brai nstemresponses, placing t hi s func-t i onal di sorder i n the peri pher al audi t ory system( i nner hai r cel l s of the cochl eaand/or audi torynerve) . Audi tory neuropathy can coexi st wthother mtor andsensory neuropathies as acomponent of knowndiseasesyndroms or canbeunique t o the audi tory system I t i s imortant

coms andmnagemnt str ategi es,Outcoms of earl y i nterventi on f or APDThe rel ati ve effi cacy of i nterventi onapproaches at various ages, andCol l aborat i ve research t o examnerel at i onsamngAPDanddi sorders i nother systemthat imact audi toryfuncti on

t o di sti ngui shaudi tory neuropathy fromAPDsand t o determnewhether t i s coexi sti ng wthother mtor and/or sensory neuropathy I t i spresentl y possi bl e t o separate audi tory neu-ropathy fromother APDs wth avai l abl e di ag-nosti c audi tory tests . Determnationof coexi sti ngneural di sorders i n other systemcanbe madethrough ref erral f or appropriate mdical andphysi ol ogi c tests .

APPENDXBHearingSensi tivi ty

Ordi nari l y, APDs are associ ated wthnormlperi pheral hearingsens i t i v i t y However, APDsmaycoexi st wthperi pheral hearing l oss or as

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a resul t of conducti ve heari ng l oss . Moreover,peri pheral audi tory di sorders can impact l an-guagedeve opment, readi ng, and l earn ng

J erger S, A l enJ . (1998) . Howglobal behavi oral tests ofcentral audi tory processi ngmycompl i catemnagemntI n Bess F, ed . Chi l dren wth Hearing Imarmnt .Contemporary 7Y-ends . Nashvi l l e Bi l l Wl kersonCenter,163-177

APPENDXCSuggestedReadi ngsArnst D Katz , eds . ( 1982) . Centr al Audi t ory Assessment :TheSSWTest . SanD ego Col l ege Hi l l .Bel l i s T (1996) . Central Audi tory Processi ngD sordersSanD ego Si nguar .Berl i nC, Lowe-Be l S, et al . (1972) . Central audi torydefi cit s after temporal l obectomy Arch Oo aryngo96: 4-10 Berl i nC, Lowe-Be l S, et al . (1973) . D choti cspeechper-cepti on an i nterpretati onof ri ght-ear advantageandtemporal of fset ef f ects . JAcoust SocAm53:699-709 BrydenM Zuri fD (1970) . D choti c l i steni ngperformancei n acase of agenesi s of the corpus cal l osumNeuropsycho ogi a 8: 443-450.CacaceA McFarl andD ( 1995) . Open ngPandora' s box :t he r e l i a b i l i t y of CAPDests . AmJ Audio 4: 61-62 .ChermkG Musi ekF(1997) . Central Audi toryProcessi ngD sorder . SanD ego Si nguar .ChermkGDHal lWI I , Musi ekFE (1999) . D f f erent i aldiagnosi s andmnagemnt of central audi tory process-i ngdi sorder andattenti ondef i c i t hyperacti vi ty di sorder .JAmAcadAudi o 10:289-303 Cherry R (1992) Screen ngandeval uati onof centralaudi tory processing disorders i nyoungchi l dren I n KatzJ , Stecker N HendersonD eds Central Audi toryProcessi ng : ARansdi sci pl i nary V ew St . Lou s MosbyYearbook,Dal ebout SD StackJW1999) . Msmtchnegati vi ty toacousti c di f ferences not di f f erenti atedbehavioral l y JAmAcadAudi o 10:388-399 Damsi oH Damsi oA, Castro-Cal dasA, FerroJ . (1976)Dchoti c l i steni ngpattern n relati on t o i nterhemspheri cdi sconnexi on Neuropsycho ogi a 14: 247-250.Damasi oH Damasi oA ( 1979) . Paradoxic ear ext i nct i oni n di choti c l i s teni ng Neuro ogy 29:644-653 F i f er R, J erger , Ber l i n C, Tobey E, Campbe l J . ( 1983) .Deve opment of a di choti c sentence i denti f i cati on test f orheari ng- i mpai red adul ts . Ear Hear 4: 300-305 Gatehouse S ( 1991) . The contr i buti on of central audi -to ry factors t o audi tory d isab i l i ty ActaOt ol aryngol Suppl(Stockh) 476: 182-188 Goodgl assH (1967) . B naural di gi t presentati onandearl y l ateral brai ndamge Cortex3: 295-306 J erger S, Marti nR, et al . ( 1987) . Specif i c audi tory per-ceptual dysf uncti on i n a l earni ng di sabl ed chi l d Ear Hear8: 78- 86 .J erger J , A ford B, et al . (1995) . D choti c l i steni ng,event- rel ated potenti als, and i nterhemspheri c transferi n the el derl y Ear Hear 16:482-498

J erger J , Chme R, et al . ( 1999) . Twn study of centralaudi tory processing di sorder . JAmAcadAudi o10 : 521-528 J i r s a R ( 1992) . The cl i n i c al ut i l i t y of the P3AERP nchi l dren wth audi tory processi ng di sorders J SpeechHear Res 35:903-912 Katz J , Basi l R, et al ( 1963) . A taggered spondai cwordtest f or det ect i ng central audi tory l esi ons . AnnOt ol RhinolLaryngo 72:906-917 Katz J , Stecker N et al , eds (1992) Central Audi toryProcessi ng Aransdi sci pl i nary V ew St . Lou s MosbyYearbook .Katz J , Kusn erczykK (1993) . Central audi tory pro-cessi ng the audio ogical contri but i on . SemnHear14:191-199 Ke th R (1977) . Central Audi tory Dysfuncti on NewYork Grune&Stratton Ke thR (1986) . SCAN AScreen ng Test for Audi toryProcessi ngD sorders SanAnton o, TX ThePsycho ogicalCorporati onKe thR, J erger S (1991) . Central audi tory disorders I nJ acobson , NorthernJ , eds Dagnosti cAudio ogy Austi nTX Pro-ed, 235-248Ke thR (2000) . SCANC Test for Audi tory Processi ngD sorders i n Chi l drenRevi sed SanAnton o, TX ThePsycho ogical Corporati onK muraD ( 1961) . Someeffects of temporal obe damageonaudi tory percepti on . Can J Psychol 15:156-165 MFarlandD CacaceA (1995) . Modal i ty s peci f i ci t y asacri teri on for di agnosi ngcentral audi tory processingdi s-orders .AmAudo 4 36-48 Merzen ch M J enki nsWt al . (1996) . Temporal pro-cessing def i ci t s of l anguage-l earn ngi mpai red chi l drename i oratedby trai n ng. Science 271: 77-84Ml l er S, Del aney T, Tal l alP1995) Speech andothercentral audi tory processes i nsi ghts f romcogn ti veneu-roscience Curr Opi nNeurobi o 5: 198-204 Musi ek F (1983) . Assessment of central audi tory dys-functi on thedi choti c di gi t test revisi ted Ear Hear4 79-83Musi ek, F ( 1994) . Frequency (pi tch) and durati on pat-tern tests . J AmAcadAudio 5: 265-268 Musi ek F, Pi nhe roM (1985) . D choti c speech tests i nthedetecti onof central audi torydysfuncti on I n: Pi nhe roM Musi ek F, eds Assessmnt of Central Audi toryDysfunct i on FoundationsandC i n cal Corre ates.Bal t i more Wl l i amsandWlkins, 201-219Musi ek F, WlsonD et al . (1979) . Audio ogical man fes-tat i ons i n s pl i t - b r ai n pati ents . JAmudi o Soc 5:25-29

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Musi ekFWl sonD (1979) .SSWnddi choti c di gi t resul tspre- andpostcommssurotom acase report . J SpeechHear Dsord 44:528-533 Musi ek F, Baran , et al . (1990) . Durati onpatternrecog-ni ti on i nnorml sub ects andpatientswth cerebral andcochl ear l esions Audi ology29:304-313 Musiek F, Charette L, Kel l y T, Wi LeeWusiekE(1999) . Ht and al se-posi t i ve rates f or themddl e l atencyresponsei npati entswth central nervoussystemi nvol ve-ment . JAmAcadAudi ol 10:124-132.Musiek F, Gol l egl y K, et al . ( 1984) . Mel ination of t hecorpus cal l osumand audi tory processing prob em i nchi l dren : theor eti cal and cli ni cal corr el ates. SemnHear5: 231-241

Roeser R J ohns D et al . (1972) . Ef fects of i ntensi ty ondi choti cal l y presenteddi gi ts . J Audi toryRes12:184-186 Salamat MT, McPhersonD (1999) . I nteracti onsamongvari ab es i n the P300 response to aconti nuous perfor-mancetask JAmAcadAudi ol 10:379-387.Si l mnS, Si l vermnC, EmmeM ( 2000) . Central audi -tor y pr ocessi ng di sorder s andreducedmoti vati on threecase studi es JAmAcadAudiol 11 : 57-63 Sl oanC (1986) . 7}eatingAudi toryProcessi ngD f f i cul t i esi n Chi l dren SanD ego Col l ege H l l .Sparks R GeschwndN (1968) . Dchotic l i stening i nmanafter secti onof neocorti cal commssures Cort ex43-16

Musi ekFol l egl yK, et al . (1991) .Aroposedscreeni ngtest f or central audi torydisorder.AmJ ol 12:109-113 Mykl ebustH (1954) . Audi tory D sorders i n Chi l dren NewYork Gune&Stratton Noffsinger D Kurdzi el S (1979) . Assessmnt of centralaudi tory l esions . I n : R ntel manW ed . Heari ngAssessmnt . Bal ti mre Universi ty Park, 351-377Phi l l i ps D ( 1995) . Central audi tory processi ng : a viewfromaudi tory neurosci ence . AmOt ol 16:338-352 Pinhei ro M MusiekFds (1985) . Assessmnt of CentralAudi tory Dysfuncti on: Foundations andC inicalCorrelates. Bal ti mre Wl l i am&Wlki ns Pinhei ro M MusiekF (1985) . Sequencingandtemoralorderi ng i n the audi torysystem I n Pinhei ro M MusiekF, eds Assessmnt of Central Audi tory Dysfuncti onFoundati onsandCl i ni cal Correl ates . Bal ti mre Wl l iam&Wlkins

StachB (1992) . Controversies i n the screeningof cen-tra l auditory processingdisorders I n BessFal l J , edsScreeningof Chi l drenfor Audi tory Functi on Nashvi l l eBi l l Wl kersonCenter, 61-77 Tal l al P, M l l er S, Fi tchR ( 1993) . Neur obi ol ogi cal basi sof speech a case f or the preemnence of temoral pro-cessi ng NYAcadSci 682: 27-47 Thomson M Abel S ( 1972) . I ndi ces of hear i ng i n pati entsw th central audi tory pathol ogy ScandAudiol 21(Suppl35) :3-15 .Wl l efordJ . (1977) . Assessingcentral audi tory behaviori n chi l dren atest battery approach I n Kei th R, ed Central Audi tory Dysfuncti onNwork Grune&Stratton,Zeng F, ObaS, GardeS, Si ni nger Y, StarrA (1999) .Temoral andspeechprocessingdefi cits i naudi toryneuro-pathy NeuroReport 10:3429-3435

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