Prevalence of Spatial Processing Disorders and impact of Cognition on CAPD testing

Central auditory processing disorders (CAPD): diagnosis and remediationHarvey Dillon

With thanks to:

Helen GlydeMridula SharmaDani Tomlin

1

JessWhitfieldSharon Cameron

National Acoustic LaboratoriesNALwww.CAPD.NAL.gov.au2

Presentation OverviewCentral Auditory Processing Disorder (CAPD)Spatial Processing Disorder (SPD)What is SPD and how does it relate to CAPD?What causes it?How do we remediate it?Testing for CAPD Test batteries and remediationCognitive ability, listening difficulty and academic successSound Scouts a new quick online test

3????????National Acoustic Laboratories, Sydney, Australia3What is CAPD?An Auditory Processing Disorder (APD) is a deficit in the way the neural representations of sounds are processed by the brainWhat we do with what we hear.(Katz, Stecker & Henderson; 1992) IC: Form full spatial map,Parallel processing paths join,History dependentMSO: Detect interaural timeLSO: Detect interaural levelAVCN: Frequency analysis,PVCN: Timing well preservedDCN: Inhibitory circuits, pinna cue detection?Parallel processingNeeds to be fed to develop & maintainAuditory System: Central Pathways

Lateral lemnisci

SC: Visual spatial mapCortex: Complex detectionThalamus: Auditory and visual map integrated, relayed to cortex

Sorting, comparing and categorizingPerceptionVNLL: Fed by contralateral CNOKSomething not OK10/15/20156Dorsal CN: HF? Ventral CN: LF? according to Vivs neuroanatomy!

APD creates difficulty in listeningi.e. hearing with intent to extract information

difficulty understanding speech in noise or reverberation

difficulty hearing on the phone

inconsistent or inappropriate responses to requests for information

difficulty following rapid speech

frequent requests for repetition and/or rephrasing of information

difficulty following directions

difficulty learning a foreign language or new words

problems localizing sound

difficulty detecting the subtle changes in prosody that underlie humor and sarcasm

difficulty maintaining attention

a tendency to be easily distracted

poor singing, musical ability, and/or appreciation of music

academic difficulties, including reading, spelling and/or learning problems

AAA (2010)Assessing children with CAPDAudiometric test (to rule out hearing loss)HistoryA test batterySometimes proposed to instead make the assessment symptom-based (e.g. use a questionnaire)CHAPS, SIFTER, LIFE, CCC2, Fishers checklistDisorders other than APD (e.g. language disorders) can also create difficulty in listeningLanguage disordersAttention deficit disorderAuditory working memory deficitExecutive function deficitAutism spectrum disorderLow IQDifficulty of relying on symptoms

Child fails to understand an instructionEventActs (inappropriately) based on what was heardAsks for repetition of instructionDoes nothingMisbehavesResponse by childInterpretation by observerDaydreamsBadly behavedCant follow instructionsIs not very smartPoor concentration11Questionnaires (or other ways to gather symptoms) might be able to confirm there is a problem, but cant tell us the cause. Diagnosing CAPD by symptoms?CognitionLanguageAuditory processingNational Acoustic Laboratories, Sydney, AustraliaCAPD or AD(H)D?Auditory processing deficitUnderstanding is difficultDont pay attentionAttention deficit disorderDont pay attentionRelation between APD and Attention Disorder13Auditory attention disorder51Auditory processing disorder58Visual attention disorder251913220145424No disorderGyldenkaerne et al. (2015)101 children with listening difficultiesWhat do we include in Auditory Processing?Rapid spectro-temporal analysisLocalisation abilitySlow temporal analysisStream segregationAttentionWorking memoryExecutive functionRapid spectro-temporal analysisLocalisation abilitySlow temporal analysisStream segregationAttentionWorking memoryExecutive functionAuditory Processing AbilityCognitive abilityWhat do we include in Auditory Processing?Causation .. unknownAuditory processing abilitiesLanguage abilitiesCognitive abilitiesAcademic abilitiesReported listening ability17

ASHA (2005)(C)APD is a deficit in neural processing of auditory stimuli that is not due to higher orderlanguage, cognitive, or related factors.""WhenIuse a word,' Humpty Dumpty said in rather a scornful tone, 'it means just what I choose it to mean neither more nor less."

"The question is," said Alice, "whether youcanmake words mean so many different things."

Moore, Ferguson et al (2010)What is currently called APD, for individuals without known neurologic lesions, should be redefined as primarily a cognitive disorder, rather than a sensory disorder.What is APD?National Acoustic Laboratories, Sydney, AustraliaMy comment 18It is not productive to define APD as either not involving cognition, or as only involving cognition.

Rather, focus on finding out Whether individual children have difficulty listening,Why they have difficulty when listening, andWhat can be done to change that.National Acoustic Laboratories, Sydney, AustraliaTeachers CHAPS scores children referred to Great Ormond Street Hospital for APD assessment

Slightly more difficultyMore difficultyConsiderably more difficultySame difficulty

Slightly more difficultyMore difficultyConsiderably more difficultyParents CHAPS scores children referred to Great Ormond Street Hospital for APD assessmentSame difficultyCAPD

SPDIn reviewCAPD is an umbrella term for a variety of deficits in auditory processing that cause listening difficultiesSymptoms shared with other disordersSome differences of opinion in what should be included under the umbrella

Spatial Processing Disorder:

Diagnosis, cause, remediationSpatial Processing Disorder(deficit in spatial release from masking)

NoiseNoiseNoiseNoiseSpeech

24CAPD test battery National Acoustic Laboratories, Sydney, Australia24Spatial Processing Disorder

Unique amongst CAPD because we:Know its major causeCan diagnose it, unrelated to cognitive abilityHave extensive normative and reliability dataCan remediate it (blinded, randomized trial)Remediation generalizes to real life25National Acoustic Laboratories, Sydney, Australia26CatalystThe Australian Broadcasting CommissionNational Acoustic Laboratories, Sydney, Australia

Assessing Spatial Processing Ability

27National Acoustic Laboratories, Sydney, Australia27Listening in Spatialized Noise Sentences Test (LiSN-S) Test ability to separate target stimuli from distracting stimuli that arrive from other directions.

Test design to differentiate this ability from other problems.

28National Acoustic Laboratories, Sydney, AustraliaLiSN-S

Adaptive speech-in-noise test.Virtual auditory environment under headphones.Target sentences from 0.Distracter stories at 55 dB SPL from either 0 or 90. Stops when SE < 1.0 dB, or max of 30 sentences.

29National Acoustic Laboratories, Sydney, Australia29SPD is diagnosed using the Listening in Spatialized Noise- Sentences Test (LiSN-S). The LiSN-S is an adaptive speech in noise test conducted under headphones in a simulated auditory environment. The test uses sentences designed for young children as they target speech and that is heard as if it is coming from directly in front of the listener. At the same time looped childrens stories are presented from either directly in front of the speaker or from either side of the speaker depending on the condition. The SRT is calculated for four LiSN-S conditions and based on those scores 3 advantage measures or difference scores are also calculated.LiSN-S Measurement Screen

30Two Distracters at 55 dB SPLLevel of Target (adaptive)SRT average SNRNational Acoustic Laboratories, Sydney, AustraliaSame DirectionDifferentDirectionsDifferent Voices Four LiSN-S ConditionsSame VoiceTD1D2TD1D2TD1D2Low CueSRT Spatial AdvantageTalker AdvantageD1D2THigh CueSRTTotal Advantage31National Acoustic Laboratories, Sydney, AustraliaAnticipated Advantage of Using Difference ScoresFour base scores likely affected by:Cognitive abilities (memory, IQ, attention)Language abilities (vocabulary, closure skills, second language)

Three difference scores relatively immune to these

32National Acoustic Laboratories, Sydney, AustraliaLiSN-S results profile: spatial processing disorder

33National Acoustic Laboratories, Sydney, AustraliaExplanation Screen

Client Assessment Report

Spatial Advantage ( Spatial Release from Masking)BetterAustralia

Nth America

This graph shows performance on the spatial advantage measure.

Spatial advantage is calculated as the difference between the low-cue SRT and SV90 condition.

Adult like performance on the spatial advantage measure is achieved earlier than on talker advantage. Children are able to use ITD and IID as well as adults by about 11 years of age.

Again, there is no decline in spatial processing ability in older adults.

36High Cue SRT

Betterp < 0.000001Moving on to the high cue SRT, this condition provides participants with both spatial and pitch cues to differentiate the target sentences from the distracter voices.

ANOVA showed that a significant difference does exist between the groups.

You can once again see that performance improves with age and then begins to plateau. However, like low-cue SRT performance starts to decline slightly but not significantly at about age 50

Planned comparisons revealed adult like performance was achieved by 14-15 years of age for high cue SRT as well.

37LiSN-S Cut-off Scores

38Cameron et al. 2011BetterNational Acoustic Laboratories, Sydney, AustraliaLow Cue SRT: max (1.94 - 2.24* age, -1.61) + (2 * 0.96)

39LiSN-S Spatial Advantage Test-Retest Reliability (n=95)BetterPaired Difference = 0.3 dBp = 0.178r = 0.2Critical Difference Score = 3.3 dBChildren with spatial processing disorderNational Acoustic Laboratories, Sydney, AustraliaChildren with Spatial Processing DisorderNine children aged 6 to 11 years experiencing listening difficulties in class relative to peers who had no learning or attention disorder and WISC IQ >90 on all subscales (SusAPD group).Eleven children with confirmed language, memory or attention disorders, and WISC IQ overall score >90 (LD group).Assessed on LISN-S and results compared to 70 age-matched controls.Assessed with a traditional (C)APD test batteryNational Acoustic Laboratories, Sydney, Australia

Cameron & Dillon (2008)LiSN-S vs. Traditional Battery (LD Group)National Acoustic Laboratories, Sydney, AustraliaLiSN-S vs. Traditional Battery SusAPD Group

Cameron & Dillon (2008)LiSN-S vs.Traditional Battery (sus CAPD Group)National Acoustic Laboratories, Sydney, Australia

Link between SPD andChronic Otitis Media (COM)

44

National Acoustic Laboratories, Sydney, Australia4445SPD and chronic otitis media (COM)50% of children (24/49) diagnosed with SPD at NAL reported a history of COM. (Dillon et al., 2012).30% of children (15/50) previously diagnosed with COM at University of Melbourne were diagnosed with SPD. (Graydon & Rance, ongoing).Spatial processing deficit worse for early onset age and longer duration of COM (n=35; Tomlin & Rance, under review).6 yo children with history of COM have below average spatial advantage (n=17; z= -1.0) (Kapadia et al, 2012).13-17 yo adolescents with history of COM have below average spatial advantage (n=20; z= -0.75) (Kapadia et al, 2014).10% of a population sample (9/90) of Aboriginal children from remote Australia diagnosed with SPD. (Unpublished data). 7% of a population sample (10/144) of Aboriginal children from regional Australia diagnosed with SPD. (Cameron et al., in review).

National Acoustic Laboratories, Sydney, AustraliaIndigenous Australian children experience, on average, 2.6 years of conductive hearing loss (vs. 3 months for non-Indigenous children).4546Interpretation Based on These and Other StudiesChronic otitis mediaFluctuating access to binaural cuesreduced effectiveness in better-ear glimpsingNational Acoustic Laboratories, Sydney, Australia

Remediation of SPD:

The LiSN & Learn Auditory Training Software

47National Acoustic Laboratories, Sydney, Australia47LiSN & LearnDeficit-specific remediation for SPD.Trains children to attend to a frontal target stimulus and filter out distracting talkers from left and right.Adapts to 70% performance level.Used in the home or schools/clinics).Provides detailed feedback, analysis and reporting.

48National Acoustic Laboratories, Sydney, AustraliaDescription of LISN & LearnFive games presented on PC over headphones.Target sentences at 0 azimuth.Competing stories - same voice at 90 - (55 dB SPL).Weighted up-down adaption of target level.SRT calculated over 40 sentences.131,220 unique sentences.50 training sessions (2 games x 5 days p/w x 10 weeks).Reward system.

49National Acoustic Laboratories, Sydney, AustraliaA weighted up-down adaptive procedure is used to adjust the signal level of the target based on participants response:

decreased by 1.5 dB when target correctly identifiedincreased by 2.5 dB if wrong target identifiedincreased by 1.5 dB if the unsure response is made

LISN & Learn Game

Target at 0:Distracters at + and -90:

Target: The horse kicked six wet shoesLC SRT p = 0.158Talker Advantagep = 0.981HC SRTp = 0.0002Spatial Advantagep = 0.0002Total Advantagep = 0.001

LiSN-S Results - Pre- vs. Post-TrainingCameron & Dillon (2011)52National Acoustic Laboratories, Sydney, AustraliaVertical bars denote 0.95 confidence intervals

F(8, 64)=5.3847, p=.0000352LiSN & Learn Preliminary Study 9 children with SPD (6 to 11 years)LiSN & Learn 2 games/day, 5 days/week, 12 weeks

LiSN & Learn SRT (dB)BetterGame NumberCameron & Dillon (2011)Average SRTFirst vs Last 30 Daysp = 0.0000525310 dBNational Acoustic Laboratories, Sydney, AustraliaSelf-Report Questionnaire - Pre- vs. Post-Training

Very HardHardOKEasyVery EasySSQ Listening in Noise:Pre vs Post - p = 0.0002 *Post vs 3MP - p = 0.397SSQ Listening in Quiet:Pre vs Post - p = 0.103Post vs 3MP - p = 0.529Cameron & Dillon (2011)54National Acoustic Laboratories, Sydney, Australia55Blinded Randomized Control Study 10 children (aged 6 yrs 0 mths to 9 yrs, 9 mths) diagnosed with LiSN-S as having SPD:

5 x LiSN & Learn (experimental group)5 x Earobics (control group)

Questionnaires

Participant (LIFE)Parent (Fishers)Teacher (LIFE)

LiSN & Learn or Earobics training 15 minutes daily x 60 sessionsRe-evaluate LiSN-S and questionnaires post-training

National Acoustic Laboratories, Sydney, Australia55SSQ = Speech, Spatial and Qualities of Hearing Scale LISN-S one-sided critical difference was calculated as (Mean Test-Retest Difference) - (1.64 x SD of Mean Test-Retest Difference).This represents the decrease in dB needed to infer that there has been a genuine improvement in auditory performance on retest, taking into account mean practice effects and day-to-day fluctuations in performance.Mean difference between test and retest was 0.5 dB for Low-cue SRT, 1.1 dB for High-cue SRT, 0.9 dB for talker advantage, 0.1 dB for spatial advantage, and 0.7 for total advantage.A critical difference on the spatial advantage measure is 2.8 dB, and on the Low-cue SRT it is 2.5 dB

LiSN-S Results Pre vs. Post TrainingEarobics (n = 5)Lisn & Learn (n = 5)56

Cameron, Glyde & Dillon (2012)p = 0.5 to 0.7p = 0.03 to 0.0008National Acoustic Laboratories, Sydney, Australia

Questionnaires Post Training ImprovementsTeachersChildren57ParentsL&L = 22%; Earobics = 9%L&L = 31%; Earobics = 9%L&L = 16 pts; Earobics = 7 pts;where 0 pts = no improvementp = 0.028National Acoustic Laboratories, Sydney, AustraliaDisclosureThe National Acoustic Laboratories, is an Australian government laboratory NAL licences the LiSN-S test to Phonak, and is paid a royalty on sales. NAL directly sells the LiSN & Learn training package through its web site.

58National Acoustic Laboratories, Sydney, AustraliaIn reviewSpatial processing disorder (SPD) can unambiguously be diagnosedSPD is very often caused by protracted otitis media in infancySPD can be remediatedTesting for CAPDA typical test batteryGap detection (GIN, RGDT)Dichotic perception (DDT, SSW, CST)Temporal ordering (FPT, PPT)Binaural processing (MLD, LiSN-S)Degraded speech (Compressed speech, LPFS)[Auditory memory (digits forward and reverse)]

CAPD if two tests failed by two standard deviations or more62Traditional approach to CAPD testingHistoryAudiometryIs there a problem that CAPD might explain?Exclude CAPD;Refer elsewhereNoTest result interpretation & diagnosisNon-specific remediation and management: Classroom placement FM use Instruction style Soundfield amplification Auditory training softwareDetailed test batteryYesFurther problems with a large test batteryIncreased demands on childs attention(The tests are often very boring!!)Relevance of the normative dataStatistical implications of presenting multiple tests - inflating Type I error rate.

63Principles in constructing a test batteryInclude tests where: poor results are linked to poor listening in real life diagnose conditions for which evidence-based remediation exists64NAL position statement on CAPD:www.CAPD.NAL.gov.au

Test structureLiSN-S high cueAuditory memory(digits forward and reverse)Dichotic digitsLiSN-SRemediate(Memory booster)Remediate(FM ..)Remediate(L&L)National Acoustic Laboratories, Sydney, AustraliaDichotic Digits and CognitionDichotic Digits Test6746924, 96, 2Dichotic Digits Difference Test4, 96, 2Diotic conditionAuditory working memoryAttentionIQ

Dichotic presentationDichotic abilityAuditory working memoryAttentionIQ

Correlations DDDT and cognition68DichoticDioticAttention - Prudence0.370.32Attention - Vigilance0.340.24Number memory forward0.350.41Number memory reverse0.340.47Non-verbal IQ0.260.26

Dichotic vs diotic perception69Dichotic presentationDichotic abilityAuditory working memoryAttentionIQ

Diotic condition

Auditory working memoryAttentionIQ

R= 0.69National Acoustic Laboratories, Sydney, AustraliaFM useageHornickel and Krauss (2012; PNAS)70

National Acoustic Laboratories, Sydney, AustraliaResults from a clinical service:

prevalence and remediation effectivenessAustralian Hearings CAPD ServiceOperating in 42 Australian Hearing centers around Australia since May 2012.Diagnosis, assessment and management of specific aspects of CAPD.Recruitment targets children experiencing difficulty hearing in background noise.Tests are chosen which:Have been shown to be associated with difficulties in real life.Are reliable, repeatable and relatively quick to administer.Lead to remediation that is backed by research evidence.

72National Acoustic Laboratories, Sydney, Australia72Age DistributionN=618

73National Acoustic Laboratories, Sydney, AustraliaPasses and FailsHearing screeningLiSN - HCMinimal SensorineuralMild ConductiveUnknownLiSN MemoryAgeDDT2366643636PassZ < -1 329Z -1307SPDFail120Pass (not SPD) 209Pass 349Auditory memoryFail167< 7 years76 7 yrs 273 Pass 173Dichotic deficitFail100Testing discontinued19%26%20%27%National CAPD service results: LiSN & Learn effects

LiSN & Learn training: COSI results

N = 34Effect of Memory Booster training77

COSI scores for Memory Booster training

Questionnaire / historyAudiometryMeasured disabilityIs there a problem that CAPD might explain?Detailed test batteryExclude CAPD;Refer elsewhereNoDealing with problems in understanding speechMaster test batteryYesNon-specific remediation and management: Classroom placement FM use Instruction style Soundfield amplificationTest result interpretation leading toa disorder-specific diagnosisDisorder-specific remediationLiSN& LearnLiSN-S High CueLiSN-S SpatialAdvantageLiSN-S TalkerAdvantageLiSN-S Low CueSPDUndiag-nosed deficitPitch deficitFPT VerbalFPT HumSPINHi ContSPINLo ContClosure skill deficits?Top-down training?DDDT DichoticDDDTDioticIntegrationDeficitARIA / DIIDNational Acoustic Laboratories, Sydney, AustraliaIn reviewBig test batteries have big problems, and do not have an evidence-based path to remediationEvidence of benefit exists for:Training to overcome spatial processing disorderTraining to improve working memory Use of FM (wireless remote microphone) systemsMore specific diagnostic tests and corresponding remediation methods are neededCAPD test scores, listening in real life, academic performance and cognition

Subjects

Clinical Group: (n=105) Children referred for clinical AP assessment Aged 7.0 to 12.9 years (Mean Age 8.9 yrs, 1.5)

Control group: (n=50) No reported auditory, listening or academic difficulties Aged 7.0 to 12.2 years (Mean age 9.1 yrs. 1.4)

Peripheral hearing assessments all normalDani Tomlin

82Measures obtainedAP Frequency Pattern Test (%)Dichotic Digits Test (%)Gaps In Noise (msec)Listening in Spatialised Noise Sentences test (LiSN-S) (dB)Masking Level Differences (dB)

CognitionNon verbal IQAuditory Working Memory Sustained Attention (Quotient Scores)

Academic ResultsReading Fluency WARPNAPLAN (Numerical scores)

Listening AbilityQuestionnaires:LIFE (child)Fisher (Parent)TEAP (Teacher)(Total item scores)

Results need to allow for development & comparison of measures z scoresSource: Dani Tomlin83CAPD scores versus cognitive scoresDigit Span ForwardDigit Span ReverseNon-verbal IQSus Aud AttenDDT_L0.430.390.380.19RDT_R0.360.340.280.22FPT0.250.360.430.16GIN0.090.040.130.12MLD0.15-0.050.070.04LiSN_LC0.270.180.280.00LiSN_HC0.120.110.220.14LiSN_Spat Adv0.000.030.080.04DDTavgFPTavgGINavgLiSNavgMemavgAttenavgNVIQListening abilityReading fluencyPath analysis (model; no latent variable)Remove the latent variable but allow the cognitive skills to share some variance with each other and to affect the AP test scores. Propose that each of the cognitive and AP variables affect listening ability and that the cognitive variables and listening ability affect reading fluency. How strong do the paths need to be to fit the observed relationships? (Model 0A structure)

85DDTavgFPTavgGINavgLiSNavgMemavgAttenavgNVIQ66%Listening abilityReading fluencyPath analysis (results; no latent variable)P=0.12Most metrics OK49%76%88%97%77%Listening ability is significantly affected only by NVIQ, not by any AP scores. Reading fluency is affected by listening ability (but reverse is probably also true).DDT, FPT and LiSN all affected by both Memory and NVIQ.GIN not much related to anything! (Model 0A results)

86In reviewCognitive problems are often associated with failures on commonly used test batteriesTreatment of APD88Treatment (i.e. training to reverse the deficit) should be specified on the basis of a detailed diagnosis of the deficit, but there are very, very few examples of an evidence-based treatment that follows from the detailed diagnosis, that improves performance on the test, and that generalizes to real-life benefit.National Acoustic Laboratories, Sydney, Australia

Harvey Dillon Carolyn MeeTesting hearing is childs play

John SeymourJesus CuauhtemocHearing loss in those first fitted with hearing aids at 5 or 6 years of age.

Aim 1: develop a game to test for hearing issues in preschool and school-aged children

Sensorineural hearing lossMiddle ear disordersAuditory processing disordersAim 2: differentiate these conditions !

The game has been 3 years in the making due to the need for rigorous testing to ensure that it meets both the stringent clinical requirements and the creative expectations of our digitally savve 5year olds.

Creating a game with its roots based in science has not been without its challenges.

Every element of the game had to be carefully considered and we had ensure that nothing affected or influenced the diagnostic aspects of the of the game.At the same time we had to hold true to the principles of game play ie engagement, anticipation, reward cycles and rhythm.

Just to give an example of what I mean we had originally included peanut butter as a target item but because of allergies parents are obviously not feeding their children peanut butter and children did not know what it was. So in the game while we expected a correction rate of 65-70%, we achieved rates of 30-35% well below the expectation. We had to change this item as it was effecting the clinical results.

Basis of the test algorithmTest of word recognition threshold in quiet used to set level of rest of test comparison with threshold for adult useful itselfTest of speech recognition in spatially separated noiseTest of tone perception in spatially separated noise

Expected resultsGroupCalibration testSpeech in noise testTone in noise testNormal

Conductivex

Sensorineuralxx

x

CAPD

x

?

ESL, language impairment?

x

PASS: Speech-in-noise average; tone-in-noise good

The childs results can be represented graphically.

As mentioned the game looks at tone and speech in order to provide a clearer picture of what is going on in relation to the childs hearing health. Testing tone we eliminate the influence of language allowing us to isolate the childs hearing ability. By adding a speech test, delivered in sound, we can look at Auditory Processing and language.

In this image the grey lines represent the averages, the purple line represents the childs tone test and the red line represents the childs speech in sound results. This graph indicates a pass as both tests results track along the norm.Normative data: 4 to 12 years

Speech in noise

Z scores

Deriving resultsNormal hearing childrenObtain scores Regress against ageExpress scores as z-scoresCombine z-scores for calibration, speech and toneCompare z-scores for calibration, speech and toneOverall pass, uncertain, or failProbable cause of failTest unknown childOverall resultsGroupPassInconclusiveFailIncompleteTotalNorm hear127911138Conductive3017020Sensori1224027Mixed00606SIM_SPD01304ESL606012Correctness of single diagnosisSensoriCondCAPD/LangSensori1010Conductive061Mixed400ESL013SIM_CAPD013In reviewSound Scouts: A tablet-based hearing game that:Detects hearing problemsIndicates the most likely type of hearing problemRecommends who to seek further help fromIn summarySpatial Processing Disorder (SPD) is a well-defined type of APDSPD is commonly caused by COM, but can be fully remediatedPerformance on many other AP tests affected by cognitive abilities.Link between AP test scores and real-life hearing difficulties is uncertainHearing difficulties can be managed, irrespective of diagnosis of APDTreatment of APD likely to benefit from very specific diagnosesNeed for auditory processing tests less affected by cognitive abilities.102 Difference testsReferencesDillon, H., Cameron, S., Glyde, H., Wilson, W., & Tomlin, D. (2012). Opinion: Re-designing the process of assessing people suspected of having central auditory processing disorders. Journal of the American Academy of Audiology (Accepted 17 June 2011).

Cameron, S., Glyde, H. & Dillon, H. (in press). Listening in Spatialized Noise- Sentences Test (LiSN-S): Normative and retest reliability data for adolescents and adults up to 60 years of age. Journal of the American Academy of Audiology (Accepted 18 May 2011).

Cameron, S. & Dillon, H. (in press). Development and Evaluation of the LiSN & Learn Auditory Training Software for Deficit-Specific Remediation of Binaural Processing Deficits in Children: Preliminary Findings. Journal of the American Academy of Audiology (Accepted 29 April 2011).

Cameron, S., & Dillon, H. (2010). LiSN & Learn Auditory Training Software (Version 1.1.0) [Computer software]. Sydney, NSW: National Acoustic Laboratories.

Brown, D., Cameron, S. Martin, J., Watson, C., & Dillon, H. (2010). The North American Listening in Spatialized Noise Sentences Test (NA LiSN-S): Normative data and test-retest reliability studies for adolescents and young adults. Journal of the American Academy of Audiology, 21(10), 629-641.

Cameron ,S., Brown, D., Keith, R., Martin, J., Watson, C., & Dillon, H. (2009). Development of the North American Listening in Spatialized Noise - Sentences Test (NA LISN-S): Sentence equivalence, normative data and test-retest reliability studies. Journal of the American Academy of Audiology, 20(2), 128-146.

Cameron, S. & Dillon H. (2009) Listening in Spatialized Noise Sentences test (LISN-S) (Version 1.013) [Computer software]. Murten, Switzerland: Phonak Communications AG.

Cameron, S. & Dillon, H. (2008). The Listening in Spatialized Noise Sentences Test: Comparison to prototype LISN test and results from children with either a suspected (central) auditory processing disorder of a confirmed language disorder. Journal of the American Academy of Audiology, 19(5), 377-391.

Cameron, S. & Dillon, H. (2008). Spatial hearing deficits as a major cause of auditory processing disorders: Diagnosis with the LISN-S and management options. In R. Seewald & J. Bamford, eds. A Sound Foundation Through Early Amplification 2007. Proceedings of the Fourth International Conference: Phonak AG, Switzerland, 235-241.

Cameron, S. & Dillon, H. (2007). Development of the Listening in Spatialized Noise - Sentences Test (LISN-S). Ear and Hearing, 28(2), 196-211.

Cameron, S. & Dillon, H. (2007). The Listening in Spatialized Noise - Sentences Test (LISN-S): Test-retest reliability study. International Journal of Audiology, 46, 145-153.103Thanks for listening

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