Josee Lagace - Auditory Processing Disorder - bev edits...- Pure tone audiometry (preferably with...

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Auditory Processing Disorder: an overview

Josée Lagacé, Ph.D.Associate Professor and Audiologist

University of Ottawa, Ottawa, Canada

REFERENCES

▪ Canadian Interorganizational Steering Group for Speech-Language Pathology and Audiology. (2012). Canadian guidelines on auditory processing disorder in children and adults: assessment and intervention. Ottawa: Authors.

▪ British Society of Audiology. (2011). Practice Guidance. An overview of current management of auditory processing disorder (APD). Reading: Authors.

▪ American Academy of Audiology Clinical Practice Guidelines. (2010). Diagnosis, Treatment, and Management of Children and Adults with Central Auditory Processing Disorder. Reston:TaskForce Members.

▪ American Speech-Language Hearing Association. (2005). (Central) auditory processing disorders. Technical report: Working Group on Auditory Processing Disorders. Rockville: Authors.

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OVERVIEW

▪ Definition of Auditory Processing Disorder (APD)

▪ How do we identify the presence of APD in school aged children

▪ Therapeutic intervention strategies

▪ Case Study

▪ Frequently asked questions

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https://teachingteacher.wordpress.com/2012/07/31/ten-steps-to-effective-classroom-listening/

Auditory Processing

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Image from: https://www.researchgate.net/profile/Paul_Delano/publication/282436992/figure/fig2/AS:289262537854982@1445976971329/Figure-1-Schematic-diagram-of-the-auditory-efferent-network-Ascending-and-descending.png

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▪ Localization and lateralization

▪ Auditory discrimination

▪ Auditory pattern recognition

▪ Temporal processing • Temporal resolution • Temporal masking• Temporal integration • Temporal ordering

▪ Recognition of degraded acoustical signals

▪ Recognition of acoustic signals presented with competitive stimuli

Reference: American Speech-Language-Hearing Association (2005). (Central) Auditory Processing Disorders [Technical Report].

Auditory abilities

Binaural interaction

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Essential mechanism for : - localization- signal detection in noise

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▪ Localization and lateralization

▪ Auditory discrimination


▪ Temporal processing • Temporal resolution • Temporal masking• Temporal integration • Temporal ordering

▪ Recognition of degraded acoustical signals

▪ Recognition of acoustic signals presented with competitive stimuli


Auditory abilities

Auditory Processing Disorder

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Image from https://www.researchgate.net/profile/Paul_Delano/publication/282436992/figure/fig2/AS:289262537854982@1445976971329/Figure-1-Schematic-diagram-of-the-auditory-efferent-network-Ascending-and-descending.png

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Common Symptoms

- Difficulty understanding spoken language in competing messages, noisy backgrounds, or in reverberant environments

- Misunderstanding messages

- Inconsistent or inappropriate responding

- Frequent requests for repetitions, saying « what »

« huh » frequently

- Taking longer to respond

- Difficulty paying attention

- Being easily distracted

Image from: https://www.healthxchange.sg/sites/hexassets/Assets/children/auditory-processing-disorder-when-sounds-dont-make-sense.jpg


Common Symptoms (continued)

- Difficulty following complex auditory directions or commands

- Difficulty localizing sounds

- Language development often compromised

- Academic performance below what would be expected (considering intellectual abilities)

- Hypersensitivity to sounds (even not so loud sounds)

Image from: https://www.healthxchange.sg/sites/hexassets/Assets/children/auditory-processing-disorder-when-sounds-dont-make-sense.jpg


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APD- Difficulty understanding spoken language in competing

messages, noisy backgrounds, or in reverberant environments



- Frequent requests for repetitions




- Difficulty following complex auditory directions





LANGUAGE IMPAIRMENT






APD- Difficulty understanding spoken language in competing

messages, noisy backgrounds, or in reverberant environments












ATTENTION DEFICIT DISORDER






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APD is rarely an isolated condition

- almost ½ of children referred for suspicion of auditory processing disorder fail auditory, reading and language test batteries (Sharma et al., 2009)

- 40 and 60% of children diagnosed with APD also showed indications of attention deficits (Jutras et al., 2007; Riccio et al., 1996; Riccio et al., 1994).

- 20% and 50% of the children diagnosed with APD have reading problems(Dawes et al., 2009; Dawes & Bishop, 2010)

REFERENCESDawes, P. & Bishop, D.V. (2010). Psychometric profile of children with auditory processing disorder and children of dyslexia. Archives of Disease in Childhood, 95, 432-436. Dawes, P. et al. (2009). Temporal auditory and visual motion processing of children diagnosed with auditory processing disorder and dyslexia. Ear & Hearing, 30, 675-686.Jutras, B. et al. (2007). Applicability of central auditory processing models. American Journal of Audiology, 16, 100-108. Riccio, C.A., Cohen, M.J., Hynd, G.W., & Keith, R.W. (1996). Validity of the Auditory Continuous Performance Test in differentiating central processing auditory disorders with and without

ADHD. Journal of Learning Disabilities, 29, 561-566.Riccio, C.A., Hynd, G.W., Cohen, M.J., Hall, J., & Molt, L. (1994). Comorbidity of central auditory processing disorder and attention-deficit hyperactivity disorder. Journal of the American

Academy of Child and Adolescent Psychiatry, 33, 849-8‐57.Sharma, M., Purdy, S.C., & Kelly, A.S. (2009) Comorbidity of auditory processing, language, and reading disorders. Journal of Speech, Language and Hearing Research, 52, 706-722.

OVERVIEW




▪ Case Study


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https://teachingteacher.wordpress.com/2012/07/31/ten-steps-to-effective-classroom-listening/

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SCREENING FOR APD

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▪ Fisher’s Auditory Problems Checklist (FAPC; Fisher, 1976)

▪ Screening Instrument for Targeting Educational Risk (SIFTER; Anderson, 1989)

▪ Children’s Auditory Processing Performance Scale (CHAPPS; Smoski, Brunt &Tannahill, 1998)

▪ Children’s Home Inventory of Listening Difficulties (CHILD; Anderson & Smaldino, 2000)

▪ Scale of Auditory Behaviors (SAB; Schow & Seikel, 2006)

▪ Test of Auditory Perceptual Skills-Revised (TAPS-R; Wilson et al., 2011)

▪ Listening Inventory for Education-Revised *(LIFE-R; Anderson, Smaldino, & Spangler, 2011)

QUESTIONNAIRES

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CASE HISTORY

Should include (but not limited to):▪ pre-, peri-, and postnatal information

▪ speech and language development (communication, listening, and auditory behavior);

▪ physical development milestones

▪ otological history (incidence of middle ear problems, interventions)

▪ general health (medications, allergies)

▪ educational achievement

▪ prior related therapies and current treatments

▪ social development and psychological factors

▪ linguistic background

▪ information on the subject’s family/genetic history (history of learning and hearing difficulties)

REFERENCE: American Speech-Language-Hearing Association (2005). (Central) Auditory Processing Disorders [Technical Report]

STANDARD AUDIOMETRIC ASSESSMENT

- Pure tone audiometry (preferably with interoctave 3 & 6 kHz)

- Immittance battery with both ipsilateral and contralateral acoustic reflexes

- Otoacoustic emissions

- Speech recognition testing – in quiet

Image from: http://aja.pubs.asha.org/data/Journals/AJA/934174/AJA_24_2_250fig0.jpeg

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ASSESSMENT OF THE AUDITORY ABILITIES

Test categories: (Musiek & Chermak, 2014)

▪ Binaural Interaction Tests ▪ Dichotic Speech Tests▪ Monaural Low-Redundancy Speech Tests▪ Temporal Processing Tests

Auditory abilities:(ASHA, 2005)

▪ Localization and lateralization▪ Auditory discrimination ▪ Auditory pattern recognition▪ Temporal processing − Temporal resolution − Temporal masking− Temporal integration − Temporal ordering

▪ Recognition of degraded acoustical signals▪ Recognition of acoustic signals presented

with competitive stimuli

REFERENCE:American Speech-Language-Hearing Association (2005). (Central) Auditory Processing Disorders [Technical Report]. Musiek, F.E. & Chermak, G.D. (2014). Handbook of Central Auditory Processing Disorder – Auditory Neurosciences and Diagnosis. Volume 1 (second edition). San Diego: Plural Publishing.

ASSESSMENT OF AUDITORY ABILITIES

Test categories: (Musiek & Chermak, 2014)

Binaural Interaction Tests (MLD)

Dichotic Speech Tests (DD, SSW)

Monaural Low-Redundancy Speech Tests (Filtered speech test, LISN, HINT, SSI-ICM, quick SIN, WIN)

Temporal Processing

- Temporal Patterning (PPST, DPST)

- Temporal Resolution Tests (RGDT, GIN)

Auditory abilities:(ASHA, 2005)

▪ Localization and lateralization (MLD, DD, SSW, LISN, HINT)

▪ Auditory discrimination (PPST, DPST)


▪ Temporal processing • Temporal resolution (RGDT, GIN)• Temporal masking• Temporal integration • Temporal ordering (PPST, DPST, SSW)

▪ Recognition of degraded acoustical signals (Filtered speech test..)

▪ Recognition of acoustic signals presented with competitive stimuli (LISN, HINT, SSI-ICM, quick SIN, WIN)

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TEST BATTERY

•Binaural Interaction Tests (MLD)

•Dichotic Speech Tests (DD, SSW)

•Monaural Low-Redundancy Speech Tests

(Filtered speech test, LISN, HINT, SSI-ICM,

quick SIN, WIN)

•Temporal Processing Temporal Patterning (PPST, DPST)

Temporal Resolution (RGDT, GIN)

GOAL: to develop representative and age-appropriate normative data and to propose which of the these tests should remain in a final tests battery for identifying APD in Norwegian children aged 7-12 years

PARTICIPANTS: 268 children aged 7-12 years (mean: 9.5 years). All were native speakers of Norwegian and 4 of the children were native speakers of two languages. English as a second language (from age 7 – learned at school). Children with diagnosis of attention disorder or autistic spectrum disorder were excluded from the study. Normal pure-tone threshold ( 20 dB HL) from 250 to 6000 Hz.

* Essentially 43-45 children per age group

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PROCEDURE:Monaural low redundancy speech tests

- Filtered Words (FW; Keith, 2000) - HIST Speech in Noise test (HIST SIN; Øygarden, 2009)

Binaural Interaction tests- Masking Level Difference (MLD)

Binaural Integration of speech signals (Dichotic test)- Dichotic Digits (DD; Musiek, 1983) - Competing Words (CW; Keith, 2000)

Temporal processing - Gaps In Noise test (GIN, Musiek et al., 2005)- Frequency Pattern test (FP; Musiek & Pinheiro, 1987)- Duration Pattern test (DP; Musiek et al., 1990)

.

RESULTS:

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RESULTS: DP & FP

7 years(n=48)

8 years(n=45)

9-10 years(n= 88)

11-12 years(n=87)

Mean SD 2.5 perc.

Mean SD 2.5 perc.

Mean SD 2.5 perc.

Mean SD 2.5 perc.

Left 27.0 17.8 4 30.3 15.8 7 45.3 21.9 9 51.6 21.3 17

Right 22.2 15.3 3 25.8 14.6 5 39.9 17.8 12 50.1 21.2 17

Left 33.6 23.3 5 38.6 15.1 10 49.3 24.6 9 66.6 24 19

Right 29.2 22.3 7 35 15.4 10 48.3 21.4 15 64.3 23 20

DP

FP

TEST BATTERY




(Filtered speech test, LISN, HINT, SSI-ICM, quick SIN, WIN)

•Temporal ProcessingTemporal Patterning (PPST, DPST)Temporal Resolution (RGDT, GIN)

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GOAL: To compare 4 tests used in clinical settings to assess temporal resolution

PARTICIPANTS: 10 children with normal hearing (mean age = 8.7 years

METHODS: Auditory Fusion Test-Revised (AFTR)Random Gap Detection Test (RGDT)Binaural Fusion Test (BFT)Gaps-in-noise Test (GIN)

RESULTS: all tests yielded comparable results (normal temporal resolution ability)

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RGDT GIN

PRESENTATION MODE Binaural Monaural

PRESENTATION LEVEL 55 dB HL 50 dB SL (Re.: PTA)

RESPONSE MODE Verbal Motor

TOTAL TEST TIME 10 min.(if tones only: 6 min)

20 minutes

COMPARISON: RGDT & GIN

TEST BATTERY





•Temporal Processing Test (GIN)

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BINAURAL INTERACTION

MASKING LEVEL DIFFERENCE TEST (MLD)

- “Masking Level Difference” - improvement in detecting a tone (or speech) in noise when the phase of the tone or the noise is reversed by 180 degrees

- MLD is a low frequency phenomenon : test is conducted with a 500 Hz pure tone

- A recorded version is available through Auditec

DICHOTIC LISTENING TESTS

DICHOTIC DIGITS Test (DD) (Musiek, 1983)

Two digits pair (i.e., four digits) typically are presented, with one digit of each pair is being delivered to each ear in an overlapping manner, and the person is asked to repeat all digits perceived

The DD includes age-specific normative data for ages 7 and up.

Is available through Auditec

A similar version has been developed in Canadian French (Test d’écoute dichotique de chiffres; Jutras et al., 2012)

REFERENCESMusiek, F.E. (1983). Assessment of central auditory dysfunction: the dichotic digit test revisited. Ear & Hearing, 4, 70-83.Jutras, B., Mayer, D., Joannette, E., Carrier, M.-E. & Chénard, G. (2012). Assessing, the develpment of binaural integration ability with French dichotic digit test: Écoute dichotique de chiffres. American Journal of Audiology, 21, 51-59.

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STAGGERED SPONDAIC WORD TEST (SSW) (Katz, 1962)

Two different spondees are presented to each ear. The stimuli are temporally offset relative to each other, such that 2nd syllable of the 1st spondee overlaps with the 1st syllable of the 2nd spondee. The person is asked to repeat the 2 spondees (or 4 monosyllabic words)

The SSW includes age-specific normative data for ages 7 and up

Is available through Precision acoustics

A similar version has been developed in Canadian French (Test SSW)(Normandin & Rudmin, 1983)

REFERENCES:Katz J. 1962. The use of staggered spondaic words for assessing the integrity of central auditory system. J Aud Res , 2327 – 2337.Rudmin F. & Normandin N. 1983. Experimental dichotic tests in French modeled on SSW design. Hum Commun Can , 7, 348 – 360.

DICHOTIC LISTENING TESTS

MONAURAL LOW REDUNDANCY SPEECH TESTS

LOW-PASS FILTERED SPEECH TEST (FST)

There are different recordings available

FST are useful to assess auditory skills because they simulated listening in poor (degraded) listening conditions and therefore reveal functional deficit

No similar version is available in Canadian French

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MONAURAL LOW REDUNDANCY SPEECH TESTS (2)

LISTENING IN SPATIALIZED NOISE – SENTENCE TEST (LISN-S) (Cameron & Dillon, 2007)

- The LISN-S has been designed to assess the ability of children to understand speech in noise. Specifically measures the ability of children to segregate a target speech signal from simultaneously presented competing speech signals

- Normative data available for the North American context (Brown & al., 2010)

- No similar version is available in Canadian French

Reference: Brown, D.K., Cameron, S., Martin, J.S., Watson, C. & Dillon, H. (2010). The North American Listeningin Spatialized Noise – Sentences Test (NA LiSN-S): normative data and test-retest reliability studiesfor adolescents and young adults. JAAA, 21, 629-641Cameron S, Dillon H. Development of the Listening in Spatialized Noise-Sentences Test (LISN-S). Ear Hear. 2007;28(2):196-211.


HEARING IN NOISE TEST (HINT) (Nilsson, Soli and Sullivan, 1994)

- Scoring is based on the correct repetition of entire sentences to determine the SRT for sentences

- Under headphones or in a sound field by measuring SRTs in quiet and in 3 noise conditions: (a) noise front (NF, speech and noise in front at 0° azimuth)(b) noise right (NR, speech in front and noise at 90° azimuth)(c) noise left (NL, speech in front and noise at 270°azimuth)

- Spatial separation advantage can be obtained by subtracting noise side (NS) score from NF

- This measure highlights the advantage associated with the spatial separation of speech and noise sources for understanding speech in noise

- HINT has been adapted in many languages including Canadian French - Vaillancourt et al., 2008 (children version) and Vaillancourt et al., 2005 (adult version)

REFERENCESNilsson, M., Soli, S. D., & Sullivan, J. A. (1994). Development of the Hearing in Noise Test for the measurement of speech reception thresholds in quiet and in noise. JASA, 95, 1085–1099.Vaillancourt, V., Laroche, C., Giguère, C. et Soli, S.D. (2008). Establishment of age-specific normative data for the Canadian French version of the Hearing in Noise Test for Children, Ear & Hearing, 29, 453-466.Vaillancourt, V., Laroche, C., Mayer, C., Basque, C., Nali, M., Eriks-Brophy, A., Soli, S. D. et Giguère, C. (2005). Adaptation of the HINT (Nearing in Noise Test) for adult Canadian Francophone populations. IJA, 44(6), 358-369.

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SYNTHETIC SENTENCE IDENTIFICATION WITH IPSILATERAL COMPETING MESSAGE (SSI-ICM) (Jerger & Jerger, 1974)

- consists of presenting sentences that are altered from the standard rules of grammar and syntax, called 3rd order sentences, along with an ipsilateral continuous discourse

- sentences are presented at at fixed level and the level of the competitive continuous discourse is varied – SNR: +10, 0, -10 and -20

- a similar version is available in Canadian French (Lynch & Normandin, 1983)

Sample of SSI sentences

REFERENCES:Jerger, J. F., & Jerger, S. W. (1974). Auditory findings in brainstem disorders. Archives of Otolaryngology, 99, 342–349.Lynch A. & Normandin N. (1983). SSI: É laboration d’une version française et application auprès d’une population d’enfants avec troubles d’apprentissage. Master’s thesis, University of Montreal, Canada.

BAMFORD-KOWAL-BENCH SPEECH-IN-NOISE TEST (BKB-SIN)(Etymōtic Research, 2005; Bench, Kowal & Bamford, 1979)

The BKB-SIN test is a speech in noise test for children (ages 5 and up) - measures SNR loss (increase in SNR required by an individual to understand speech in noise

Uses the BKB sentences (List 1-8: 10 sentences, List 9-18: 8 sentences) and a 4-talker babble

Normative data for children 5 to 14

Available through Auditec

No similar version is available in Canadian French


REFERENCES:Etymotic Research. (2005). Bamford-Kowal-Bench Speech-in-Noise Test (Version 1.03)-User manual; Retrieved fromhttp://www.etymotic.com/ pdf/ bkbsin-user-manual.pdf Bench J, Kowal A, Bamford J. (1979). The BKB (Bamford-Kowal-Bench) sentence lists for partially-hearing children. Br J Audiol. 13, 108-12.

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WORDS-IN-NOISE (WIN) TEST (Wilson, 2003)

The Words-in-Noise (WIN) test uses monosyllabic words in seven signal-to-noise ratios of multitalker babble to evaluate the ability of individuals to understand speech in background noise

The level of the babble is fixed and words are presented at 7 SNR from 24 to 0 dB in 4 dB decrements. Words (10 words by levels) are from the NU Auditory Test No. 6 (Tillman & Carhart, 1966)

spoken by a female speaker.

The metric of interest is the SNR at which recognition performance is 50%

Available through http://www.healthmeasures.net/explore-measurement-systems/nih-toolbox

A similar version is available in Canadian French ( Test de Mots dans le Bruit) (Lagacé et al., 2013)

REFERENCESLagacé, J., LeBlanc, L., Boisvert, V., Arseneau, M. J. et Breau-Godwin, S. (2013). Mise à jour sur le développement du Testde Mots dans le Bruit, Acoustique Canadienne, 41, 65-72. Tillman, T. W., & Carhart, R. (1966, June). An Expanded Test for Speech Discrimination Utilizing CNC Monosyllabic Words. Northwestern UniversityAuditory Test No. 6. SAM-TR-66-55 (pp. 1–12). Base, TX: U.S. Air Force. Wilson, R. H. (2003). Development of a speech in multitalker babble paradigm to assess word-recognition performance. Journal of the American Academy of Audiology, 14, 453–470.

TEST BATTERY





•Temporal Processing Test (GIN)

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INTERPRETATION OF AUDITORY ABILITIES &

CLINICAL CONCLUSION

• … APD is characterized by abnormal performance on tests of auditory processing must be based on performance below cut‐off scores (commonly performance deficits of at least 2 SD below the mean) on at least 2 tests…

• … if results of only one test are below cut‐off scores to identify APD, stricter criteria of performance deficits on one test of at least 3 SD

• … when a 1st evaluation is completed and abnormal results are obtained, it is preferable to use the term “delay” in the development of auditory capacities or

“hypothesis of APD”

▪ The conclusion of APD should rely on results of subsequent evaluation

REFERENCES: Canadian Interorganizational Steering Group for Speech-Language Pathology and Audiology (2012). Canadian Guidelines on Auditory Processing Disorder in Children and Adults: Assessment and Intervention [Professional Guidelines]American Speech-Language-Hearing Association (2005). (Central) Auditory Processing Disorders [Technical Report

FOLLOW-UP

▪ When AP delay or APD has been identified, re-evaluations at least every 2 years are strongly recommended

REFERENCES: Canadian Interorganizational Steering Group for Speech-Language Pathology and Audiology. (2012). Canadian guidelines on auditory processing disorder in children and adults: assessment and intervention. Ottawa: AuthorsIMAGE FROMhttp://tampachildrensent.com/wp-content/uploads/2015/07/Untitled1.png

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PERSONNAL FACTORS

- ATTENTION

- MEMORY

- MULTI- OR BILINGUALISM

- MOTIVATION

- SLEEP

Image fromhttps://image.shutterstock.com/z/stock-vector-the-concept-of-modern-education-infographic-template-with-silhouette-child-head-abstract-brain-191894966.jpg

ATTENTION - Auditory Continuous Performance Test (ACPT; Keith 1994)

▪ Was developed to screen for auditory attention deficits in children 6 through 11

▪ The child listens to a list of words and raises a thumb every time he or she hears the target word (dog)

▪ Available through Auditec

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MEMORY

▪ CELF™ - Clinical Evaluation of Language Fundamentals (Elisabeth H. Wiig, Eleanor Semel, Wayne A. Secord)

Subtests: Number repetition & Sentence repetition

▪ AUDITORY SEQUENTIAL MEMORY TEST (Wepman & Morency, 1973) – for children of 5 to 8 years

▪ DIGIT SPAN (DS) - subtest WISC (children version of Wechsler, 1949, 1991)

MULTI- OR BILINGUALISM

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MOTIVATION

SLEEP

RECOMMANDATIONS 6 – 13 years 9 to 11 hours

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Participants: 30 adults 31 years (± 7)

Methods: 24 hours - no sleep for 24 hr

BSL : pre-APD measures

24hSD: post measures

BMC Neuroscience, 2012, 13, 83

SLEEP

OVERVIEW



▪Therapeutic intervention strategies

▪ Case Study


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THERAPEUTIC INTERVENTION STRATEGIES

▪ Buffalo Model (Katz, 1992)▪ Decoding▪ Tolerance fading memory▪ Integration▪ Organization

▪ Bellis-Ferre Model (Bellis, 2003) ▪ Decoding▪ Integration▪ Prosodic

REFERENCES:Canadian Interorganizational Steering Group for Speech-Language Pathology and Audiology. (2012). Canadian guidelines on auditory processing disorder in children and adults: assessment and intervention. Ottawa: Authors.

Applicability of central auditory processing disorder models. Jutras, B., Dumont, V., Marcoux, C., Loubert, M., Dupuis, J.-L. & Baril, M. (2007). American Journal of Audiology, 16, 100-106.

GOAL: Verify the applicability of central auditory processing disorder models.

METHODS: retrospective study on 178 files of children with a diagnosis of APD

(48 were analyzed)

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0

20

40

60

80

100

APD APD-AD APD-ASS

APD-HL APD-AD-ASS

APD-AD-HL

Num

ber o

f chi

ldre

n 48

70

35

8 4 13

Cohorte(n = 178)


CASES:

0

20

40

60

80

100

DECODING TFM ORG

PER

CEN

TAG

E O

F C

HIL

DR

EN

60%

21%

6%


BUFFALO MODELRESULTS:

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0

20

40

60

80

100

DECODING PROSODIC INTEG ASSOC ORG na

PE

RC

EN

TAG

E O

F C

HIL

DR

EN

0% 0% 2% 2% 4%

92%BELLIS-FERRE MODEL

RESULTS:

THERAPEUTIC INTERVENTION STRATEGIES (2)

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Model for intervention to improve participation for individuals with APD

From: Canadian InterorganizationalSteering Group for Speech-Language Pathology and Audiology. (2012). Canadian guidelines on auditory processing disorder in children and adults: assessment and intervention. Ottawa: Authors.(Figure 2, p. 27)

ENVIRONNEMENTAL FACTORS TO IMPROVE PARTICIPATION

Physical environment and listening factors

- Partnerships

- Acoustics of the environment

- Assistive devices

Social and communication factors

- Support, attitudes & relationships

- Services, systems & policies

REFERENCE: Canadian Interorganizational Steering Group for Speech-Language Pathology and Audiology. (2012). Canadian guidelines on auditory processing disorder in children and adults: assessment and intervention. Ottawa: Authors.

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PERSONAL FACTORS TO IMPROVE PARTICIPATION

Improving capacity through direct training

Improving ability to be active in communication

REFERENCE: Canadian Interorganizational Steering Group for Speech-Language Pathology and Audiology. (2012). Canadian guidelines on auditoryprocessing disorder in children and adults: assessment and intervention. Ottawa: Authors.

IMAGE: https://media.licdn.com/mpr/mpr/AAEAAQAAAAAAAAVEAAAAJDZlYmYzZGUxLWE1M2QtNGFjZi1iMzhhLWMwNDI3YTYyZDExOA.jpg

OVERVIEW




▪Case Study



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CASE STUDY

▪ JENNA - 8 years. Adoptive father reports that she has difficulties to stay attentive for long period of time and she is easily distracted by environmental noise

▪ JENNA – sits in the middle of the class (the teacher is moving around the classroom when teaching) & reports she has no difficulty understanding the teacher – when there is no background noise

▪ In grade 3 (regular academic program) – grades are « ok » according to father but her performance does not correspond to her intellectual capacity

▪ At home: Turkish and French

At school: French

After school care and friends: English & French

CASE STUDY (continued 2)

▪ RESULTS: peripheral hearing

Audiogram

Normal hearing threshold ( 20 dB HL) bilaterally from 0,25 to 8 kHz, including 3 & 6 kHz

Speech testing (in quiet)

Word recognition is excellent (100%) bilaterally at conversational level (50 dB HL – 25 words/ear).

Immitance measures

Normal tympanogram bilaterally

Acoustic reflex is present in both ears with ipsilateral stimulation at 85 dB HL (minimum level presented) at 0,5, 1 & 2 kHz, and contralateral stimulation at 90 dB HL (minimum level presented) at 0,5 & 1 kHz

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▪ RESULTS: peripheral hearing

Otoacoustic emissions

Distortion product otoacoustic emissions were within normal range bilaterally, suggesting outer good integrity of the inner hair cells

▪ RESULTS: Auditory abilities

Binaural interaction - MLD: within normal range

Dichotic speech tests - Dichotic Digits Test: within normal range bilaterally

- Staggered Spondaic Word (SSW) : below normal range bilaterally

Temporal processing - Gaps-In-Noise Test: within normal range bilaterally

Monaural low-redundancy speech test – Filtered Words (SCAN – subtest) - below normal range bilaterally

- BKB – SIN: below normal range


▪ RESULTS: Complementary tests

Screening – attention abilities – ACPT : within normal range

Screening – memory abilities – CELF - Number repetition : within normal range

▪ CONCLUSION:

Results suggest speech recognition in background noise

Considering the linguistic history of the child: underlying nature (cause) of the speech recognition difficulties can not be determined

Follow-up in one year

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▪ RECOMMENDATIONS:

Investigation in SLP, re.: language delay

Intervention strategies

▪ Considering speech recognition difficulties in noise and staying attentive for long period

- Environmental factors: FM trial + meeting with teacher

- Personnal factors: SLP + activities to improve language abilities (school)

▪ Considering speech recognition difficulties and reported difficulties when there is background noise

- Environmental and personal factors: Improving ability to be active in communication (8 audiology sessions)

OVERVIEW




▪ Case Study



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FREQUENTLY ASKED QUESTIONS

▪ When should I re-test a child with a diagnosis of APD?

▪ Should I test a child with a diagnosis of Language Disorder?

▪ Should I test a child with a peripheral hearing loss?

▪ How about electrophysiological measures?

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THANK YOU!

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