Testing for Central Auditory Processing Disorders Harvey Dillon With thanks to: Sharon Cameron Helen...

1

Testing for Central Auditory Processing Disorders

Harvey Dillon

With thanks to:

Sharon Cameron

Helen Glyde

Wayne Wilson

Pia Gyldenkaerne

Mridula Sharma

Dani Tomlin

2

On the basis of evidence, what should CAPD testing and remediation services consist of?

4

A clinician’s question

• Does this child have a problem hearing or understanding sound that adversely affects him or her, and that I or anyone else can do something about?• What is the specific nature of the problem?• Is there a specific remediation for that problem?• What general management techniques will minimize its

effects?• What tests should I use to determine the child’s problems?

5

Problems with current definitions

1. Requirement for modality specificity and absence of other problems.

Auditory processing

neurons

Deficient auditory skill

Life consequences

Trauma or failure to develop Visual

processing neurons

Deficient visual skill

Life consequences

Consequent disabilities

Hearing loss

Language processing

neurons

Deficient language skill

Life consequences

6

Problems with current definitions2. Arbitrariness of fail criterion

– Which tests to include in battery?– How many tests have to be failed, in how many

ears, in what combinations? – What is a fail on each test?

7

Impact of criterion on diagnosis of CAPD

Fail ≥2 tests [ASHA (2005), AAA (2010)]

Fail ≥1 tests [ASHA (2005), AAA (2010)]

Fail ≥1 non-speech [McArthur, 2009]

Fail ≥1 speech + ≥1 non-speech [BSA(2011)]

Reported sympotoms [Ferguson (2011)]

0 10 20 30 40 50 60 70 80 90 100

Percent of children “with CAPD”

Binaural failMonaural fail

Wayne Wilson

Problems with a Large Test Battery

Impact on child’s attention

(The tests are often very boring!!)

Relevance of the normative data

Statistical implications of presenting multiple tests - inflating Type II error rate.

So …. how do we solve this problem??8

Possible, but not very good, solutions….

1. Tighten the pass-fail criteria on each test (e.g. 3 SD):

have to be very aberrant to fail

2. Require that the individual fail more than one test:

Only logical if CAPD is a “generalized disorder”

3. Repeat any test that produces a failed result:

Not consistent with normative data

An inefficient use of time

9

History Audiometry

Is there a problem that CAPD

might explain?

Exclude CAPD;Refer elsewhere

No

Current approach to CAPD testing

Detailed test battery

Yes

Test result interpretationNon-specific remediation and management:• Classroom placement• FM use• Instruction style• Soundfield amplification• Auditory training software

Questionnaire / history Audiometry Measured disability


might explain?



No

Dealing with problems in understanding speech

Master test battery

Yes

Non-specific remediation and management:• Classroom placement• FM use• Instruction style• Soundfield amplification

Test result interpretation leading toa disorder-specific diagnosis

Disorder-specific remediation

Questionnaire / history Audiometry Measured disability


might explain?



No

Dealing with problems in understanding speech

Master test battery

Yes

Non-specific remediation and management:• Classroom placement• FM use• Instruction style• Soundfield amplification

Test result interpretation leading toa disorder-specific diagnosis

Disorder-specific remediationLiSN& Learn

LiSN-S High Cue

LiSN-S Spatial

Advantage

LiSN-S Talker

Advantage

LiSN-S Low Cue

SPDUndiag-nosed deficit

Pitch deficit

FPT Verbal

FPT Hum

SPINHi Cont

SPINLo Cont

Closure skill

deficits?

Top-down training?

13

What is a fail on one test?

40 60 80 100 120 140 160

-4 -3 -2 -1 0 1 2 3 4

Z-score

Prop

ortio

n of

chi

ldre

n

Test score

14

Test score sensitivity relative to functional listening ability

• Can estimate from correlation between test scores and functional ability– Questionnaire scores of listening ability– Educational attainment scores

-3 -2 -1 0 1 2 30

50

100

150

CAPD test z-score

Func

tiona

l lis

teni

ng a

bilit

y

Test A

Test B

15

Test score sensitivity relative to functional ability:

• Sensitivity

-3 -2 -1 0 1 2 30

50

100

150

CAPD test z-score

Func

tiona

l lis

teni

ng a

bilit

y

Test A

Test B

16

Criteria for adopting a CAPD test

• Test is associated with variation in functional ability – High sensitivity )– Deviant results common in clinical population– Attributes tested minimally shared with other tests in battery

• Test result indicates specific remediation necessary (and remediation affects real life)

• Time taken is small• Test is minimally affected by attention, intelligence, motivation,

working memory• Associated with a known anatomical site and neural

mechanism

17

Experiment 1

Dani Tomlin current PhD study• Two subject recruitment groups:

– Children referred to Uni of Melbourne Audiology Clinic due to suspected APD (n=65) • Teachers, parent, speech pathologist referral

– Normative group (n=47)• School enrolment, open invitation

• Age range of 7–12 years• Both groups to complete full test battery• Results converted to Z scores (derived using age specific

norms)

18

Measures obtained• Dichotic Digits Test (DDT): Binaural integration (Musiek, 1993)

• Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990)

• Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005)

• MLD: Binaural interaction (Bellis, 2003)

• LiSN-S: Binaural integration – spatial listening ability (Cameron & Dillon, 2006)

• Memory CELF-4: Forward and reverse digits • Attention: BrainTrain®: Continuous Performance Test: Sustained auditory and visual

attention • Cognition -TONI-4: Nonverbal cognitive assessment

• Questionnaires and interview:– Child completed LIFE questionnaire & recorded interview– Parent completed Fisher checklist & written interview– Teacher Evaluation of Auditory Performance (TEAP) & written interview

• Academic Performance - NAPLAN & WARP (reading fluency)

19

Relations between questionnairesLif e (c hildren)

Fis her (parents )

TEA P ( teac hers )

Listening Capabilities Score

20

Relations between outcome variablesLis tening Capability Sc ore

NA PLA N Literac y Z s c ore

W A RP Z SCORE

Test score sensitivity relative to functional abilitiesDichotic digits - left

List

enin

g ca

pabi

lities

Dani Tomlin

L istening C apab ility S core = 0 .2085+0.2417*x

-10 -8 -6 -4 -2 0 2 4

LD D Z S core

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Liste

nin

g C

ap

ab

ility Sco

re


List

enin

g ca

pabi

lities

Dani Tomlin


-10 -8 -6 -4 -2 0 2 4

LD D Z S core

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Listening C

apability S

core

23


List

enin

g ca

pabi

lities

Dani Tomlin

Read

ing

fluen

cyLi

tera

cy

A verage NA P LA N L ite racy Z score = 0 .6834+0.2485*x

-10 -8 -6 -4 -2 0 2 4

LD D A S IN Z S core

-3

-2

-1

0

1

2

Ave

rag

e N

AP

LA

N L

itera

cy Z sco

re

W A RP Z S C ORE = 0 .2969+0.2647*x

-10 -8 -6 -4 -2 0 2 4


-3

-2

-1

0

1

2

WA

RP

Z S

CO

RE


-10 -8 -6 -4 -2 0 2 4


-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0.0

0.5

1.0

1.5

2.0

Liste

nin

g C

ap

ab

ility Sco

re

Dichotic digits - right Freq pattern - left Freq pattern - right


-10 -8 -6 -4 -2 0 2 4

RD D A S IN Z S core

-3

-2

-1

0

1

2

Ave

rag

e N

AP

LA

N L

itera

cy Z sco

re


-10 -8 -6 -4 -2 0 2 4

LF P T A S IN Z S C ORE

-3

-2

-1

0

1

2

Ave

rag

e N

AP

LA

N L

itera

cy Z sco

re


-10 -8 -6 -4 -2 0 2 4

R F P T A S IN Z S C ORE

-3

-2

-1

0

1

2

Ave

rag

e N

AP

LA

N L

itera

cy Z sco

re

W A RP Z S C ORE = 0 .0871+0.2002*x

-10 -8 -6 -4 -2 0 2 4


-3

-2

-1

0

1

2

WA

RP

Z S

CO

RE

W A RP Z S C ORE = 0 .1039+0.2143*x

-10 -8 -6 -4 -2 0 2


-3

-2

-1

0

1

2

WA

RP

Z S

CO

RE

W A RP Z S C ORE = 0 .0602+0.205*x

-10 -8 -6 -4 -2 0 2 4


-3

-2

-1

0

1

2

WA

RP

Z S

CO

RE

L istening C apab ility S core = -0 .0343+0.2005*x

-10 -8 -6 -4 -2 0 2 4


-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Liste

nin

g C

ap

ab

ility Sco

re


-10 -8 -6 -4 -2 0 2 4


-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Liste

nin

g C

ap

ab

ility Sco

re


-10 -8 -6 -4 -2 0 2 4


-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Liste

nin

g C

ap

ab

ility Sco

re

24

Test score sensitivity relative to functional abilitiesGaps in noise - left Gaps in noise - right Digit span - Forward Digit span - Reversed

List

enin

g ca

pabi

lities

Read

ing

fluen

cy

Dani Tomlin

Lite

racy


-1 .6-1 .4

-1 .2-1 .0

-0 .8-0 .6

-0 .4-0 .2

0 .00 .2

0 .40 .6

0 .81 .0

1 .2

L G in Z score

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Listening Capability S

core


-3 .0 -2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5

R Gin Z score

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Liste

nin

g C

ap

ab

ility Sco

re


-2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5 2 .0

D S F W Z S C ORE

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Listening Capability S

core


-2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5 2 .0

D S Rev Z S core

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Liste

nin

g C

ap

ab

ility Sco

re


-2 .0 -1 .5 -1 .0 -0 .5 0.0 0.5 1.0 1.5 2.0

D S Rev Z S core

-2 .0

-1 .5

-1 .0

-0 .5

0.0

0.5

1.0

1.5

2.0

NA

PL

AN

Lite

racy Z

score


-2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5

D S F W Z S C ORE

-2.0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Ave

rag

e N

AP

LA

N L

itera

cy Z sco

re

A verage NA P LA N L ite racy Z score = 0 .3701-0 .1306*x

-3 .0 -2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5

R Gin Z score

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Ave

rag

e N

AP

LA

N L

itera

cy Z sco

re

A verage NA P LA N L iteracy Z score = 0 .3754-0.2565*x

-0 .6 -0 .4 -0 .2 0.0 0.2 0.4 0.6

L Gin Z score

-2 .0

-1 .5

-1 .0

-0 .5

0.0

0.5

1.0

1.5

2.0

Average N

AP

LAN

Literacy Z score

W A RP Z S C ORE = -0 .006+0.5397*x

-1 .6-1 .4

-1 .2-1 .0

-0 .8-0 .6

-0 .4-0 .2

0.00.2

0.40.6

0.81.0

1.2

L G in Z score

-3

-2

-1

0

1

2

3

WA

RP

Z S

CO

RE

W A RP Z S C ORE = 0 .0099+0.3944*x

-3 .0 -2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5

R Gin Z score

-3

-2

-1

0

1

2

3

WA

RP

Z S

CO

RE

W A RP Z S C ORE = 0 .0673+0.541*x

-2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0.0 0.5 1.0 1.5 2.0

D S FW Z S C ORE

-3

-2

-1

0

1

2

3

WA

RP

Z S

CO

RE

W A RP Z S C ORE = 0 .0897+0.7375*x

-2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5 2 .0

D S Rev Z S core

-3

-2

-1

0

1

2

3

WA

RP

Z S

CO

RE

25

Test score sensitivity relative to functional abilitiesLiSN-S Low Cue LiSN-S High cue attention

List

enin

g ca

pabi

lities

Read

ing

fluen

cy

Dani Tomlin

Lite

racy

W A RP Z S C ORE = 0 .0719+0.2626*x

-5 -4 -3 -2 -1 0 1 2 3

LC S dev from avg

-3

-2

-1

0

1

2

WA

RP

Z S

CO

RE

W A RP Z S C ORE = 0 .1186+0 .3258*x

-5 -4 -3 -2 -1 0 1 2 3

HC S dev from avg

-3

-2

-1

0

1

2

WA

RP

Z S

CO

RE


-5 -4 -3 -2 -1 0 1 2 3

LC S dev from avg

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Ave

rag

e N

AP

LA

N L

itera

cy Z sco

re


-5 -4 -3 -2 -1 0 1 2 3

HC S dev from avg

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Ave

rage

NA

PL

AN

Litera

cy Z sco

re


-5 -4 -3 -2 -1 0 1 2 3

LC S dev from avg

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Liste

nin

g C

ap

ab

ility Sco

re


-5 -4 -3 -2 -1 0 1 2 3

HC S dev from avg

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Liste

nin

g C

ap

ab

ility Sco

re

MLD z score

Listening C apability S core = -0 .0792-0 .0256*x

-3 -2 -1 0 1 2 3 4 5

MLD Z score

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0.0

0.5

1.0

1.5

2.0

Liste

nin

g C

ap

ab

ility Sco

re

W A RP Z S C ORE = 0 .0107+0.0001*x

-3 -2 -1 0 1 2 3 4 5

M LD Z score

-3

-2

-1

0

1

2

WA

RP

Z S

CO

RE


-3 -2 -1 0 1 2 3 4 5

M LD Z score

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Ave

rag

e N

AP

LA

N L

itera

cy Z sco

re


-6 -5 -4 -3 -2 -1 0 1 2

A ttention Quotient Z score

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Ave

rag

e N

AP

LA

N L

itera

cy Z sco

re

W A RP Z S C ORE = 0 .2157+0.2121*x

-6 -5 -4 -3 -2 -1 0 1 2


-3

-2

-1

0

1

2

WA

RP

Z S

CO

RE


-6 -5 -4 -3 -2 -1 0 1 2


-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5

2 .0

Liste

nin

g C

ap

ab

ility Sco

re

26

Sensitivity: Effect on outcome variable of being 1 SD below the mean on test score

TONI

Digit Span Rev

Digit Span Fwd

LiSN-S Low cue

L GIN

Lisn-S High cue

L DD

R GIN

Attention

L FPT

R DD

R FPT

MLD

-0.2 0 0.2 0.4 0.6 0.8 1

Reading abilityLiteracyListening capabilities

27

FPT results highly correlated between ears

-1 2 -1 0 -8 -6 -4 -2 0 2

L P P Z sco re

-1 2

-1 0

-8

-6

-4

-2

0

2

Rp

p Z

Sco

re

c l i n i c sch o o l

28

Dichotic digit results less correlated

-12 -10 -8 -6 -4 -2 0 2

LDD Zs c ore

-12

-10

-8

-6

-4

-2

0

2

RD

D Z

score

C linic S c hool

30

Correlations – outcomes and test scoresLiter

acyWAR

PListe

n Cap

L DD R DD L FPT R FPT MLD L GIN R

GINLiSN

LCLiSN

HCLiSN

SADS

FwdDS

Rev TONI Att

Literacy - 0.60 0.77 0.66 0.41 0.49 0.46 0.03 -0.12 -0.07 0.39 0.34 -0.03 0.56 0.67 0.62 0.49

WARP 0.60 - 0.64 0.47 0.33 0.34 0.37 0.00 0.25 0.22 0.21 0.34 0.09 0.44 0.56 0.51 0.32

Listening Cap 0.77 0.64 - 0.47 0.37 0.34 0.26 -0.04 0.14 0.13 0.43 0.32 0.15 0.34 0.43 0.53 0.35

L DD 0.66 0.47 0.47 - 0.47 0.46 0.37 -0.12 0.08 0.14 0.28 0.25 0.13 0.53 0.48 0.49 0.27

R DD 0.41 0.33 0.37 0.47 - 0.27 0.35 -0.17 0.09 0.11 0.22 0.14 0.14 0.33 0.33 0.30 0.22

L FPT 0.49 0.34 0.34 0.46 0.27 - 0.87 -0.12 0.00 -0.03 0.12 0.07 0.17 0.29 0.42 0.38 0.19

R FPT 0.46 0.37 0.26 0.37 0.35 0.87 - -0.12 0.11 0.01 0.12 0.11 0.22 0.26 0.36 0.37 0.08

MLD 0.03 0.00 -0.04 -0.12 -0.17 -0.12 -0.12 - -0.17 -0.19 0.03 -0.08 0.06 0.05 -0.07 -0.02 -0.03

L GIN -0.12 0.25 0.14 0.08 0.09 0.00 0.11 -0.17 - 0.73 -0.02 0.02 0.12 0.04 0.04 -0.04 -0.09

R GIN -0.07 0.22 0.13 0.14 0.11 -0.03 0.01 -0.19 0.73 - -0.05 0.02 0.18 0.05 0.09 0.08 -0.04

LiSN LC 0.39 0.21 0.43 0.28 0.22 0.12 0.12 0.03 -0.02 -0.05 - 0.26 -0.04 0.30 0.21 0.28 0.08

LiSN HC 0.34 0.34 0.32 0.25 0.14 0.07 0.11 -0.08 0.02 0.02 0.26 - 0.43 0.09 0.16 0.24 0.06

LiSN SA -0.03 0.09 0.15 0.13 0.14 0.17 0.22 0.06 0.12 0.18 -0.04 0.43 - 0.02 0.08 0.14 -0.02

DS Fwd 0.56 0.44 0.34 0.53 0.33 0.29 0.26 0.05 0.04 0.05 0.30 0.09 0.02 - 0.59 0.30 0.11

DS Rev 0.67 0.56 0.43 0.48 0.33 0.42 0.36 -0.07 0.04 0.09 0.21 0.16 0.08 0.59 - 0.38 0.31

TONI 0.62 0.51 0.53 0.49 0.30 0.38 0.37 -0.02 -0.04 0.08 0.28 0.24 0.14 0.30 0.38 - 0.23

Attention 0.49 0.32 0.35 0.27 0.22 0.19 0.08 -0.03 -0.09 -0.04 0.08 0.06 -0.02 0.11 0.31 0.23 -

P<0.01

NAPLAN literacy

1 2 3 4 5 6 7 8 9 10 11 12

L DD * * * * * * * * * * *

R DD * * * * * *

L FPT * * * * * * * *

R FPT * * * * * * * * *

MLD *

L GIN * * * *

R GIN * * * * * * * * * *

DS Fwd * *

DS Rev * * * * * * * * * * * *

LiSN LC * * * * *

LiSN HC * * * * *

LiSN SA * * * * *31

What is affecting listening capabilities?TONI

DS Fwd

DS Rev

Att

LDDListening

capabilities

0.27

0.10

0.19

0.10

0.20

32

N=59Adj R2 = 0.31

What is affecting literacy?TONI

DS Fwd

DS Rev

Att

LDD NAPLAN Literacy

0.24

0.30

0.18

0.16

0.29

But only 14 clinic participants with NAPLAN so far.

33

N=35Adj R2 = 0.64

34

Importance of the presenting symptoms?

FO

LL

OW

ING

INS

T

no

ne

LE

AR

NIN

G D

IFF

IC.

AT

TN

/CO

NC

Atte

ntio

n

RE

AD

ING

LA

NG

UA

GE

Sp

ellin

g/W

riting

P rim ary C oncern

05

101520253035404550

No

of o

bse

rvatio

ns

35

Importance of presenting symptoms

LDD A SIN Z Sc ore LFPT A SIN Z SCORE L Gin Z s c ore DS FW Z SCORE DS Rev Z Sc ore LC Sdev f rom av g TONI Z Sc ore

FOL L OW IN G IN STL EAR N IN G D IFFIC .

ATTN /C ON CR EAD IN G

P rim ary C oncern

-4 .0

-3 .5

-3 .0

-2 .5

-2 .0

-1 .5

-1 .0

-0 .5

0 .0

0 .5

1 .0

1 .5MANOVA analysis: p=0.94

36

Importance of presenting symptoms

Child fails to understand an

instruction

Acts (inappropriately) based on what

was heard

Asks for repetition of instruction

Does nothing

Misbehaves

Event Response by child

Interpretation by observer

Daydreams

Badly behaved

Can’t follow instructions

Is not very smart

Poor concentration

37

Experiment 2

Pia Gyldenkaerne current PhD study• Children referred to Macquarie Uni

Audiology Clinic due to suspected APD (n=119)

• Teachers, parent, speech pathologist referral• Age range of 7–13 years

38

Measures obtained• Dichotic Digits Test (DDT): Binaural integration (Musiek, 1993)

• Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990)

• Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005)

• MLD: Binaural interaction (Bellis, 2003)

• Memory CELF-4: Forward and reverse digits • Attention: BrainTrain®: Continuous Performance Test: Sustained auditory

and visual attention • Cognition -TONI-4: Nonverbal cognitive assessment

• Questionnaire:– Purpose designed – yes/no answers to 18 questions asking about difficulties in listening

and its possible consequences

• Academic Performance: WARP (reading fluency)

39

Test score sensitivity relative to functional ability: Reported difficulties and reading fluency

-1 2 -1 0 -8 -6 -4 -2 0 2

FP T _ R_ S D

-2

0

2

4

6

8

1 0

1 2

1 4

Re

po

rted

Difficu

lties

-1 2 -1 0 -8 -6 -4 -2 0 2

FP T _ L _ S D

-2

0

2

4

6

8

1 0

1 2

1 4

Re

po

rted

Difficu

lties

-5 -4 -3 -2 -1 0 1 2

DDT _ R_ S D

-2

0

2

4

6

8

1 0

1 2

1 4

Re

po

rted

Difficu

lties

-7 -6 -5 -4 -3 -2 -1 0 1 2

DDT _ L _ S D

-2

0

2

4

6

8

1 0

1 2

1 4

Re

po

rted

Difficu

lties

Dichotic digits - left Dichotic digits - right Freq pattern - left Freq pattern - right

Repo

rted

diffi

culti

esRe

adin

g sp

eed

-1 2 -1 0 -8 -6 -4 -2 0 2 4

FP T _ R_ S D

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

2 2 0

WA

RP

Ave

rag

e

-1 2 -1 0 -8 -6 -4 -2 0 2

FP T _ L _ S D

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

2 2 0

WA

RP

Ave

rag

e

-6 -4 -2 0 2 4

DDT _ R_ S D

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

2 2 0

WA

RP

Ave

rag

e

-7 -6 -5 -4 -3 -2 -1 0 1 2 3

DDT _ L _ S D

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

2 2 0

WA

RP

Ave

rag

e

Pia Gyldenkaerne and Mridula Sharma

40

Test score sensitivity relative to functional ability: Reported difficulties and reading speed

Gaps in noise - right

-7 -6 -5 -4 -3 -2 -1 0 1 2

M L D_ S D

-2

0

2

4

6

8

1 0

1 2

1 4

Re

po

rted

Difficu

lties

Binaural masking level difference

0 2 0 4 0 6 0 8 0 1 0 0 1 2 0

B T Re sp o n se Co n tro l Q u o ti e n t

-2

0

2

4

6

8

1 0

1 2

1 4

Re

po

rted

Difficu

lties

0 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0

B T A tte n ti o n Q u o ti e n t

-2

0

2

4

6

8

1 0

1 2

1 4

Re

po

rted

Difficu

lties

234567891 01 1

G IN Rig h t

-2

0

2

4

6

8

1 0

1 2

1 4

Re

po

rted

Difficu

lties

Brain Train attention quotient

Brain Train response control quotient

-7 -6 -5 -4 -3 -2 -1 0 1 2

M L D_ S D

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

2 2 0

WA

RP

Ave

rag

e

0 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0

B T Re sp o n se Co n tro l Q u o ti e n t

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

2 2 0W

AR

P A

vera

ge

0 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0

B T A tte n ti o n Q u o ti e n t

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

2 2 0

WA

RP

Ave

rag

e

234567891 01 1

G IN Rig h t

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

2 2 0

WA

RP

Ave

rag

e

Repo

rted

diffi

culti

esRe

adin

g sp

eed

Pia Gyldenkaerne and Mridula Sharma

42

Simple correlation matrix – outcome scores and test scores

Reported Difficulties

WARP L DDT R DD L FPT R FPT R GIN MLD TONIBT

Attention Quotient


- -0.57 -0.49 -0.24 -0.42 -0.44 0.28 0.11 -0.55 -0.35

WARP -0.57 - 0.41 0.20 0.35 0.41 -0.33 -0.07 0.35 0.50

L DDT -0.49 0.41 - 0.43 0.42 0.49 -0.20 0.01 0.31 0.36

R DDT -0.24 0.20 0.43 - 0.22 0.23 -0.11 -0.00 0.07 0.27

L FPT -0.42 0.35 0.42 0.22 - 0.86 -0.28 -0.05 0.34 0.22

R FPT -0.44 0.41 0.49 0.23 0.86 - -0.33 -0.06 0.33 0.26

R GIN 0.28 -0.33 -0.20 -0.11 -0.28 -0.33 - 0.01 -0.05 -0.02

MLD 0.11 -0.07 0.01 -0.00 -0.05 -0.06 0.01 - 0.12 0.04

TONI -0.55 0.35 0.31 0.07 0.34 0.33 -0.05 0.12 - 0.41

BT Attention Quotient

-0.35 0.50 0.36 0.27 0.22 0.26 -0.02 0.04 0.41 -

P<0.01

43

No. of predictors

DDT_L_SD DDT_R_SD

FPT_L_SD

FPT_R_SD

MLD_SD

GIN_R

BT.AttQuot

TONI.Quot

1 *2 * *3 * * *4 * * * *5 * * * * *6 * * * * * *7 * * * * * * *8 * * * * * * * *

No. of predictors

DDT_L_SD

DDT_R_SD

FPT_L_SD

FPT_R_SD

MLD_SD

GIN_R

BT.AttQuot

1 * 2 * * 3 * * *4 * * * *5 * * * * *6 * * * * * *7 * * * * * * *


Criteria for adopting a CAPD test• Test is associated with variation in functional ability

– High sensitivity )

– Deviant results common in clinical population

– Attributes tested minimally shared with other tests in battery

• Leads to a specific diagnosis, for which remediation exists, and remediation affects real life functional ability

• Time taken is small

• Test is minimally affected by attention, intelligence, motivation, working memory, and language ability

• Known high reliability and critical differences

• Associated with a known anatomical site and/or neural mechanism 44

45

Comparison of tests against criteriaLiSN-S LC/SA

Dichotic digits

Freq Patt Test

GIN Digit span fwd

Digit span

reverse

MLD

Sens: slope re functional 4 3 2 3 5 6 0Sens: deviant results common 2 7 5 2 2 2 0Uniqueness re other tests 3 6.5 2 2.5 0 12 0Specific diagnosis leading to effective proven remediation

0/10 4 0 0 0 0 0

Time taken

Minimal effect of attention, working memory, intelligence, motivation, language ability

5/15 3 3 16 3 5 25

Known high reliability and small critical differences

10 ? ? ? ? ? ?

Known anatomical site and neural mechanism

0 1 0 0 0 0 5

46

Diagnosis and intervention

• Spatial processing disorder LiSN & Learn

• Auditory working memory (digit span fwd and reverse) Memory booster or Cog Med

• Any other disorder causing speech in noise difficulties dichotic digits Remote microphone hearing aids (Hornickel and Krauss), dichotic training (DIID or ARIA)

47

Thanks for listening

http://capd.nal.gov.au/

http://capd.nal.gov.au/

Testing for Central Auditory Processing Disorders Harvey Dillon With thanks to: Sharon Cameron Helen...

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