CAPD: ”Behavioral assessment” CAPD: ”Behavioral assessment” Dr Amani shalaby Professor of...

CAPD: ”Behavioral CAPD: ”Behavioral assessment”assessment”

Dr Amani shalabyDr Amani shalaby

Professor of AudiologyProfessor of Audiology

Ain Shams universityAin Shams university

Definition of CAPDDefinition of CAPD

CAPDCAPD is the auditory system mechanisms and is the auditory system mechanisms and processes responsible for the following processes responsible for the following behavioralbehavioral phenomena:phenomena:

Sound localization and laterlization.Sound localization and laterlization.

Auditory discrimination.Auditory discrimination.

Auditory pattern recognitionAuditory pattern recognition

Definition of CAPD ( cont.)Definition of CAPD ( cont.)

Temporal aspect of audition, includingTemporal aspect of audition, including::

temporal resolutiontemporal resolution

temporal maskingtemporal masking

temporal integration temporal integration

temporal orderingtemporal ordering

Auditory performance decrements withAuditory performance decrements with competing acoustic signalscompeting acoustic signals..

Auditory performance decrements withAuditory performance decrements with degraded acoustic signalsdegraded acoustic signals..

(ASHA, 1996, 2005)

Central Auditory abilitiesCentral Auditory abilities

Auditory Discrimination.Auditory Discrimination.Auditory localization.Auditory localization.Auditory closure.Auditory closure.Binaural interaction Binaural interaction Auditory selective attention.Auditory selective attention.

Binaural separationBinaural separation..Binaural integrationBinaural integration

Central Auditory abilities Central Auditory abilities (Cont.)(Cont.)

Temporal ProcessingTemporal Processing

* Temporal ordering* Temporal ordering

* Temporal resolution* Temporal resolution

* Temporal integration* Temporal integration

* Temporal masking* Temporal masking

Other auditory AbilitiesOther auditory Abilities

Attention and memory for auditory Attention and memory for auditory information.information.

Auditory synthesis.Auditory synthesis. Phonological awareness.Phonological awareness. Comprehension and interpretation of Comprehension and interpretation of

auditory information. auditory information. ((higher order cognitive- higher order cognitive-

communicative and /or language communicative and /or language related functions.)related functions.)

When to suspect the presence When to suspect the presence of CAPD in a childof CAPD in a child

Difficulty in following instructions.Difficulty in following instructions.

Difficulties in understanding speech Difficulties in understanding speech in background noise.in background noise.

Localization problems.Localization problems.

Attention and memory problems.Attention and memory problems.

Scholastic underachievement.Scholastic underachievement.

Impact of CAPD on ChildrenImpact of CAPD on Children

Communication problems.Communication problems.

Academic problems.Academic problems.

Social problems.Social problems.

Emotional problems.Emotional problems.

Behavioral problems.Behavioral problems.

Diagnosis is challengingDiagnosis is challenging

Heterogeneous group.Heterogeneous group.

One or more ability affected.One or more ability affected.

Tools for testing were not Tools for testing were not available to test available to test

-Children.-Children.

-Egyptian culture. -Egyptian culture.

Objectives of CAPD Assessment:Objectives of CAPD Assessment:

To detect the presence of CAPDTo detect the presence of CAPDTo identify the affected abilitiesTo identify the affected abilitiesTo assess the level of CAPDTo assess the level of CAPDTo identify associated disorders To identify associated disorders

To design an appropriate To design an appropriate intervention plan for CAPDintervention plan for CAPD

Diagnosis of CAPDDiagnosis of CAPD

Detailed history takingDetailed history taking

Comprehensive questionnaireComprehensive questionnaire

Psychosocial evaluationPsychosocial evaluation

Basic audiological evaluationBasic audiological evaluation

** Pure tone audiometry Pure tone audiometry** Speech audiometry Speech audiometry** Immittancemetry Immittancemetry

History and History and QuestionnaireQuestionnaire

Age distribution of CAPD childrenAge distribution of CAPD children

Audiology unit, Ain Shams University statistics (1995-Audiology unit, Ain Shams University statistics (1995-2005)2005)

7.50%7.50%

25.50%33.50%

26%

4 years

4-7 years

7-9 years

9-12 years

12 years

Gender distribution of CAPD childrenGender distribution of CAPD children

Audiology unit, Ain Shams University statistics (1995-2005)Audiology unit, Ain Shams University statistics (1995-2005)

65%

35%

Male

Female

Main complaint of CAPD childrenMain complaint of CAPD children


4%11%

16.50%

7.50% 15%

40%Scholastic underachievement

Attention

Memory

Difficult speech in noise

Reading problem

DLD

Phon. Errors

Psychophysical or Psychophysical or behavioral testingbehavioral testing

Challenge the intrinsic Challenge the intrinsic redundancy of CANS by redundancy of CANS by changing the extrinsic changing the extrinsic redundancy of the signal.redundancy of the signal.

I= 2tw log S+N / NI= 2tw log S+N / N

I= I= information in a speech signalinformation in a speech signal

t= duration of signalt= duration of signal

w= width of frequency bandw= width of frequency band

S= amplitude of the signalS= amplitude of the signal

N= just noticeable difference of intensity N= just noticeable difference of intensity of signal over the background noise or of signal over the background noise or refrence refrence

(Calearo and Lazzaroni, (Calearo and Lazzaroni, 1957)1957)

Diagnosis of CAPD (contDiagnosis of CAPD (cont.).)

Central test batteryCentral test battery

Psychophysical testsPsychophysical tests

Electrophysiological testsElectrophysiological tests

Selection criteria of CAP testsSelection criteria of CAP tests

Factors affecting CAPD test Factors affecting CAPD test resultsresults

Types of CAPD testsTypes of CAPD tests

Diagnosis of CAPD (contDiagnosis of CAPD (cont.).)

Selection criteria of CAP testsSelection criteria of CAP tests

ValidityValidity

ReliabilityReliability

Specificity and sensitivitySpecificity and sensitivity

Age appropriateAge appropriate

Culture appropriateCulture appropriate

Development of Arabic test Development of Arabic test battery for diagnosisbattery for diagnosis

Collection of Arabic test Collection of Arabic test materials pertinent to Egyptian materials pertinent to Egyptian children’s vocabulary and children’s vocabulary and culture.culture.

Standardization of test Standardization of test materials on normal Egyptian materials on normal Egyptian children.children.

Factors affecting CAPD test Factors affecting CAPD test resultsresults

ChildChild

AudiologistAudiologist

Test procedureTest procedure

ChildChild

Effect of ageEffect of age

Effect of peripheral hearing lossEffect of peripheral hearing loss

MotivationMotivation

Communicative competenceCommunicative competence

Effect of socioeconomic statusEffect of socioeconomic status

Intellectual abilitiesIntellectual abilities

AudiologistAudiologist

KnowledgeKnowledge

TrainingTraining

CompetenceCompetence

Test procedureTest procedure

Signal and presentation modeSignal and presentation mode

Response modeResponse mode

Psychophysical testsPsychophysical tests

Monaural low redundancy speech Monaural low redundancy speech test test

Dichotic speech testsDichotic speech testsAuditory temporal processing Auditory temporal processing

and patterning testsand patterning testsBinaural interaction testsBinaural interaction testsAuditory discrimination testsAuditory discrimination tests

Monaural low redundancy testsMonaural low redundancy tests

Low Pass Filtered Low Pass Filtered speech speech (LPF)(LPF)

Speech In Noise Speech In Noise (SPIN)(SPIN)

Synthetic Sentence Synthetic Sentence Identification test with Identification test with Ipsilateral Competing Ipsilateral Competing Message Message (SSI-ICM)(SSI-ICM)

Time Compressed Time Compressed speech speech (TC)(TC)

Dichotic testsDichotic tests

Dichotic testsDichotic tests

Dichotic Digits Dichotic Digits (DDT)(DDT)

Dichotic Consonant Vowels Dichotic Consonant Vowels (DCV)(DCV)

Staggered Spondaic words Staggered Spondaic words (SSW)(SSW)

Competing Sentence test Competing Sentence test (CST)(CST)

Dichotic Rhyme Dichotic Rhyme (DR)(DR)

Dichotic Sentence Identification Dichotic Sentence Identification ( DSI)( DSI)

Synthetic sentence Identification with Synthetic sentence Identification with Contralateral Competing MessageContralateral Competing Message ( (SSI-SSI-CCM)CCM)

Binaural interactionBinaural interaction

Masking Level Masking Level Difference (MLD)Difference (MLD)

Binaural fusion (BF)Binaural fusion (BF)

Rapidly Alternating Rapidly Alternating Speech Perception Speech Perception (RASP)(RASP)

Auditory discrimination testsAuditory discrimination tests

Auditory Discrimination tests (ADT) specifically Auditory Discrimination tests (ADT) specifically measures auditory discrimination skills for fine measures auditory discrimination skills for fine differences.differences.

* * Difference Limen for FrequencyDifference Limen for Frequency

* * Difference Limen for IntensityDifference Limen for Intensity

Temporal processing testsTemporal processing tests

Pitch Pattern Sequence test (PPST)Pitch Pattern Sequence test (PPST)

Duration Pattern test (DPT)Duration Pattern test (DPT)

Auditory Fusion test (AF)Auditory Fusion test (AF)

Time compressed speech (TC)Time compressed speech (TC)

Central test battery resultsCentral test battery results

O: Right earO: Right ear

X: Left earX: Left ear

Shaded area: normal Shaded area: normal rangerange

LPFLPF SPINSPIN CSTCST PPSPPS

100%100% O O XX

9595

9090 O O XX O O XX

8585 OO

8080 XX

7575

7070

6565

6060

5555

5050

4545

4040

3535

3030

2525

2020

1515

1010

55

00

Affected central auditory abilityAffected central auditory ability

75%

38%33%

0%

20%

40%

60%

80%

ATPD SAAD D. separation


Cognitive abilitiesCognitive abilities


90

10

Normal

Memory & attentiondeficit

Isolated versus combinedIsolated versus combined


83

17

Isolated

Combined

Interpretation of test resultsInterpretation of test results

Absolute or norm basedAbsolute or norm based

Relative or patient basedRelative or patient based

--comparison of pattern within a given testcomparison of pattern within a given test

--comparison of trends observed across the comparison of trends observed across the teststests

--comparison of results observed across comparison of results observed across diagnostic test and results from non-diagnostic test and results from non-audiological disciplinesaudiological disciplines

Multidisciplinary assessment Multidisciplinary assessment involving other professionals is involving other professionals is mandatory in order to:mandatory in order to:

Determine the functional Determine the functional impact of impact of CAPD. CAPD. Presence of any associatedPresence of any associated disorders.disorders.

Multidisciplinary Multidisciplinary assessmentassessment

Speech and language Speech and language

NeuropsychologicalNeuropsychological

EducationalEducational

InvestigationsInvestigations

Laboratory investigationLaboratory investigation

Genetic evaluationGenetic evaluation

Radiological studiesRadiological studies

Associated neuropsychiatry Associated neuropsychiatry disordersdisorders


78%

10%

10% 2%

None

ADHA

Autism

Epilepsy

SummarySummary

No one, easy, right answer to the No one, easy, right answer to the CAPD question exists. The CAPD question exists. The complexity of the “problem” complexity of the “problem” reflects the complexity and reflects the complexity and heterogeneityheterogeneity of the disorder. of the disorder. Hence, an individual approach Hence, an individual approach must be taken for the selection must be taken for the selection of diagnostic measures and the of diagnostic measures and the interpretation of the resultsinterpretation of the results. .

Thank You

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