Hearing and Auditory Processing in School-age Children
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Transcript of Hearing and Auditory Processing in School-age Children
B R A D L E Y M C P H E R S O N
D I V I S I O N O F S P E E C H A N D H E A R I N G S C I E N C E S
U N I V E R S I T Y O F H O N G K O N G
Hearing and Auditory Processing in School-age Children
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DAHK May 2012 Meeting
Hearing Disorders
Outline
1. Hearing disorders in children
explained
2. Assessment for hearing loss
3. Management for hearing loss
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Hearing Disorders
Hearing loss can occur due to problems:
in the outer ear
in the middle ear
in the inner ear
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Hearing Disorders
Common hearing disorders in children are:
Impacted ear wax
Middle ear disease (“glue ear”)
Congenital hearing loss – problem from birth (includes many cases of genetic hearing loss)
Middle ear disease – about 50% of all children will get 1 or more episodes of this by age 5
Congenital hearing loss – much rarer, 1 or 2 cases for every 1,000 births
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Hearing Disorders
Hearing tactics such as positioning, preferential seating, visual supplements
Lip-reading
Amplification: hearing aids
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Auditory Processing Disorders
Outline
1. Auditory processing disorders
explained
2. APD assessment
3. APD management
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Auditory Processing Disorders
Also known as:
Central auditory
dysfunction
Central auditory
processing disorder
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Auditory Processing Disorders 11
APD is an auditory disorder that results from deficits in central auditory nervous system function
American Speech, Language, Hearing Association definition of auditory processing:
“…perceptual processing of auditory information in the CNS and the neurobiological activity that underlies that processing…”
DAHK May 2012 Meeting
APD behavioural processes
Central auditory processes are the auditory system mechanisms and processes responsible for the following behaviours:
1. Sound localization and lateralization
2. Auditory discrimination
3. Auditory pattern recognition
4. Temporal aspects of audition including: temporal resolution, temporal masking, temporal integration and temporal ordering.
5. Auditory performance with competing acoustic signals
6. Auditory performance with degraded signals
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APD behavioural processes
CAPD is an observed deficiency in one or more of the ASHA listed behaviours
CAPD can result directly from dysfunctional auditory processes or from more global deficits (e.g., language deficits, memory deficits, attention deficits)
The prevalence of CAPD in children is estimated to be between 2 and 3%
Twice as prevalent in male children
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Auditory Processing Disorders
Clinically, APD usually involves:
Speech-in-noise problems
Dichotic (different sounds to different ears) deficits
Temporal processing disorders
Usually CAPD is idiopathic (unknown cause)
In children it can be associated with mild developmental delay, or with PDD (pervasive developmental delay), or ADD (attention deficit disorder), or LD (learning disorders)
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APD is not...
Receptive language processing disorder
Poor language processing skills that affect language comprehension and vocabulary development — linguistic disorder
Neuropsychological disorder
Auditory attention or auditory memory problems — cognitive disorders
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Or other learning disabilities…
Learning disabled children
Have average to superior IQ
Serious learning deficits
Generally working 2 years or greater below grade level
Learning skill areas
Visual Perception
Visual Memory
Auditory Perception
Auditory Memory
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DAHK May 2012 Meeting
Auditory memory disorders
Listening (processing and storing)
Recall
ADD (Attention Deficit Disorder), ADHD (Attention Deficit Hyperactivity Disorder) children often have deficits in this area
Difficulty developing good understanding of orally presented material
Vocabulary and meanings
Remembering facts in history and science
Following oral directions
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DAHK May 2012 Meeting
APD is...
Impaired ability to process
acoustic information that is
not due to impaired hearing
sensitivity, impaired language
or impaired cognitive
function
Usually effects are most
apparent in poor acoustic
environments with low
“signal to noise ratio”
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APD and dyslexia
Dyslexia: difficulties in learning to read and write despite “adequate cognitive ability, motivation, access to instruction, and intact peripheral sensory mechanisms.”
At least a sub-group (around 40%) of individuals with dyslexia have auditory processing problems
Often these problems relate to processing small differences in sound pitch and small changes in sound intensity
Unknown whether these problems cause dyslexia or are unrelated
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Everyday behaviours associated with APD
1. Difficulty hearing in noisy situations
2. Difficulty following long conversations
3. Difficulty hearing conversations on the telephone
4. Difficulty learning a foreign language or challenging vocabulary words
5. Difficulty remembering spoken information (i.e., auditory memory deficits)
6. Difficulty taking notes
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Everyday behaviours associated with APD
7. Difficulty maintaining focus on an activity if other sounds are present —child is easily distracted by other sounds in the environment
8. Difficulty with organizational skills
9. Difficulty following multi-step directions
10. Difficulty in directing, sustaining, or dividing attention
11. Difficulty with reading and/or spelling
12. Difficulty processing nonverbal information (e.g., lack of music appreciation)
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APD assessment
No consensus on the ideal tests
Case history results* often show:
1. Poor educational achievement
2. Need for repetition
3. Failure to follow instructions
4. Difficulties in background noise or groups
5. Behavioural problems
Conventional audiometry results are normal
Speech understanding tests often used: in quiet and in noise
Specialised CAPD tests
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*Behavioural checklists useful: • Children’s Auditory
Performance Scale (CHAPS) • Fisher Auditory Problems
Checklist • Screening Identification for
Targeting Educational Risk (SIFTER)
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APD assessment
May be difficult to interpret CAPD tests
ADD children, PDD children, etc., may show reduced scores because of non-auditory problems
Some audiology material may fail to distinguish CAPD from children with other problems
However, only 1 behaviour common to both CAPD and ADHD
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APD assessment 24
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ADHD APD
1. Inattentive 1. Difficulty hearing in background noise
2. Distracted 2. Difficulty following oral instructions
3. Hyperactive 3. Poor listening skills
4. Restless 4. Academic difficulties
5. Hasty/impulsive 5. Poor auditory association skills
6. Interrupts/intrudes 6. Distracted
APD assessment
SCAN-C Test: Screening Test for Auditory Processing Disorders
1. Filtered Words
2. Auditory Figure-Ground
3. Competing Words
4. Competing Sentences
For children 5 - 11 years
High false positive rate
Best used as part of a test battery
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APD assessment
Diagnostic approach rather than a screening approach is preferred
Many other tests used: cover localization/ lateralization, discrimination, pattern recognition, temporal processing, competing acoustic signals, degraded speech signals
Speech tests: Staggered Spondaic Word Test (SSW)
Dichotic Digit Test (DD)
Low-Pass/High Pass Filtered Speech Test (Binaural fusion: BF)
Time Compressed Speech Test (TC)
Speech-in-Noise tests (such as HINT)
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APD assessment
Non-speech tests:
Pitch Pattern Sequence Test (PPS)
Random Gap Detection Test (RGD) or Gaps in Noise Test (GIN)
Duration Pattern Sequence Test (DPS)
Electrophysiological tests:
Auditory brain response tests
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APD management
Improving signal quality
Primary aim is to increase child’s ability to use sound information
Learning environment needs to be changed:
1. Environment modifications
2. Preferential seating
3. FM listening device
4. Pre-teaching, visual support, checks on understanding (repeat and rephrase)
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APD management 30
Assistive Listening Device fitting
Need for counselling and monitoring of children, parents and teachers
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APD management
Auditory training
Concept of auditory plasticity – neural connections can be modified and improved over time with training
Programs usually intensive – 1 hour or more, several times per week, for months
Programs progressively increase listening task difficulty
Programs target specific auditory processes
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APD management
Basic discrimination deficits: training in speech and non-speech discrimination tasks
Temporal processing deficits: training in sequencing tasks, rhythm training, poetry reading, directions learning
Perception of speech in noise deficits: vocabulary building and listening practice
Binaural listening deficits: Dichotic listening tasks
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APD management
Training materials
Katz, J. (2009) Therapy for auditory processing disorders: Simple effective procedures. Westminster, CO: Educational Audiology Association.
Earobics - http://www.earobics.com/
FastForWord - http://www.scilearnglobal.com/
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APD management
Other strategies
Equip children with tools to cope with APD
Motivational training
Cognitive behaviour modification to promote active listening
Assertiveness training
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