Testing for Central Auditory Processing Disorders
45
Testing for Central Auditory Processing Disorders Harvey Dillon With thanks to: Sharon Cameron Helen Glyde Wayne Wilso n Pia Gyldenkae rne Mridu la Sharm a Dani Tomli n 1
description
Testing for Central Auditory Processing Disorders. Harvey Dillon With thanks to:. Pia Gyldenkaerne. Sharon Cameron. Helen Glyde. Dani Tomlin. Mridula Sharma. Wayne Wilson. On the basis of evidence, what should CAPD testing and remediation services consist of?. - PowerPoint PPT Presentation
Transcript of Testing for Central Auditory Processing Disorders
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?
What gaps in evidence are there that our research should fill in
the future?
Suggestions to Pia and Dani in the interpretation of their data
3
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?• Are there general management techniques that might
minimize its effects?
4
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
5
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
6
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
7
Test score sensitivity relative to functional ability:
• Sensitivity
8
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
9
First a brief background on the LiSN-S
Same Voice - 0° Condition Different Voices - 0° Condition
Same Voice - ±90° Condition Different Voices - ±90° Condition
Spatial Advantage
Total Advantage
Talker Advantage
(LiSN-S) Conditions
Low cue
High cue
Sharon Cameron 10
Results profile: spatial processing disorder
11
Target: The horse kicked six wet shoesLiSN & Learn training software
Cameron & Dillon, JAAA, 2011 12
Effect of training on LiSN-S scores
L o w cu eH ig h C u e
Ta lke r ad van ta geSp a tia l ad van ta g e
To ta l a dva n ta g e
L iSN -S s ca le
-3 .0
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
LiSN
-S score (popn S
D units)
Pre
Post
Follow-up
Cameron & Dillon, JAAA, 201113
LiSN & Learn - Performance Over Time (n=9)Li
SN
& L
earn
SR
T (d
B)
10 dB
Bet
ter
Cameron & Dillon, JAAA, 201114
Randomized Control TrialEarobicsLisn & Learn
N = 5 N = 5
Grou p : L iSN & L e a rn
L o w Cu eHi g h Cu e
T a l ke r A d vS p a ti a l A d v
T o ta l A d v-6
-5
-4
-3
-2
-1
0
1
2
3
LiSN
-S S
core (P
opulation Standard D
eviation Units)
G rou p : Ea ro b ics
L o w Cu eHig h Cu e
T a l ke r A d vS p a ti a l A d v
T o ta l A d v
P re -tra i n i n g P o st-tra i n i n g
Cameron et al15
16
Experiment 1Dani 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)
17
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)
18
Relations between outcome variablesMatrix P lo t (D ani F eb24 data .sta 113v*112c)
Lis tening Capability Sc ore
A v erage NA PLA N Literac y Z s c ore
W A RP Z SCORE
19
Test score sensitivity relative to functional abilitiesDichotic digits - left Dichotic digits - right Freq pattern - left Freq pattern - right
List
enin
g ca
pabi
lities
Read
ing
fluen
cy
Dani Tomlin
Lite
racy
Averag e NA P LA N Li te ra cy Z score = 0 .4 14 5+0.1672*x
-10 -8 -6 -4 -2 0 2 4
RD D A S IN Z S core
-3
-2
-1
0
1
2
Average N
AP
LAN
Literacy Z score
A verage NA P LA N Literacy Z sco re = 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
Average N
AP
LAN
Literacy Z score
A verage NA P L A N L ite racy Z score = 0 .5726+0 .265*x
-10 -8 -6 -4 -2 0 2 4
LF P T A S IN Z S C ORE
-3
-2
-1
0
1
2
Average N
AP
LAN
Literacy Z score
A verage NA P LA N L ite racy Z sco re = 0 .5054+0 .1976*x
-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
Average N
AP
LAN
Literacy Z score
W A RP Z S C ORE = 0.0871 +0.2002 *x
-10 -8 -6 -4 -2 0 2 4
R FP T A S IN Z S C ORE
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
W A RP Z S C ORE = 0 .1039+0.2143*x
-10 -8 -6 -4 -2 0 2
LF P T A S IN Z S C ORE
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
W A RP Z S C ORE = 0 .2969+0 .2647*x
-10 -8 -6 -4 -2 0 2 4
LD D A S IN Z S core
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
W A RP Z S C ORE = 0.0602+0 .2 05*x
-1 0 -8 -6 -4 -2 0 2 4
RD D A S IN Z Score
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
L istening C apab ility S core = 0.2085+0.2417*x
-10 -8 -6 -4 -2 0 2 4
LD D A S IN Z S core
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0.0
0.5
1.0
1.5
2.0
Listening Capability S
core
L is tening C apab ility S core = -0 .0343+0.2005 *x
-10 -8 -6 -4 -2 0 2 4
RD D A S IN Z S co re
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Listening Capability S
core
L istening C a pab ility S core = -0 .0 218+0.1664 *x
-1 0 -8 -6 -4 -2 0 2 4
LF P T A S IN 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
Listening C apab ility S core = -0.068+0.1102*x
-10 -8 -6 -4 -2 0 2 4
R F P T A S IN 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
20
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
L istening C apab ility S core = -0 .1 24+0.2894*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 Gin 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
Liste ning C apab ility S core = -0 .1261+0 .2162*x
-3 .0 -2 .5 -2 .0 -1.5 -1 .0 -0.5 0 .0 0.5 1.0 1.5
R G in Z sco re
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Listening Capability S
core
Listening C apab ility S core = -0 .0312+0 .4149*x
-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
L istening C apab ility S core = -0 .0199+0 .5467*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
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0.0
0.5
1.0
1.5
2.0
Listening Capability S
core
Average NA P LAN L ite racy Z sco re = 0 .4358+0.6129*x
-2 .0 -1 .5 -1 .0 -0 .5 0.0 0 .5 1.0 1 .5 2 .0
D S Rev Z S co re
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
NA
PLA
N Literacy Z score
A ve ra ge NA PL A N L ite racy Z score = 0 .45 4+0 .564 3*x
-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
Average N
AP
LAN
Literacy Z score
A verage NA P LA N L ite ra cy Z score = 0 .37 01-0 .1 306*x
-3 .0 -2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1.5
R G in 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
A verage NAP LA N L ite racy Z sco re = 0.3754-0 .2565*x
-0 .6 -0 .4 -0 .2 0.0 0.2 0.4 0.6
L G in 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 O RE = -0 .006+0 .539 7*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 sco re
-3
-2
-1
0
1
2
3
WA
RP
Z SC
OR
E
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 SC
OR
E
W A RP Z S C O RE = 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 F W Z S C ORE
-3
-2
-1
0
1
2
3
WA
RP
Z SC
OR
E
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 SC
OR
E
21
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 SC
OR
E
W A RP Z S C ORE = 0 .1186+0.32 58*x
-5 -4 -3 -2 -1 0 1 2 3
HC S dev from avg
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
A verage NA P LA N L iteracy Z score = 0 .4274+0.3453*x
-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
Average N
AP
LAN
Literacy Z score
A verage NA P LA N L iteracy Z score = 0 .4454+0 .3003*x
-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
Average N
AP
LAN
Literacy Z score
L istening C apa b ility S core = 0 .0 843+0.56*x
-5 -4 -3 -2 -1 0 1 2 3
LC S dev fro m avg
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Listening Capability S
core
L istening C apab ility S core = 0.0332+0 .3098*x
-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
Listening Capability S
core
MLD z score
L istening C apabili ty S core = -0.0792-0 .0 256*x
-3 -2 -1 0 1 2 3 4 5
M LD 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
W A RP Z S C O RE = 0 .010 7+0 .0001*x
-3 -2 -1 0 1 2 3 4 5
ML D Z sco re
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
A verage NA P LA N L ite racy Z score = 0 .3523+0.0132*x
-3 -2 -1 0 1 2 3 4 5
MLD Z sco re
-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
A ve ra ge NA P LA N Literacy Z sco re = 0.4196+0 .274*x
-6 -5 -4 -3 -2 -1 0 1 2
A ttentio n Quotient 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 .2157+0.2121*x
-6 -5 -4 -3 -2 -1 0 1 2
A ttentio n Quotient Z score
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
Lis tening C apabi lity S core = 0.188+0 .2352*x
-6 -5 -4 -3 -2 -1 0 1 2
A ttention Quo tient 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
22
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
23
Correlations – outcomes and test scoresLiteracy
WARP
Listen
CapL DD R DD L FPT R
FPT MLD L GIN R GIN
LiSN LC
LiSN HC
LiSN SA
DS Fwd
DS 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 0.32Listening
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 12L DD * * * * * * * * * * *
R DD * * * * * *
L FPT * * * * * * * *
R FPT * * * * * * * * *
MLD *
L GIN * * * *
R GIN * * * * * * * * * *
DS Fwd * *
DS Rev * * * * * * * * * * * *
LiSN LC * * * * *
LiSN HC * * * * *
LiSN SA * * * * *24
What is affecting listening capabilities?TONI
DS Fwd
DS Rev
Att
LDDListening
capabilities
0.27
0.10
0.19
0.10
0.20
25
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.
26
N=35Adj R2 = 0.64
27
Importance of the presenting symptoms?
FO
LLOW
ING
INS
T
none
LEA
RN
ING
DIF
FIC
.
AT
TN
/CO
NC
Attention
RE
AD
ING
LAN
GU
AG
E
Spelling/W
riting
P rim ary C oncern
05
101520253035404550
No of observations
28
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 .50.00.51.01.5
MANOVA analysis: p=0.94
29
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
30
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
31
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)
32
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
10
12
14
Reported D
ifficulties
-12 -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
Reported D
ifficulties
-5 -4 -3 -2 -1 0 1 2
DDT _ R_S D
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
-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
Reported D
ifficulties
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
Average
-12 -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
Average
-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
Average
-7 -6 -5 -4 -3 -2 -1 0 1 2 3
D DT _ 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
Average
Pia Gyldenkaerne and Mridula Sharma
33
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 LD _ S D
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
Binaural masking level difference
0 2 0 40 6 0 8 0 10 0 1 20
B T Re sp o nse Co n tro l Q u o tie n t
-2
0
2
4
6
8
1 0
1 2
1 4
Reported D
ifficulties
0 2 0 4 0 6 0 8 0 1 0 0 1 20 1 4 0
B T A tten t io n Q u o ti en t
-2
0
2
4
6
8
1 0
1 2
1 4
Reported D
ifficulties
234567891 01 1
G IN Ri g h t
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
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
20
40
60
80
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0
WA
RP
Average
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
verage
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
Average
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
Average
Repo
rted
diffi
culti
esRe
adin
g sp
eed
Pia Gyldenkaerne and Mridula Sharma
34
Simple correlation matrix – outcome scores and test scores
Reported Difficulties WARP L DDT R DD L FPT R FPT R GIN MLD TONI
BT Attention Quotient
Reported Difficulties - -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 -0.02MLD 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
35
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 * * * * * * *
Reported Difficulties
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 Audiometry Measured disability
Is there a problem that CAPD
might explain?
Detailed test battery
Exclude CAPD;Refer elsewhere
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 Audiometry Measured disability
Is there a problem that CAPD
might explain?
Detailed test battery
Exclude CAPD;Refer elsewhere
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?
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
39
40
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 0 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
41
Test structure????
Parental / teacher report of difficulties
LiSN - HC
LiSN remainder
DD
Att TONI
DS rev
Psych
PsychPsych
Low
Strategies, FM
Low Low
Low
SA low: LiSN&LearnHC low: Strategies, FM
Low
Strategies, FM
42
Thanks for listening
www.NAL.gov.au
43
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
Detection of an APD in the presence of hearing loss
LiSN-S Prescribed Gain Amplifier
44
45
0 1 0 2 0 3 0 4 0 5 0 6 0
4 FA HL i n wo rse e a r (d B HL )
-2 2
-2 0
-1 8
-1 6
-1 4
-1 2
-1 0
-8
-6
-4
-2
0
2
4
6
8
Speech reception threshold (dB
SN
R)
D i ffe re n t vo i ce s 9 0 S a m e vo i ce s 9 0 Di ffe re n t vo i ce s 0 S a m e vo i ce 0
Helen Glyde and Sharon Cameron
Bette
rChanges in LiSN-S scores with hearing loss
