Speech-evoked neurophysiologic responses in children with learning problems: development and behavioral correlates of perception

Maturation of auditory evoked potentials from 6 to 48 months: prediction to 3 and 4 year language and cognitive abilities

OBJECTIVE

To investigate the maturation of long-latency auditory evoked potentials (LLAEP) from 6 to 48 months in infants with a family history of language impairment (FH+) and control infants (FH-).

METHODS

LLAEPs of seventeen FH+ infants were compared to 28 FH- infants at 6, 9, 12, 16, 24, 36 and 48 months. Participants received a passive oddball paradigm using fast- and slow-rate non-linguistic auditory stimuli and at 36 and 48 months completed a battery of standardized language and cognitive tests.

RESULTS

Overall, the morphology of LLAEP responses differed for fast- versus slow-rate stimuli. Significant age-related changes in latency and amplitude were observed. Group differences, favoring FH- infants, in the rate of maturation of LLAEPs were found. Responses to fast-rate stimuli predicted language abilities at 36 and 48 months of age.

CONCLUSIONS

The development of LLAEP in FH+ children is modulated by differences in the rate of maturation as well as variations in temporal processing abilities.

SIGNIFICANCE

These findings provide evidence for the role of non-linguistic auditory processes in early language development and illustrate the utility of using a perceptual-processing skills model to further our understanding of the precursors of language development and impairment.

Cortical-evoked potentials reflect speech-in-noise perception in children

Children are known to be particularly vulnerable to the effects of noise on speech perception, and it is commonly acknowledged that failure of central auditory processes can lead to these difficulties with speech-in-noise (SIN) perception. However, little is known about the mechanistic relationship between central processes and the perception of SIN. Our aims were twofold: to examine the effects of noise on the central encoding of speech through measurement of cortical event-related potentials and to examine the relationship between cortical processing and behavioral indices of SIN perception. We recorded cortical responses to the speech syllable [da] in quiet and multi-talker babble noise in 32 children with a broad range of SIN perception. Outcomes suggest inordinate effects of noise on auditory function in the bottom SIN perceivers compared with the top perceivers. The cortical amplitudes in the top SIN group remained stable between conditions, whereas amplitudes increased significantly in the bottom SIN group, suggesting a developmental central processing impairment in the bottom perceivers that may contribute to difficulties in encoding and perceiving speech in challenging listening environments.

Analysis of p1 latency in normal hearing and profound sensorineural hearing loss

Objectives

P1 is a robust positivity at a latency of 50-150 msec in the auditory evoked potential of young children. It has been reported that over the first 2-3 years of life, there is a rapid decrease of the latency and the mean P1 latency in adults with normal hearing is approximately 60 msec. This study was designed to evaluate the change of the P1 latency in Koreans with normal hearing according to age and to compare this with the P1 latency of young patients with profound sensorineural hearing loss before and/or after cochlear implantation.

Methods

Among the patients who visited the Department of Otorhinolaryngology at Seoul National University Hospital from June 2007 to September 2009, the P1 response was recorded in 53 patients in the normal hearing group, in 13 patients in the pre-cochlear implantation (CI) group and in 10 patients in the post-CI group. A synthesized consonant-vowel syllable /ba/ was used to elicit the evoked responses. The evoked responses were collected using the center of the frontal head. For each subject, an individual grand average waveform was computed by averaging the ten recordings. The P1 latency was visually identified as a robust positivity in the waveform.

Results

For the normal hearing group, the P1 latency showed the pattern of shortening as the age increased (coefficient, -0.758; P<0.001). For the pre-CI group, 10 cases showed delayed latencies and 3 cases did not show the P1 wave. For the post-CI group, the P1 latencies showed a less delayed tendency than those of the pre-CI group, but this was not statistically different.

Conclusion

This report provides the standard value of the P1 latency at each age in Koreans for the first time and the findings support that the maturation of the central auditory pathways could be measured objectively using the P1 latency.

Objective neural indices of speech-in-noise perception

Numerous factors contribute to understanding speech in noisy listening environments. There is a clinical need for objective biological assessment of auditory factors that contribute to the ability to hear speech in noise, factors that are free from the demands of attention and memory. Subcortical processing of complex sounds such as speech (auditory brainstem responses to speech and other complex stimuli [cABRs]) reflects the integrity of auditory function. Because cABRs physically resemble the evoking acoustic stimulus, they can provide objective indices of the neural transcription of specific acoustic elements (e.g., temporal, spectral) important for hearing speech. As with brainstem responses to clicks and tones, cABRs are clinically viable in individual subjects. Subcortical transcription of complex sounds is also clinically viable because of its known experience-dependence and role in auditory learning. Together with other clinical measures, cABRs can inform the underlying biological nature of listening and language disorders, inform treatment strategies, and provide an objective index of therapeutic outcomes. In this article, the authors review recent studies demonstrating the role of subcortical speech encoding in successful speech-in-noise perception.

Atypical brain response to novelty in rural African children with a history of severe falciparum malaria

Plasmodium falciparum is the most common parasitic infection of the central nervous system causing neuro-cognitive deficits in 5-26% of paediatric cases. The burden cannot be reliably estimated because of lack of sensitive, culture-fair and robust assessments in rural settings. Auditory and visual brain event related potentials (ERPs) are used to compare novelty processing in children exposed to severe malaria with community controls. Fifty children previously admitted and discharged from Kilifi District Hospital with severe falciparum malaria were selected and compared with 77 unexposed age matched children. The results showed that up to 14% of children exposed to severe malaria had significantly different responses to novelty compared to unexposed children. Children exposed to severe malaria had smaller P3a amplitudes to novelty in both auditory [F (3, 119)=4.545, p=0.005] and visual [F (3, 119)=6.708, p<0.001] paradigms compared to unexposed children. In the auditory domain the differences in processing of novelty were not related to early component processing. The percentage of children with severe malaria showing impaired performance using ERPs is within the range previously reported using neuropsychological tests. The overall pattern suggests that severe malaria affects prefrontal and temporal cortices normally activated by stimulus novelty.

Auditory and visual novelty processing in normally-developing Kenyan children

OBJECTIVE

The aim of this study was to describe the normative development of the electrophysiological response to auditory and visual novelty in children living in rural Kenya.

METHODS

We examined event-related potentials (ERPs) elicited by novel auditory and visual stimuli in 178 normally-developing children aged 4-12 years (86 boys, mean 6.7 years, SD 1.8 years and 92 girls, mean 6.6 years, SD 1.5 years) who were living in rural Kenya.

RESULTS

The latency of early components (auditory P1 and visual N170) decreased with age and their amplitudes also tended to decrease with age. The changes in longer-latency components (Auditory N2, P3a and visual Nc, P3a) were more modality-specific; the N2 amplitude to novel stimuli decreased with age and the auditory P3a increased in both latency and amplitude with age. The Nc amplitude decreased with age while visual P3a amplitude tended to increase, though not linearly.

CONCLUSIONS

The changes in the timing and magnitude of early-latency ERPs likely reflect brain maturational processes. The age-related changes to auditory stimuli generally occurred later than those to visual stimuli suggesting that visual processing matures faster than auditory processing.

SIGNIFICANCE

ERPs may be used to assess children's cognitive development in rural areas of Africa.

Follow up of P1 peak amplitude and peak latency in a group of specific language-impaired children

This project investigated the maturation of P1 of 32 native Arabic speaking children; all had a primary diagnosis of SLI. The study group had a mean age 60.25 (+/-6.4) months (range 50-80 months) at the time of the primary diagnosis. The control group consisted of 69 children matched for age, language level and academic skills, with no history of language disability. 30 children of the SLI group were re-examined 28 months after primary diagnosis. The test battery included basic audiological evaluation and P(1)/N(2) complex evoked by speech syllable /da/ and presented binaurally through sound field.

RESULTS

Stepwise regression analysis of variables showed significant shortening of P1 peak latency in both control and SLI group showed proportional to the natural logarithm of the chronological age (r=-.414 &r(2)=.418). P1 peak amplitude showed significant decrease in amplitude in both control and SLI group proportional to the square of the chronological age (r=-.375 & r(2)=.140). However, no significant difference could be detected between the SLI group and the control group as regards P1 peak latency and peak amplitude. Moreover, the study showed no statistical significant difference between the control group and the study group as regards the correlation between P1 and language age (P1 latency t=.153, while significant t=.879 and P1 amplitude (t=-.37) significant t=.712). The partial correlation coefficient was .04 for P1 latency and .088 for P1 amplitude.

CONCLUSIONS

Considering the heterogeneity of the SLI group, P1 peak amplitude and peak latency may be valuable to follow up the maturation of the auditory system on individual basis rather than for differential diagnosis of SLI patient from normal. P1 does not show dramatic developmental change in the age range 5-10 years to be used clinically. Further researches are needed to standardize statistical method for analyzing P1 waveform.

Subcortical differentiation of stop consonants relates to reading and speech-in-noise perception

Children with reading impairments have deficits in phonological awareness, phonemic categorization, speech-in-noise perception, and psychophysical tasks such as frequency and temporal discrimination. Many of these children also exhibit abnormal encoding of speech stimuli in the auditory brainstem, even though responses to click stimuli are normal. In typically developing children the auditory brainstem response reflects acoustic differences between contrastive stop consonants. The current study investigated whether this subcortical differentiation of stop consonants was related to reading ability and speech-in-noise performance. Across a group of children with a wide range of reading ability, the subcortical differentiation of 3 speech stimuli ([ba], [da], [ga]) was found to be correlated with phonological awareness, reading, and speech-in-noise perception, with better performers exhibiting greater differences among responses to the 3 syllables. When subjects were categorized into terciles based on phonological awareness and speech-in-noise performance, the top-performing third in each grouping had greater subcortical differentiation than the bottom third. These results are consistent with the view that the neural processes underlying phonological awareness and speech-in-noise perception depend on reciprocal interactions between cognitive and perceptual processes.

Development of auditory processing in 6–12-year-old children: a longitudinal study

The development of auditory processing in children was investigated in a longitudinal study. A group of 20 children with normal cognitive and language development underwent several auditory tests at the ages of 6, 7, 8, 10 and 12 years. At the age of 10 years, three subjects were lost to follow-up, as was one more subject at the age of 12 years. The auditory performance of the children was compared to the performance of a group of 20 adults. The auditory test battery consisted of a speech-in-noise test, a filtered speech test, a binaural fusion test and two auditory sequencing tests. At the ages of 6, 7 and 8 years, data on the performance on an auditory word discrimination test, an auditory synthesis test, an auditory closure test and a number recall test were also obtained. All auditory tests except the speech-in-noise test showed a clear effect of age on the performance of children. Our data suggest that maturational effects play an important role in auditory processing (at least) up to an age of 12-13 years. Correlations between the tests are in general not indicative of large amounts of overlap between the different tests. Factor analysis shows that three factors account for 68-70% of explained variance, with the three factors contributing equally. A composite score obtained by averaging all (sub)test scores can be used next to the individual test scores to describe the development of auditory processing abilities in children.

Deprivation-induced cortical reorganization in children with cochlear implants

A basic finding in developmental neurophysiology is that some areas of the cortex cortical areas will reorganize following a period of stimulus deprivation. In this review, we discuss mainly electroencephalography (EEG) studies of normal and deprivation-induced abnormal development of the central auditory pathways in children and in animal models. We describe age cut-off for sensitive periods for central auditory development in congenitally deaf children who are fitted with a cochlear implant. We speculate on mechanisms of decoupling and reorganization which may underlie the end of the sensitive period. Finally, we describe new magentoencephalography (MEG) evidence of somatosensory cross-modal plasticity following long-term auditory deprivation.

Cortical development, plasticity and re-organization in children with cochlear implants

A basic tenet of developmental neurobiology is that certain areas of the cortex will re-organize, if appropriate stimulation is withheld for long periods. Stimulation must be delivered to a sensory system within a narrow window of time (a sensitive period) if that system is to develop normally. In this article, we will describe age cut-offs for a sensitive period for central auditory development in children who receive cochlear implants. We will review de-coupling and re-organization of cortical areas, which are presumed to underlie the end of the sensitive period in congenitally deaf humans and cats. Finally, we present two clinical cases which demonstrate the use of the P1 cortical auditory evoked potential as a biomarker for central auditory system development and re-organization in congenitally deaf children fitted with cochlear implants.

LEARNING OUTCOMES

Readers of this article should be able to (i) describe the importance of the sensitive period as it relates to development of central auditory pathways in children with cochlear implants; (ii) discuss the hypothesis of de-coupling of primary from higher-order auditory cortex as it relates to the end of the sensitive period; (iii) discuss cross-modal re-organization which may occur after long periods of auditory deprivation; and (iv) understand the use of the P1 response as a biomarker for development of central auditory pathways.

Effects of background noise on cortical encoding of speech in autism spectrum disorders

This study provides new evidence of deficient auditory cortical processing of speech in noise in autism spectrum disorders (ASD). Speech-evoked responses (approximately 100-300 ms) in quiet and background noise were evaluated in typically-developing (TD) children and children with ASD. ASD responses showed delayed timing (both conditions) and reduced amplitudes (quiet) compared to TD responses. As expected, TD responses in noise were delayed and reduced compared to quiet responses. However, minimal quiet-to-noise response differences were found in children with ASD, presumably because quiet responses were already severely degraded. Moreover, ASD quiet responses resembled TD noise responses, implying that children with ASD process speech in quiet only as well as TD children do in background noise.

Language impairment is reflected in auditory evoked fields

Specific language impairment (SLI) is diagnosed when a child has problems in producing or understanding language despite having a normal IQ and there being no other obvious explanation. There can be several associated problems, and no single underlying cause has yet been identified. Some theories propose problems in auditory processing, specifically in the discrimination of sound frequency or rapid temporal frequency changes. We compared automatic cortical speech-sound processing and discrimination between a group of children with SLI and control children with normal language development (mean age: 6.6 years; range: 5-7 years). We measured auditory evoked magnetic fields using two sets of CV syllables, one with a changing consonant /da/ba/ga/ and another one with a changing vowel /su/so/sy/ in an oddball paradigm. The P1m responses for onsets of repetitive stimuli were weaker in the SLI group whereas no significant group differences were found in the mismatch responses. The results indicate that the SLI group, having weaker responses to the onsets of sounds, might have slightly depressed sensory encoding.

Sensory-based learning disability: Insights from brainstem processing of speech sounds

Speech-evoked auditory brainstem responses (speech-ABR) provide a reliable marker of learning disability in a substantial subgroup of individuals with language-based learning problems (LDs). Here we review work describing the properties of the speech-ABR in typically developing children and in children with LD. We also review studies on the relationships between speech-ABR and the commonly used click-ABR, and between speech-ABR and auditory processing at the level of the cortex. In a critical examination of previously published data, we conclude that as many as 40% of LDs have abnormal speech-ABRs and that these individuals are also likely to exhibit abnormal cortical processing. Yet, the profile of learning problems these individuals exhibit is unspecific. Leaving open the question of causality, these data suggest that speech-ABR can be used to identify a large sub-population of LDs, those with abnormal auditory physiological function. Further studies are required to determine the functional relationships among abnormal speech-ABR, speech perception, and the pattern of literacy-related and cognitive deficits in LD.

Child-adult differences in second-language phonological learning: the role of cross-language similarity

This study evaluated whether age effects on second language (L2) speech learning derive from changes in how the native language (L1) and L2 sound systems interact. According to the "interaction hypothesis" (IH), the older the L2 learner, the less likely the learner is able to establish new vowel categories needed for accurate L2 vowel production and perception because, with age, L1 vowel categories become more likely to perceptually encompass neighboring L2 vowels. These IH predictions were evaluated in two experiments involving 64 native Korean- and English-speaking children and adults. Experiment 1 determined, as predicted, that the Korean children were less likely than the Korean adults to perceive L2 vowels as instances of a single L1 vowel category. Experiment 2 showed that the Korean children surpassed the Korean adults in production of certain vowels but equaled them in vowel perception. These findings, which partially support the IH, are discussed in relation to L2 speech learning.

Central auditory development: evidence from CAEP measurements in children fit with cochlear implants

In normal-hearing children the latency of the P1 component of the cortical evoked response to sound varies as a function of age and, thus, can be used as a biomarker for maturation of central auditory pathways. We assessed P1 latency in 245 congenitally deaf children fit with cochlear implants following various periods of auditory deprivation. If children experience less than 3.5 years of auditory deprivation before implantation, P1 latencies fall into the range of normal following 3-6 months of electrical stimulation. Children who experience greater than 7 years of deprivation, however, generally do not develop normal P1 latencies even after years of stimulation. Moreover, the waveforms for these patients can be markedly abnormal. Cortical reorganization stimulated by deprivation is likely to be a significant factor in both variation in the latency and morphology of the cortical evoked response to sound for children fit with a cochlear implant and variation in the development of oral speech and language function.

LEARNING OUTCOMES

The reader will be introduced to research using cortical evoked responses (CAEPs), positron emission tomography (PET) scans and in-depth recording from the auditory cortex of congenitally deaf cats that converges on the existence of a sensitive period for the development of central auditory pathways in children. The reader will also be provided with two case studies that illustrate the use of the P1 response as biomarker for development of central auditory pathways. Finally, suggestions for future research will be provided.

Auditory event-related potentials and cognitive function of preterm children at five years of age

OBJECTIVE

In our previous study, auditory event-related potentials (AERPs) in preterm 1-year-old children had a positive deflection at 150-350 ms that correlated positively with their 2-year neurodevelopmental outcome. In a study of the same subjects at age 5, our aim was to assess AERPs and their relationship to neuropsychological test results.

METHODS

Preterm small (SGA, n=13), appropriate for gestational age (AGA, n=15), and control (n=13) children were assessed with an Easy paradigm presenting a large frequency change accompanied with occasional novel sounds, and a Challenging paradigm presenting small frequency and duration changes with a rapid rate. The preterm children underwent neurocognitive tests.

RESULTS

Easy paradigm. The P1 response to frequency deviant was smaller and MMN larger in the preterm than in the control children. Challenging paradigm. The P1 response to standard, frequency, and duration deviants was smaller in the preterm than in the control children. The N2 response to frequency deviant was larger in the preterm than in the control children. AGA and SGA children had similar AERPs. The P1, N2, and MMN amplitudes correlated with verbal IQ and NEPSY language subtests.

CONCLUSIONS

Small P1 response(s) appears to be typical for preterm children.

SIGNIFICANCE

Small P1 response in preterm children may suggest altered primary auditory processing.

Effects of auditory pathway anatomy and deafness characteristics? Part 2: On electrically evoked late auditory responses

The purpose of this study was to distinguish the effects of different parameters on latencies of wave N1, wave P2, and inter-peak interval N1-P2 of electrical late auditory responses (ELARs). ELARs were recorded from four intra-cochlear electrodes in fourteen adult HiRes90K cochlear implant users who had at least three months of experience. The relationship between latencies and stimulation sites in the cochlea was characterized to assess the influence of the auditory pathway anatomy on ELARs, i.e., whether the speed of neural propagation varies according to the place that is activated in the cochlea. Audiograms before implantation, duration of deafness, and psychophysics at first fitting were used to describe the influence of deafness characteristics on latencies. The stimulation sites were found to have no effect on ELAR latency and, while there was no influence of psychophysics on latency, a strong relationship was shown with duration of deafness and the pre-implantation audiogram. Thus, ELAR latency was longer for poorer audiograms and longer durations of deafness and this relationship appeared to be independent of stimulation parameters such as stimulation site. Comparison between these findings and those from the equivalent study on EABR waves IIIe and Ve latency [Guiraud, J., Gallego, S., Arnold, L., Boyle, P., Truy, E., Collet, L., 2007. Effects of auditory pathway anatomy and deafness characteristics? (1): On electrically evoked auditory brainstem responses. Hear. Res. 223 (1-2), 48-60] shows that, while ELAR and EABR latencies are related with parameters that reflect the integrity of the auditory pathway, ELAR latency is less dependent on stimulation parameters than EABR latency.

Abnormalities in central auditory maturation in children with language-based learning problems

OBJECTIVE

To examine maturation of the central auditory pathways in children with language-based learning problems (LP).

METHODS

Cortical auditory evoked potentials (CAEPs) recorded from 26 children with LP were compared to CAEPs recorded from 38 typical children. CAEP responses were recorded in response to a speech sound, /uh/, which was presented in a stimulus train with decreasing inter-stimulus intervals (ISIs) of 2000, 1000, 560, and 360 ms.

RESULTS

We identified three atypical morphological categories of CAEP responses in the LP group. Category 1 responses revealed delayed P1 latencies and absent N1/P2 components. Category 2 responses revealed typical P1 responses, but delayed N1 and P2 responses. Category 3 responses revealed generally low-amplitude CAEP responses. A fourth sub-group of LP children had normal CAEP responses.

CONCLUSIONS

Overall, the majority of children with LP had abnormal CAEP responses. These children fell into distinct categories based on the abnormalities in maturational patterns of their CAEP responses.

SIGNIFICANCE

We describe a rate sensitive stimulation paradigm which may be used to identify and categorize LP children who exhibit abnormal patterns of central auditory maturation.

Envelope Following Responses to Natural Vowels

Envelope following responses to natural vowels were recorded in 10 normal hearing people. Responses were recorded to individual vowels (/a/, /i/, /u/) with a relatively steady pitch, to /[symbol: see text]/ with a variable and steady pitch, and to a multivowel stimulus (/[symbol: see text]ui/) with a steady pitch. Responses were analyzed using a Fourier analyzer, so that recorded responses could follow the changes in the pitch. Significant responses were detected for all subjects to /a/, /i/ and /u/ with the time required to detect a significant response ranging from 6 to 66 s (average time: 19 s). Responses to /[symbol: see text]/ and /[symbol: see text]ui/ were detected in all subjects, but took longer to demonstrate (average time: 73 s). These results support the use of a Fourier analyzer to measure envelope following responses to natural speech.

Maturation of the cortical auditory evoked potential in infants and young children

The aim of this study was to evaluate the maturation of the cortical auditory evoked potential (CAEP) in humans. The participants in this experiment were 10 newborns (<7 days), 19 toddlers (13-41 months), 20 children (4-6 years) and 9 adults (18-45 years). CAEPs were obtained in response to low (400 Hz) and high (3000 Hz) tones and to the word token /baed/, all presented at 60 dB HL, at a rate of 0.22 Hz. Latency and amplitude measures were made for CAEP components P1, N1, P2 and N2 as a function of participant age, stimulus type and electrode montage. CAEP component latencies were relatively stable from birth to 6 years, but adults demonstrated significantly shorter latencies compared to infants and children. Components P1 and N2 decreased in amplitude, while components N1 and P2 increased in amplitude from birth to adulthood. Words evoked significantly larger CAEPs in newborns compared to responses evoked by tones, but in other age groups the effects of stimulus type on component amplitudes and latencies were less consistent. There was evidence of immature tonotopic organisation of the generators of N1 when responses from infants and young children were compared to those of adults. The scalp distribution of components N1 and P2 was clearly different in newborns and toddlers compared to children and adults. In the younger groups, both N1 and P2 were uniformly distributed across the scalp but in children and adults these components showed more focal distributions, with evidence of response laterality increasing with maturity. The results of the present study describe, for the first time, CAEPs recorded from multiple scalp electrodes, for tones and speech stimuli, in infants and children from birth to 6 years of age. Frequency-related differences in component amplitude were apparent at all ages reflecting development of tonotopic organisation of the CAEP neural generators.

Maturation of CAEP in infants and children: A review

This paper reviews our current understanding of the development of the obligatory cortical auditory evoked potential (CAEP) components P1, N1, P2, and N2. Firstly, the adult CAEP is briefly reviewed with respect to its morphology, neural generators and stimulus-dependence. Secondly, age-related changes occurring from the newborn period through childhood and adolescence are reviewed. The focus is on the maturation of CAEP morphology, changes in the scalp topography of the various components, changes in their amplitude and latency and in their stimulus-dependence. This review identifies periods of development in which we have only limited understanding of cortical auditory processing, as revealed by evoked potentials.

Brainstem timing: implications for cortical processing and literacy

The search for a unique biological marker of language-based learning disabilities has so far yielded inconclusive findings. Previous studies have shown a plethora of auditory processing deficits in learning disabilities at both the perceptual and physiological levels. In this study, we investigated the association among brainstem timing, cortical processing of stimulus differences, and literacy skills. To that end, brainstem timing and cortical sensitivity to acoustic change [mismatch negativity (MMN)] were measured in a group of children with learning disabilities and normal-learning children. The learning-disabled (LD) group was further divided into two subgroups with normal and abnormal brainstem timing. MMNs, literacy, and cognitive abilities were compared among the three groups. LD individuals with abnormal brainstem timing were more likely to show reduced processing of acoustic change at the cortical level compared with both normal-learning individuals and LD individuals with normal brainstem timing. This group was also characterized by a more severe form of learning disability manifested by poorer reading, listening comprehension, and general cognitive ability. We conclude that abnormal brainstem timing in learning disabilities is related to higher incidence of reduced cortical sensitivity to acoustic change and to deficient literacy skills. These findings suggest that abnormal brainstem timing may serve as a reliable marker of a subgroup of individuals with learning disabilities. They also suggest that faulty mechanisms of neural timing at the brainstem may be the biological basis of malfunction in this group.

The discrimination of and orienting to speech and non-speech sounds in children with autism

The present study aimed to find out how different stages of cortical auditory processing (sound encoding, discrimination, and orienting) are affected in children with autism. To this end, auditory event-related potentials (ERP) were studied in 15 children with autism and their controls. Their responses were recorded for pitch, duration, and vowel changes in speech stimuli, and for corresponding changes in the non-speech counterparts of the stimuli, while the children watched silent videos and ignored the stimuli. The responses to sound repetition were diminished in amplitude in the children with autism, reflecting impaired sound encoding. The mismatch negativity (MMN), an ERP indexing sound discrimination, was enhanced in the children with autism as far as pitch changes were concerned. This is consistent with earlier studies reporting auditory hypersensitivity and good pitch-processing abilities, as well as with theories proposing enhanced perception of local stimulus features in individuals with autism. The discrimination of duration changes was impaired in these children, however. Finally, involuntary orienting to sound changes, as reflected by the P3a ERP, was more impaired for speech than non-speech sounds in the children with autism, suggesting deficits particularly in social orienting. This has been proposed to be one of the earliest symptoms to emerge, with pervasive effects on later development.

Similarities in the phenotype of the auditory neural substrate in children with Asperger syndrome and their parents

Asperger syndrome (AS) is a developmental disorder of brain function characterized by deficits in social interaction including difficulties in understanding emotional expressions. Children with AS share some of the behavioural characteristics with their parents and AS seems to run particularly in the male members of the same families. The aim of the present study was to determine whether similarities could be found between children with AS and their parents at central auditory processing. It was found that in children with AS the sound encoding, as reflected by the exogenous components of event-related potentials, was similarly abnormal as in both their mothers and fathers. However, their abnormal cortical auditory discrimination, as indexed by the prolonged latency of the mismatch negativity, resembled that of their fathers but not that of their mothers. The present results suggest that complex genetic mechanisms may contribute to auditory abnormalities encountered in children with AS.

The influence of a sensitive period on central auditory development in children with unilateral and bilateral cochlear implants

We examined the longitudinal development of the cortical auditory evoked potential (CAEP) in 21 children who were fitted with unilateral cochlear implants and in two children who were fitted with bilateral cochlear implants either before age 3.5 years or after age 7 years. The age cut-offs (<3.5 years for early-implanted and >7 years for late-implanted) were based on the sensitive period for central auditory development described in [Ear Hear. 23 (6), 532.] Our results showed a fundamentally different pattern of development of CAEP morphology and P1 cortical response latency for early- and late-implanted children. Early-implanted children and one child who received bilateral implants by age 3.5 years showed rapid development in CAEP waveform morphology and P1 latency. Late-implanted children showed aberrant waveform morphology and significantly slower decreases in P1 latency postimplantation. In the case of a child who received his first implant by age 3.5 years and his second implant after age 7 years, CAEP responses elicited by the second implant were similar to late-implanted children. Our results are consistent with animal models of central auditory development after implantation and confirm the presence of a relatively brief sensitive period for central auditory development in young children.

Developmental changes in refractoriness of the cortical auditory evoked potential

OBJECTIVE

This study examined morphological changes in the cortical auditory evoked potential (CAEP) waveform as a function of varying stimulation rate. Stimuli were presented in a paradigm which indirectly assesses the refractory properties of the underlying neuronal generators.

METHODS

CAEPs were recorded in 50 normal-hearing children (3-12 years) and 10 young adults (24-26 years). A speech sound was presented in a stimulus train with sequentially decreasing inter-stimulus intervals (ISIs) of 2000, 1000, 560, and 360ms. Latencies and amplitudes of the P1, N1, and P2 components at the Cz electrode were examined as a function of stimulus rate and age.

RESULTS

Results revealed significant changes in the CAEP as a function of age and stimulation rate. At younger ages the N1-P2 component was elicited only at the slowest stimulation rates, and was more clearly apparent at successively faster stimulation rates as age increased.

CONCLUSIONS

We have described a stimulus paradigm that allows examination of the development of refractoriness by highlighting the interaction between age and rate on CAEP morphology.

SIGNIFICANCE

Complex maturational patterns of CAEP components are best understood when the effects of both age and stimulus rate on the CAEP waveform are considered.

Developmental changes in distinguishing concurrent auditory objects

Children have considerable difficulties in identifying speech in noise. In the present study, we examined age-related differences in central auditory functions that are crucial for parsing co-occurring auditory events using behavioral and event-related brain potential measures. Seventeen pre-adolescent children and 17 adults were presented with complex sounds containing multiple harmonics, one of which could be 'mistuned' so that it was no longer an integer multiple of the fundamental. Both children and adults were more likely to report hearing the mistuned harmonic as a separate sound with an increase in mistuning. However, children were less sensitive in detecting mistuning across all levels as revealed by lower d' scores than adults. The perception of two concurrent auditory events was accompanied by a negative wave that peaked at about 160 ms after sound onset. In both age groups, the negative wave, referred to as the 'object-related negativity' (ORN), increased in amplitude with mistuning. The ORN was larger in children than in adults despite a lower d' score. Together, the behavioral and electrophysiological results suggest that concurrent sound segregation is probably adult-like in pre-adolescent children, but that children are inefficient in processing the information following the detection of mistuning. These findings also suggest that processes involved in distinguishing concurrent auditory objects continue to mature during adolescence.

Neural plasticity following auditory training in children with learning problems

OBJECTIVE

This study examined the plasticity of the central auditory pathway and accompanying cognitive changes in children with learning problems.

METHODS

Children diagnosed with a learning disability and/or attention deficit disorder worked with commercial auditory processing training software for 8 weeks; control groups consisted of normal-learning and learning-impaired children who did not participate in any remedial programs. Auditory brainstem function was evaluated in response to click and speech stimuli in quiet; cortical responses to speech stimuli were obtained in quiet and noise. Academic achievement and cognitive abilities were assessed with standardized measures.

RESULTS

Compared to controls, the trained group improved on measures of auditory processing and exhibited changes in cortical responses in quiet and in noise. In quiet, cortical responses reflected an accelerated maturational pattern; in background noise, cortical responses became more resistant to degradation. Brainstem responses did not change with training.

CONCLUSIONS

Children with learning problems who practiced with auditory training software exhibited plasticity of neural encoding of speech sounds at the cortical, but not subcortical, level of the auditory pathway. This plasticity was accompanied by improvement in behavioral performance.

SIGNIFICANCE

This study demonstrates that in learning-impaired children working with commercial auditory processing training programs affects both the perception and the cortical representation of sound.

Neurophysiology of cochlear implant users II: comparison among speech perception, dynamic range, and physiological measures

OBJECTIVE

The overall objective of this study was to relate electrically evoked potentials recorded from different levels of the auditory pathway with behavioral measures obtained from adult cochlear implant subjects. The hypothesis was that adult recipients of cochlear implants who have open-set speech perception and those recipients with no open-set speech perception would differ in their neurophysiologic responses recorded at one or more levels of the auditory pathway.

DESIGN

The subjects were 11 adults implanted with the Clarion cochlear implant. The electrical auditory brainstem response (EABR, Wave V), electrical auditory middle latency response (EAMLR, Na-Pa complex), and the electrical late auditory response (ELAR, N1-P2 complex), were recorded from three intra-cochlear electrodes. The stimuli used to record the evoked potentials varied in rate and amplitude. Behavioral measures (between threshold and upper limit of comfortable loudness) were used to define the subject's dynamic range at the different stimulus rates. Word and sentence recognition tests evaluated subjects' speech perception in quiet and noise. Evoked potential and behavioral measures were examined for statistical significance using analysis of variance for repeated measures and correlational analyses.

RESULTS

Subjects without open-set speech recognition demonstrated 1) poorly formed or absent evoked potential responses, 2) reduced behavioral dynamic ranges, 3) lack of change in the size of the dynamic range with a change in stimulus rate, and 4) longer periods of auditory deprivation. The variables that differentiated the best performers included 1) presence of responses at all three levels of the auditory pathway, with large normalized amplitudes for the EAMLR, 2) lower evoked potential thresholds for the Na-Pa complex, 3) relatively large dynamic ranges, and 4) changes in the size of the dynamic range with changes in stimulus rate.

CONCLUSIONS

In this study, the inability to follow changes in the temporal characteristics of the stimulus was associated with poor speech perception performance. Results also illustrate that variability in speech perception scores of cochlear implant recipients relates to neurophysiologic responses at higher cortical levels of the auditory pathway. Presumably, limited neural synchrony for elicitation of electrophysiologic responses underlies limited speech perception. Results confirm that neural encoding with electrical stimulation must provide sufficient physiologic responses of the central nervous system to perceive speech through a cochlear implant.

A sensitive period for the development of the central auditory system in children with cochlear implants: implications for age of implantation

OBJECTIVE

The aim of the present experiment was to assess the consequences of cochlear implantation at different ages on the development of the human central auditory system.

DESIGN

Our measure of the maturity of central auditory pathways was the latency of the P1 cortical auditory evoked potential. Because P1 latencies vary as a function of chronological age, they can be used to infer the maturational status of auditory pathways in congenitally deafened children who regain hearing after being fit with a cochlear implant. We examined the development of P1 response latencies in 104 congenitally deaf children who had been fit with cochlear implants at ages ranging from 1.3 yr to 17.5 yr and three congenitally deaf adults. The independent variable was the duration of deafness before cochlear implantation. The dependent variable was the latency of the P1 cortical auditory evoked potential.

RESULTS

A comparison of P1 latencies in implanted children with those of age-matched normal-hearing peers revealed that implanted children with the longest period of auditory deprivation before implantation-7 or more yr-had abnormal cortical response latencies to speech. Implanted children with the shortest period of auditory deprivation-approximately 3.5 yr or less-evidenced age-appropriate latency responses within 6 mo after the onset of electrical stimulation.

CONCLUSIONS

Our data suggest that in the absence of normal stimulation there is a sensitive period of about 3.5 yr during which the human central auditory system remains maximally plastic. Plasticity remains in some, but not all children until approximately age 7. After age 7, plasticity is greatly reduced. These data may be relevant to the issue of when best to place a cochlear implant in a congenitally deaf child.

Neurobiologic responses to speech in noise in children with learning problems: deficits and strategies for improvement

OBJECTIVES

Some children with learning problems (LP) experience speech-sound perception deficits that worsen in background noise. The first goal was to determine whether these impairments are associated with abnormal neurophysiologic representation of speech features in noise reflected at brain-stem and cortical levels. The second goal was to examine the perceptual and neurophysiological benefits provided to an impaired system by acoustic cue enhancements.

METHODS

Behavioral speech perception measures (just noticeable difference scores), auditory brain-stem responses, frequency-following responses and cortical-evoked potentials (P1, N1, P1', N1') were studied in a group of LP children and compared to responses in normal children.

RESULTS

We report abnormalities in the fundamental sensory representation of sound at brain-stem and cortical levels in the LP children when speech sounds were presented in noise, but not in quiet. Specifically, the neurophysiologic responses from these LP children displayed a different spectral pattern and lacked precision in the neural representation of key stimulus features. Cue enhancement benefited both behavioral and neurophysiological responses.

CONCLUSIONS

Overall, these findings contribute to our understanding of the preconscious biological processes underlying perception deficits and may assist in the design of effective intervention strategies.