The feasibility of a structured cognitive training protocol to address progressive cognitive decline in individuals with vascular dementia

PURPOSE

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, better known as CADASIL, is a rare, genetic form of early-onset vascular dementia. The purpose of this study was to use a modified version of Attention Process Training--II (APT-II; Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001) with an individual with early-stage CADASIL.

METHOD

APT-II, modified to include strategy training, was applied in an A-B, multiple-probe design for an individual who had been diagnosed with early-stage CADASIL. Outcome measures included pre-post neuropsychological testing of attention, memory, and executive function; within-treatment probes of visual and auditory attention; and a measure of subjective experience of cognitive functioning in daily living.

RESULTS

The participant demonstrated nominal gains on visual and auditory attention probes but improved performance on several posttreatment measures of processing speed and executive function. The participant also reported substantially improved functional outcomes following the intervention protocol.

CONCLUSION

This case illustrates the potential utility of behavioral intervention for individuals with CADASIL and highlights issues for speech-language pathologists to consider when using structured cognitive training protocols in the setting of progressive cognitive decline. These data suggest that further controlled studies for treating this population are warranted.

Hearing abilities in children with dyslexia and attention deficit hyperactivity disorder

BACKGROUND

auditory processing and co-occurrence of pathologies.

AIM

to investigate the performance of children with Dyslexia and attention deficit hyperactivity disorder (ADHD) in behavioral and auditory processing tests, comparing the results to a control group.

METHOD

participants of the study were 30 children, with ages between 7 and 12 years, divided into three groups: a control group of 10 children, a study group of 10 children with dyslexia and a study group of 10 children with ADHD. All participants were submitted to the following auditory processing tests: Speech in Noise, Dichotic of Digits and Frequency Pattern.

RESULTS

concerning the Speech in Noise Test, there was an interactive effect between the control group and the ADHD group (p < 0.001), with the ADHD group presenting a significantly lower performance; for the Dichotic of Digits test, there was an interactive effect between the three groups (p < 0.001), with the ADHD group presenting a lower performance, followed by the dyslexic and control groups; for the Frequency Pattern, there was a marginal effect (p = 0.056) with the ADHA group presenting a lower performance, followed by the dyslexic and control groups.

CONCLUSION

the ADHD group presented a poorer performance in all tests when compared to the dyslexic and control groups. This result suggests a relationship between attention and hearing abilities.

Childhood auditory processing disorder as a developmental disorder: the case for a multi-professional approach to diagnosis and management

Auditory processing disorder (APD) is diagnosed when a patient presents with listening difficulties which can not be explained by a peripheral hearing impairment or higher-order cognitive or language problems. This review explores the association between auditory processing disorder (APD) and other specific developmental disorders such as dyslexia and attention-deficit hyperactivity disorder. The diagnosis and aetiology of APD are similar to those of other developmental disorders and it is well established that APD often co-occurs with impairments of language, literacy, and attention. The genetic and neurological causes of APD are poorly understood, but developmental and behavioural genetic research with other disorders suggests that clinicians should expect APD to co-occur with other symptoms frequently. The clinical implications of co-occurring symptoms of other developmental disorders are considered and the review concludes that a multi-professional approach to the diagnosis and management of APD, involving speech and language therapy and psychology as well as audiology, is essential to ensure that children have access to the most appropriate range of support and interventions.

Auditory Processing Measures: Correlation with Neuropsychological Measures of Attention, Memory, and Behavior

It has been suggested that measures of auditory processing (AP) are sensitive measures of attention resulting in the high comorbidity of auditory processing disorder (APD) and attention deficit/hyperactivity disorder (ADHD). Others have found that selected AP measures share significant variance with memory tasks. The current study investigated the relation between AP measures and various neuropsychological measures presumed to measure attention and memory in 36 children with a mean age of 7.78 years (SD=1.61) referred to an outpatient facility. Results indicate that AP measures significantly correlated with each other as well as with some measures of attention, memory, and behavior ratings. Results suggest that although AP measures include elements of both attention and memory, these measures also appear to assess processes not tapped by other measures of attention and memory. The correlation of AP measures with parent-and teacher-rated withdrawal, parent-rated somatization, conduct, and depression, as well as teacher-rated attention, anxiety, learning problems, social skills, and leadership suggest that auditory processing problems may manifest in myriad behaviors across settings. Implications for practice and future research are presented.

Construct validity of the auditory continuous performance test for preschoolers

Development of diagnostic instruments directed toward neuropsychological assessment of preschoolers lags significantly behind those available for school-age children (DeWolfe, Byrne, & Bawden, 2000). This is particularly true for measures of executive function (EF). The Auditory Continuous Performance Test for Preschoolers (ACPT-P; Mahone, Pillion, & Hiemenz, 2001) is a computerized, Go-No-go test developed to measure selected EF skills in preschoolers. First, to determine whether performance on the ACPT-P is associated with hearing impairment, we compared performance of children with mild hearing loss (MHL) to controls on the ACPT-P, and measures of spatial working memory (SWM) and motor persistence (MP). There were no differences between performance of the MHL group and controls on any of these measures. Second, to examine the construct validity of the ACPT-P, we compared performance of 40 preschoolers with ADHD to 40 age- and sex-matched controls, using the ACPT-P to measure response preparation, sustained attention, and inhibitory control. We also compared these groups on measures of SWM and MP. The group with attention deficit hyperactivity disorder (ADHD) performed significantly worse than controls on the ACPT-P (omissions, mean response time, variability) and MP. The ACPT-P was correlated with the MP, but not with the SWM measure. Both the ACPT-P and the MP measures showed low to moderate correlations with parent ratings of behavior associated with ADHD. These findings support the use of performance-based assessment of executive control skills in preschoolers suspected of having ADHD. In this age group, the ACPT-P may be particularly useful in assessing sustained attention and response preparation and may complement behavior rating scales.

Sensitivity and Specificity of Keith's Auditory Continuous Performance Test

The Auditory Continuous Performance Test (ACPT) was evaluated on one group of subjects who had been diagnosed as having attention deficit-hyperactivity disorder (ADHD) and another group for whom ADHD had been ruled out. Although the specificity of the ACPT was acceptably high for a screening test, the sensitivity was very low. The conclusions drawn from these results are limited because of small sample size (n=23). However, until reports based on large study samples are forthcoming, the use of the ACPT as a screening test for ADHD appears questionable.

Central auditory processing disorder in school-aged children: a critical review

The rationale to evaluate for central auditory processing disorder (CAPD) in school-aged children is based on the assumption that an auditory-specific perceptual deficit underlies many learning problems including specific reading and language disabilities. A fundamental issue in this area is whether convincing empirical evidence exists to validate this proposition. Herein, we consider the issue of modality specificity by examining the extent to which reading, language, and attention disorders in school-aged children involve perceptual dysfunctions limited to a single sensory modality. Difficulty in validating CAPD as a diagnostic label is due in large part to use of the unimodal inclusive framework, which has biased the diagnosis to favor sensitivity of test results over documenting the specificity of the deficit. Indeed, empirical research documenting modality-specific auditory-perceptual dysfunction in this population is scarce. Therefore, the existing literature on this topic has not clarified the "true" nature of the problem, and has left many questions about this disorder unanswered. It is argued that demonstrating modality specificity is one way to rule out supramodal disorders as explanations for observed dysfunction. Multimodal perceptual testing is one logical approach to help clarify this area of investigation.