Normative data for diagnosing auditory processing disorder in Norwegian children aged 7–12 years

Interventions for School-Aged Children with Auditory Processing Disorder: A Scoping Review

(1) Background: Auditory processing (AP) disorder is associated with learning difficulties and poses challenges to school-aged children in their daily activities. This scoping review identifies interventions and provides audiologists with protocol insights and outcome measures. (2) Methods: A systematic search of both peer-reviewed and grey literature (January 2006 to August 2023) covered ten databases. Studies included had the following characteristics: (i) published in French or English; (ii) participants were school-aged, and had a normal audiogram, AP difficulties or disorder, and no cognitive, developmental, congenital or neurological disorder (with the exception of learning, attention, and language disabilities); (iii) were intervention studies or systematic reviews. (3) Results: Forty-two studies were included, and they predominantly featured auditory training (AT), addressing spatial processing, dichotic listening, temporal processing and listening to speech in noise. Some interventions included cognitive or language training, assistive devices or hearing aids. Outcome measures listed included electrophysiological, AP, cognitive and language measures and questionnaires addressed to parents, teachers or the participants. (4) Conclusions: Most interventions focused on bottom-up approaches, particularly AT. A limited number of top-down approaches were observed. The compiled tools underscore the need for research on metric responsiveness and point to the inadequate consideration given to understanding how children perceive change.

Impact of Prematurity on Auditory Processing in Children

Prematurity is one of the most crucial risk factors negatively affecting the maturation of the auditory system. Children born preterm demonstrate high rates of hearing impairments. Auditory processing difficulties in preterm children might be a result of disturbances in the central auditory system development and/or sensory deprivation due to peripheral hearing loss. To investigate auditory processing in preterm children, we utilized a set of psychoacoustic tests to assess temporal processing and speech intelligibility. A total of 241 children aged 6-11 years old (136 born preterm and 105 healthy full-term children forming the control group) were assessed. The preterm children were divided into three groups based on their peripheral hearing status: 74 normal hearing (NH group); 30 children with bilateral permanent sensorineural hearing loss (SNHL group) and 32 children with bilateral auditory neuropathy spectrum disorder (ANSD group). The results showed significantly worse performance in all tests in premature children compared with full-term children. NH and SNHL groups showed significant age-related improvement in speech recognition thresholds in noise that might signify a "bottom-up" auditory processing maturation effect. Overall, all premature children had signs of auditory processing disorders of varying degrees. Analyzing and understanding the auditory processing specificity in preterm children can positively contribute to the more effective implementation of rehabilitation programs.

A Study on the Reference Values and Cutoff Criteria of Masking Level Difference for Children Aged 7–12 Years

The Masking Level Difference (MLD) test is one of the main instruments for investigating binaural interaction. Studies with children aged 7–12 years still disagree about the influence of age on test performance and present discordant reference values. This study aimed to verify the effect of age on the performance of children aged 7–12 years in the MLD test and to establish reference values and cutoff criteria for this age group. Fifty-nine children with normal hearing were organized in three groups according to their age: 7–8 (n = 20), 9–10 (n = 20), and 11–12 (n = 19) years. The participants completed the MLD test by Auditec®. The Kruskal–Wallis statistical test was used to compare groups. Reference values were obtained by calculating mean, standard deviation, median, mode, and percentiles, while the cutoff criterion was obtained by subtracting two standard deviations from the mean. No statistically significant differences were observed between the groups regarding the MLD test measures. The mean MLD was 10.51 ± 1.84 dB and the cutoff point was set at 7 dB. Thus, reference values for the MLD test were established for children aged 7–12 years, who presented no effect of age on test performance.

Masking Level Difference: test-retest reliability assessment in normal hearing female university students

PURPOSE

To verify the test-retest reliability of the Masking Level Difference in normal hearing female university students.

METHODS

Prospective descriptive study with 78 young female adults without hearing complaints, submitted to the compact disc version of the Masking Level Difference by Auditec of Saint Louis. The threshold was determined by the difference between signal-to-noise ratios at hearing thresholds found in the antiphasic and homophasic conditions. The test was applied by the same examiner in two moments (test and retest) with an interval of seven to 14 days between them. Inferential statistical analysis included comparison of test and retest situations using Student's t test for paired samples, calculation of the intraclass correlation coefficient and calculation of 95% confidence intervals for signal-to-noise ratios at hearing thresholds found in the antiphasic and homophasic conditions and for masking level difference.

RESULTS

The average signal-to-noise ratio at hearing threshold ​​in the homophasic condition was -12.59 dB and -12.46 dB in the Test and Retest situations, respectively, and -21.54 dB and -21.08 dB in the antiphasic condition. The average value ​​in the final Masking Level Difference result was 8.95 dB in the Test and 8.74 dB in the Retest. Intraclass correlation coefficient values ​​obtained were 0.436, 0.625 and 0.577 for homophasic, antiphasic and Masking Level Difference conditions, respectively.

CONCLUSION

The Masking Level Difference showed moderate test-retest reliability in normal hearing adults female university students.

Auditory Processing of Non-speech Stimuli by Children in Dual-Language Immersion Programs

Perception of low-level auditory cues such as frequency modulation (FM) and rise time (RT) is crucial for development of phonemic representations, segmentation of word boundaries, and attunement to prosodic patterns in language. While learning an additional language, children may develop an increased sensitivity to these cues to extract relevant information from multiple types of linguistic input. Performance on these auditory processing tasks such as FM and RT by children learning another language is, however, unknown. Here we examine 92 English-speaking 7-8-year-olds in the U.S. and their performance in FM and RT perceptual tasks at the end of their second year in Cantonese or Spanish dual-language immersion compared to children in general English education programs. Results demonstrate that children in immersion programs have greater sensitivity to FM, but not RT, controlling for various factors. The immersion program students were also observed to have better phonological awareness performance. However, individual differences in FM sensitivity were not associated with phonological awareness, a pattern typically observed in monolinguals. These preliminary findings suggest a possible impact of formal language immersion on low-level auditory processing. Additional research is warranted to understand causal relationships and ultimate impact on language skills in multilinguals.

Auditory Processing Disorder Test Battery in European Portuguese-Development and Normative Data for Pediatric Population

There is an increasing need for state-of-the-art Central Auditory Processing assessment for Portuguese native speakers, applicable as early as possible. As a contribution to answering this need, this paper presents a new battery for Central Auditory Processing assessment for European Portuguese applicable to children aged 5 and above, named BAPA-PE, providing information regarding test selection and development. The battery consists of six behavioral tests: Staggered Spondaic Words (SSW) for European Portuguese, Filtered Speech, Speech in Noise, Detection Interval in Noise, Duration, and Frequency Pattern. The normative data for children aged 5 to 12 are also reported. A sample was obtained of 217 subjects without ear pathology and with typical development. Each age group was composed of at least 30 children. All children were evaluated using pure tone audiometry, speech audiometry, impedance, and otoacoustic emissions. Normative scores are reported for each of the six auditory processing tests. The assessment is applicable to young children (aged 5 and 6). The statistical analyses showed significant effects in scores of Age for all tests and of Ear for several tests. The main result from the work presented, the Auditory Processing Assessment Battery—European Portuguese (BAPA-PE), is available for clinical use with normative data. This battery is a new tool for behaviorism assessment of European Portuguese speakers with suspected central auditory pathology and for monitoring the results of auditory training.

The Feasibility and Reliability of a Digits-in-Noise Test in the Clinical Follow-Up of Children With Mild to Profound Hearing Loss

OBJECTIVES

Speech perception in noise is an important aspect of the rehabilitation of children with hearing loss. We aimed to evaluate the feasibility and reliability of the Dutch digits-in-noise (DIN) test in the clinical follow-up of children with hearing aids (HAs) and/or cochlear implants (CIs). A second aim of the study was to gain insight in the speech perception in noise performance of children with different degrees of hearing loss.

DESIGN

We retrospectively analyzed DIN test data of Dutch-speaking children with hearing loss (N = 188; 5 to 18 years old). A free-field version of the DIN-test was used. Children with open-set phoneme recognition in quiet of >70% at 65 dB SPL (best aided condition) were included. Ages ranged from 5 to 18 years old. All were experienced HA or CI users and had used their device(s) for at least 1 year before the measurement in the study. The DIN-test was performed in the framework of a clinical rehabilitation program. During testing, children wore their own devices with normal daily programs.

RESULTS

The average speech reception threshold (SRT) was -3.6 dB (SD 3.6) for the first list and significantly improved to -4.0 dB (SD 3.1) for the second list. HA users had a 4-dB better SRT compared with CI users. The larger the child's hearing loss, the worse the SRT is. However, 15% of the children who completed a first list of 24 trials were unable to complete a second list. Mean adaptive staircase trajectories across trials suggested that learning occurred throughout the first list, and that loss of sustained attention contributed to response variability during the second list.

CONCLUSION

The DIN test can be used to assess speech perception in noise abilities for children with different degrees of hearing loss and using HAs or CIs. The children with hearing loss required a higher signal-to-noise ratio (SNR) than did normal-hearing children and the required SNR is larger as the hearing loss increases. However, the current measurement procedure should be optimized for use in standard pediatric audiological care, as 15% of the children were unable to conduct a second list after the first list to reach a more stable SNR.

Masking level difference among brazilian military personnel: a comparison between pilots and non-pilots

OBJECTIVES

The aims of this study were to investigate auditory habits and binaural interaction among pilot and non-pilot military personnel from the Brazilian Air Force.

DESIGN

A cross-sectional study using (1) an auditory habits questionnaire to outline the groups auditory profile and (2) the masking level difference test (MLD, Auditec, Saint Louis®) to evaluate and compare the groups.

STUDY SAMPLE

Forty military male personnel aged between 30-40 years old, all with normal hearing, comprising 20 pilots in the study group (SG), and 20 non-pilots, not exposed to noise, in the control group (CG).

RESULTS

There was no significant difference between groups regarding auditory habits. In the MLD test, a significantly better performance under the homophasic condition (S0N0) was found in the SG. Under the antiphasic condition (SπN0) there were no differences between groups. This combination resulted in a significantly lower MLD in the SG compared to the CG.

CONCLUSIONS

Repeated exposure to conditions where active pilots have to learn to recognise speech in noisy backgrounds may lead to a better performance in the MLD's homophasic condition (S0N0).

Development of central auditory processes in Polish children and adolescents at the age from 7 to 16 years

There are discrepancies in the literature regarding the course of central auditory processes (CAP) maturation in typically developing children and adolescents. The purpose of the study was to provide an overview of age – related improvement in CAP in Polish primary and secondary school students aged 7–16 years. 180 children/adolescents, subdivided into 9 age categories, and 20 adults (aged 18–24 years) performed the Dichotic Digit Test (DDT), Duration Pattern Test (DPT), Frequency Pattern Test (FPT), Gap Detection Test (GDT) and adaptive Speech-in-Noise (aSpN). The 12-year-olds was retested after w week. We found the age effects only for the DDT, DPT and FPT. In the right ear DDT the 7-year-olds performed more poorly than all groups ≥12. In the left ear DDT both 7- and 8-year-olds achieved less correct responses compared with the 13-, 14-, 15-year-olds and with the adults. The right ear advantage was greater in the 7-year-olds than in the 15-year-olds and adult group. At the age of 7 there was lower DPT and FPT scores than in all participants ≥13 whereas the 8-year-olds obtained less correct responses in the FPT than all age categories ≥12. Almost all groups (except for the 7-year-olds) performed better in the DPT than FPT. The test-retest reliability for all tests was satisfactory. The study demonstrated that different CAP have their own patterns of improvement with age and some of them are specific for the Polish population. The psychoacoustic battery may be useful in screening for CAP disorders in Poland.

Test-retest reliability of the Greek Speech-in-babble test (SinB) as a potential screening tool for auditory processing disorder

INTRODUCTION

There seems to exist a specific group of people considered to be at higher risk of having Auditory Processing Disorders (APD). These patients are frequently initially referred to, or managed by various professionals such as Otolaryngologists, Speech Therapists, and Occupational Therapists. It is, therefore, essential to retain a low threshold of when to refer such individuals for a formal APD diagnostic evaluation. Under these circumstances, there might be a role for the Greek Speech-in-Babble (SinB) recognition test as a screening tool for abnormal auditory processing competency.

OBJECTIVE

To explore the test-retest reliability of a diagnostically validated speech-in-babble test, the Greek SinB, as a potential screening tool.

METHODS

Ten health professionals coming from various disciplines administered the SinB test twice, under conditions similar to those encountered when using it as a screening tool, and test-retest reliability was assessed. 93 Greek-speaking individuals, of whom 27 adults and 66 children or young adolescents aged five years old or more, served as our study sample.

RESULTS

For the right ear, the Intraclass Correlation Coefficient (ICC) was 0.858 with a 95% confidence interval (CI) = 0.786-0.906. Slightly better conditions apply for the left ear, as the ICC was 0.873 with 95% CI = 0.809-0.916. These 95% CIs indicate a 'good' to 'excellent' level of reliability for both ears. Spearman's rho was 0.86 and 0.71 for the right and left ear, respectively.

CONCLUSION

Our results suggest that the test possesses the required reliability to evaluate a subject's hearing abilities under screening conditions. On these terms, it could be used to screen populations considered as being at risk for Auditory Processing Disorders. Forthcoming research should focus on establishing its efficiency by comparing the results of the screening test with that of diagnostic tests and on fine-tuning SinB as a screening tool.

The development of auditory functions

Typical development and maturation of the auditory system, at both the peripheral and central levels, is essential for the acquisition of speech, language, and auditory skills. The peripheral system generally encodes three basic parameters associated with auditory stimuli-time, frequency, and intensity. These acoustic cues are subsequently processed by the central auditory structures to reach and be perceived by the cerebral cortex. Observations of the human fetal and neonatal ear indicate that the peripheral auditory system is structurally and functionally adult-like at birth. In contrast, the central auditory system exhibits progressive anatomical and physiologic changes until early adulthood. Enriched experience with sound is fundamental and critical to auditory development. The absence of early and prolonged acoustic stimulation delays neuronal maturation, affecting the central auditory nervous system, in particular, and leading to atypical development. The present chapter reviews the various stages of development of the auditory system structures, especially the embryology of the human ear, before briefly presenting the trajectories of typical development of auditory abilities from infants to school-aged children.

Factors affecting the Mandarin dichotic digits test

Objective: Data with regard to the Mandarin dichotic digits test (DDT) are limited, with conflicting results reported between the Mandarin and English DDTs. The current study examined factors that might affect the performance in the Mandarin DDT. Design: The digits were arranged in 3 sets of 20 dichotic pairs; each set comprised 2, 3 or 4 digits in a pair. Study sample: Forty-one young, native Mandarin speakers with normal hearing were tested; 30 of them were right-handed and 11 left-handed. Six participants repeated the test. Results: The prevalence of ceiling effect in recognition score decreased systematically as the digit-pair length increased. At digit sets of 3-pair and 4-pair, the right-handed group showed a significant higher recognition score at right ear than left ear, while the left-handed group reversed the performance. The score difference between ears is significantly different between the right- and left-handed groups. The retest of the Mandarin DDT was reliable. Conclusions: For the right-handed group, a right-ear advantage can exist in the Mandarin DDT at a longer digit-pair length, similar to what was reported in the English DDT. Moreover, for the left-handed group, the attended right hemisphere in processing the tonal digits can result in a left-ear advantage.

Electrophysiological characteristics in children with listening difficulties, with or without auditory processing disorder

Objective: To determine if the auditory middle latency responses (AMLR), auditory late latency response (ALLR) and auditory P300 were sensitive to auditory processing disorder (APD) and listening difficulties in children, and further to elucidate mechanisms regarding level of neurobiological problems in the central auditory nervous system. Design: Three-group, repeated measure design. Study sample: Forty-six children aged 8-14 years were divided into three groups: children with reported listening difficulties fulfilling APD diagnostic criteria, children with reported listening difficulties not fulfilling APD diagnostic criteria and normally hearing children. Results: AMLR Na latency and P300 latency and amplitude were sensitive to listening difficulties. No other auditory evoked potential (AEP) measures were sensitive to listening difficulties, and no AEP measures were sensitive to APD only. Moderate correlations were observed between P300 latency and amplitude and the behavioural AP measures of competing words, frequency patterns, duration patterns and dichotic digits. Conclusions: Impaired thalamo-cortical (bottom up) and neurocognitive function (top-down) may contribute to difficulties discriminating speech and non-speech sounds. Cognitive processes involved in conscious recognition, attention and discrimination of the acoustic characteristics of the stimuli could contribute to listening difficulties in general, and to APD in particular.

The Danish test battery for auditory processing disorder evaluated with patient and control data

OBJECTIVE

This study evaluates the Danish test battery for auditory processing disorder (APD). The battery consists of four behavioural tests, two speech and two non-speech stimuli tests. The evaluation includes determination of: (1) new cut-off values (pass-fail criteria), (2) the sensitivity and the specificity of the entire test battery and (3) the failure rate of different test combinations.

DESIGN

For each test in the battery, cut-off values were determined using the weighted Youden index. Applying the newly derived cut-off values, the distribution of failing specific test combinations was determined.

STUDY SAMPLE

A group of 112 children diagnosed with APD (57 boys, 55 girls, aged 6-16 years) and a control group containing 158 children without auditory problems (75 boys, 83 girls, aged 6-16 years).

RESULTS

Cut-off values for different weights of the sensitivity and the specificity have been determined. Using the criterion that at least two tests have to be failed for APD to be suspected, the sensitivity and the specificity of the entire test battery were 95.3% and 91.6%, respectively. Some test combinations were found to have higher failure rates than others.

CONCLUSIONS

Due to the high sensitivity and specificity the test battery has good predictive value in APD assessment.