Auditory development and the role of experience

Infants' abilities to segment word forms from spectrally degraded speech in the first year of life

Infants begin to segment word forms from fluent speech-a crucial task in lexical processing-between 4 and 7 months of age. Prior work has established that infants rely on a variety of cues available in the speech signal (i.e., prosodic, statistical, acoustic-segmental, and lexical) to accomplish this task. In two experiments with French-learning 6- and 10-month-olds, we use a psychoacoustic approach to examine if and how degradation of the two fundamental acoustic components extracted from speech by the auditory system, namely, temporal (both frequency and amplitude modulation) and spectral information, impact word form segmentation. Infants were familiarized with passages containing target words, in which frequency modulation (FM) information was replaced with pure tones using a vocoder, while amplitude modulation (AM) was preserved in either 8 or 16 spectral bands. Infants were then tested on their recognition of the target versus novel control words. While the 6-month-olds were unable to segment in either condition, the 10-month-olds succeeded, although only in the 16 spectral band condition. These findings suggest that 6-month-olds need FM temporal cues for speech segmentation while 10-month-olds do not, although they need the AM cues to be presented in enough spectral bands (i.e., 16). This developmental change observed in infants' sensitivity to spectrotemporal cues likely results from an increase in the range of available segmentation procedures, and/or shift from a vowel to a consonant bias in lexical processing between the two ages, as vowels are more affected by our acoustic manipulations. RESEARCH HIGHLIGHTS: Although segmenting speech into word forms is crucial for lexical acquisition, the acoustic information that infants' auditory system extracts to process continuous speech remains unknown. We examined infants' sensitivity to spectrotemporal cues in speech segmentation using vocoded speech, and revealed a developmental change between 6 and 10 months of age. We showed that FM information, that is, the fast temporal modulations of speech, is necessary for 6- but not 10-month-old infants to segment word forms. Moreover, reducing the number of spectral bands impacts 10-month-olds' segmentation abilities, who succeed when 16 bands are preserved, but fail with 8 bands.

An auditory perspective on phonological development in infancy

Introduction

The auditory system encodes the phonetic features of languages by processing spectro-temporal modulations in speech, which can be described at two time scales: relatively slow amplitude variations over time (AM, further distinguished into the slowest <8-16 Hz and faster components 16-500 Hz), and frequency modulations (FM, oscillating at higher rates about 600-10 kHz). While adults require only the slowest AM cues to identify and discriminate speech sounds, infants have been shown to also require faster AM cues (>8-16 Hz) for similar tasks.

Methods

Using an observer-based psychophysical method, this study measured the ability of typical-hearing 6-month-olds, 10-month-olds, and adults to detect a change in the vowel or consonant features of consonant-vowel syllables when temporal modulations are selectively degraded. Two acoustically degraded conditions were designed, replacing FM cues with pure tones in 32 frequency bands, and then extracting AM cues in each frequency band with two different low-pass cut- off frequencies: (1) half the bandwidth (Fast AM condition), (2) <8 Hz (Slow AM condition).

Results

In the Fast AM condition, results show that with reduced FM cues, 85% of 6-month-olds, 72.5% of 10-month-olds, and 100% of adults successfully categorize phonemes. Among participants who passed the Fast AM condition, 67% of 6-month-olds, 75% of 10-month-olds, and 95% of adults passed the Slow AM condition. Furthermore, across the three age groups, the proportion of participants able to detect phonetic category change did not differ between the vowel and consonant conditions. However, age-related differences were observed for vowel categorization: while the 6- and 10-month-old groups did not differ from one another, they both independently differed from adults. Moreover, for consonant categorization, 10-month-olds were more impacted by acoustic temporal degradation compared to 6-month-olds, and showed a greater decline in detection success rates between the Fast AM and Slow AM conditions.

Discussion

The degradation of FM and faster AM cues (>8 Hz) appears to strongly affect consonant processing at 10 months of age. These findings suggest that between 6 and 10 months, infants show different developmental trajectories in the perceptual weight of speech temporal acoustic cues for vowel and consonant processing, possibly linked to phonological attunement.

Predictors of Susceptibility to Noise and Speech Masking Among School-Age Children With Hearing Loss or Typical Hearing

OBJECTIVES

The purpose of this study was to evaluate effects of masker type and hearing group on the relationship between school-age children's speech recognition and age, vocabulary, working memory, and selective attention. This study also explored effects of masker type and hearing group on the time course of maturation of masked speech recognition.

DESIGN

Participants included 31 children with normal hearing (CNH) and 41 children with mild to severe bilateral sensorineural hearing loss (CHL), between 6.7 and 13 years of age. Children with hearing aids used their personal hearing aids throughout testing. Audiometric thresholds and standardized measures of vocabulary, working memory, and selective attention were obtained from each child, along with masked sentence recognition thresholds in a steady state, speech-spectrum noise (SSN) and in a two-talker speech masker (TTS). Aided audibility through children's hearing aids was calculated based on the Speech Intelligibility Index (SII) for all children wearing hearing aids. Linear mixed effects models were used to examine the contribution of group, age, vocabulary, working memory, and attention to individual differences in speech recognition thresholds in each masker. Additional models were constructed to examine the role of aided audibility on masked speech recognition in CHL. Finally, to explore the time course of maturation of masked speech perception, linear mixed effects models were used to examine interactions between age, masker type, and hearing group as predictors of masked speech recognition.

RESULTS

Children's thresholds were higher in TTS than in SSN. There was no interaction of hearing group and masker type. CHL had higher thresholds than CNH in both maskers. In both hearing groups and masker types, children with better vocabularies had lower thresholds. An interaction of hearing group and attention was observed only in the TTS. Among CNH, attention predicted thresholds in TTS. Among CHL, vocabulary and aided audibility predicted thresholds in TTS. In both maskers, thresholds decreased as a function of age at a similar rate in CNH and CHL.

CONCLUSIONS

The factors contributing to individual differences in speech recognition differed as a function of masker type. In TTS, the factors contributing to individual difference in speech recognition further differed as a function of hearing group. Whereas attention predicted variance for CNH in TTS, vocabulary and aided audibility predicted variance in CHL. CHL required a more favorable signal to noise ratio (SNR) to recognize speech in TTS than in SSN (mean = +1 dB in TTS, -3 dB in SSN). We posit that failures in auditory stream segregation limit the extent to which CHL can recognize speech in a speech masker. Larger sample sizes or longitudinal data are needed to characterize the time course of maturation of masked speech perception in CHL.

Can Playing a Game Improve Children's Speech Recognition? A Preliminary Study of Implicit Talker Familiarity Effects

PURPOSE

The goal was to evaluate whether implicit talker familiarization via an interactive computer game, designed for this study, could improve children's word recognition in classroom noise. It was hypothesized that, regardless of age, children would perform better when recognizing words spoken by the talker who was heard during the game they played.

METHOD

Using a one-group pretest-posttest experimental design, this study examined the impact of short-term implicit voice exposure on children's word recognition in classroom noise. Implicit voice familiarization occurred via an interactive computer game, played at home for 10 min a day for 5 days. In the game, children (8-12 years) heard one voice, intended to become the "familiar talker." Pre- and postfamiliarization, children identified words in prerecorded classroom noise. Four conditions were tested to evaluate talker familiarity and generalization effects.

RESULTS

Results demonstrated an 11% improvement when recognizing words spoken by the voice heard in the game ("familiar talker"). This was observed only for words that were heard in the game and did not generalize to unfamiliarized words. Before familiarization, younger children had poorer recognition than older children in all conditions; however, after familiarization, there was no effect of age on performance for familiarized stimuli.

CONCLUSIONS

Implicit short-term exposure to a talker has the potential to improve children's speech recognition. Therefore, leveraging talker familiarity through gameplay shows promise as a viable method for improving children's speech-in-noise recognition. However, given that improvements did not generalize to unfamiliarized words, careful consideration of exposure stimuli is necessary to optimize this approach.

Immediate visual reproduction negatively correlates with brain entropy of parahippocampal gyrus and inferior occipital gyrus in bipolar II disorder adolescents

BACKGROUND

Brain entropy reveals complexity and irregularity of brain, and it has been proven to reflect brain complexity alteration in disease states. Previous studies found that bipolar disorder adolescents showed cognitive impairment. The relationship between complexity of brain neural activity and cognition of bipolar II disorder (BD-II) adolescents remains unclear.

METHODS

Nineteen BD-II patients (14.63 ±1.57 years old) and seventeen age-gender matched healthy controls (HCs) (14.18 ± 1.51 years old) were enlisted. Entropy values of all voxels of the brain in resting-state functional MRI data were calculated and differences of them between BD-II and HC groups were evaluated. After that, correlation analyses were performed between entropy values of brain regions showing significant entropy differences and clinical indices in BD-II adolescents.

RESULTS

Significant differences were found in scores of immediate visual reproduction subtest (VR-I, p = 0.003) and Stroop color-word test (SCWT-1, p = 0.015; SCWT-2, p = 0.004; SCWT-3, p = 0.003) between the two groups. Compared with HCs, BD-II adolescents showed significant increased brain entropy in right parahippocampal gyrus and right inferior occipital gyrus. Besides, significant negative correlations between brain entropy values of right parahippocampal gyrus, right inferior occipital gyrus and immediate visual reproduction subtest scores were observed in BD-II adolescents.

CONCLUSIONS

The findings of the present study suggested that the disrupted function of corticolimbic system is related with cognitive abnormality of BD-II adolescents. And from the perspective temporal dynamics of brain system, the current study, brain entropy may provide available evidences for understanding the underlying neural mechanism in BD-II adolescents.

Age differences in binaural and working memory abilities in school-going children

OBJECTIVES

Binaural hearing is the interplay of acoustic cues (interaural time differences: ITD, interaural level differences: ILD, and spectral cues) and cognitive abilities (e.g., working memory, attention). The current study investigated the effect of developmental age on auditory binaural resolution and working memory and the association between them (if any) in school-going children.

METHODS

Fifty-seven normal-hearing school-going children aged 6-15 y were recruited for the study. The participants were divided into three groups: Group 1 (n=17, M_age = 7.1y ± 0.72 y), Group 2 (n = 23; M_age = 10.2y ± 0.8 y), Group 3 (n = 17; M_age: 14.1 y ±1.3 y). Group 4, with normal hearing young adults (n = 20; M_age = 21.1 y± 3.2 y), was included for comparing the maturational changes in former groups with adult values. Tests of binaural resolution (ITD and ILD thresholds) and auditory working memory (forward and backward digit span and 2n-back digit) were administered to all the participants.

RESULTS

Results indicated a main effect of age on spatial resolution and working memory, with the median of lower age groups (Group 1 & Group 2) being significantly poorer (p < 0.01) than the higher age groups (Group 3 & Group 4). Groups 2, 3, and 4 performed significantly better than Group 1 (p < 0.001) on the forward span and ILD task. Groups 3 and 4 had significantly better ITD (p = 0.04), backward span (p = 0.02), and 2n-back scores than Group 2. A significant correlation between scores on working memory tasks and spatial resolution thresholds was also found. On discriminant function analysis, backward span and ITD emerged as sensitive measures for segregating older groups (Group 3 & Group 4) from younger groups (Group 1 & Group 2).

CONCLUSIONS

The present study showed that the ILD thresholds and forward digit span mature by nine years. However, the backward digit span score continued to mature beyond 15 y. This finding can be attributed to the influence of auditory attention (a working memory process) on the binaural resolution, which is reported to mature till late adolescence.

Development of categorical speech perception in Mandarin-speaking children and adolescents

Although children develop categorical speech perception at a very young age, the maturation process remains unclear. A cross-sectional study in Mandarin-speaking 4-, 6-, and 10-year-old children, 14-year-old adolescents, and adults (n = 104, 56 males, all Asians from mainland China) was conducted to investigate the development of categorical perception of four Mandarin phonemic contrasts: lexical tone contrast Tone 1-2, vowel contrast /u/-/i/, consonant aspiration contrast /p/-/p^h /, and consonant formant transition contrast /p/-/t/. The results indicated that different types of phonemic contrasts, and even the identification and discrimination of the same phonemic contrast, matured asynchronously. The observation that tone and vowel perception are achieved earlier than consonant perception supports the phonological saliency hypothesis.

Effects of Abacus Training on Auditory Spatial Maturation in Children with Normal Hearing

Introduction  The spatial auditory system, though developed at birth, attains functional maturity in the late childhood (12 years). Spatial changes during childhood affect navigation in the environment and source segregation. Accommodation of a new skill through learning, especially during childhood, can expedite this process. Objective  To explore the auditory spatial benefits of abacus training on psychoacoustic metrics in children. The study also aimed to identify the most sensitive metric to abacus training related changes in spatial processing, and utilize this metric for a detailed spatial error profiling. Methods  A standard group comparison analysis with 90 participants divided into three groups: I: children with abacus training (C-AT); II: children with no training (C-UT); III: adults with no training (A-UT). The groups underwent a series of psychoacoustic tests, such as interaural time difference (ITD), interaural level difference (ILD), and virtual auditory space identification (VASI), as well as perceptual tests such as the Kannada version of the speech, spatial, and quality questionnaire (K-SSQ). Results  Significant group differences were observed in the multivariate analysis of variance (MANOVA) and post-hoc tests, with the C-AT group showing significantly lower ILD scores ( p  = 0.01) and significantly higher VASI scores ( p <0.001) compared to the C-UT group, which is indicative of better spatial processing abilities in the former group. The discriminant function (DF) analyses showed that the VASI was the most sensitive metric for training-related changes, based on which elaborate error analyses were performed. Conclusions  Despite the physiological limits of the immature neural framework, the performance of the C-AT group was equivalent to that of untrained adults on psychoacoustic tests, which is reflective of the positive role of abacus training in expediting auditory spatial maturation.

Hyperacusis in Children: A Thematic Analysis of Discussions in Online Forums

PURPOSE

Hyperacusis is commonly defined as reduced tolerance to everyday sounds leading to avoidance behavior and disrupting normal functioning. Hyperacusis is prevalent in children. However, the literature on the manifestation and impact of hyperacusis on children is scant. This qualitative study examined online discussion forums to understand the lived experiences of hyperacusis in children from a parent or carer perspective.

METHOD

Posts from publicly available online discussion forums were thematically analyzed. Online searching identified 219 potentially relevant conversation threads across 18 forums and involving 1,436 forum users. A total number of 170 eligible conversation threads, containing 1,834 messages, were used in the analysis.

RESULTS

Thematic analysis of the data generated six themes: personal and health information about the child, onset and prognosis, bothersome sounds and characteristics, reactions, coping strategies, and impact. Hyperacusis onset was associated with loud noise, physical trauma, or stress. Bothersome sounds were categorized in terms of appliances, vehicles, public places, nature, and very loud sounds. Children's reactions included panic, shaking, and screaming. Strategies to manage hyperacusis included ear defenders, building up tolerance, and school adaptations. Hyperacusis had an impact on various aspects of the child's life including academic performance and social development.

CONCLUSIONS

This is the first study to account for the lived experiences of children experiencing hyperacusis from a parent/carer perspective using online forum data. These findings expand on existing research on the manifestation of hyperacusis in children and provide a basis for further work improving clinical assessment and management.

NCS Assessments of the Motor, Sensory, and Physical Health Domains

As part of the National Children's Study (NCS) comprehensive and longitudinal assessment of the health status of the whole child, scientific teams were convened to recommend assessment measures for the NCS. This manuscript documents the work of three scientific teams who focused on the motor, sensory, or the physical health aspects of this assessment. Each domain team offered a value proposition for the importance of their domain to the health outcomes of the developing infant and child. Constructs within each domain were identified and measures of these constructs proposed. Where available extant assessments were identified. Those constructs that were in need of revised or new assessment instruments were identified and described. Recommendations also were made for the age when the assessments should take place.

Paediatric hearing aid use: a systematic review

CONTEXT

Hearing loss (HL) is one of the most common disorders present at birth. Parents' management of their child's hearing aids (HAs) and regular follow-up with healthcare providers HA are fundamental components of effective intervention.

OBJECTIVE

The primary objective of this systematic review was to synthesise the current literature on HA use in the paediatric population, and the secondary objective was to review the factors associated with HA use.

METHODS

Electronic databases, including MEDLINE, EMBASE, CINAHL, and LLBA from 2005 to 2019, were searched. Two reviewers individually screened potentially relevant articles over two phases.

RESULTS

Fifteen studies met this review criteria. Four studies reported HA use based on data logging records. In nine studies, the amount of HA use was evaluated based on parents' reports, and three studies concluded that parents overestimate their child's HA use. Age, degree of HL and parents' education level were the most frequently reported factors associated with a child's amount of HA use.

CONCLUSIONS

The results of this review will provide a foundation for future studies on the importance of monitoring HA use and the impact of consistent HA use on the language development of children with HL.

Effects of Hearing Loss on School-Aged Children's Ability to Benefit From F0 Differences Between Target and Masker Speech

OBJECTIVES

The objectives of the study were to (1) evaluate the impact of hearing loss on children's ability to benefit from F0 differences between target/masker speech in the context of aided speech-in-speech recognition and (2) to determine whether compromised F0 discrimination associated with hearing loss predicts F0 benefit in individual children. We hypothesized that children wearing appropriately fitted amplification would benefit from F0 differences, but they would not show the same magnitude of benefit as children with normal hearing. Reduced audibility and poor suprathreshold encoding that degrades frequency discrimination were expected to impair children's ability to segregate talkers based on F0.

DESIGN

Listeners were 9 to 17 year olds with bilateral, symmetrical, sensorineural hearing loss ranging in degree from mild to severe. A four-alternative, forced-choice procedure was used to estimate thresholds for disyllabic word recognition in a 60-dB-SPL two-talker masker. The same male talker produced target and masker speech. Target words had either the same mean F0 as the masker or were digitally shifted higher than the masker by three, six, or nine semitones. The F0 benefit was defined as the difference in thresholds between the shifted-F0 conditions and the unshifted-F0 condition. Thresholds for discriminating F0 were also measured, using a three-alternative, three-interval forced choice procedure, to determine whether compromised sensitivity to F0 differences due to hearing loss would predict children's ability to benefit from F0. Testing was performed in the sound field, and all children wore their personal hearing aids at user settings.

RESULTS

Children with hearing loss benefited from an F0 difference of nine semitones between target words and masker speech, with older children generally benefitting more than younger children. Some children benefitted from an F0 difference of six semitones, but this was not consistent across listeners. Thresholds for discriminating F0 improved with increasing age and predicted F0 benefit in the nine-semitone condition. An exploratory analysis indicated that F0 benefit was not significantly correlated with the four-frequency pure-tone average (0.5, 1, 2, and 4 kHz), aided audibility, or consistency of daily hearing aid use, although there was a trend for an association with the low-frequency pure-tone average (0.25 and 0.5 kHz). Comparisons of the present data to our previous study of children with normal hearing demonstrated that children with hearing loss benefitted less than children with normal hearing for the F0 differences tested.

CONCLUSIONS

The results demonstrate that children with mild-to-severe hearing loss who wear hearing aids benefit from relatively large F0 differences between target and masker speech during aided speech-in-speech recognition. The size of the benefit increases with increasing age, consistent with previously reported age effects for children with normal hearing. However, hearing loss reduces children's ability to capitalize on F0 differences between talkers. Audibility alone does not appear to be responsible for this effect; aided audibility and degree of loss were not primary predictors of performance. The ability to benefit from F0 differences may be limited by immature central processing or aspects of peripheral encoding that are not characterized in standard clinical assessments.

Auditory neurophysiological development in early childhood: A growth curve modeling approach

OBJECTIVE

During early childhood, the development of communication skills, such as language and speech perception, relies in part on auditory system maturation. Because auditory behavioral tests engage cognition, mapping auditory maturation in the absence of cognitive influence remains a challenge. Furthermore, longitudinal investigations that capture auditory maturation within and between individuals in this age group are scarce. The goal of this study is to longitudinally measure auditory system maturation in early childhood using an objective approach.

METHODS

We collected frequency-following responses (FFR) to speech in 175 children, ages 3-8 years, annually for up to five years. The FFR is an objective measure of sound encoding that predominantly reflects auditory midbrain activity. Eliciting FFRs to speech provides rich details of various aspects of sound processing, namely, neural timing, spectral coding, and response stability. We used growth curve modeling to answer three questions: 1) does sound encoding change across childhood? 2) are there individual differences in sound encoding? and 3) are there individual differences in the development of sound encoding?

RESULTS

Subcortical auditory maturation develops linearly from 3-8 years. With age, FFRs became faster, more robust, and more consistent. Individual differences were evident in each aspect of sound processing, while individual differences in rates of change were observed for spectral coding alone.

CONCLUSIONS

By using an objective measure and a longitudinal approach, these results suggest subcortical auditory development continues throughout childhood, and that different facets of auditory processing follow distinct developmental trajectories.

SIGNIFICANCE

The present findings improve our understanding of auditory system development in typically-developing children, opening the door for future investigations of disordered sound processing in clinical populations.

Hyperacusis in children: a scoping review

Background

Hyperacusis is a chronic condition commonly defined as a lowered tolerance or increased sensitivity to everyday environmental sounds. It has been viewed as a paediatric disorder which can cause significant impairment to a child’s normal functioning. Although clinical guidance highlights the importance of identifying whether the child has intolerance to loud sounds and managing this appropriately, there are currently no assessment or treatment methods that have been designed and tested for use with children with hyperacusis. A review is therefore indicated to consider the profile of children with hyperacusis as a basis for future research into their assessment and treatment.

Method

A scoping review methodology was followed with literature searches conducted in Embase, PsychINFO, PubMed CENTRAL, Scopus, Web of Science and Google Scholar. Research articles were included if they reported on research studies describing children diagnosed with hyperacusis, providing clinical profile information, and/or reporting on an assessment or management method for children with a primary complaint of hyperacusis. Data were charted on Excel and verified by a second researcher. Twenty-one research articles were included.

Results

Children with hyperacusis are typically described in terms of age at presentation, troublesome sounds, physical sensation, behavioural reactions, coping strategies, comorbid conditions and impact on daily life. Methods of assessing the children include semi-structured interviews, questionnaires, neurological assessment, observation and uncomfortable loudness levels. Management methods include psychological therapy, sound therapy, tinnitus retraining therapy, medication and neuro-rehabilitation.

Conclusion

The information we catalogued on various elements of clinical profile, assessment and management can serve as a stepping stone in future research developing questionnaires for clinical measurement of the impact of hyperacusis on children, and the measurement of treatment related change in clinic and in trials. Positive outcomes were noted by the authors following all of the above treatments; future research must compare these and specify the parameters for optimal results.

Early exposure to environment sounds and the development of cortical auditory evoked potentials of preterm infants during the first 3 months of life

OBJECTIVE

Preterm infants are exposed earlier than their term counterparts to unattenuated sounds from the external environment during the sensitive period of the organization of the auditory cortical circuitry. In the current study, we investigate the effect of preterm birth on the course of development of auditory cortical areas by evaluating how gestational age (GA) correlates with the latency of the P1 component of the cortical auditory evoked potential (CAEP) of two experimental groups measured at 1 or 3 months of age.

RESULTS

Our sample consisted of 23 infants delivered at GA ranging from 31.28 to 41.42 weeks and separated into two groups evaluated transversally at 1 or 3 months of corrected age (CA). In the group evaluated at 1-month CA, the latency of the component P1 was similar in both terms and infants classified as late-preterm (GA > 32 weeks). However, in the group evaluated at 3 months CA, P1 latency was significantly smaller in preterms. These preliminary results suggest an acceleration of the development of auditory cortical pathways in preterms, probably due to their early exposure to socially relevant auditory stimuli from the external environment.

Altered Gray Matter Volume and White Matter Integrity in Sensorineural Hearing Loss Patients: A VBM and TBSS Study

OBJECTIVE

The purpose of the present study was to detect structural changes in the brains of patients with sensorineural hearing loss (SNHL) by combining voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS).

METHODS

Thirty-five patients with SNHL (mean age: 39.72 ± 1.81 yr) and 23 age-matched control subjects (mean age: 39.83 ± 1.96 yr) were assessed using three-dimensional, T1-weighted imaging, and diffusion tensor imaging. TBSS and VBM analyses were performed to evaluate grey matter (GM) volume changes and white matter (WM) alternations, as measured by mean diffusivity (MD), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD).

RESULTS

VBM showed decreased GM volume in patients with SNHL in the fusiform gyrus of the right temporal lobe and right middle occipital gyrus. TBSS revealed WM integrity changes, including decreased FA and RD and increased RD in several WM regions. However, MD showed no significant difference between patients with SNHL and age-matched controls.

CONCLUSION

Patients with SNHL showed smaller GM volume and WM integrity changes in several regions.

Platinum-drugs Ototoxicity in Pediatric Patients With Brain Tumors: A 10-Year Review

PURPOSE

Platinum-derived chemotherapy is one of the cornerstones in the treatment of central nervous system tumors in children. We aimed to assess the incidence of hearing loss in children after the exposure to platinum drugs.

MATERIAL AND METHODS

Retrospective study of prospectively collected data on children consecutively diagnosed with brain tumors and treated with platinum derivatives at a tertiary referral hospital between January 2006 and December 2015. We analyzed multiples variables, such as: age at diagnosis, tumor location, hydrocephalus, platinum drug type, radiotherapy, and follow-up time. The final sample size was 51 patients.

RESULTS

The median age at diagnosis was 6 years. The median overall follow-up time was 75 months. The incidence of ototoxicity was 23.5%. Rates of hearing loss with carboplatinum were lower than with cisplatinum. A statistically significant association occurred between the presence of hydrocephalus, radiotherapy exposure, infratentorial tumor location, and ototoxicity after treatment with platinum derivatives.

CONCLUSIONS

Childhood central nervous system tumors nowadays exhibit improved cure and survival rates. However, the ototoxicity resulting from the chemotherapy treatment may accompany patients for the rest of their lives. This study reveals that this occurrence is not negligible, and the association of radiotherapy and the presence of hydrocephalus can be potentiating factors.

Reducing Simulated Channel Interaction Reveals Differences in Phoneme Identification Between Children and Adults With Normal Hearing

OBJECTIVES

Channel interaction, the stimulation of overlapping populations of auditory neurons by distinct cochlear implant (CI) channels, likely limits the speech perception performance of CI users. This study examined the role of vocoder-simulated channel interaction in the ability of children with normal hearing (cNH) and adults with normal hearing (aNH) to recognize spectrally degraded speech. The primary aim was to determine the interaction between number of processing channels and degree of simulated channel interaction on phoneme identification performance as a function of age for cNH and to relate those findings to aNH and to CI users.

DESIGN

Medial vowel and consonant identification of cNH (age 8-17 years) and young aNH were assessed under six (for children) or nine (for adults) different conditions of spectral degradation. Stimuli were processed using a noise-band vocoder with 8, 12, and 15 channels and synthesis filter slopes of 15 (aNH only), 30, and 60 dB/octave (all NH subjects). Steeper filter slopes (larger numbers) simulated less electrical current spread and, therefore, less channel interaction. Spectrally degraded performance of the NH listeners was also compared with the unprocessed phoneme identification of school-aged children and adults with CIs.

RESULTS

Spectrally degraded phoneme identification improved as a function of age for cNH. For vowel recognition, cNH exhibited an interaction between the number of processing channels and vocoder filter slope, whereas aNH did not. Specifically, for cNH, increasing the number of processing channels only improved vowel identification in the steepest filter slope condition. Additionally, cNH were more sensitive to changes in filter slope. As the filter slopes increased, cNH continued to receive vowel identification benefit beyond where aNH performance plateaued or reached ceiling. For all NH participants, consonant identification improved with increasing filter slopes but was unaffected by the number of processing channels. Although cNH made more phoneme identification errors overall, their phoneme error patterns were similar to aNH. Furthermore, consonant identification of adults with CI was comparable to aNH listening to simulations with shallow filter slopes (15 dB/octave). Vowel identification of earlier-implanted pediatric ears was better than that of later-implanted ears and more comparable to cNH listening in conditions with steep filter slopes (60 dB/octave).

CONCLUSIONS

Recognition of spectrally degraded phonemes improved when simulated channel interaction was reduced, particularly for children. cNH showed an interaction between number of processing channels and filter slope for vowel identification. The differences observed between cNH and aNH suggest that identification of spectrally degraded phonemes continues to improve through adolescence and that children may benefit from reduced channel interaction beyond where adult performance has plateaued. Comparison to CI users suggests that early implantation may facilitate development of better phoneme discrimination.

Age-Related Performance on Vowel Identification and the Spectral-temporally Modulated Ripple Test in Children With Normal Hearing and With Cochlear Implants

Children’s performance on psychoacoustic tasks improves with age, but inadequate auditory input may delay this maturation. Cochlear implant (CI) users receive a degraded auditory signal with reduced frequency resolution compared with normal, acoustic hearing; thus, immature auditory abilities may contribute to the variation among pediatric CI users’ speech recognition scores. This study investigated relationships between age-related variables, spectral resolution, and vowel identification scores in prelingually deafened, early-implanted children with CIs compared with normal hearing (NH) children. All participants performed vowel identification and the Spectral-temporally Modulated Ripple Test (SMRT). Vowel stimuli for NH children were vocoded to simulate the reduced spectral resolution of CI hearing. Age positively predicted NH children’s vocoded vowel identification scores, but time with the CI was a stronger predictor of vowel recognition and SMRT performance of children with CIs. For both groups, SMRT thresholds were related to vowel identification performance, analogous to previous findings in adults. Sequential information analysis of vowel feature perception indicated greater transmission of duration-related information compared with formant features in both groups of children. In addition, the amount of F2 information transmitted predicted SMRT thresholds in children with NH and with CIs. Comparisons between the two CIs of bilaterally implanted children revealed disparate task performance levels and information transmission values within the same child. These findings indicate that adequate auditory experience contributes to auditory perceptual abilities of pediatric CI users. Further, factors related to individual CIs may be more relevant to psychoacoustic task performance than are the overall capabilities of the child.

Recommendations for ototoxicity surveillance for childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group in collaboration with the PanCare Consortium

Childhood, adolescent, and young adult (CAYA) cancer survivors treated with platinum-based drugs, head or brain radiotherapy, or both have an increased risk of ototoxicity (hearing loss, tinnitus, or both). To ensure optimal care and reduce consequent problems-such as speech and language, social-emotional development, and learning difficulties-for these CAYA cancer survivors, clinical practice guidelines for monitoring ototoxicity are essential. The implementation of surveillance across clinical settings is hindered by differences in definitions of hearing loss, recommendations for surveillance modalities, and remediation. To address these deficiencies, the International Guideline Harmonization Group organised an international multidisciplinary panel, including 32 experts from ten countries, to evaluate the quality of evidence for ototoxicity following platinum-based chemotherapy and head or brain radiotherapy, and formulate and harmonise ototoxicity surveillance recommendations for CAYA cancer survivors.

Discrimination and Identification of a Third Formant Frequency Cue to Place of Articulation by Young Children and Adults

Typically-developing children, 4 to 6 years of age, and adults participated in discrimination and identification speech perception tasks using a synthetic consonant-vowel continuum ranging from /da/ to /ga/. The seven-step synthetic /da/-/ga/ continuum was created by adjusting the first 40 ms of the third formant frequency transition. For the discrimination task, listeners participated in a Change/No-Change paradigm with four different stimuli compared to the endpoint-1 /da/ token. For the identification task, listeners labeled each token along the /da/-/ga/ continuum as either "DA" or "GA." Results of the discrimination experiment showed that sensitivity to the third-formant transition cue improved for the adult listeners as the stimulus contrast increased, whereas the performance of the children remained poor across all stimulus comparisons. Results of the identification experiment support previous hypotheses of age-related differences in phonetic categorization. Results have implications for normative data on identification and discrimination tasks. These norms provide a metric against which children with auditory-based speech sound disorders can be compared. Furthermore, the results provide some insight into the developmental nature of categorical and non-categorical speech perception.

Maturational Changes in Ear Advantage for Monaural Word Recognition in Noise Among Listeners with Central Auditory Processing Disorders

This study aimed to investigate differences between ears in performance on a monaural word recognition in noise test among individuals across a broad range of ages assessed for (C)APD.

Word recognition scores in quiet and in speech noise were collected retrospectively from the medical files of 107 individuals between the ages of 7 and 30 years who were diagnosed with (C)APD. No ear advantage was found on the word recognition in noise task in groups less than ten years. Performance in both ears was equally poor. Right ear performance improved across age groups, with scores of individuals above age 10 years falling within the normal range. In contrast, left ear performance remained essentially stable and in the impaired range across all age groups. Findings indicate poor left hemispheric dominance for speech perception in noise in children below the age of 10 years with (C)APD. However, a right ear advantage on this monaural speech in noise task was observed for individuals 10 years and older.

Perisylvian GABA levels in schizophrenia and bipolar disorder

The aim of this study is to measure GABA levels of perisylvian cortices in schizophrenia and bipolar disorder patients, using proton magnetic resonance spectroscopy (¹H-MRS). Patients with schizophrenia (n=25), bipolar I disorder (BD-I; n=28) and bipolar II disorder (BD-II; n=20) were compared with healthy controls (n=30). ¹H-MRS data was acquired using a Siemens 3T whole body scanner to quantify right and left perisylvian structures' (including superior temporal lobes) GABA levels. Right perisylvian GABA values differed significantly between groups [χ²=9.62, df: 3, p=0.022]. GABA levels were significantly higher in the schizophrenia group compared with the healthy control group (p=0.002). Furthermore, Chlorpromazine equivalent doses of antipsychotics correlated with right hemisphere GABA levels (r²=0.68, p=0.006, n=33). GABA levels are elevated in the right hemisphere in patients with schizophrenia in comparison to bipolar disorder and healthy controls. The balance between excitatory and inhibitory controls over the cortical circuits may have direct relationship with GABAergic functions in auditory cortices. In addition, GABA levels may be altered by brain regions of interest, psychotropic medications, and clinical stage in schizophrenia and bipolar disorder.

Determinants of ototoxicity in 451 platinum-treated Dutch survivors of childhood cancer: A DCOG late-effects study

Platinum-containing chemotherapeutics are efficacious for a variety of pediatric malignancies, nevertheless these drugs can induce ototoxicity. However, ototoxicity data on large cohorts of childhood cancer survivors (CCSs) who received platinum agents, but not cranial irradiation are scarce. Therefore, we have studied the frequency and determinants of ototoxicity in a cross-sectional multicenter CCS cohort, including the role of co-medication since it has been suggested that these play a role in ototoxicity. We have collected treatment data and audiograms from the medical records of CCS treated in the seven pediatric oncology centres in The Netherlands. Ototoxicity was defined as Münster grade ≥2b (>20 dB at ≥4-8 kHz). Four-hundred-fifty-one CCS who received platinum agents, but not cranial irradiation (median age at diagnosis: 4.9 years, range: 0.01-19 years) were included. The overall frequency of ototoxicity was 42%. Ototoxicity was observed in 45% of the cisplatin-treated CCS, in 17% of the carboplatin-treated CCS and in 75% of the CCS that had received both agents. Multivariate analysis showed that younger age at diagnosis (odds ratio [OR]: 0.6, 95% confidence interval [CI]: 0.5-0.6 per 5 years increase); higher total cumulative dose cisplatin (OR: 1.2, 95% CI: 1.2-1.5 per 100 mg/m² increase); and co-treatment with furosemide (OR: 2.3, 95% CI: 1.4-3.9) were associated with ototoxicity. We conclude that treatment with (higher total cumulative dose of) cisplatin, young age and furosemide co-medication independently are associated with an increased risk of ototoxicity in CCS. Future prospective studies are necessary to confirm the additive risk of co-medication on the development of ototoxicity.

Late postnatal shifts of parvalbumin and nitric oxide synthase expression within the GABAergic and glutamatergic phenotypes of inferior colliculus neurons

The inferior colliculus (IC) is partitioned into three subdivisions: the dorsal and lateral cortices (DC and LC) and the central nucleus (ICC), and serves as an integration center of auditory information. Recent studies indicate that a certain population of IC neurons may represent the non-GABAergic phenotype, while they express well-established cortical/hippocampal GABAergic neuron markers. In this study we used the optical disector to investigate the phenotype of IC neurons expressing parvalbumin (PV) and/or nitric oxide synthase (NOS) in C57BL/6J mice during the late postnatal period. Four major types of IC neurons were defined by the presence (+) or absence (-) of PV, NOS, and glutamic acid decarboxylase 67 (GAD67): PV⁺ /NOS^- /GAD67⁺ , PV⁺ /NOS⁺ /GAD67⁺ , PV⁺ /NOS^- /GAD67^- , and PV^- /NOS⁺ /GAD67^- . Fluorescent in situ hybridization for vesicular glutamate transporter 2 mRNA indicated that almost all GAD67^- IC neurons represented the glutamatergic phenotype. The numerical densities (NDs) of total GAD67⁺ IC neurons remained unchanged in all subdivisions. The NDs of PV⁺ /NOS^- /GAD67⁺ neurons and PV^- /NOS⁺ /GAD67^- neurons were reduced with age in the ICC, while they remained unchanged in the DC and LC. By contrast, the NDs of PV⁺ /NOS⁺ /GAD67⁺ neurons and PV⁺ /NOS^- /GAD67^- neurons were increased with age in the ICC, although there were no changes in the DC and LC. The cell body size of GAD67⁺ IC neurons did not vary according to the expression of PV with or without NOS. The present findings indicate that the expression of PV and NOS may shift with age within the GABAergic and glutamatergic phenotypes of IC neurons during the late postnatal period. J. Comp. Neurol. 525:868-884, 2017. © 2016 Wiley Periodicals, Inc.

Influence of medial olivocochlear efferents on the sharpness of cochlear tuning estimates in children

The present study objectively quantified the efferent-induced changes in the sharpness of cochlear tuning estimates and compared these alterations in cochlear tuning between adults and children. Click evoked otoacoustic emissions with and without contralateral broadband noise were recorded from 15 young adults and 14 children aged between 5 and 10 yrs. Time-frequency distributions of click evoked otoacoustic emissions were obtained via the S-transform, and the otoacoustic emission latencies were used to estimate the sharpness of cochlear tuning. Contralateral acoustic stimulation caused a significant reduction in the sharpness of cochlear tuning estimates in the low to mid frequency region, but had no effect in the higher frequencies (3175 and 4000 Hz). The magnitude of efferent-induced changes in cochlear tuning estimates was similar between adults and children. The current evidence suggests that the stimulation of the medial olivocochlear efferent neurons causes similar alterations in cochlear frequency selectivity in adults and children.

Thalamocortical-auditory network alterations following cuprizone-induced demyelination

Background

Demyelination and remyelination are common pathological processes in many neurological disorders, including multiple sclerosis (MS). Clinical evidence suggests extensive involvement of the thalamocortical (TC) system in patients suffering from MS.

Methods

Using murine brain slices of the primary auditory cortex, we investigated the functional consequences of cuprizone-induced de- and remyelination on neuronal activity and auditory TC synaptic transmission in vitro.

Results

Our results revealed an impact of myelin loss and restoration on intrinsic cellular firing patterns, synaptic transmission, and neuronal plasticity in layer 3 and 4 neurons of the auditory TC network. While there was a complex hyper- and depolarizing shift of the resting membrane potential, spontaneous and induced action potential firing was reduced during demyelination and early remyelination. In addition, excitatory postsynaptic potential amplitudes were decreased and induction of LTP was reduced during demyelination.

Conclusions

These data indicate that demyelination-induced impairment of neurons and network activity within the TC system may underlie clinical symptoms observed in demyelinating diseases, corroborating human findings that disease progression is significantly correlated with microstructural tissue damage of the TC system. Further investigation into focal inflammation-induced demyelination models ex vivo and in vivo are needed to understand the functional implication of local and remote lesion formation on TC network activity in MS.

Vocal differentiation parallels development of auditory saccular sensitivity in a highly soniferous fish

Vocal differentiation is widely documented in birds and mammals but has been poorly investigated in other vertebrates, including fish, which represent the oldest extant vertebrate group. Neural circuitry controlling vocal behaviour is thought to have evolved from conserved brain areas that originated in fish, making this taxon key to understanding the evolution and development of the vertebrate vocal-auditory systems. This study examines ontogenetic changes in the vocal repertoire and whether vocal differentiation parallels auditory development in the Lusitanian toadfish Halobatrachus didactylus (Batrachoididae). This species exhibits a complex acoustic repertoire and is vocally active during early development. Vocalisations were recorded during social interactions for four size groups (fry: &lt;2 cm; small juveniles: 2–4 cm; large juveniles: 5–7 cm; adults &gt;25 cm, standard length). Auditory sensitivity of juveniles and adults was determined based on evoked potentials recorded from the inner ear saccule in response to pure tones of 75–945 Hz. We show an ontogenetic increment in the vocal repertoire from simple broadband-pulsed ‘grunts’ that later differentiate into four distinct vocalisations, including low-frequency amplitude-modulated ‘boatwhistles’. Whereas fry emitted mostly single grunts, large juveniles exhibited vocalisations similar to the adult vocal repertoire. Saccular sensitivity revealed a three-fold enhancement at most frequencies tested from small to large juveniles; however, large juveniles were similar in sensitivity to adults. We provide the first clear evidence of ontogenetic vocal differentiation in fish, as previously described for higher vertebrates. Our results suggest a parallel development between the vocal motor pathway and the peripheral auditory system for acoustic social communication in fish.

Developmental hearing loss impairs signal detection in noise: putative central mechanisms

Listeners with hearing loss have difficulty processing sounds in noisy environments. This is most noticeable for speech perception, but is reflected in a basic auditory processing task: detecting a tonal signal in a noise background, i.e., simultaneous masking. It is unresolved whether the mechanisms underlying simultaneous masking arise from the auditory periphery or from the central auditory system. Poor detection in listeners with sensorineural hearing loss (SNHL) is attributed to cochlear hair cell damage. However, hearing loss alters neural processing in the central auditory system. Additionally, both psychophysical and neurophysiological data from normally hearing and impaired listeners suggest that there are additional contributions to simultaneous masking that arise centrally. With SNHL, it is difficult to separate peripheral from central contributions to signal detection deficits. We have thus excluded peripheral contributions by using an animal model of early conductive hearing loss (CHL) that provides auditory deprivation but does not induce cochlear damage. When tested as adults, animals raised with CHL had increased thresholds for detecting tones in simultaneous noise. Furthermore, intracellular in vivo recordings in control animals revealed a cortical correlate of simultaneous masking: local cortical processing reduced tone-evoked responses in the presence of noise. This raises the possibility that altered cortical responses which occur with early CHL can influence even simple signal detection in noise.

Developmental plasticity of spatial hearing following asymmetric hearing loss: context-dependent cue integration and its clinical implications

Under normal hearing conditions, comparisons of the sounds reaching each ear are critical for accurate sound localization. Asymmetric hearing loss should therefore degrade spatial hearing and has become an important experimental tool for probing the plasticity of the auditory system, both during development and adulthood. In clinical populations, hearing loss affecting one ear more than the other is commonly associated with otitis media with effusion, a disorder experienced by approximately 80% of children before the age of two. Asymmetric hearing may also arise in other clinical situations, such as after unilateral cochlear implantation. Here, we consider the role played by spatial cue integration in sound localization under normal acoustical conditions. We then review evidence for adaptive changes in spatial hearing following a developmental hearing loss in one ear, and show that adaptation may be achieved either by learning a new relationship between the altered cues and directions in space or by changing the way different cues are integrated in the brain. We next consider developmental plasticity as a source of vulnerability, describing maladaptive effects of asymmetric hearing loss that persist even when normal hearing is provided. We also examine the extent to which the consequences of asymmetric hearing loss depend upon its timing and duration. Although much of the experimental literature has focused on the effects of a stable unilateral hearing loss, some of the most common hearing impairments experienced by children tend to fluctuate over time. We therefore propose that there is a need to bridge this gap by investigating the effects of recurring hearing loss during development, and outline recent steps in this direction. We conclude by arguing that this work points toward a more nuanced view of developmental plasticity, in which plasticity may be selectively expressed in response to specific sensory contexts, and consider the clinical implications of this.

The impoverished brain: disparities in maternal education affect the neural response to sound

Despite the prevalence of poverty worldwide, little is known about how early socioeconomic adversity affects auditory brain function. Socioeconomically disadvantaged children are underexposed to linguistically and cognitively stimulating environments and overexposed to environmental toxins, including noise pollution. This kind of sensory impoverishment, we theorize, has extensive repercussions on how the brain processes sound. To characterize how this impoverishment affects auditory brain function, we compared two groups of normal-hearing human adolescents who attended the same schools and who were matched in age, sex, and ethnicity, but differed in their maternal education level, a correlate of socioeconomic status (SES). In addition to lower literacy levels and cognitive abilities, adolescents from lower maternal education backgrounds were found to have noisier neural activity than their classmates, as reflected by greater activity in the absence of auditory stimulation. Additionally, in the lower maternal education group, the neural response to speech was more erratic over repeated stimulation, with lower fidelity to the input signal. These weaker, more variable, and noisier responses are suggestive of an inefficient auditory system. By studying SES within a neuroscientific framework, we have the potential to expand our understanding of how experience molds the brain, in addition to informing intervention research aimed at closing the achievement gap between high-SES and low-SES children.

Perceptual learning: top to bottom

Perceptual learning has traditionally been portrayed as a bottom-up phenomenon that improves encoding or decoding of the trained stimulus. Cognitive skills such as attention and memory are thought to drive, guide and modulate learning but are, with notable exceptions, not generally considered to undergo changes themselves as a result of training with simple perceptual tasks. Moreover, shifts in threshold are interpreted as shifts in perceptual sensitivity, with no consideration for non-sensory factors (such as response bias) that may contribute to these changes. Accumulating evidence from our own research and others shows that perceptual learning is a conglomeration of effects, with training-induced changes ranging from the lowest (noise reduction in the phase locking of auditory signals) to the highest (working memory capacity) level of processing, and includes contributions from non-sensory factors that affect decision making even on a "simple" auditory task such as frequency discrimination. We discuss our emerging view of learning as a process that increases the signal-to-noise ratio associated with perceptual tasks by tackling noise sources and inefficiencies that cause performance bottlenecks, and present some implications for training populations other than young, smart, attentive and highly-motivated college students.

Musical training heightens auditory brainstem function during sensitive periods in development

Experience has a profound influence on how sound is processed in the brain. Yet little is known about how enriched experiences interact with developmental processes to shape neural processing of sound. We examine this question as part of a large cross-sectional study of auditory brainstem development involving more than 700 participants, 213 of whom were classified as musicians. We hypothesized that experience-dependent processes piggyback on developmental processes, resulting in a waxing-and-waning effect of experience that tracks with the undulating developmental baseline. This hypothesis led to the prediction that experience-dependent plasticity would be amplified during periods when developmental changes are underway (i.e., early and later in life) and that the peak in experience-dependent plasticity would coincide with the developmental apex for each subcomponent of the auditory brainstem response (ABR). Consistent with our predictions, we reveal that musicians have heightened response features at distinctive times in the life span that coincide with periods of developmental change. The effect of musicianship is also quite specific: we find that only select components of auditory brainstem activity are affected, with musicians having heightened function for onset latency, high-frequency phase-locking, and response consistency, and with little effect observed for other measures, including lower-frequency phase-locking and non-stimulus-related activity. By showing that musicianship imparts a neural signature that is especially evident during childhood and old age, our findings reinforce the idea that the nervous system's response to sound is “chiseled” by how a person interacts with his specific auditory environment, with the effect of the environment wielding its greatest influence during certain privileged windows of development.

Behavioral sensitivity to broadband binaural localization cues in the ferret

Although the ferret has become an important model species for studying both fundamental and clinical aspects of spatial hearing, previous behavioral work has focused on studies of sound localization and spatial release from masking in the free field. This makes it difficult to tease apart the role played by different spatial cues. In humans and other species, interaural time differences (ITDs) and interaural level differences (ILDs) play a critical role in sound localization in the azimuthal plane and also facilitate sound source separation in noisy environments. In this study, we used a range of broadband noise stimuli presented via customized earphones to measure ITD and ILD sensitivity in the ferret. Our behavioral data show that ferrets are extremely sensitive to changes in either binaural cue, with levels of performance approximating that found in humans. The measured thresholds were relatively stable despite extensive and prolonged (>16 weeks) testing on ITD and ILD tasks with broadband stimuli. For both cues, sensitivity was reduced at shorter durations. In addition, subtle effects of changing the stimulus envelope were observed on ITD, but not ILD, thresholds. Sensitivity to these cues also differed in other ways. Whereas ILD sensitivity was unaffected by changes in average binaural level or interaural correlation, the same manipulations produced much larger effects on ITD sensitivity, with thresholds declining when either of these parameters was reduced. The binaural sensitivity measured in this study can largely account for the ability of ferrets to localize broadband stimuli in the azimuthal plane. Our results are also broadly consistent with data from humans and confirm the ferret as an excellent experimental model for studying spatial hearing.

Listening difficulties in children: bottom-up and top-down contributions

The brain mechanisms of hearing include large regions of the anterior temporal, prefrontal, and inferior parietal cortex, and an extensive network of descending connections between the cortex and sub-cortical components of what is presently known as the auditory system. One important function of these additional ('top-down') mechanisms for hearing is to modulate the ascending, sensory ('bottom-up') auditory information from the ear. In children, normal, immature hearing during the first decade of life is more strongly influenced by top-down mechanisms than in adulthood. In some children, impaired top-down function presents a significant challenge to their auditory perception, often associated with a range of language and learning difficulties and sometimes called auditory processing disorder.

Is auditory discrimination mature by middle childhood? A study using time-frequency analysis of mismatch responses from 7 years to adulthood

Behavioural and electrophysiological studies give differing impressions of when auditory discrimination is mature. Ability to discriminate frequency and speech contrasts reaches adult levels only around 12 years of age, yet an electrophysiological index of auditory discrimination, the mismatch negativity (MMN), is reported to be as large in children as in adults. Auditory ERPs were measured in 30 children (7 to 12 years), 23 teenagers (13 to 16 years) and 32 adults (35 to 56 years) in an oddball paradigm with tone or syllable stimuli. For each stimulus type, a standard stimulus (1000 Hz tone or syllable [ba]) occurred on 70% of trials, and one of two deviants (1030 or 1200 Hz tone, or syllables [da] or [bi]) equiprobably on the remaining trials. For the traditional MMN interval of 100–250 ms post-onset, size of mismatch responses increased with age, whereas the opposite trend was seen for an interval from 300 to 550 ms post-onset, corresponding to the late discriminative negativity (LDN). Time-frequency analysis of single trials revealed that the MMN resulted from phase-synchronization of oscillations in the theta (4–7 Hz) range, with greater synchronization in adults than children. Furthermore, the amount of synchronization was significantly correlated with frequency discrimination threshold. These results show that neurophysiological processes underlying auditory discrimination continue to develop through childhood and adolescence. Previous reports of adult-like MMN amplitudes in children may be artefactual results of using peak measurements when comparing groups that differ in variance.

Nature of auditory processing disorder in children

OBJECTIVE

We tested the specific hypothesis that the presentation of auditory processing disorder (APD) is related to a sensory processing deficit.

METHODS

Randomly chosen, 6- to 11-year-old children with normal hearing (N = 1469) were tested in schools in 4 regional centers across the United Kingdom. Caregivers completed questionnaires regarding their participating children's listening and communication skills. Children completed a battery of audiometric, auditory processing (AP), speech-in-noise, cognitive (IQ, memory, language, and literacy), and attention (auditory and visual) tests. AP measures separated the sensory and nonsensory contributions to spectral and temporal perception.

RESULTS

AP improved with age. Poor-for-age AP was significantly related to poor cognitive, communication, and speech-in-noise performance (P < .001). However, sensory elements of perception were only weakly related to those performance measures (r < 0.1), and correlations between auditory perception and cognitive scores were generally low (r = 0.1-0.3). Multivariate regression analysis showed that response variability in the AP tests, reflecting attention, and cognitive scores were the best predictors of listening, communication, and speech-in-noise skills.

CONCLUSIONS

Presenting symptoms of APD were largely unrelated to auditory sensory processing. Response variability and cognitive performance were the best predictors of poor communication and listening. We suggest that APD is primarily an attention problem and that clinical diagnosis and management, as well as further research, should be based on that premise.