Aetiology and clinical presentations of auditory processing disorders--a review

Development of auditory cognition in 5- to 10-year-old children: Focus on speech-in-babble-noise perception

Speech-in-noise perception is consistently reported to be impaired in learning disorders, which stresses the importance of documenting its developmental course in young children. In this cross-sectional study, ninety children (41 females, 5.5-11.6 years old) and nineteen normal-hearing adults (15 females, 20-30 years old) were tested with a newly developed closed-set speech perception in babble-noise test, combining two levels of phonological difficulty and two noise levels. Results showed that speech-in-babble-noise perception takes a definite maturation step around 7 years of age (d = 1.17, grade effect) and is not mature at 10 years of age when compared to young adults (d = 0.94, group effect). Developmental trajectories of both accuracy and response times were evaluated, with influences of psycholinguistic factors, to foster the development of adequate screening tests.

[Central auditory processing disorders: problems of definition and classification]

For decades, central auditory processing disorders have remained a controversial topic in audiology, probably due to the variety of clinical manifestations, etiology, state of lesion and symptoms. The variety of terms and opinions, regarding the consideration of linguistic and cognitive components, the absence of a well-established single classification of central auditory processing disorders in clinical practice lead to difficulties in diagnostics and management. Several approaches to the classification of central auditory processing disorders have been described in literature. However, there is no common classification up to date. In this regard, we have proposed the classification of central auditory processing disorders that allows unifying of diagnoses. The classification divides central auditory processing disorders by two characteristics: 1) primary (without known etiology factor) and secondary (with known etiology factor); 2) with normal and impaired peripheral hearing.

Temporal and Fronto-Central Auditory Evoked Responses in Children with Neurodevelopmental Disorders: A Scoping Review

At the cortical level, the central auditory neural system (CANS) includes primary and secondary areas. So far, much research has focused on recording fronto-central auditory evoked potentials/responses (P1-N1-P2), originating mainly from the primary auditory areas, to explore the neural processing in the auditory cortex. However, less is known about the secondary auditory areas. This review aimed to investigate and compare fronto-central and T-complex responses in populations at risk of auditory dysfunction, such as individuals with neurodevelopmental disorders. After searching the electronic databases (PubMed, Web of Science, Scopus, and Ovid), ten studies encompassing six neurodevelopmental disorders were included for the analysis. All experimental populations had atypical T-complexes, manifesting as an absence of evoked responses, shorter latency, and/or smaller amplitude. Moreover, in two experimental groups, dyslexia and attention deficit/hyperactivity disorder (ADHD), abnormal T-complex responses were observed despite the presence of normal fronto-central responses. The presence of abnormal T-complex responses in combination with normal fronto-central responses in the same population, using the same experiment, may highlight the advantage of the T-complex for indexing deficits in distinct auditory processes or regions, which the fronto-central response may not track.

Multidisciplinary clinical assessment and interventions for childhood listening difficulty and auditory processing disorder: Relation between research findings and clinical practice

Purpose

Listening difficulty (LiD), often classified as auditory processing disorder (APD), has been studied in both research and clinic settings. The aim of this study was to examine the predictive relation between these two settings. In our "SICLiD" research study, children with normal audiometry, but caregiver-reported LiD, performed poorly on both listening and cognitive tests. Here we examined results of clinical assessments and interventions for these children in relation to research performance.

Methods

Study setting was a tertiary pediatric hospital. Electronic medical records were reviewed for 64 children aged 6-13 years recruited into a SICLiD LiD group based on a caregiver report (ECLiPS). The review focused on clinical assessments and interventions provided by Audiology, Occupational Therapy, Psychology (Developmental and Behavioral Pediatrics), and Speech-Language Pathology services, prior to study participation. Descriptive statistics on clinical encounters, identified conditions, and interventions were compared with quantitative, standardized performance on research tests. Z-scores were compared for participants with and without each clinical condition using univariate and logistic prediction analyses.

Results

Overall, 24 clinical categories related to LiD, including APD, were identified. Common conditions were attention (32%), language (28%), hearing (18%), anxiety (16%), and autism spectrum (6%) disorders. Performance on research tests varied significantly between providers, conditions, and interventions. Quantitative research data combined with caregiver reports provided reliable predictions of all clinical conditions except APD. Individual test significant correlations were scarce, but included the SCAN composite score, which predicted clinical language and attention difficulties, but not APD diagnoses.

Conclusions

The variety of disciplines, assessments, conditions and interventions revealed here supports previous studies showing that LiD is a multifaceted problem of neurodevelopment. Comparisons between clinical- and research-based assessments suggest a path that prioritizes caregiver reports and selected psychometric tests for screening and diagnostic purposes.

Predictive brain activity related to auditory information is associated with performance in speech comprehension tasks in noisy environments

Introduction

Understanding speech in noisy environments is challenging even for individuals with normal hearing, and it poses a significant challenge for those with hearing impairments or listening difficulties. There are limitations associated with the current methods of evaluating speech comprehension in such environments, especially in individuals with peripheral hearing impairments. According to the predictive coding model, speech comprehension is an active inference process that integrates sensory information through the interaction of bottom-up and top-down processing. Therefore, in this study, we aimed to examine the role of prediction in speech comprehension using an electrophysiological marker of anticipation: stimulus-preceding negativity (SPN).

Methods

We measured SPN amplitude in young adults with normal hearing during a time-estimation task with auditory feedback under both quiet and noisy conditions.

Results

The results showed that SPN amplitude significantly increased in noisy environments. Moreover, individual differences in SPN amplitude correlated with performance in a speech-in-noise test.

Discussion

The increase in SPN amplitude was interpreted as reflecting the increased requirement for attentional resources for accurate prediction of speech information. These findings suggest that SPN could serve as a noninvasive neural marker for assessing individual differences in top-down processing involved in speech comprehension in noisy environments.

Etiology, Diagnostic, and Rehabilitative Methods for Children with Central Auditory Processing Disorders-A Scoping Review

APD (auditory processing disorders) is defined as difficulties in processing auditory stimuli within the central nervous system, with normative physical hearing and intellectual disabilities excluded. The scale of this phenomenon among children and adolescents and the need to raise awareness of its occurrence prompted the authors to review currently available diagnostic and therapeutic methods, as well as outline future directions for addressing children affected by APD.

Two-year Prevalence of Central Auditory Processing Disorders in Children

Introduction

Central auditory processing disorder (CAPD) refers to difficulties in processing audible signals not attributable to impaired hearing sensitivity or mental impairment. The demographic characteristics of pediatric CAPD and its prevalence are still debatable. Due to varied definitions and differences in the diagnostic criteria for CAPD, the approximate prevalence measure varies from 0.5 to 7% of the population. Thus, a retrospective study on prevalence in individuals with CAPD was conducted.

Method

A total of 3537 cases with ear-related problems were reported to Audiology OPD at All India Institute of Speech and Hearing from June 2017 to July 2019 between the age range of 6-18 years. Of these, 32 cases were diagnosed with CAPD, and this data was available for review.

Results

The prevalence of individuals with CAPD reported in this duration was 0.7%. The results also revealed that the prevalence was higher among males and individuals of lower socio-economic status. Their significant symptoms were poor academic performance and difficulty following commands or instructions. The data also revealed that speech perception in noise was the most affected process, followed by binaural integration in these individuals.

Conclusion

The study provides insight into the vulnerable population who can get CAPD (e.g., children and males or people from lower socio-economic backgrounds).

Preliminary Validation of the Children's Auditory Performance Scale (CHAPS) and the Auditory Processing Domain Questionnaire (APDQ) in Greek Cypriot Children

BACKGROUND

Identification of auditory processing disorders is achieved using questionnaires along with linguistic, non-linguistic, and auditory processing tests. Notably, the questionnaires "Children's Auditory Performance Scale" (CHAPS) and "Auditory Processing Domain Questionnaire" (APDQ) are widely recognized and used. The current study investigated the psychometric properties of the CHAPS and APDQ in Greek Cypriot children.

METHODS

The CHAPS and APDQ questionnaires were completed by parents of 40 Greek Cypriot children, 16 typically developing (TD) children, and 24 children with a history of Speech Sound Disorders (SSDs).

RESULTS

There were significant differences between the two groups on both questionnaires. Cronbach's alpha was calculated at α = 0.922 for the CHAPS total score and α = 0.926 for the APDQ total score. The Receiver Operating Curve (ROC) analysis provided a cut-off point equal to -0.30 (AUC 0.849, p < 0.001) for CHAPS and a cut-off point equal to 90.00 (AUC 0.820, p < 0.001) for APDQ. Significant positive Spearman ρ correlations were observed between the CHAPS and APDQ (ρ = 0.639, p = 0.001).

CONCLUSIONS

The CHAPS and APDQ can identify distinct auditory processing characteristics between in children with SSDs and TD children.

Hearing rehabilitation of adults with auditory processing disorder: a systematic review and meta-analysis of current evidence-based interventions

Background

For adults with auditory processing disorder (APD), listening and communicating can be difficult, potentially leading to social isolation, depression, employment difficulties and certainly reducing the quality of life. Despite existing practice guidelines suggesting treatments, the efficacy of these interventions remains uncertain due to a lack of comprehensive reviews. This systematic review and meta-analysis aim to establish current evidence on the effectiveness of interventions for APD in adults, addressing the urgent need for clarity in the field.

Methods

Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search across MEDLINE (Ovid), Embase (Ovid), Web of Science and Scopus, focusing on intervention studies involving adults with APD. Studies that met the inclusion criteria were grouped according to intervention with a meta-analysis only conducted where intervention, study design and outcome measure were comparable.

Results

Out of 1,618 screened records, 13 studies were included, covering auditory training (AT), low-gain hearing aids (LGHA), and personal remote microphone systems (PRMS). Our analysis revealed: AT, Mixed results with some improvements in speech intelligibility and listening ability, indicating potential benefits but highlighting the need for standardized protocols; LGHA, The included studies demonstrated significant improvements in monaural low redundancy speech testing (p < 0.05), suggesting LGHA could enhance speech perception in noisy environments. However, limitations include small sample sizes and potential biases in study design. PRMS, Demonstrated the most consistent evidence of benefit, significantly improving speech testing results, with no additional benefit from combining PRMS with other interventions.

Discussion

PRMS presents the most evidence-supported intervention for adults with APD, although further high-quality research is crucial for all intervention types. The establishment and implementation of standardized intervention protocols alongside rigorously validated outcome measures will enable a more evidence-based approach to managing APD in adults.

Development and Evaluation of the Italian Version of the Dichotic Digit Test: Insights from 39 Normal-Hearing Children Aged 11 to 13 years

BACKGROUND The dichotic digit test (DDT) is one of the tests for the behavioral assessment of central auditory processing. Dichotic listening tests are sensitive ways of assessing cortical structures, the corpus callossum, and binaural integration mechanisms, showing strong correlations with learning difficulties. The DDT is presently available in a number of languages, each appropriate for the subject's native language. However, there is presently no test in the Italian language. The goal of this study was to develop an Italian version of the one-pair dichotic digit test (DDT-IT) and analyze results in 39 normal-hearing Italian children 11 to 13 years old. We used 2 conditions of presentation: free recall and directed attention (left or right ear), and looked at possible effects of sex and ear side. MATERIAL AND METHODS This study involved 3 steps: creation of the stimuli, checking their quality with Italian speakers, and assessment of the DDT-IT in our subject pool. The study involved 39 children (26 girls and 13 boys), aged 11-13 years. All participants underwent basic audiological assessment, auditory brainstem response, and then DDT-IT. RESULTS Results under free recall and directed attention conditions were similar for right and left ears, and there were no sex or age effects. CONCLUSIONS The Italian version of DDT (DDT-IT) has been developed and its performance on 39 normal-hearing Italian children was assessed. We found there were no age or sex effects for either the free recall condition or the directed attention condition.

Behavioral and Cortical Activation Changes in Children Following Auditory Training for Dichotic Deficits

We report changes following auditory rehabilitation for interaural asymmetry (ARIA) training in behavioral test performance and cortical activation in children identified with dichotic listening deficits. In a one group pretest-posttest design, measures of dichotic listening, speech perception in noise, and frequency pattern identification were assessed before and 3 to 4.5 months after completing an auditory training protocol designed to improve binaural processing of verbal material. Functional MRI scans were also acquired before and after treatment while participants passively listened in silence or to diotic or dichotic digits. Significant improvements occurred after ARIA training for dichotic listening and speech-in-noise tests. Post-ARIA, fMRI activation increased during diotic tasks in anterior cingulate and medial prefrontal regions and during dichotic tasks, decreased in the left precentral gyrus, right-hemisphere pars triangularis, and right dorsolateral and ventral prefrontal cortices, regions known to be engaged in phonologic processing and working memory. The results suggest that children with dichotic deficits may benefit from the ARIA program because of reorganization of cortical capacity required for listening and a reduced need for higher-order, top-down processing skills when listening to dichotic presentations.

The Prevalence of Central Auditory Processing Disorder in Elementary School Students of Kerman, Iran

Objectives

This study aimed to determine the prevalence of central auditory processing disorder (CAPD) in elementary school students in Kerman, Iran, during 2018-2019.

Materials & Methods

This cross-sectional study was conducted on 1369 elementary school students in Kerman. These students were selected by cluster sampling from different areas of Kerman and then screened using the Buffalo Model Questionnaire (BMQ). Based on the data obtained from the questionnaire, normal children were excluded from the study. Then, children with suspected central auditory processing disorder (CAPD) underwent ear exams and were excluded from the study in case of abnormal results in the tympanic membrane examination (rapture-effusion). The remaining subjects underwent peripheral audiometry evaluation, and children with abnormal audiometry were excluded from the study. Finally, the remaining children with suspicious screening results, a normal examination, and normal audiometry underwent a specific test to detect Central auditory processing disorder. Data analysis was carried out using SPSS software.

Results

One thousand three hundred sixty-nine primary school students with a mean age of 9.15 ±2.63 years enrolled in this study. 52%% of students were male. 8.03% of them had CAPD. A statistically significant relationship was found between the prevalence of CAPD and gender (P<0.001), place of residence (P<0.001), history of middle ear inflammation (P<0.001) and history of head injury.

Conclusion

The quality of life of these students with CAPD can be improved via timely recognition of CAPD and the provision of appropriate preventive and therapeutic facilities.

[Epidemiology of central auditory disorders in school-age children. Literature review]

Central auditory disorders (CSD) - this is a violation of the processing of sound stimuli, including speech, above the cochlear nuclei of the brain stem, which is mainly manifested by difficulties in speech recognition, especially in noisy environments. Children with this pathology are more likely to have behavioral problems, impaired auditory, linguistic and cognitive development, and especially difficulties with learning at school.

OBJECTIVE

To analyze the literature data on the epidemiology of central auditory disorders in school-age children.

MATERIAL AND METHODS

As a result of an initial search in databases (PubMed, ClinicalTrials, SCOPUS, ResearchGate, eLibrary, CyberLeninka), 328 articles were found by keywords, after an initial and further detailed analysis, a description of 9 studies is included in the review.

RESULTS

The prevalence of CSD in school-age children varies from 0.2% to 43.3% (median 8.6±14.6%), depending on the research methods used and the criteria for diagnosis. Sophisticated variants of speech audiometry (speech intelligibility in noise, low-excess, dichotic tests) and non-speech tests evaluating frequency and time resolution are most often used as diagnostic methods.

CONCLUSION

In the future, it is necessary to conduct population-based studies of the epidemiology of central auditory disorders among Russian schoolchildren using a standardized diagnostic protocol and with a sufficient sample size.

Investigation of the relationship between hyperacusis and auditory processing difficulties in individuals with normal hearing

PURPOSE

This study aimed to investigate the prevalence of hyperacusis and auditory processing (listening) difficulties (APDiff) in normal-hearing young adults and to explore the relationship between these two conditions.

METHODS

A total of 333 participants aged 18-24 underwent pure-tone audiometry tests and completed the Khalfa Hyperacusis Questionnaire (KHQ) and the University of Cincinnati Auditory Processing Inventory (UCAPI) online.

RESULTS

Hyperacusis was identified in 26.43% of participants, and APDiff in 36.04%. A strong, positive correlation was found between KHQ and UCAPI scores (r = 0.603, p < 0.001). Logistic regression models indicated that hyperacusis significantly increased the likelihood of having APDiff (OR 7.688, p < 0.001).

CONCLUSION

Despite the high prevalence of hyperacusis and APDiff in young adults, few seek help from audiology clinics. Our findings highlight a significant link between hyperacusis and APDiff, emphasizing the need for screening protocols for auditory processing skills in young adults due to these conditions' potential social and academic impacts.

Study of the Effect of Minimal Sensorineural Hearing Loss on the Central Auditory Processing in Children: A Pilot Study

Hearing loss is a main cause of poor auditory, academic, and social performance especially in children. This study aimed to find out the relationship between minimal hearing loss (sensorineural or conductive) and the central auditory processing disorders in children. A cross-sectional study was conducted to compare the probability of having central auditory processing disorder in 159 children diagnosed with minimal sensorineural hearing loss and hearing loss caused by otitis media with effusion aged (6-7 years old) in 4 primary schools in Damascus Syria, and 155 children with normal hearing of the same age group using the children's auditory performance scale (C.H.A.P.S). A remarkable statistical difference was found between the two groups with higher scores of C.H.A.P.S scale in the minimal hearing loss group (P value = 0.000 < 0.05). The difference involved all the sub-scales of the C.H.A.P.S scale, which indicates that minimal hearing loss in children can be considered as one important predisposing factor for central auditory processing disorders.

Language Exposure for Preterm Infants is Reduced Relative to Fetuses

OBJECTIVE

To assess changes and deficits in language and auditory exposures consequent to preterm birth and neonatal intensive care unit stay compared with exposures in utero among typically developing fetuses.

STUDY DESIGN

We analyzed over 23 000 hours of auditory exposure data in a cohort study of 27 typically-developing fetuses and 24 preterm infants. Extrauterine exposures for fetuses were captured by having pregnant women wear 24-hour audio recording devices. For preterm infants, recording devices were placed in the infant's crib. Multilevel linear regressions were conducted to test for group differences and effects of infant sex, maternal education, and mother' occupation. A linear mixed-effects model was used to test for an effect of speaker gender.

RESULTS

Fetuses were exposed to an estimated 2.6 ± 1.8 hours/day of nearby, predominantly female language, nearly 5 times greater than 32 ± 12 minutes/day estimated for preterm infants (P < .001). Preterm infants had greater daily exposure to electronic sounds (5.1 ± 2.5 vs 1.3 ± 0.6 hours; P < .001) and noise (4.4 ± 2.1 vs 2.9 ± 2.8 hours; P < .05), with 4.7 ± 3.9 hours/day of silence. Language and extrauterine sound exposure for fetuses showed a marked day/night cyclical pattern, with low exposure during nighttime hours, but preterm infants' exposures showed significantly less change across the 24-hour cycle (P < .001). Maternal occupation requiring frequent communication predicted greater language exposure (P < .05).

CONCLUSIONS

Our findings provide the first comparison of preterm infant auditory exposures to typically-developing fetuses. Some preterm infants may incur deficits of over 150 hours of language exposure over the preterm period. Given known effects of prenatal/preterm language exposure on neurobehavioral outcomes, this magnitude of deficit is alarming.

Detecting Central Auditory Processing Disorders in Awake Mice

Mice are increasingly used as models of human-acquired neurological or neurodevelopmental conditions, such as autism, schizophrenia, and Alzheimer's disease. All these conditions involve central auditory processing disorders, which have been little investigated despite their potential for providing interesting insights into the mechanisms behind such disorders. Alterations of the auditory steady-state response to 40 Hz click trains are associated with an imbalance between neuronal excitation and inhibition, a mechanism thought to be common to many neurological disorders. Here, we demonstrate the value of presenting click trains at various rates to mice with chronically implanted pins above the inferior colliculus and the auditory cortex for obtaining easy, reliable, and long-lasting access to subcortical and cortical complex auditory processing in awake mice. Using this protocol on a mutant mouse model of autism with a defect of the Shank3 gene, we show that the neural response is impaired at high click rates (above 60 Hz) and that this impairment is visible subcortically-two results that cannot be obtained with classical protocols for cortical EEG recordings in response to stimulation at 40 Hz. These results demonstrate the value and necessity of a more complete investigation of central auditory processing disorders in mouse models of neurological or neurodevelopmental disorders.

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.

Auditory Processing Disorder: Protocols and Controversy

PURPOSE

This study examined current auditory processing disorder (APD) protocols and audiologists' perspectives on the active debate seen in the literature regarding the status of APD as a unique disorder.

METHOD

This study used a cross-sectional, nonexperimental survey design. The participants were 134 U.S. audiologists, representing diversity across experience level and work setting.

RESULTS

Popular APD tests from prior surveys remain popular, and a few new tests have emerged. Most audiologists use diverse strategies to identify potential comorbid disorders as part of their APD protocol, including multidisciplinary assessment and referral to other specialists. Most participants disagreed with the assertion that APD is not a unique disorder; however, many also pointed out that patients' struggles with listening need to be the primary focus of APD assessment and management, regardless of the label of the disorder. Qualitative analysis of participant comments on the controversy yielded six themes: Clinical Experience, Comorbidity, Listening Skills, Literature Support, Overdiagnosis, and More Information Needed.

CONCLUSION

Most participants consider APD to be a unique disorder, citing clinical experience and the literature for support; however, many also indicated APD is complicated by comorbidity and APD may be overdiagnosed.

Auditory Processing in Musicians, a Cross-Sectional Study, as a Basis for Auditory Training Optimization

Μusicians are reported to have enhanced auditory processing. This study aimed to assess auditory perception in Greek musicians with respect to their musical specialization and to compare their auditory processing with that of non-musicians. Auditory processing elements evaluated were speech recognition in babble, rhythmic advantage in speech recognition, short-term working memory, temporal resolution, and frequency discrimination threshold detection. All groups were of 12 participants. Three distinct experimental groups tested included western classical musicians, Byzantine chanters, and percussionists. The control group consisted of 12 non-musicians. The results revealed: (i) a rhythmic advantage for word recognition in noise for classical musicians (M = 12.42) compared to Byzantine musicians (M = 9.83), as well as for musicians compared to non-musicians (U = 120.50, p = 0.019), (ii) better frequency discrimination threshold of Byzantine musicians (M = 3.17, p = 0.002) compared to the other two musicians' group for the 2000 Hz region, (iii) statistically significant better working memory for musicians (U = 123.00, p = 0.025) compared to non-musicians. Musical training enhances elements of auditory processing and may be used as an additional rehabilitation approach during auditory training, focusing on specific types of music for specific auditory processing deficits.

Pain sensitivity and perceptual sensitivity are associated with severity of emotional dysregulation in children with ADHD: a cross-sectional analysis using the Temperament in Middle Childhood Questionnaire

PURPOSE

Nearly 50% of children with attention-deficit/hyperactivity disorder (ADHD) experience emotional dysregulation or sensory over-responsiveness; this study examines their association.

METHODS

This cross-sectional analysis (n = 124) used data from the Micronutrients for ADHD in Youth (MADDY) Study, which enrolled children aged 6-12 with ADHD and emotional dysregulation. Sensory responsiveness was assessed using two subscales from the factor-analyzed Temperament in Middle Childhood Questionnaire: Pain Sensitivity and Perceptual Sensitivity. Emotional dysregulation was assessed using the Emotional-Problems and Conduct-Problems subscales from the Strengths and Difficulties Questionnaire and a composite score from the Child & Adolescent Symptom Inventory-5. Multivariable linear regression measured the association of pain and perceptual sensitivity with the severity of emotional dysregulation.

RESULTS

In adjusted models, pain sensitivity was positively associated with Emotional Problems (β = 0.97; 95% CI: 0.52, 1.41; p < 0.0001), Conduct Problems (β = 0.83; 95% CI: 0.44, 1.21; p = 0.0001), and CASI-5 composite (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Perceptual sensitivity was positively associated with Emotional Problems (β = 0.75; 95% CI: 0.15, 1.35; p = 0.01) but not Conduct Problems (β = 0.27; 95% CI: -0.24, 0.77; p = 0.30) or CASI-5 composite (β = 0.12; 95% CI: -0.01, 0.24; p = 0.07).

CONCLUSION

Pain sensitivity was associated with the severity of emotional dysregulation in this ADHD sample. To better understand possible causal links, longitudinal studies are warranted.Implications for rehabilitationEmotional dysregulation and sensory over-responsiveness are both common in children with ADHD and contribute to added challenges in school and family life.Two types of sensory over-responsiveness, pain sensitivity and perceptual sensitivity, were associated with emotional dysregulation in children with ADHD in our study.Sensory over-responsiveness may be a modifiable treatment target.

The effect of ventilation tube insertion in central auditory processing disorders in children with otitis media with effusion

INTRODUCTION

Otitis media with effusion is one of the most common diseases among children. The purpose of this research is to investigate whether the resolvement of conductive hearing loss from the insertion of a ventilation tube also improves central auditory processing disorders in children with otitis media with effusion.

METHOD

In this cross-sectional study, 20 children between 6 and 12 years old were diagnosed with otitis media with effusion and 20 normal children were included in the study. The central auditory processing status was evaluated in all patients before ventilation tube insertion and after six months by Speech Discrimination Score, Speech Reception Threshold, Words-in-Noise, Speech in Noise, Consonant Vowel in Noise tests, and the results were compared.

RESULTS

The mean score of Speech Discrimination Score and Consonant Vowel in Noise tests in the control group were significantly higher than the patient group before ventilation tube insertion and after surgery, in the patient group, the mean scores increased significantly. The mean scores of the Speech Reception Threshold, Words-in-Noise, and Speech in Noise tests in the control group were significantly lower than the patient group before ventilation tube insertion and after the operation, in the patient group, the mean scores significantly decreased. After VT insertion, these tests were close to the control group.

CONCLUSION

Restituting normal hearing by ventilation tube treatment improves central auditory abilities as shown in speech reception, speech discrimination, the ability to hear, the ability to recognize monosyllabic words, and the power of speech in the presence of noise.

Subcortical and Cortical Electrophysiological Measures in Children With Speech-in-Noise Deficits Associated With Auditory Processing Disorders

PURPOSE

The aim of this study was to analyze the subcortical and cortical auditory evoked potentials for speech stimuli in children with speech-in-noise (SIN) deficits associated with auditory processing disorder (APD) without any reading or language deficits.

METHOD

The study included 20 children in the age range of 9-13 years. Ten children were recruited to the APD group; they had below-normal scores on the speech-perception-in-noise test and were diagnosed as having APD. The remaining 10 were typically developing (TD) children and were recruited to the TD group. Speech-evoked subcortical (brainstem) and cortical (auditory late latency) responses were recorded and compared across both groups.

RESULTS

The results showed a statistically significant reduction in the amplitudes of the subcortical potentials (both for stimulus in quiet and in noise) and the magnitudes of the spectral components (fundamental frequency and the second formant) in children with SIN deficits in the APD group compared to the TD group. In addition, the APD group displayed enhanced amplitudes of the cortical potentials compared to the TD group.

CONCLUSION

Children with SIN deficits associated with APD exhibited impaired coding/processing of the auditory information at the level of the brainstem and the auditory cortex.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21357735.

The development, validity, reliability, and norm of a preschool auditory processing assessment scale in China

BACKGROUND

Children with auditory processing deficits may face problems with language, learning, and social communication.

AIMS

To develop a Chinese auditory processing assessment scale for preschool children and establish the norms of the scale.

METHODS AND PROCEDURES

The predictive version of the scale was formed by a literature review, qualitative interviews, expert consultation, and a pre-test with a small sample. Nine kindergartens in Nanjing were selected by a stratified cluster sampling plan. First, 734 children from two kindergartens were selected for the large sample pre-test of the scale. Then, 1526 children from four kindergartens and 1151 children from three kindergartens were selected for the reliability and validity analysis and confirmatory factor analysis, respectively. The standardized norm data of the scale were established based on the 3411 points of scale data of the nine kindergartens. Finally, the clinical usefulness of the scale was analyzed by comparing the results of objective auditory processing tests in children with normal and abnormal auditory processing prompted by the score on the scale.

OUTCOMES AND RESULTS

The preschool auditory processing assessment scale includes 5 dimensions and 30 items. The Cronbach's alpha value of the scale is greater than 0.9. The confirmatory factor analysis results verify that the scale structure is reasonable. The percentile norm of the scale was established. The results of electrophysiological tests of the normal and abnormal auditory processing groups were statistically different (P < 0.05).

CONCLUSIONS AND IMPLICATIONS

The developed preschool auditory processing assessment scale has good reliability and validity. The scale is suitable for clinical application.

Adult Normative Data for the Adaptation of the Hearing in Noise Test in European French (HINT-5 Min)

Decreased speech-in-noise (SpIN) understanding is an early marker not only of presbycusis but also of auditory processing disorder. Previous research has shown a strong relationship between hearing disorders and cognitive limitations. It is therefore crucial to allow SpIN testing in subjects who cannot sustain prolonged diagnostic procedures. The objectives of this study were to develop a rapid and reproducible version of the Hearing in Noise Test (HINT-5 min), and to determine its adult normative values in free-field and monaural or binaural headphone conditions. Following an adaptive signal-to-noise ratio (SNR) protocol, the test used a fixed noise level, while the signal level varied to reach the 50% speech reception threshold (SRT50). The speech material consisted of five lists of 20 sentences each, all recorded in European French. The whole semi-automated procedure lasted 5 min and was administered to 83 subjects aged 19 to 49 years with no reported listening difficulties. Fifty-two subjects were retested between 7 and 8 days later. For the binaural free-field condition, the mean SRT50 was −1.0 dB SNR with a standard deviation of 1.3 dB SNR. There was no significant difference between the results obtained at test and retest, nor was there any effect of listening condition, sex, or age on SRT50. The results indicate that the procedure is robust and not affected by any learning phenomenon. The HINT-5 min was found to be both a fast and reliable marker of the ability to understand speech in background noise.

"CRISPR for Disabilities: How to Self-Regulate" or Something?

The development of the CRISPR gene editing technique has been hyped as a technique that could fundamentally change scientific research and its clinical application. Unrecognized is the fact that it joins other technologies that have tried and failed under the same discourse of scientific hype. These technologies, like gene therapy and stem cell research, have moved quickly passed basic research into clinical application with dire consequences. Before hastily moving to clinical applications, it is necessary to consider basic research and determine how CRISPR/Cas systems should be applied. In the case of single gene diseases, that application is expected to have positive impacts, but as we shift to more complex diseases, the impact could be unintentionally negative. In the context of common disabilities, the level of genetic complexity may render this technology useless but potentially toxic, aggravating a social discourse that devalues those with disabilities. This paper intends to define the issues related to disability that are associated with using the CRIPSR/Cas system in basic research. It also aims to provide a decision tree to help determine whether the technology should be utilized or if alternative approaches beyond scientific research could lead to a better use of limited funding resources.

Comparison of temporal fine structure sensitivity and concurrent vowel perception between children with and without reading disability

Background: Children with reading disabilities (RD) exhibit difficulty in perceiving speech in background noise due to poor auditory stream segregation. There is a dearth of literature on measures of temporal fine structure sensitivity (TFS) and concurrent vowel perception abilities to assess auditory stream segregation in children with reading disabilities. Hence the present study compared temporal fine structure sensitivity (TFS) and concurrent vowel perception abilities between children with and without reading deficits.

Method: The present research consisted of a total number of 30 participants, 15 children with reading disabilities (RD) and fifteen typically developing (TD) children within the age range of 7-14 years and were designated as Group 1 and Group 2 respectively. Both groups were matched for age, grade, and classroom curricular instructions. The groups were evaluated for TFS and concurrent vowel perception abilities and the performance was compared using independent ‘t’ test and repeated measure ANOVA respectively.

Results: Results revealed that the children with RD performed significantly (p < 0.001) poorer than TD children on both TFS and concurrent vowel identification task. On concurrent vowel identification tasks, there was no significant interaction found between reading ability and F0 difference suggesting that the trend was similar in both the groups.

Conclusion: The study concludes that the children with RD show poor temporal fine structure sensitivity and concurrent vowel identification scores compared to age and grade matched TD children owing to poor auditory stream segregation in children with RD.

Cortical auditory evoked potentials with different acoustic stimuli: Evidence of differences and similarities in coding in auditory processing disorders

OBJECTIVES

The use of cortical auditory evoked potentials allows for the study of the processing of acoustic signals at the cortical level, an important step in the diagnostic evaluation process, and for the monitoring of the therapeutic process associated with auditory processing disorders (APD). The differences and similarities in the acoustic coding between different types of stimuli in the context of APD remain unknown to this date.

METHODS

A total of 37 children aged between 7 and 11 years, with and without APDs (identified based on verbal and non-verbal tests), all with a suitable intelligence quotient with respect to their chronological age, were assessed. Components P1 and N1 were studied using verbal and non-verbal stimuli.

RESULTS

The comparison between stimuli in each group revealed that the control group had higher latency and amplitude values for speech stimuli, except for the P1 amplitude, while the group with APDs had different results with respect to the amplitudes of P1 and N1, yielding higher values for speech sounds. The differences between the groups varied according to the type of stimulus: the difference was in amplitude for the verbal stimulus and latency for the non-verbal stimulus.

CONCLUSION

The records of components P1 and N1 revealed that the children with APDs performed the coding underlying the detection and identification of acoustic signals, whether verbal and non-verbal, according to a different pattern than the children in the control group.

Implications for Early Diagnosis and Treatment in Schizophrenia Due to Correlation between Auditory Perceptual Deficits and Cognitive Impairment

It is indicated that auditory perception deficits are present in schizophrenia and related to formal thought disorder. The purpose of the present study was to investigate the association of auditory deficits with cognitive impairment in schizophrenia. An experimental group of 50 schizophrenia patients completed a battery of auditory processing evaluation and a neuropsychological battery of tests. Correlations between neuropsychological battery scores and auditory processing scores were examined. Cognitive impairment was correlated with auditory processing deficits in schizophrenia patients. All neuropsychological test scores were significantly correlated with at least one auditory processing test score. Our findings support the coexistence of auditory processing disorder, severe cognitive impairment, and formal thought disorder in a subgroup of schizophrenia patients. This may have important implications in schizophrenia research, as well as in early diagnosis and nonpharmacological treatment of the disorder.

Atypical beta power fluctuation while listening to an isochronous sequence in dyslexia

OBJECTIVE

Developmental dyslexia is a reading disorder that features difficulties in perceiving and tracking rhythmic regularities in auditory streams, such as speech and music. Studies on typical healthy participants have shown that power fluctuations of neural oscillations in beta band (15-25 Hz) reflect an essential mechanism for tracking rhythm or entrainment and relate to predictive timing and attentional processes. Here we investigated whether adults with dyslexia have atypical beta power fluctuation.

METHODS

The electroencephalographic activities of individuals with dyslexia (n = 13) and typical control participants (n = 13) were measured while they passively listened to an isochronous tone sequence (2 Hz presentation rate). The time-frequency neural activities generated from auditory cortices were analyzed.

RESULTS

The phase of beta power fluctuation at the 2 Hz stimulus presentation rate differed and appeared opposite between individuals with dyslexia and controls.

CONCLUSIONS

Atypical beta power fluctuation might reflect deficits in perceiving and tracking auditory rhythm in dyslexia.

SIGNIFICANCE

These findings extend our understanding of atypical neural activities for tracking rhythm in dyslexia and could inspire novel methods to objectively measure the benefits of training, and predict potential benefit of auditory rhythmic rehabilitation programs on an individual basis.

Improving Emotion Perception in Children with Autism Spectrum Disorder with Computer-Based Training and Hearing Amplification

Individuals with Autism Spectrum Disorder (ASD) experience challenges with social communication, often involving emotional elements of language. This may stem from underlying auditory processing difficulties, especially when incoming speech is nuanced or complex. This study explored the effects of auditory training on social perception abilities of children with ASD. The training combined use of a remote-microphone hearing system and computerized emotion perception training. At baseline, children with ASD had poorer social communication scores and delayed mismatch negativity (MMN) compared to typically developing children. Behavioral results, measured pre- and post-intervention, revealed increased social perception scores in children with ASD to the extent that they outperformed their typically developing peers post-intervention. Electrophysiology results revealed changes in neural responses to emotional speech stimuli. Post-intervention, mismatch responses of children with ASD more closely resembled their neurotypical peers, with shorter MMN latencies, a significantly heightened P2 wave, and greater differentiation of emotional stimuli, consistent with their improved behavioral results. This study sets the foundation for further investigation into connections between auditory processing difficulties and social perception and communication for individuals with ASD, and provides a promising indication that combining amplified hearing and computer-based targeted social perception training using emotional speech stimuli may have neuro-rehabilitative benefits.

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.

Central auditory processing and listening effort in normal-hearing children: a pilot study

OBJECTIVES

The current study aims to assess the link between central auditory processes and listening effort in a group of normal-hearing children. This will provide information over and beyond the standard central auditory processes and might have practical implications for listening situations which often require speech understanding in noisy environments.

METHOD

The current study included 35 normal-hearing children from six to eleven years old. Tympanometry, tonal audiometry, and speech audiometry was performed. Different auditory processing skills were assessed using the Frequency Pattern Test, the Staggered Spondaic Word Test, and the Dichotic Digits Test. Finally, a dual-task paradigm was used to evaluate listening effort. This paradigm consisted of the simultaneous performance of a speech-recognition task in different conditions of background noise and a visuospatial memory task using a digital Corsi Block test.

RESULTS

Significant correlations between listening effort and several components of the auditory processing tests were established. Specifically, listening effort correlated significantly with some components of the SSWT as well as the DDT. Additionally, the listening effort test showed a significant age effect for the listening condition with the highest Signal-To-Noise Ratio.

CONCLUSIONS

Based on the current results, inclusion of listening effort in the test battery for auditory processing disorders would be valuable.

Comparison of Diagnostic Auditory Processing Test Scores Measured in Clinical and School Settings

Purpose

The study aimed to compare auditory processing and cognitive test scores measured in a clinical setting with that measured in a school setting using a repeated-measures design. This was done on typically developing children and children with auditory processing disorder (APD).

Method

Thirty-two children (16 typically developing and 16 with APD), aged 7 years, were evaluated using three diagnostic auditory processing tests and a cognitive test. The tests included the Speech Perception in Noise Test in Kannada, the Gap Detection Threshold Test, the Dichotic Consonant–Vowel Test, and the Auditory Memory and Sequencing Test in Kannada. All the children were evaluated in an audiological diagnostic setting, as well as in their school.

Results

No significant difference in scores was obtained in the two settings for all the four tests that were administered. This was seen in the typically developing children and the children with APD. Additionally, the pass/fail decision for each test did not alter in the two settings. Moderate to almost perfect agreement was seen between the tests carried out in the two settings in both groups, on a Kappa test of agreement. In both settings, the children with APD performed significantly poorer than the typically developing children on the four diagnostic tests.

Conclusions

The findings of the study indicate that the diagnostic auditory processing tests and the cognitive test can be carried out in school settings as effectively as tests carried out in an audiological diagnostic clinical setting. This will enable carrying out diagnostic tests on children in schools soon after they are referred on screening auditory processing tools, administered in the educational setting. This will prevent missing diagnosis of children who fail to report to a diagnostic audiological center for detailed auditory processing evaluation.

Auditory processing disorder may be present in schizophrenia and it is highly correlated with formal thought disorder

The present study investigates the presence of Auditory Processing Disorder (APD) in schizophrenia and its association with symptomatology, especially Formal Thought Disorder (FTD). 50 patients with schizophrenia and 25 matched healthy controls completed a battery of three auditory processing tests. Positive and Negative Syndrome Scale (PANSS) and Thought, Language and Communication (TLC) scale were used to assess clinical symptoms. The patient group was divided into two subgroups, according to FTD severity. Auditory processing performance of the control group and the patient group was evaluated. Correlations between auditory processing scores and TLC scores, as well as auditory processing scores and PANSS scores were examined. Most of the patients, especially those with FTD, had auditory deficits that can be classified as APD. Patients showed impaired performance compared to controls in all tests. Total severity and specific factors of FTD, as well as other clinical symptoms and symptom categories were correlated with auditory processing performance. We provided evidence that APD may be present in schizophrenia and that FTD, as well as other clinical symptoms are associated with auditory processing deficits. There are important clinical implications for non-pharmacological interventions and early diagnosis of schizophrenia.

Impact of hearing loss on the performance of auditory processing measured by questionnaires in Korean adolescents

Increasing use of personal listening devices has been accompanied by increase in the prevalence of hearing loss (HL) among youth in Korea, as in other countries. Auditory processing disorder (APD) is one of the main factors affecting academic achievement at school. This study aimed to investigate the prevalence of HL in students attending general middle- and high schools and compare the findings with the APD survey results. From June 1 to December 31, 2016, Korean adolescents (n = 2,791) in the first years of middle- and high school underwent audiometric testing and otologic examination and completed questionnaires on APD. The survey was sponsored by the Korean Society of Otolaryngology-Head and Neck Surgery and the Korean Otology Society. The prevalence of speech-frequency hearing loss (SFHL) and high-frequency hearing loss (HFHL) in the poorer ear was 11.6% and 10.3%, respectively, among Korean adolescents. We analysed data from the Scale of Auditory Behaviors, Fisher’s Auditory Problems Checklist, and KNISE-Auditory Behavioral Checklist and compared these with the results of hearing tests. We observed positive correlations among the APD questionnaire results and mean hearing levels. This study suggested that hearing loss, especially bilateral high-frequency hearing loss, may affect central auditory processing.

Central auditory processing in adults with chronic stroke without hearing loss: A magnetoencephalography study

OBJECTIVE

Stroke lesions in non-auditory areas may affect higher-order central auditory processing. We sought to characterize auditory functions in chronic stroke survivors with unilateral arm/hand impairment using auditory evoked responses (AERs) with lesion and perception metrics.

METHODS

The AERs in 29 stroke survivors and 14 controls were recorded with single tones, active and passive frequency-oddballs, and a dual-oddball with pitch-contour and time-interval deviants. Performance in speech-in-noise, mistuning detection, and moving-sound detection was assessed. Relationships between AERs, behaviour, and lesion overlap with functional networks, were examined.

RESULTS

Despite their normal hearing, eight patients showed unilateral AER in the hemisphere ipsilateral to the affected hand with reduced amplitude compared to those with bilateral AERs. Both groups showed increasing attenuation of later components. Hemispheric asymmetry of AER sources was reduced in bilateral-AER patients. The N1 wave (100 ms latency) and P2 (200 ms) were delayed in individuals with lesions in the basal-ganglia and white-matter, while lesions in the attention network reduced the frequency-MMN (mismatch negativity) responses and increased the pitch-contour P3a response. Patients' impaired speech-in-noise perception was explained by AER measures and frequency-deviant detection performance with multiple regression.

CONCLUSION

AERs reflect disruption of auditory functions due to damage outside of temporal lobe, and further explain complexity of neural mechanisms underlying higher-order auditory perception.

SIGNIFICANCE

Stroke survivors without obvious hearing problems may benefit from rehabilitation for central auditory processing.

Synaptic Recruitment Enhances Gap Termination Responses in Auditory Cortex

The ability to detect short gaps in noise is an important tool for assessing the temporal resolution in the auditory cortex. However, the mere existence of responses to temporal gaps bounded by two short broadband markers is surprising, because of the expected short-term suppression that is prevalent in auditory cortex. Here, we used in-vivo intracellular recordings in anesthetized rats to dissect the synaptic mechanisms that underlie gap-related responses. When a gap is bounded by two short markers, a gap termination response was evoked by the onset of the second marker with minimal contribution from the offset of the first marker. Importantly, we show that the gap termination response was driven by a different (potentially partially overlapping) synaptic population than that underlying the onset response to the first marker. This recruitment of additional synaptic resources is a novel mechanism contributing to the important perceptual task of gap detection.

Development of auditory perception in preschool children

OBJECTIVE

The aim of this study was to determine whether the auditory skills presented by five-year-old children can predict their performance in auditory processing (AP) tests at seven years old.

DESIGN

Thirty-five children were evaluated for AP at two different times. At evaluation 1, the children were between 5 years 2 months and 6 years 1 month of age, and at evaluation 2, they were between 7 years 1 month and 7 years 8 months of age. The interval between the evaluations ranged from 18 to 23 months. After evaluation 2, the 7-year-olds were classified according to their performance on central AP tests. The children were divided into three groups: GI included nine children with at least two AP tests that scored two standard deviations below the mean and the presence of a speech complaint; GII included 18 children with at least two AP tests that scored two standard deviations below the mean and no speech complaints; and GIII included eight children with no more than one test scored two standard deviations below the mean and no speech disorders complaint. The analysis was performed considering each test individually and as a battery of applied tests. From the results obtained, a discriminant analysis was performed to assess the differences in test performance between the groups when the children were 5 years old.

RESULTS

The discriminant analysis showed that with the results obtained during evaluation 1, it was possible to predict which group 74.3% of the children would be classified into after evaluation 2. The percentage of correct classifications for each group was 77.8% for GI, 66.7% for GII and 87.5% for GIII. That is, 87.5% of the children who were classified as GIII after evaluation 2 had already demonstrated good auditory performance in the tests applied at 5 years of age.

CONCLUSIONS

Children who exhibited lower scores on AP tests at 7 years of age had demonstrated poor auditory perception at 5 years of age. This finding is relevant because it offers the possibility of stimulating or training these auditory skills in preschoolers to foster their development.

Deficits in Auditory Rhythm Perception in Children With Auditory Processing Disorder Are Unrelated to Attention

Auditory processing disorder (APD) is defined as a specific deficit in the processing of auditory information along the central auditory nervous system, including bottom-up and top-down neural connectivity. Even though music comprises a big part of audition, testing music perception in APD population has not yet gained wide attention in research. This work tests the hypothesis that deficits in rhythm perception occur in a group of subjects with APD. The primary focus of this study is to measure perception of a simple auditory rhythm, i.e., short isochronous sequences of beats, in APD children and to compare their performance to age-matched normal controls. The secondary question is to study the relationship between cognition and auditory processing of rhythm perception. We tested 39 APD children and 25 control children aged between 6 and 12 years via (a) clinical APD tests, including a monaural speech in noise test, (b) isochrony task, a test measuring the detection of small deviations from perfect isochrony in a isochronous beats sequence, and (c) two cognitive tests (auditory memory and auditory attention). APD children scored worse in isochrony task compared to the age-matched control group. In the APD group, neither measure of cognition (attention nor memory) correlated with performance in isochrony task. Left (but not right) speech in noise performance correlated with performance in isochrony task. In the control group a large correlation (r = -0.701, p = 0.001) was observed between isochrony task and attention, but not with memory. The results demonstrate a deficit in the perception of regularly timed sequences in APD that is relevant to the perception of speech in noise, a ubiquitous complaint in this condition. Our results suggest (a) the existence of a non-attention related rhythm perception deficit in APD children and (b) differential effects of attention on task performance in normal vs. APD children. The potential beneficial use of music/rhythm training for rehabilitation purposes in APD children would need to be explored.

Auditory processing disorder evaluations and cognitive profiles of children with specific learning disorder

•

Children with altered auditory processing exhibit a specific cognitive profile.

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Lower verbal and spatial reasoning performance are associated with altered auditory processing.

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Children with specific learning disorder should undergo a complete multimodal examination.

Objective

This study investigated the auditory sensory-perceptual level of specific learning disorder (SLD) and explored relationships among neuropsychological assessments for SLD, auditory processing, and short and long latencies of auditory event-related potentials (ERPs).

Methods

Fifteen children (7–14 years old) comprised the control group; 34 children comprised the SLD group. Audiologic assessments included tone audiometry, acoustic immittance measurements, acoustic reflex, central auditory processing, brainstem evoked response audiometry, and long latency potentials (P3 and N2). Children’s intelligence levels were assessed with 2 intelligence batteries, 1 verbal and 1 non-verbal, as well as with visuomotor skills.

Results

Multiple regression showed a significant interaction effect of APE tests and P3/N2 over Wechsler Scale performance in freedom of distractibility indexes and multiple subtests. Errors in the Bender Visual Motor Gestalt Test were predicted by lower parental education, lower performance in APE tests: dichotic digits and pediatric/synthetic sentence identification-ipsilateral, and longer P3/N2 latencies, particularly regarding integration and rotation distortions.

Conclusions

Children with altered auditory processing exhibit a specific cognitive profile, including lower verbal and spatial reasoning performance, that is sensitive to parental education level.

Significance

Children with SLD should undergo a complete multimodal examination to identify their specific difficulties and needs.

Deficits in auditory sensory discrimination among children with attention-deficit/hyperactivity disorder

Research into children with attention-deficit/hyperactivity disorder (ADHD) has focused on complex cognitive dysfunction, but less attention has been paid to sensory perception processes underlying the symptoms of ADHD. Based on signal detection theory, the present study compared the sensory discrimination ability and decision bias of children with and without ADHD. It also investigated the differences between ADHD with predominantly inattentive (ADHDi) and combined presentations (ADHDc). The sample of 75 children and adolescents with ADHD (24 ADHDi, 51 ADHDc) (16 females and 59 males) and 22 typical developing controls (TD) (8 females and 14 males) completed an auditory signal detection task. Participants were asked to detect signals against levels of transient background noise (35, 45, 55, and 65 dB). The results showed that with the increase of noise levels, both the ADHD and TD groups demonstrated decreased sensory discrimination. Although both groups successfully detected signal against noise levels from 35 to 55 dB, the ADHD group showed lower discrimination ability than that of the TD group. For decision bias, no group difference was found. Further comparisons regarding the predominant symptom presentation of ADHD sub-groups showed no differences. Current research has suggested that the deficit in ADHD people's signal detection performance can be attributed to sensory discrimination rather than decision bias. We suggest that background noise should be taken into account when using auditory stimuli to investigate cognitive functions in people with ADHD.

Auditory Localization and Spatial Release From Masking in Children With Suspected Auditory Processing Disorder

OBJECTIVES

We sought to investigate whether children referred to our audiology clinic with a complaint of listening difficulty, that is, suspected of auditory processing disorder (APD), have difficulties localizing sounds in noise and whether they have reduced benefit from spatial release from masking.

DESIGN

Forty-seven typically hearing children in the age range of 7 to 17 years took part in the study. Twenty-one typically developing (TD) children served as controls, and the other 26 children, referred to our audiology clinic with listening problems, were the study group: suspected APD (sAPD). The ability to localize a speech target (the word "baseball") was measured in quiet, broadband noise, and speech-babble in a hemi-anechoic chamber. Participants stood at the center of a loudspeaker array that delivered the target in a diffused noise-field created by presenting independent noise from four loudspeakers spaced 90° apart starting at 45°. In the noise conditions, the signal-to-noise ratio was varied between -12 and 0 dB in 6-dB steps by keeping the noise level constant at 66 dB SPL and varying the target level. Localization ability was indexed by two metrics, one assessing variability in lateral plane [lateral scatter (Lscat)] and the other accuracy in the front/back dimension [front/back percent correct (FBpc)]. Spatial release from masking (SRM) was measured using a modified version of the Hearing in Noise Test (HINT). In this HINT paradigm, speech targets were always presented from the loudspeaker at 0°, and a single noise source was presented either at 0°, 90°, or 270° at 65 dB A. The SRM was calculated as the difference between the 50% correct HINT speech reception threshold obtained when both speech and noise were collocated at 0° and when the noise was presented at either 90° or 270°.

RESULTS

As expected, in both groups, localization in noise improved as a function of signal-to-noise ratio. Broadband noise caused significantly larger disruption in FBpc than in Lscat when compared with speech babble. There were, however, no group effects or group interactions, suggesting that the children in the sAPD group did not differ significantly from TD children in either localization metric (Lscat and FBpc). While a significant SRM was observed in both groups, there were no group effects or group interactions. Collectively, the data suggest that children in the sAPD group did not differ significantly from the TD group for either binaural measure investigated in the study.

CONCLUSIONS

As is evident from a few poor performers, some children with listening difficulties may have difficulty in localizing sounds and may not benefit from spatial separation of speech and noise. However, the heterogeneity in APD and the variability in our data do not support the notion that localization is a global APD problem. Future studies that employ a case study design might provide more insights.

Same or Different: The Overlap Between Children With Auditory Processing Disorders and Children With Other Developmental Disorders: A Systematic Review

Supplemental Digital Content is available in the text.

Objectives:

Children diagnosed with auditory processing disorders (APD) experience difficulties in auditory functioning and with memory, attention, language, and reading tasks. However, it is not clear whether the behavioral characteristics of these children are distinctive from the behavioral characteristics of children diagnosed with a different developmental disorder, such as specific language impairment (SLI), dyslexia, attention-deficit hyperactivity disorder (ADHD), learning disorder (LD), or autism spectrum disorder. This study describes the performance of children diagnosed with APD, SLI, dyslexia, ADHD, and LD to different outcome measurements. The aim of this study was to determine (1) which characteristics of APD overlap with the characteristics of children with SLI, dyslexia, ADHD, LD, or autism spectrum disorder; and (2) if there are characteristics that distinguish children diagnosed with APD from children diagnosed with other developmental disorders.

Design:

A systematic review. Six electronic databases (Pubmed, CINAHL, Eric, PsychINFO, Communication & Mass Media Complete, and EMBASE) were searched to find peer-reviewed studies from 1954 to May 2015. The authors included studies reporting behaviors and performance of children with (suspected) APD and children diagnosed with a different developmental disorder (SLI, Dyslexia, ADHD, and LD). Two researchers identified and screened the studies independently. Methodological quality of the included studies was assessed with the American Speech-Language-Hearing Association’s levels-of-evidence scheme.

Results:

In total, 13 studies of which the methodological quality was moderate were included in this systematic review. In five studies, the performance of children diagnosed with APD was compared with the performance of children diagnosed with SLI: in two with children diagnosed with dyslexia, one with children diagnosed with ADHD, and in another one with children diagnosed with LD. Ten of the studies included children who met the criteria for more than one diagnosis. In four studies, there was a comparison made between the performances of children with comorbid disorders. There were no studies found in which the performance of children diagnosed with APD was compared with the performance of children diagnosed with autism spectrum disorder. Children diagnosed with APD broadly share the same characteristics as children diagnosed with other developmental disorders, with only minor differences between them. Differences were determined with the auditory and visual Duration Pattern Test, the Children’s Auditory Processing Performance Scale questionnaire, and the subtests of the Listening in Spatialized Noise-Sentences test, in which noise is spatially separated from target sentences. However, these differences are not consistent between studies and are not found in comparison to all groups of children with other developmental disorders.

Conclusions:

Children diagnosed with APD perform equally to children diagnosed with SLI, dyslexia, ADHD, and LD on tests of intelligence, memory or attention, and language tests. Only small differences between groups were found for sensory and perceptual functioning tasks (auditory and visual). In addition, children diagnosed with dyslexia performed poorer in reading tasks compared with children diagnosed with APD. The result is possibly confounded by poor quality of the research studies and the low quality of the used outcome measures. More research with higher scientific rigor is required to better understand the differences and similarities in children with various neurodevelopmental disorders.

Auditory event-related potentials and function of the medial olivocochlear efferent system in children with auditory processing disorders

OBJECTIVE

The objectives were to investigate the function of central auditory pathways and of the medial efferent olivocochlear system (MOCS).

DESIGN

Event-related potentials (ERP) were recorded following the delivery of the stimulus /da/ in quiet and in ipsilateral, contralateral, and binaural noise conditions and correlated to the results of the auditory processing disorders (APD) diagnostic test battery. MOCS function was investigated by adding ipsilateral, contralateral, and binaural noise to transient evoked otoacoustic emission recordings. Auditory brainstem responses and pure tone audiogram were also evaluated.

STUDY SAMPLE

Nineteen children (7 to 12 years old) with APD were compared with 24 age-matched controls.

RESULTS

Otoacoustic emissions and ABR characteristics did not differ between groups, whereas ERP latencies were significantly longer and of higher amplitudes in APD children than in controls, in both quiet and noise conditions. The MOCS suppression was higher in APD children.

CONCLUSIONS

Findings indicate that children with APD present with neural deficiencies in both challenging and nonchallenging environments with an increase in the timing of several central auditory processes correlated to their behavioural performances. Meanwhile, their modulation of the auditory periphery under noisy conditions differs from control children with higher suppression.

[The application of the screening questionnaires for the diagnostics of the central auditory processing disorders in the pediatric practice]

Identification and diagnostics of auditory processing disorders (APD) in the children continues to be a challenge. Screening tools help to decide the need for evaluation. However, none of them are used routinely in Russia, nor are there thus far auditory checklist questionnaires in the Russian language. The aim of his study was to approve Children's Auditory Performance Scale (CHAPS) and Fisher's Auditory Checklist in Russian for the children at the age of 5-10 years. The study included 52 children at the age from 5 to 11 years. All of them were native Russian speakers. Pure tone audiometry, immitancemetry, and the Simplified RuMatrix test were performed for all the children. All of them had normal hearing thresholds, speech and language development, and normal academic achievement at school. The parents filled in the CHAPS and Fisher's Auditory Checklist questionnaires in Russian. The mean value of Fisher's Auditory Checklist was 85.7 ± 9.3, the mean value of CHAPS questionnaire was equal to 0.08 ± 0.26. The results obtained with the use of the Russian language questionnaires are in excellent agreement with the test data yielded by the respective English language versions. It is recommended that the clinical assessment for APD should be performed for children with the result of the Fisher questionnaire less than 67 points and with the result of the CHAPS questionnaire less than -1 point. It is concluded that Fisher's questionnaire was more convenient for the parents to fill in.

Subcortical pathways: Towards a better understanding of auditory disorders

Hearing loss is a significant problem that affects at least 15% of the population. This percentage, however, is likely significantly higher because of a variety of auditory disorders that are not identifiable through traditional tests of peripheral hearing ability. In these disorders, individuals have difficulty understanding speech, particularly in noisy environments, even though the sounds are loud enough to hear. The underlying mechanisms leading to such deficits are not well understood. To enable the development of suitable treatments to alleviate or prevent such disorders, the affected processing pathways must be identified. Historically, mechanisms underlying speech processing have been thought to be a property of the auditory cortex and thus the study of auditory disorders has largely focused on cortical impairments and/or cognitive processes. As we review here, however, there is strong evidence to suggest that, in fact, deficits in subcortical pathways play a significant role in auditory disorders. In this review, we highlight the role of the auditory brainstem and midbrain in processing complex sounds and discuss how deficits in these regions may contribute to auditory dysfunction. We discuss current research with animal models of human hearing and then consider human studies that implicate impairments in subcortical processing that may contribute to auditory disorders.