Sensory, cognitive, and linguistic factors in the early academic performance of elementary school children: The Benton-IU project

From vision to cognition: potential contributions of cerebral visual impairment to neurodevelopmental disorders

Vision has a crucial role to play in human development and functioning. It is, therefore, not surprising that vision plays a fundamental role in the development of the child. As a consequence, an alteration in visual function is, therefore, likely to hinder the child's development. Although ocular disorders are well known, diagnosed and taken into account, cerebral visual impairments (CVI) resulting from post-chiasmatic damage are largely underdiagnosed. However, among the disorders resulting from an episode of perinatal asphyxia and/or associated with prematurity, or neonatal hypoglycaemia, CVIs are prominent. In this article, we focus on the role of the possible effects of CVI on a child's learning abilities, leading to major difficulty in disentangling the consequences of CVI from other neurodevelopmental disorders (NDD) such as dyslexia, dyscalculia, dysgraphia, attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD) and autism spectrum disorders (ASD). Although we focus here on the possible overlap between children with CVI and children with other NDD, De Witt et al. (Wit et al. Ear Hear 39:1-19, 2018) have raised exactly the same question regarding children with auditory processing disorders (the equivalent of CVI in the auditory modality). We underline how motor, social and cognitive development as well as academic success can be impaired by CVI and raise the question of the need for systematic evaluation for disorders of vision, visual perception and cognition in all children presenting with a NDD and/or previously born under adverse neurological conditions.

Deficient neural encoding of speech sounds in term neonates born after fetal growth restriction

Infants born after fetal growth restriction (FGR)-an obstetric condition defined as the failure to achieve the genetic growth potential-are prone to neurodevelopmental delays, with language being one of the major affected areas. Yet, while verbal comprehension and expressive language impairments have been observed in FGR infants, children and even adults, specific related impairments at birth, such as in the ability to encode the sounds of speech, necessary for language acquisition, remain to be disclosed. Here, we used the frequency-following response (FFR), a brain potential correlate of the neural phase locking to complex auditory stimuli, to explore the encoding of speech sounds in FGR neonates. Fifty-three neonates born with FGR and 48 controls born with weight adequate-for-gestational age (AGA) were recruited. The FFR was recorded to the consonant-vowel stimulus (/da/) during sleep and quantified as the spectral amplitude to the fundamental frequency of the syllable and its signal-to-noise ratio (SNR). The outcome was available in 45 AGA and 51 FGR neonates, yielding no differences for spectral amplitudes. However, SNR was strongly attenuated in the FGR group compared to the AGA group at the vowel region of the stimulus. These findings suggest that FGR population present a deficit in the neural pitch tracking of speech sounds already present at birth. Our results pave the way for future research on the potential clinical use of the FFR in this population, so that if confirmed, a disrupted FFR recorded at birth may help deriving FGR neonates at risk for postnatal follow-ups.

Diverse patterns of vulnerability to visual illusions in children with neurodevelopmental disorders

Research on how children with neurodevelopmental disorders perceive, process, and interpret visual illusions (VIs) has been extensively focused on children with autism spectrum disorder providing controversial findings. In this study, we investigated the patterns of vulnerability to a wide set of VIs comprising 23 standard text book VIs and their variations in a clinical sample of children with neurodevelopmental disorders compared to typically developing children (TD). A total of 176 children, aged between 4.6 and 13.8 years old, were distributed into four groups: high-functioning autism (HFA; N = 23), attention-deficit/hyperactivity disorder (ADHD; N = 42), specific learning disorder (SLD; N = 70), and TD (N = 41). Regression models, adjusted for sex, age, and non-verbal IQ, showed that HFA was associated with greater responses accuracy than TD children to the full battery of VIs, to the cognitive illusions, to the distortions, and to both geometrical illusions of size/shape (cognitive distortions) and lightness contrast effects (physical distortions). The susceptibility of ADHD children was found attenuated for illusory contours and greater for paradoxical illusions in comparison with TD children. No significant differences were shown between the SLD group and the TD children. Our findings, which were adjusted for the same duration of visual working memory across groups, showed that there is a potential specific tendency of HFA children to failure of processing visual information in context. Contrarily, children with ADHD showed in general normal global processing such as children diagnosed with SLD.

Students’ attitudes towards performance heterogeneity and their relation to contextual factors

Previous studies examining attitudes towards performance heterogeneity have focused on attitudes among teachers. However, positive attitudes towards the school environment are also assumed to be conducive for students. The aim of this paper is to examine students’ attitudes towards performance heterogeneity with a sample of 784 5th-grade students. Based on the three-component theory of attitudes (Eagly & Chaiken, 1993), we investigated whether students’ attitudes towards performance heterogeneity are positive or negative. Furthermore, we analyzed contextual relations, focusing on whether students’ attitudes are linked to performance heterogeneity in the classroom and to a teachers’ behavior to manage performance heterogeneity. Descriptive statistics show that students’ attitudes towards performance heterogeneity are rather positive. Multi-level structural equation models reveal that contextual rather than individual characteristics relate to students’ attitudes towards performance heterogeneity. Accordingly, students in heterogeneous classes show a more positive attitude towards performance heterogeneity than students in less heterogeneous classes. In addition, a teachers’ capability of professionally managing heterogeneity is positively associated with students’ attitudes towards performance heterogeneity. Accordingly, students’ show more positive attitudes if teachers implement rules, effectively manage disruptions, orient themselves towards temporal reference norms, cultivate a positive error culture, and differentiate instruction in the classroom. We will discuss our results and consider implications for psychological aspects of education and learning.

Associations Between Hearing and Cognitive Abilities From Childhood to Middle Age: The National Child Development Study 1958

Previous cross-sectional findings indicate that hearing and cognitive abilities are positively correlated in childhood, adulthood, and older age. We used an unusually valuable longitudinal dataset from a single-year birth cohort study, the National Child Development Study 1958, to test how hearing and cognitive abilities relate to one another across the life course from childhood to middle age. Cognitive ability was assessed with a single test of general cognitive ability at age 11 years and again with multiple tests at age 50. Hearing ability was assessed, using a pure tone audiogram, in childhood at ages 11 and 16 and again at age 44. Associations between childhood and middle-age hearing and cognitive abilities were investigated using structural equation modelling. We found that higher cognitive ability was associated with better hearing (indicated by a lower score on the hearing ability variables); this association was apparent in childhood (r  =  -0.120, p <0.001) and middle age (r  =  -0.208, p <0.001). There was a reciprocal relationship between hearing and cognitive abilities over time: better hearing in childhood was weakly associated with a higher cognitive ability in middle age (β  =  -0.076, p  =  0.001), and a higher cognitive ability in childhood was associated with better hearing in middle age (β  =  -0.163, p <0.001). This latter, stronger effect was mediated by occupational and health variables in adulthood. Our results point to the discovery of a potentially life-long relationship between hearing and cognitive abilities and demonstrate how these variables may influence one another over time.

The impact of speech and language problems in kindergarten on academic learning and special education status in grade three

PURPOSE

This study addressed the implications of experiencing early speech-language pathologies (SLPs) in kindergarten on special education needs (SEN) and academic outcomes in grade three.

METHOD

Early Development Instrument (EDI) kindergarten data on development and the presence or absence of SLPs were matched with grade three school-system standardised tests of reading, writing and maths, and SEN classification in Ontario, Canada for 59 015 students. Children were classified as having a Persistent speech language pathology (SLP), Remittent SLP, Latent SEN or as a typically developing Control.

RESULT

Even though 72.3% of children's SLPs remitted by grade three, kindergarten SLPs conveyed higher likelihood of having an SEN, and of lower achievement levels in grade three. The degree of impact varied between Persistent and Remittent groups. Children in the Latent group had lower scores in kindergarten on all five EDI domains than Control children.

CONCLUSION

These population level results provide strong evidence to indicate that all children who present with an SLP in kindergarten face further academic challenges, even if their SLP resolves over time. Findings have implications for early intervention and treatment for children with early SLPs.

AAA (2010) CAPD clinical practice guidelines: need for an update

OBJECTIVE

Review and critique of the clinical value of the AAA CAPD guidance document in light of criteria for credible and useful guidance documents, as discussed by Field and Lohr.

DESIGN

A qualitative review of the of the AAA CAPD guidelines using a framework by Field and Lohr to assess their relative value in supporting the assessment and management of CAPD referrals.

STUDY SAMPLE

Relevant literature available through electronic search tools and published texts were used along with the AAA CAPD guidance document and the chapter by Field and Lohr.

RESULTS

The AAA document does not meet many of the key requirements discussed by Field and Lohr. It does not reflect the current literature, fails to help clinicians understand for whom auditory processing testing and intervention would be most useful, includes contradictory suggestions which reduce clarity and appears to avoid conclusions that might cast the CAPD construct in a negative light. It also does not include input from diverse affected groups. All of these reduce the document's credibility.

CONCLUSIONS

The AAA CAPD guidance document will need to be updated and re-conceptualised in order to provide meaningful guidance for clinicians.

The contribution of visual processing to academic achievement in adolescents born extremely preterm or extremely low birth weight

Children born extremely preterm (EP, <28 weeks) and/or extremely low birth weight (ELBW, <1000 g) have more academic deficiencies than their term-born peers, which may be due to problems with visual processing. The aim of this study is to determine (1) if visual processing is related to poor academic outcomes in EP/ELBW adolescents, and (2) how much of the variance in academic achievement in EP/ELBW adolescents is explained by visual processing ability after controlling for perinatal risk factors and other known contributors to academic performance, particularly attention and working memory. A geographically determined cohort of 228 surviving EP/ELBW adolescents (mean age 17 years) was studied. The relationships between measures of visual processing (visual acuity, binocular stereopsis, eye convergence, and visual perception) and academic achievement were explored within the EP/ELBW group. Analyses were repeated controlling for perinatal and social risk, and measures of attention and working memory. It was found that visual acuity, convergence and visual perception are related to scores for academic achievement on univariable regression analyses. After controlling for potential confounds (perinatal and social risk, working memory and attention), visual acuity, convergence and visual perception remained associated with reading and math computation, but only convergence and visual perception are related to spelling. The additional variance explained by visual processing is up to 6.6% for reading, 2.7% for spelling, and 2.2% for math computation. None of the visual processing variables or visual motor integration are associated with handwriting on multivariable analysis. Working memory is generally a stronger predictor of reading, spelling, and math computation than visual processing. It was concluded that visual processing difficulties are significantly related to academic outcomes in EP/ELBW adolescents; therefore, specific attention should be paid to academic remediation strategies incorporating the management of working memory and visual processing in EP/ELBW children.

It Is Time to Rethink Central Auditory Processing Disorder Protocols for School-Aged Children

PURPOSE

The purpose of this article is to review the literature that pertains to ongoing concerns regarding the central auditory processing construct among school-aged children and to assess whether the degree of uncertainty surrounding central auditory processing disorder (CAPD) warrants a change in current protocols.

METHOD

Methodology on this topic included a review of relevant and recent literature through electronic search tools (e.g., ComDisDome, PsycINFO, Medline, and Cochrane databases); published texts; as well as published articles from the Journal of the American Academy of Audiology; the American Journal of Audiology; the Journal of Speech, Language, and Hearing Research; and Language, Speech, and Hearing Services in Schools.

RESULTS

This review revealed strong support for the following: (a) Current testing of CAPD is highly influenced by nonauditory factors, including memory, attention, language, and executive function; (b) the lack of agreement regarding the performance criteria for diagnosis is concerning; (c) the contribution of auditory processing abilities to language, reading, and academic and listening abilities, as assessed by current measures, is not significant; and (d) the effectiveness of auditory interventions for improving communication abilities has not been established.

CONCLUSIONS

Routine use of CAPD test protocols cannot be supported, and strong consideration should be given to redirecting focus on assessing overall listening abilities. Also, intervention needs to be contextualized and functional. A suggested protocol is provided for consideration. All of these issues warrant ongoing research.

Auditory processing disorders with and without central auditory discrimination deficits

Auditory processing disorder (APD) is defined as a processing deficit in the auditory modality and spans multiple processes. To date, APD diagnosis is mostly based on the utilization of speech material. Adequate nonspeech tests that allow differentiation between an actual central hearing disorder and related disorders such as specific language impairments are still not adequately available. In the present study, 84 children between 6 and 17 years of age (clinical group), referred to three audiological centers for APD diagnosis, were evaluated with standard audiological tests and additional auditory discrimination tests. Latter tests assessed the processing of basic acoustic features at two different stages of the ascending central auditory system: (1) auditory brainstem processing was evaluated by quantifying interaural frequency, level, and signal duration discrimination (interaural tests). (2) Diencephalic/telencephalic processing was assessed by varying the same acoustic parameters (plus signals with sinusoidal amplitude modulation), but presenting the test signals in conjunction with noise pulses to the contralateral ear (dichotic(signal/noise) tests). Data of children in the clinical group were referenced to normative data obtained from more than 300 normally developing healthy school children. The results in the audiological and the discrimination tests diverged widely. Of the 39 children that were diagnosed with APD in the audiological clinic, 30 had deficits in auditory performance. Even more alarming was the fact that of the 45 children with a negative APD diagnosis, 32 showed clear signs of a central hearing deficit. Based on these results, we suggest revising current diagnostic procedure to evaluate APD in order to more clearly differentiate between central auditory processing deficits and higher-order (cognitive and/or language) processing deficits.

Simulating the effects of common and specific abilities on test performance: an evaluation of factor analysis

PURPOSE

Factor analysis is a useful technique to aid in organizing multivariate data characterizing speech, language, and auditory abilities. However, knowledge of the limitations of factor analysis is essential for proper interpretation of results. The present study used simulated test scores to illustrate some characteristics of factor analysis.

METHOD

Linear models were used to simulate test scores that were determined by multiple latent variables. These simulated test scores were evaluated with principal components analysis and, in certain cases, structural equation modeling. In addition, a subset of simulated individuals characterized by poor test performance was examined.

RESULTS

The number of factors recovered and their identity do not necessarily correspond to the structure of the latent variables that generated the test scores. The first principal component may represent variance from multiple uncorrelated sources. Practices such as correction or control for general cognitive ability may produce misleading results.

CONCLUSIONS

Inferences from the results of factor analysis should be primarily about the structure of test batteries rather than the structure of human mental abilities. Researchers and clinicians should consider multiple sources of evidence to evaluate hypotheses about the processes generating test results.

Colors, colored overlays, and reading skills

In this article, we are concerned with the role of colors in reading written texts. It has been argued that colored overlays applied above written texts positively influence both reading fluency and reading speed. These effects would be particularly evident for those individuals affected by the so called Meares-Irlen syndrome, i.e., who experience eyestrain and/or visual distortions – e.g., color, shape, or movement illusions – while reading. This condition would interest the 12–14% of the general population and up to the 46% of the dyslexic population. Thus, colored overlays have been largely employed as a remedy for some aspects of the difficulties in reading experienced by dyslexic individuals, as fluency and speed. Despite the wide use of colored overlays, how they exert their effects has not been made clear yet. Also, according to some researchers, the results supporting the efficacy of colored overlays as a tool for helping readers are at least controversial. Furthermore, the very nature of the Meares-Irlen syndrome has been questioned. Here we provide a concise, critical review of the literature.

Exploring the role of auditory analysis in atypical compared to typical language development

The relationship between auditory processing and language skills has been debated for decades. Previous findings have been inconsistent, both in typically developing and impaired subjects, including those with dyslexia or specific language impairment. Whether correlations between auditory and language skills are consistent between different populations has hardly been addressed at all. The present work presents an exploratory approach of testing for patterns of correlations in a range of measures of auditory processing. In a recent study, we reported findings from a large cohort of eleven-year olds on a range of auditory measures and the data supported a specific role for the processing of short sequences in pitch and time in typical language development. Here we tested whether a group of individuals with dyslexic traits (DT group; n = 28) from the same year group would show the same pattern of correlations between auditory and language skills as the typically developing group (TD group; n = 173). Regarding the raw scores, the DT group showed a significantly poorer performance on the language but not the auditory measures, including measures of pitch, time and rhythm, and timbre (modulation). In terms of correlations, there was a tendency to decrease in correlations between short-sequence processing and language skills, contrasted by a significant increase in correlation for basic, single-sound processing, in particular in the domain of modulation. The data support the notion that the fundamental relationship between auditory and language skills might differ in atypical compared to typical language development, with the implication that merging data or drawing inference between populations might be problematic. Further examination of the relationship between both basic sound feature analysis and music-like sound analysis and language skills in impaired populations might allow the development of appropriate training strategies. These might include types of musical training to augment language skills via their common bases in sound sequence analysis.

Auditory sequence analysis and phonological skill

This work tests the relationship between auditory and phonological skill in a non-selected cohort of 238 school students (age 11) with the specific hypothesis that sound-sequence analysis would be more relevant to phonological skill than the analysis of basic, single sounds. Auditory processing was assessed across the domains of pitch, time and timbre; a combination of six standard tests of literacy and language ability was used to assess phonological skill. A significant correlation between general auditory and phonological skill was demonstrated, plus a significant, specific correlation between measures of phonological skill and the auditory analysis of short sequences in pitch and time. The data support a limited but significant link between auditory and phonological ability with a specific role for sound-sequence analysis, and provide a possible new focus for auditory training strategies to aid language development in early adolescence.

Understanding Dyslexia in Children through Human Development Theories

Dyslexia is a specific learning disability that is neurological in origin, with an estimated overall worldwide prevalence of 5-10% of the population. It is characterised by difficulties in reading, accuracy, fluency, spelling and decoding abilities. The majority of publications reviewed indicated that screening is performed at the preschool level. Screening can also be conducted at birth or the first year of life. Understanding human development theory, for example, Piaget's human development theory, may help determine at which stage of childhood development dyslexia is more detectable, and therefore guide the management of this disability. The objective of this review is to provide a brief and updated overview of dyslexia and its management in children through human development issues.

Auditory processing theories of language disorders: past, present, and future

PURPOSE

The purpose of this article is to provide information that will assist readers in understanding and interpreting research literature on the role of auditory processing in communication disorders.

METHOD

A narrative review was used to summarize and synthesize the literature on auditory processing deficits in children with auditory processing disorder (APD), specific language impairment (SLI), and dyslexia. The history of auditory processing theories of these 3 disorders is described, points of convergence and controversy within and among the different branches of research literature are considered, and the influence of research on practice is discussed. The theoretical and clinical contributions of neurophysiological methods are also reviewed, and suggested approaches for critical reading of the research literature are provided.

CONCLUSION

Research on the role of auditory processing in communication disorders springs from a variety of theoretical perspectives and assumptions, and this variety, combined with controversies over the interpretation of research results, makes it difficult to draw clinical implications from the literature. Neurophysiological research methods are a promising route to better understanding of auditory processing. Progress in theory development and its clinical application is most likely to be made when researchers from different disciplines and theoretical perspectives communicate clearly and combine the strengths of their approaches.

What Speech-Language Pathologists Need to Know About Auditory Processing Disorder

Purpose

To consider whether auditory processing disorder (APD) is truly a distinct clinical entity or whether auditory problems are more appropriately viewed as a processing deficit that may occur with various developmental disorders.

Method

Theoretical and clinical factors associated with APD are critically evaluated.

Results

There are compelling theoretical and clinical reasons to question whether APD is in fact a distinct clinical entity. Not only is there little evidence that auditory perceptual impairments are a significant risk factor for language and academic performance (e.g., Hazan, Messaoud-Galusi, Rosan, Nouwens, & Shakespeare, 2009; Watson & Kidd, 2009), there is also no evidence that auditory interventions provide any unique benefit to auditory, language, or academic outcomes (Fey et al., 2011).

Conclusion

Because there is no evidence that auditory interventions provide any unique therapeutic benefit (Fey et al., 2011), clinicians should treat children who have been diagnosed with APD the same way they treat children who have been diagnosed with language and learning disabilities. The theoretical and clinical problems associated with APD should encourage clinicians to consider viewing auditory deficits as a processing deficit that may occur with common developmental language and reading disabilities rather than as a distinct clinical entity.

Communication, listening, cognitive and speech perception skills in children with auditory processing disorder (APD) or Specific Language Impairment (SLI)

PURPOSE

Parental reports of communication, listening, and behavior in children receiving a clinical diagnosis of specific language impairment (SLI) or auditory processing disorder (APD) were compared with direct tests of intelligence, memory, language, phonology, literacy, and speech intelligibility. The primary aim was to identify whether there were differences between these characteristics in children with SLI or APD.

METHOD

Normally hearing children who were clinically diagnosed with SLI (n = 22) or APD (n = 19), and a quasirandom sample of mainstream school (MS) children (n = 47) aged 6-13 years, underwent tests of verbal and nonverbal IQ, digit span, nonsense word repetition, Spoonerisms, reading, grammar, and sentence and VCV nonword intelligibility. Parents completed questionnaires on the children's communication, listening, and behavior.

RESULTS

There was generally no difference between the performance of the children with SLI and the children with APD on the questionnaire and test measures, and both groups consistently and significantly underperformed compared with the children in the MS group. Speech intelligibility in both noise and quiet was unimpaired in the SLI and APD groups.

CONCLUSION

Despite clinical diagnoses of SLI or APD, the 2 groups of children had very similar behavioral and parental report profiles, suggesting that the children were differentially diagnosed based on their referral route rather than on actual differences.

Auditive Verarbeitungs- und Wahrnehmungsstörungen (AVWS) im Kindesalter

Auditive Verarbeitungs- und Wahrnehmungsstörungen (AVWS) sind umschriebene Funktionsdefizite in der auditiven Informationsverarbeitung und Wahrnehmung bei intaktem peripherem Gehör und mindestens durchschnittlicher Intelligenz. Häufig sind Lernstörungen, primäre bzw. sekundäre Spracherwerbsstörungen, supramodale Aufmerksamkeitsprobleme oder tiefgreifende Entwicklungsstörungen mit AVWS im Sinn von Komorbidität assoziiert. Deswegen erscheint Eltern, Lehrern oder Untersuchern das AVWS-Konzept zur Erklärung solcher Entwicklungs- und Lernauffälligkeiten plausibel. Da Sprachsignale zerebral anders als nicht sprachliche Signale ausgewertet werden, kann Sprachwahrnehmung allenfalls als ein Spezialfall der auditiven Verarbeitung und Wahrnehmung betrachtet werden. Kausale Beziehungen zwischen gestörten auditiven Funktionen und klinischen Störungsbildern wurden bislang nicht zuverlässig belegt. Es besteht ein Mangel an kontrollierten bzw. randomisierten Therapiestudien.

Sagen Wahrnehmungsleistungen zu Beginn der Schulzeit den Lese-Rechtschreiberfolg in Klasse 1 und 2 voraus?

Zusammenfassung. Die Studie überprüft die Validität der Differenzierungsproben (DP) 1 und 2 ( Breuer & Weuffen, 2006 ) bezüglich der Vorhersage von Lese-Rechtschreibschwierigkeiten am Ende von Klasse 1 und 2. Kinder mit deutscher Muttersprache wurden zu Beginn von Klasse 1 mit der DP 1 und in der Mitte von Klasse 1 mit der DP 2 getestet. Die Leistungen in den DP klären zwischen 3 und 9% der Varianz im späteren Lesen und Schreiben auf. Bei Einbeziehung zusätzlicher Prädiktoren erhöht sich die aufgeklärte Varianz. Es setzen sich aber andere Variablen, insbesondere IQ und vorschulische Lese-Rechtschreibfähigkeit als wichtigere Prädiktoren durch. Die klassifikatorischen Güteindizes Prädiktortrefferquote, Sensitivität und RATZ-Index liegen überwiegend im inakzeptablen Bereich. Somit ist die prognostische Validität von DP 1 und DP 2 als unzureichend zu bewerten. Die im Vergleich zu anderen Screeningverfahren geringere Validität wird auch im Zusammenhang mit Unterschieden hinsichtlich des Einschlusses von Kindern mit nicht-deutscher Muttersprache diskutiert.

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.

Computer-based auditory training (CBAT): benefits for children with language- and reading-related learning difficulties

This article reviews the evidence for computer-based auditory training (CBAT) in children with language, reading, and related learning difficulties, and evaluates the extent it can benefit children with auditory processing disorder (APD). Searches were confined to studies published between 2000 and 2008, and they are rated according to the level of evidence hierarchy proposed by the American Speech-Language Hearing Association (ASHA) in 2004. We identified 16 studies of two commercially available CBAT programs (13 studies of Fast ForWord (FFW) and three studies of Earobics) and five further outcome studies of other non-speech and simple speech sounds training, available for children with language, learning, and reading difficulties. The results suggest that, apart from the phonological awareness skills, the FFW and Earobics programs seem to have little effect on the language, spelling, and reading skills of children. Non-speech and simple speech sounds training may be effective in improving children's reading skills, but only if it is delivered by an audio-visual method. There is some initial evidence to suggest that CBAT may be of benefit for children with APD. Further research is necessary, however, to substantiate these preliminary findings.

Auditory and cognitive abilities of children suspected of auditory processing disorder (APD)

OBJECTIVE

Auditory processing disorder (APD) is typically characterised by difficulties in 'listening', particularly to speech in a noisy environment, despite normal peripheral function. In school-age children, APD has attracted considerable interest because of suspicions that it may lead to learning difficulties, especially affecting language and literacy. Here, we evaluated auditory and cognitive abilities in a group of children referred for an auditory evaluation on the grounds of a suspected auditory processing disorder (susAPD), and in age-matched children who were typically developing, in order to determine the extent to which any deficits in cognitive abilities could be related to auditory deficits.

METHODS

A battery of auditory and cognitive tests was applied to 20 susAPD school-age children, all reported as having listening/hearing problems but performing within normal limits for standard audiometric assessments. Also tested was a group of 28 age-matched controls. The auditory tasks consisted of two simple same/different discrimination tasks, one using speech, and one nonspeech. The cognitive evaluation comprised a vocabulary test, a test of grammar and four non-verbal IQ measures. Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) were assessed in the susAPD group through a standardised questionnaire.

RESULTS

A significant proportion of susAPD children appeared to display genuine auditory deficits evidenced by poor performance on at least one of the auditory tasks, although about 1/3 had no detectable deficit. Children in the susAPD group scored consistently lower than the controls on cognitive measures that were both verbal (vocabulary and grammar) and non-verbal. Strikingly, susAPD children with relatively good auditory performance did not differ in cognitive ability from susAPD children with poor auditory performance. Similarly, within-group correlations between auditory and cognitive measures were weak or non-existent. Measures of ADHD did not correlate with any aspect of auditory or cognitive performance.

CONCLUSIONS

Although children suspected of having APD do show, on average, poorer performance on a number of auditory tasks, the presence or absence of an auditory deficit appears to have little impact on the development of the verbal and non-verbal skills tested here.

Assessing speech perception in young children and relationships with language skills

Few materials are available to assess speech perceptual skills in young children without hearing impairments. However, children with a range of developmental conditions are at risk of speech discrimination deficits. Tasks that reliably assess speech perception skills are thus necessary for research and clinical practice. The development and application of two speech perception tests are described. Data were collected from 105 children, aged 4-5 years, attending mainstream schools, on two tasks, mispronunciation detection and non-word XAB, in quiet and in a background of multi-talker babble. Children's receptive language skills were also measured. Performance on mispronunciation detection was significantly better than on the XAB non-word task, and significantly better in quiet than in babble. Performance significantly improved with age, and speech discrimination was significantly related to receptive language abilities. Scores obtained in quiet and in babble were highly correlated and findings suggest there may be no advantage to testing in noise, except to avoid ceiling effects on performance. These tasks prove useful in the assessment of young children who may have speech discrimination deficits.

Visual processing characteristics of children with Meares-Irlen syndrome

The potential role of visual processing deficits in reading difficulty was brought to public attention by claims that a large proportion of children with dyslexia suffer from a perceptual dysfunction currently referred to as Meares-Irlen syndrome (MISViS). A previous study showing that visual perceptual measures involving visual memory and discrimination predict independent variance in reading achievement [J. Learn. Disabil. 28 (1995) 216] provides a basis to examine their relationships with the diagnostic criteria of MISViS. This study examined these visual processing characteristics in 36 eight- to ten-year-old children, half of whom were experiencing reading difficulty. Children were assessed for MISViS by Irlen screeners; approximately half of the participants in each group were positively identified. Concurrent performance on standardized visual processing tests showed that while a positive diagnosis of MISViS is not indicative of reading ability, nor in particular of a visual-processing deficit subtype identified by Watson and Willows [J. Learn. Disabil. 28 (1995) 216], MISViS can indicate visual processing difficulties potentially related to visual attention inefficiency.

Auditory processing disorders: an update for speech-language pathologists

PURPOSE

Unanswered questions regarding the nature of auditory processing disorders (APDs), how best to identify at-risk students, how best to diagnose and differentiate APDs from other disorders, and concerns about the lack of valid treatments have resulted in ongoing confusion and skepticism about the diagnostic validity of this label. This poses challenges for speech-language pathologists (SLPs) who are working with school-age children and whose scope of practice includes APD screening and intervention. The purpose of this article is to address some of the questions commonly asked by SLPs regarding APDs in school-age children. This article is also intended to serve as a resource for SLPs to be used in deciding what role they will or will not play with respect to APDs in school-age children.

METHOD

The methodology used in this article included a computerized database review of the latest published information on APD, with an emphasis on the work of established researchers and expert panels, including articles from the American Speech-Language-Hearing Association and the American Academy of Audiology.

CONCLUSIONS

The article concludes with the authors' recommendations for continued research and their views on the appropriate role of the SLP in performing careful screening, making referrals, and supporting intervention.

Alternative organization of speech perception deficits in children

Children's first-language perception base takes shape gradually from birth onwards. Empirical research has confirmed that children may continue to fall short of age-based expectations in their speech perception. The purpose of this study was to assess the contribution of various perception processes in both reading and learning disabled children. A series of experiments was carried out with 450 Hungarian-speaking schoolchildren: learning disabled, reading disabled and typically developing control first-, second-, and third-graders. Data from seven perception tasks - focusing on acoustic, phonetic and phonological perception processes - were analysed. Results revealed that (i) there is no linear development in all groups across ages, (ii) correct performance is characteristic of both the perception process and the type of disability, and (iii) a specific pattern of organization can be drawn up as a factor in development.

The importance of modality specificity in diagnosing central auditory processing disorder

PURPOSE

This article argues for the use of modality specificity as a unifying framework by which to conceptualize and diagnose central auditory processing disorder (CAPD). The intent is to generate dialogue and critical discussion in this area of study.

METHOD

Research in the cognitive, behavioral, and neural sciences that relates to the concept of modality specificity was reviewed and synthesized.

RESULTS

Modality specificity has a long history as an organizing construct within a diverse collection of mainstream scientific disciplines. The principle of modality specificity was contrasted with the unimodal inclusive framework, which holds that auditory tests alone are sufficient to make the CAPD diagnosis. Evidence from a large body of data demonstrated that the unimodal framework was unable to delineate modality-specific processes from more generalized dysfunction; it lacked discriminant validity and resulted in an incomplete assessment. Consequently, any hypothetical model resulting from incomplete assessments or potential therapies that are based on indeterminate diagnoses are themselves questionable, and caution should be used in their application.

CONCLUSIONS

Improving specificity of diagnosis is an imperative core issue to the area of CAPD. Without specificity, the concept has little explanatory power. Because of serious flaws in concept and design, the unimodal inclusive framework should be abandoned in favor of a more valid approach that uses modality specificity.

The contribution of phonological awareness and visual attention in early reading and spelling

We examined the development of phonological processing, naming speed, and visual attention in kindergarten and addressed the question of their contribution to reading and spelling in grade 1. Seventy five French-speaking children were administered seven tasks at the two phases of the study, and reading and spelling were assessed in grade 1. The major findings revealed that syllable awareness and visual attention were the most important predictors of early reading and spelling, and confirm the influence of naming speed and phoneme awareness on specific skills. These observations strongly suggest that written language acquisition relies on linguistic, perceptual and cognitive cross-modal skills and highlight the need for diversifying written language measures and analyzing their specific predictors.

Reduced speaking rate as an early predictor of reading disability

PURPOSE

This study evaluated whether developmental reading disability could be predicted in children at the age of 30 months, according to 3 measures of speech production: speaking rate, articulation rate, and the proportion of speaking time allocated to pausing.

METHOD

Speech samples of 18 children at high risk and 10 children at low risk for reading disability were recorded at 30 months of age. High risk was determined by history of reading disability in at least 1 of the child's parents. In grade school, a reading evaluation identified 9 children within the high-risk group as having reading disability and 9 children as not having reading disability. The 10 children at low risk for reading disability tested negative for reading disability.

RESULTS

Children with reading disability showed a significantly slower speaking rate than children at high risk without reading disability. Children with reading disability allocated significantly more time to pausing, as compared with the other groups. Articulation rate did not differ significantly across groups.

CONCLUSIONS

Speaking rate and the proportion of pausing time to speaking time may provide an early indication of reading outcome in children at high risk for reading disability.

Auditory processing disorder (APD)-potential contribution of mouse research

APD is a common, heterogeneous and poorly understood listening impairment that is receiving increasing recognition, especially in children and the elderly. The primary symptom in humans is poor speech perception despite normal pure tone audiometry. Diagnostic practice is patchy, but current proposals are to distinguish APD by reduced ability to detect, discriminate, localize and order non-speech sounds. APD appears to result predominantly from core malfunctioning of the central auditory system, but with strong cognitive influences and possible additional influences from peripheral auditory and crossmodal sources. APD may be acquired (e.g. through middle ear disease), but it is likely that a more common etiology would involve both environmental and inherited contributions. Mice are increasingly being used for studies of central auditory processing. Most work to date has documented the basic response properties of auditory neurons, or used single gene mutations to investigate specific functions. For high throughput, primary screening, reflex and/or event-related potential measures are required. Pre-pulse inhibition (PPI), the regulation of an acoustic startle reflex by a preceding sound having distinct spatial, temporal or spectral properties, is one way in which auditory processing may be screened. For secondary assessment, standard psychoacoustic tests for mice have been developed.

Normative data for modified Thorington phorias and prism bar vergences from the Benton-IU study

BACKGROUND

The use of a phoropter for measuring phorias and vergences in children is common in the optometric profession. For young children, the use of the phoropter can be confusing, making it difficult to obtain accurate measurements. Free space testing allows for direct observation of the eyes in a natural environment and is easier for children to understand the directions. The normal values for phorias and vergences used with children are derived from testing with a phoropter or free space measurements with mostly adult patients.

METHODS

The Benton-IU Project was a large multidisciplinary study of factors affecting school performance conducted by the Indiana University School of Optometry and the Indiana University Department of Speech and Hearing with the cooperation of the Benton Community School Corporation (Benton County, Indiana). This project allowed the authors to obtain data on modified Thorington phorias and prism bar vergences from a nonselected group of first and fourth graders as part of an eye/vision examination.

RESULTS

In this report, central tendency and variability statistics for modified Thorington and prism bar vergences are reported based on the data from the Benton-IU Study.

CONCLUSION

The data presented in this report can be used by optometrists when deciding if the patient's phorias and vergences are within normal limits for children in the first through fourth grades.

Nonmodularity of the Central Auditory Nervous System

This response to A. T. Cacace and D. J. McFarland (2005) identifies points of agreement and disagreement regarding the concept of modularity in the diagnosis of (central) auditory processing disorder [(C)APD]. We concur that the evaluation of (C)APD must take into consideration the influence of higher order global or pansensory issues on performance on tests of central auditory function. To accomplish this goal, multidisciplinary (e.g., multimodal) testing is an integral part of differential diagnosis of (C)APD. We also agree that the efficiency of diagnostic tests of (C)APD should not be evaluated by imprecise criteria [e.g., "presumed" or "suspected" (C)APD], which do not provide accurate measures of the true sensitivity and specificity of these tests. Our conceptualization and recommendations for clinical practice in this area diverge, however, from that of Cacace and McFarland in a number of pivotal ways. Based on the current limitations of multimodal assessment relative to issues related to scope of practice and test efficiency, as well as the accumulated basic science and clinical literature that demonstrates the nonmodularity and interactive organization of the brain, we recommend use of the sensitized test battery of the central auditory nervous system (CANS) in combination with multidisciplinary testing to differentially diagnose (C)APD and to guide treatment of the disorder. We assert that sensitivity and specificity measures derived from individuals with well-circumscribed lesions of the CANS provide an important guide to establishing the validity of central auditory diagnostic tests. We note that researchers in the area of auditory science and (C)APD must acknowledge the challenges of the clinical arena, and we encourage their continued help to develop diagnostic tools that are both efficient and practical for the differential diagnosis of (C)APD. We conclude that our approach, which combines multidisciplinary evaluation and specific tests of central auditory function that have demonstrated sensitivity and specificity for disorders of the CANS, allows us to identify (and thus rehabilitate) the auditory deficits present in individuals with (C)APD in its "purest" form. It also permits the identification and rehabilitation of auditory deficits in individuals who exhibit auditory perceptual problems that coexist with other processing problems, while ruling out those who perform poorly on auditory tests because of a global, supramodal problem involving cognition, attention, language, memory, or related skills.

Visual perceptual skills in children born with very low birth weights

INTRODUCTION

A disproportionate number of very low birth weight (VLBW; < or =1500 g) children require special education services and have school-related problems even when they are free from major disabilities and have average intelligence quotient scores. Visual-perceptual problems have been suggested as contributors to deficits in academic performance, but few data are available describing specific visual-perceptual problems. This study was designed to identify specific visual-perceptual skills in VLBW children.

METHOD

Participants were 92 VLBW children aged 4 through 5 years who were free from major disability and appropriate for gestational age at birth. The Test of Visual-Perceptual Skills (non-motor)-Revised was used.

RESULTS

Despite intelligent quotient scores in the average range, the majority (63% to 78.3%) of the children performed below age level on all seven subscales of a normed assessment of visual perceptual skills.

DISCUSSION

Results suggest that visual perceptual screening should be considered as a part of routine evaluations of preschool-aged children born prematurely. Early identification of specific deficits could lead to interventions to improve achievement trajectories for these high-risk children.