Central auditory processing ability in children with ADHD with and without learning disabilities

Auditory P3a response to native and foreign speech in children with or without attentional deficit

The aim of this study was to investigate the attentional mechanism in speech processing of native and foreign language in children with and without attentional deficit. For this purpose, the P3a component, cognitive neuromarker of the attentional processes, was investigated in a two-sequence two-deviant oddball paradigm using Finnish and English speech items via event-related potentials (ERP) technique. The difference waves reflected the temporal brain dynamics of the P3a response in native and foreign language contexts. Cluster-based permutation tests evaluated the group differences over the P3a time window. A correlation analysis was conducted between the P3a response and the attention score (ATTEX) to evaluate whether the behavioral assessment reflected the neural activity. The source reconstruction method (CLARA) was used to investigate the neural origins of the attentional differences between groups and conditions. The ERP results showed a larger P3a response in the group of children with attentional problems (AP) compared to controls (CTR). The P3a response differed statistically between the two groups in the native language processing, but not in the foreign language. The ATTEX score correlated with the P3a amplitude in the native language contrasts. The correlation analyses hint at some hemispheric brain activity difference in the frontal area. The group-level CLARA reconstruction showed activation in the speech perception and attention networks over the frontal, parietal, and temporal areas. Differences in activations of these networks were found between the groups and conditions, with the AP group showing higher activity in the source level, being the origin of the ERP enhancement observed on the scalp level.

Listen up! ADHD slows spoken-word processing in adverse listening conditions: Evidence from eye movements

BACKGROUND

Cognitive skills such as sustained attention, inhibition and working memory are essential for speech processing, yet are often impaired in people with ADHD. Offline measures have indicated difficulties in speech recognition on multi-talker babble (MTB) background for young adults with ADHD (yaADHD). However, to-date no study has directly tested online speech processing in adverse conditions for yaADHD.

AIMS

Gauging the effects of ADHD on segregating the spoken target-word from its sound-sharing competitor, in MTB and working-memory (WM) load.

METHODS AND PROCEDURES

Twenty-four yaADHD and 22 matched controls that differ in sustained attention (SA) but not in WM were asked to follow spoken instructions presented on MTB to touch a named object, while retaining one (low-load) or four (high-load) digit/s for later recall. Their eye fixations were tracked.

OUTCOMES AND RESULTS

In the high-load condition, speech processing was less accurate and slowed by 140ms for yaADHD. In the low-load condition, the processing advantage shifted from early perceptual to later cognitive stages. Fixation transitions (hesitations) were inflated for yaADHD.

CONCLUSIONS AND IMPLICATIONS

ADHD slows speech processing in adverse listening conditions and increases hesitation, as speech unfolds in time. These effects, detected only by online eyetracking, relate to attentional difficulties. We suggest online speech processing as a novel purview on ADHD. WHAT THIS PAPER ADDS?: We suggest speech processing in adverse listening conditions as a novel vantage point on ADHD. Successful speech recognition in noise is essential for performance across daily settings: academic, employment and social interactions. It involves several executive functions, such as inhibition and sustained attention. Impaired performance in these functions is characteristic of ADHD. However, to date there is only scant research on speech processing in ADHD. The current study is the first to investigate online speech processing as the word unfolds in time using eyetracking for young adults with ADHD (yaADHD). This method uncovered slower speech processing in multi-talker babble noise for yaADHD compared to matched controls. The performance of yaADHD indicated increased hesitation between the spoken word and sound-sharing alternatives (e.g., CANdle-CANdy). These delays and hesitations, on the single word level, could accumulate in continuous speech to significantly impair communication in ADHD, with severe implications on their quality of life and academic success. Interestingly, whereas yaADHD and controls were matched on WM standardized tests, WM load appears to affect speech processing for yaADHD more than for controls. This suggests that ADHD may lead to inefficient deployment of WM resources that may not be detected when WM is tested alone. Note that these intricate differences could not be detected using traditional offline accuracy measures, further supporting the use of eyetracking in speech tasks. Finally, communication is vital for active living and wellbeing. We suggest paying attention to speech processing in ADHD in treatment and when considering accessibility and inclusion.

Compromised word-level neural tracking in the high-gamma band for children with attention deficit hyperactivity disorder

Children with attention deficit hyperactivity disorder (ADHD) exhibit pervasive difficulties in speech perception. Given that speech processing involves both acoustic and linguistic stages, it remains unclear which stage of speech processing is impaired in children with ADHD. To investigate this issue, we measured neural tracking of speech at syllable and word levels using electroencephalography (EEG), and evaluated the relationship between neural responses and ADHD symptoms in 6-8 years old children. Twenty-three children participated in the current study, and their ADHD symptoms were assessed with SNAP-IV questionnaires. In the experiment, the children listened to hierarchical speech sequences in which syllables and words were, respectively, repeated at 2.5 and 1.25 Hz. Using frequency domain analyses, reliable neural tracking of syllables and words was observed in both the low-frequency band (<4 Hz) and the high-gamma band (70-160 Hz). However, the neural tracking of words in the high-gamma band showed an anti-correlation with the ADHD symptom scores of the children. These results indicate that ADHD prominently impairs cortical encoding of linguistic information (e.g., words) in speech perception.

Remote Microphone Technology for Children with Hearing Loss or Auditory Processing Issues

School classrooms are noisy and reverberant environments, and the poor acoustics can be a barrier to successful learning in children, particularly those with multiple disabilities, auditory processing issues, and hearing loss. A new set of listening challenges have been imposed by the recent global pandemic and subsequent online learning requirements. The goal of this article is to review the impact of poor acoustics on the performance of children with auditory processing issues, mild hearing loss, and unilateral hearing loss. In addition, we will summarize the evidence in support of remote microphone technology by these populations.

Attentional modulation of neural entrainment to sound streams in children with and without ADHD

To extract meaningful information from complex auditory scenes like a noisy playground, rock concert, or classroom, children can direct attention to different sound streams. One means of accomplishing this might be to align neural activity with the temporal structure of a target stream, such as a specific talker or melody. However, this may be more difficult for children with ADHD, who can struggle with accurately perceiving and producing temporal intervals. In this EEG study, we found that school-aged children's attention to one of two temporally-interleaved isochronous tone 'melodies' was linked to an increase in phase-locking at the melody's rate, and a shift in neural phase that aligned the neural responses with the attended tone stream. Children's attention task performance and neural phase alignment with the attended melody were linked to performance on temporal production tasks, suggesting that children with more robust control over motor timing were better able to direct attention to the time points associated with the target melody. Finally, we found that although children with ADHD performed less accurately on the tonal attention task than typically developing children, they showed the same degree of attentional modulation of phase locking and neural phase shifts, suggesting that children with ADHD may have difficulty with attentional engagement rather than attentional selection.

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.

Auditory Lateralization Training Effects on Binaural Interaction Component of Middle Latency Response in Children Suspected to Central Auditory Processing Disorder

Many children with central auditory processing disorder (C)APD suffer from spatial processing disorder and benefit from binaural processing training including auditory lateralization training. There are subjective tests for evaluating auditory training effects in children with (C)APD but they rely on patient's attention and cooperation so there is a need for appropriate objective tests. The aim of present study was investigating effects of auditory lateralization training on binaural interaction component (BIC) of middle latency response (MLR). This study was an analytical interventional study. Sixty children suspected to (C)APD (40 boys and 20 girls) were selected based on inclusion criteria and were divided into two groups: control and training group. Auditory lateralization training included 12 formal sessions under headphone by using interaural time difference and performed as a game. MLR (monaural right ear, monaural left ear and binaural) and monaural selective auditory attention test (mSAAT) tests were performed in all the cases. BIC was calculated by subtracting binaural response from summed monaural responses. Covariance test showed that BIC latency decreased and BIC amplitude increased significantly and mSAAT score increased significantly in training group after auditory lateralization training (p value ≤ 0.001). In present study BIC of MLR had potential to show underlying neurophysiologic changes after auditory lateralization training in children suspected to (C)APD objectively. It is in agreement with behavioral improvements after training (mSAAT improvements).

Effects of an Auditory Lateralization Training in Children Suspected to Central Auditory Processing Disorder

Background and Objectives

Central auditory processing disorder [(C)APD] refers to a deficit in auditory stimuli processing in nervous system that is not due to higher-order language or cognitive factors. One of the problems in children with (C)APD is spatial difficulties which have been overlooked despite their significance. Localization is an auditory ability to detect sound sources in space and can help to differentiate between the desired speech from other simultaneous sound sources. Aim of this research was investigating effects of an auditory lateralization training on speech perception in presence of noise/competing signals in children suspected to (C)APD.

Subjects and Methods

In this analytical interventional study, 60 children suspected to (C)APD were selected based on multiple auditory processing assessment subtests. They were randomly divided into two groups: control (mean age 9.07) and training groups (mean age 9.00). Training program consisted of detection and pointing to sound sources delivered with interaural time differences under headphones for 12 formal sessions (6 weeks). Spatial word recognition score (WRS) and monaural selective auditory attention test (mSAAT) were used to follow the auditory lateralization training effects.

Results

This study showed that in the training group, mSAAT score and spatial WRS in noise (p value≤0.001) improved significantly after the auditory lateralization training.

Conclusions

We used auditory lateralization training for 6 weeks and showed that auditory lateralization can improve speech understanding in noise significantly. The generalization of this results needs further researches.

Neural Biomarkers for Dyslexia, ADHD, and ADD in the Auditory Cortex of Children

Dyslexia, attention deficit hyperactivity disorder (ADHD), and attention deficit disorder (ADD) show distinct clinical profiles that may include auditory and language-related impairments. Currently, an objective brain-based diagnosis of these developmental disorders is still unavailable. We investigated the neuro-auditory systems of dyslexic, ADHD, ADD, and age-matched control children (N = 147) using neuroimaging, magnetencephalography and psychoacoustics. All disorder subgroups exhibited an oversized left planum temporale and an abnormal interhemispheric asynchrony (10–40 ms) of the primary auditory evoked P1-response. Considering right auditory cortex morphology, bilateral P1 source waveform shapes, and auditory performance, the three disorder subgroups could be reliably differentiated with outstanding accuracies of 89–98%. We therefore for the first time provide differential biomarkers for a brain-based diagnosis of dyslexia, ADHD, and ADD. The method allowed not only allowed for clear discrimination between two subtypes of attentional disorders (ADHD and ADD), a topic controversially discussed for decades in the scientific community, but also revealed the potential for objectively identifying comorbid cases. Noteworthy, in children playing a musical instrument, after three and a half years of training the observed interhemispheric asynchronies were reduced by about 2/3, thus suggesting a strong beneficial influence of music experience on brain development. These findings might have far-reaching implications for both research and practice and enable a profound understanding of the brain-related etiology, diagnosis, and musically based therapy of common auditory-related developmental disorders and learning disabilities.

[Minimal cerebral dysfunctions and ADHD in adulthood]

Attention deficit hyperactivity disorder (ADHD) is of great importance not only in children but also in adults; however, despite extensive research there are still many unsolved questions with respect to the diagnosis. Patients not only suffer from attention deficits and hyperactivity but also a variety of other problems, such as dyspraxia, problems with stimulus discrimination, dysgrammatism, legasthenia, or motor coordination problems. Furthermore, there are also psychopathological disorders, such as problems with memory, formal thinking, emotional modulation, drive and vegetative stability, in the sense of a psycho-organic syndrome. Such syndromes have long been known in psychiatry under terms, such as complex capacity disorders, minimal cerebral dysfunction (MCD), minimal brain dysfunction (MBD), mild psycho-organic syndrome, psycho-organic axis syndrome, mild cognitive impairment, developmental disorder and developmental biological syndrome. Etiological data with respect to genetics and early childhood brain trauma support the notion of a psychobiological disorder for complex cerebral dysfunction in the sense of a psycho-organic syndrome. Depending on the individual life and work situation, these additional symptoms of ADHD are in many cases of greater relevance for life adjustment than the core symptoms, depending on the individual life and work situations. The concept of minimal cerebral dysfunction describes the ADHD problem better and has a direct bearing on the diagnosis, therapy and sociomedical care of the patients.

Sensory and motor secondary symptoms as indicators of brain vulnerability

In addition to the primary symptoms that distinguish one disorder from the next, clinicians have identified, yet largely overlooked, another set of symptoms that appear across many disorders, termed secondary symptoms. In the emerging era of systems neuroscience, which highlights that many disorders share common deficits in global network features, the nonspecific nature of secondary symptoms should attract attention. Herein we provide a scholarly review of the literature on a subset of secondary symptoms––sensory and motor. We demonstrate that their pattern of appearance––across a wide range of psychopathologies, much before the full-blown disorder appears, and in healthy individuals who display a variety of negative symptoms––resembles the pattern of appearance of network abnormalities. We propose that sensory and motor secondary symptoms can be important indicators of underlying network aberrations and thus of vulnerable brain states putting individuals at risk for psychopathology following extreme circumstances.

Personal FM systems for children with autism spectrum disorders (ASD) and/or attention-deficit hyperactivity disorder (ADHD): an initial investigation

The goal of this initial investigation was to examine the potential benefit of a frequency modulation (FM) system for 11 children diagnosed with autism spectrum disorders (ASD), attention-deficit hyperactivity disorder (ADHD), or both disorders through measures of speech recognition performance in noise, observed classroom behavior, and teacher-rated educational risk and listening behaviors. Use of the FM system resulted in significant average improvements in speech recognition in noise for the children with ASD and ADHD as well as large effect sizes. When compared to typically functioning peers, children with ASD and ADHD had significantly poorer average speech recognition performance in noise without the FM system but comparable average performance when the FM system was used. Similarly, classroom observations yielded a significant increase in on-task behaviors and large effect sizes when the FM system was in use during two separate trial periods. Although teacher ratings on questionnaires showed no significant improvement in the average level of educational risk of participants, they did indicate significant improvement in average listening behaviors during two trial periods with the FM system. Given the significantly better speech recognition in noise, increased on-task behaviors, and improved teacher ratings of listening behaviors with the FM system, these devices may be a viable option for children who have ASD and ADHD in the classroom. However, an individual evaluation including audiological testing and a functional evaluation in the child's primary learning environment will be necessary to determine the benefit of an FM system for a particular student.

LEARNING OUTCOMES

1. The reader will be able to describe the potential benefit of FM systems for children with ASD and/or ADHD. 2. The reader will be able to identify on-task versus off-task listening behaviors in children with ASD and/or ADHD. 3. The reader will be able to explain the components of a successful pre-fit education program that may be necessary prior to fitting an FM system in children with ASD.

Hearing abilities in children with dyslexia and attention deficit hyperactivity disorder

BACKGROUND

auditory processing and co-occurrence of pathologies.

AIM

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

METHOD

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

RESULTS

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

CONCLUSION

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

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.

Evidence review to investigate the support for subtypes of children with difficulty processing and integrating sensory information

We investigated the evidence for subtypes in children with difficulty processing and integrating sensory information. Fifty-seven articles were incorporated into a systematic literature review; only 4 articles provided direct evidence for subtypes. These studies did not provide a comprehensive assessment of all sensory functions and sensory-based motor functions (i.e., praxis) and included different diagnostic groups. Therefore, generalized conclusions about subtypes could not be drawn. The other 53 studies reviewed provided meaningful information about strengths and challenges that children with difficulty processing and integrating sensory information demonstrate, but these studies were limited in scope. A principal theme was the importance of conducting comprehensive assessments of sensory-based functions, including multiple measures of sensory integrative functions such as praxis, sensory modulation, and sensory discrimination in children and adolescents with various clinical disorders. In addition, more consistency in the use of specific assessment tools will allow for synthesis of data across studies.

Attention deficit/hyperactivity disorder: a review and update

Attention deficit/hyperactivity disorder (ADHD) is a prevalent, chronic, and pervasive childhood disorder characterized by developmentally inappropriate activity level, impulsivity, and inability to sustain attention and concentration. Core symptoms of the disorder are associated with impairment in multiple domains of functioning and often coexist with other psychiatric disorders, the most prevalent being oppositional defiant disorder, conduct disorder, depression, and anxiety disorders. Concerns have been expressed about the overdiagnosis of ADHD, an upsurge in prescription of stimulant medication, and wide variations in practice patterns related to diagnosis and treatment of children with ADHD among primary care providers. Clinical research and expert consensus guidelines over the past decade have increasingly clarified the most effective approaches to diagnosis and treatment of the disorder. Hence, the purpose of this article was to provide primary care providers with the most current, evidence-based information on the assessment and treatment of children with ADHD.

Can children with (central) auditory processing disorders ignore irrelevant sounds?

This study investigated the effects of irrelevant sounds on the serial recall performance of visually presented digits in a sample of children diagnosed with (central) auditory processing disorders [(C)APD] and age- and span-matched control groups. The irrelevant sounds used were samples of tones and speech. Memory performance was significantly disrupted in the presence of irrelevant sounds in all three groups of children. While irrelevant speech was more disruptive than irrelevant tones in the two control groups, children diagnosed with (C)APD did not show larger disruption from irrelevant speech compared to irrelevant tones. Children diagnosed with (C)APD appear to process speech differently from their typically developing peers, and this may be remediated with auditory training procedures and the placement of these children in smaller classes.

Attention-deficit/hyperactivity disorder: a neuropsychological perspective towards DSM-V

Neuropsychological methods and techniques have much to offer in the evaluation of the individual suspected as having Attention-Deficit/Hyperactivity Disorder (ADHD). After a review of the historical evolution of the ADHD concept, incidence and prevalence, and DSM-IV criteria for diagnosis, especially as regards omission related to gender differences, and other associated cultural, familial, socioenvironmental, and subject influences, this paper describes a number of dilemmas and obstacles encountered in clinical practice. Included are the confounds associated with the wide range of possible comorbidities, the insufficiency of current DSM-IV criteria, the emergence of subtype differentiation and its impact on diagnosis and treatment. The complex relationship between neuropsychological constructs and ADHD, and obstacles to valid assessment are also addressed. The complexities associated with a thorough ADHD evaluation are viewed within an impressive and expansive existing scientific framework and recommendations are made for future directions.

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

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

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.

Deciphering auditory processing disorders in children

APD is not a label for a unitary disease entity but rather a description of functional deficits [3]. It is a complex and heterogeneous group of auditory-specific disorders usually associated with a range of listening and learning deficits [3,4]. Underlying APD is a deficit observed in one or more of the auditory processes responsible for generating the auditory evoked potentials and the following behaviors: around localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal resolution, masking, integration, and ordering; auditory performance with competing acoustic signals; and auditory performance with degraded acoustic signals [2]. Comprehensive assessment is necessary for the accurate differential diagnosis of APD from other "look-alike" disorders, most notably ADHD and language processing disorders. Speech-language pathologists, psychologists, educators, and physicians contribute to this more comprehensive assessment. The primary role of otolaryngologists is to evaluate and treat peripheral hearing disorders, such as otitis media. Children with APDs may present to an otolaryngologist, thus requiring the physician to make appropriate referral for assessment and intervention. Currently, diagnosis of APD is based on the outcomes of behavioral tests, supplemented by electroacoustic measures and, to a lesser extent, by electrophysiologic measures [1]. Intervention for APD focuses on improving the quality of the acoustic signal and the listening environment, improving auditory skills, and enhancing utilization of metacognitive and language resources [2]. Additional controlled case studies and single-subject and group research designs are needed to ascertain systematically the relative efficacy of various treatment and management approaches.