Processamento auditivo (central) em crianças com dislexia: avaliação comportamental e eletrofisiológica

Mismatch negativity in children with developmental Dyslexia

OBJECTIVE

To describe and compare the latencies and amplitudes of Mismatch Negativity between children with and without Developmental Dyslexia.

METHODS

Cross-sectional and comparative study, consisting of a study group of 52 children with Developmental Dyslexia and a control group of 52 children with typical development, matched by age and sex, aged between 9 years and 11 years and 11 months of both sexes. All participants underwent Otoscopy, Acoustic Immittance Measurements, Pure Tone Audiometry, Speech Audiometry, Brainstem Auditory Evoked Potential and Mismatch Negativity.

RESULTS

It was verified a statistically significant difference when comparing Mismatch Negativity latencies between the groups, with higher values for children with Developmental Dyslexia (p = 0.012). However, there was no statistically significant difference in Mismatch Negativity amplitudes between the groups studied.

CONCLUSION

The results suggest that children with Developmental Dyslexia may present difficulties in auditory processing and discrimination skills compared to children with typical development.

Discriminatory Brain Processes of Native and Foreign Language in Children with and without Reading Difficulties

The association between impaired speech perception and reading difficulty has been well established in native language processing, as can be observed from brain activity. However, there has been scarce investigation of whether this association extends to brain activity during foreign language processing. The relationship between reading skills and neuronal speech representation of foreign language remains unclear. In the present study, we used event-related potentials (ERPs) with high-density EEG to investigate this question. Eleven- to 13-year-old children typically developed (CTR) or with reading difficulties (RD) were tested via a passive auditory oddball paradigm containing native (Finnish) and foreign (English) speech items. The change-detection-related ERP responses, the mismatch response (MMR), and the late discriminative negativity (LDN) were studied. The cluster-based permutation tests within and between groups were performed. The results showed an apparent language effect. In the CTR group, we found an atypical MMR in the foreign language processing and a larger LDN response for speech items containing a diphthong in both languages. In the RD group, we found unstable MMR with lower amplitude and a nonsignificant LDN response. A deficit in the LDN response in both languages was found within the RD group analysis. Moreover, we observed larger brain responses in the RD group and a hemispheric polarity reversal compared to the CTR group responses. Our results provide new evidence that language processing differed between the CTR and RD groups in early and late discriminatory responses and that language processing is linked to reading skills in both native and foreign language contexts.

Post-Attentive Integration and Topographic Map Distribution During Audiovisual Processing in Dyslexia: A P300 Event-Related Component Analysis

Background

Research on audiovisual post-attentive integration has been carried out using a variety of experimental paradigms and experimental groups but not yet studied in dyslexia. We investigated post-attentive integration and topographic voltage distribution in children with dyslexia by analysing the P300 event-related potential (ERP) component.

Methods

We used a 128-child ERP net for the ERP experiment. Two types of stimuli were presented as either congruent or incongruent stimuli. Congruent stimuli included a matching auditory sound with an animal image, whereas incongruent stimuli included unmatched animal sounds. A total of 24 age-matched children were recruited in the control (n = 12) and dyslexia (n = 12) groups. Children pressed button ‘1’ or ‘2’ when presented with congruent or incongruent stimuli, respectively. The P300 amplitudes and latencies with topographic voltage distribution were analysed for both groups.

Results

The dyslexia group evoked significantly higher P300 amplitudes at the T4 area than the control group. No significant differences were found in cases of P300 latency. Moreover, the dyslexia group demonstrated a higher intensity of P300 voltage distribution in the right parietal and left occipital areas than the control group.

Conclusion

Post-attentive integration for children with dyslexia is higher and that this integration process implicated the parietal and occipital areas.

Cortical Auditory Evoked Potentials in 2-Year-Old Subjects

Introduction  Cortical auditory evoked potentials (CAEPs) can be used to evaluate both peripheral and cortical components of auditory function, and contribute to the assessment of functional sensitivity and auditory thresholds, especially in neonates and infants. Auditory evoked potentials reflect auditory maturity and precede the acquisition of more complex auditory and cognitive skills, and are therefore crucial for speech and language development.

Objective  The aim of the present study was to determine the presence, latency and amplitude of CAEP components in response to verbal stimuli in children aged 2 years old.

Methods  The sample consisted of 19 subjects, 10 of whom were male while 9 were female. All of the participants were 24 months old at the time of assessment.

Results  A total of 17 of the participants displayed all components of the CAEP. Additionally, no significant differences were observed between genders or ears in the present sample. The presence of all components of the CAEP in subjects aged 2 years old confirms the existence of a critical period for the maturation of auditory pathways in the first 2 years of life.

Conclusion  In the present study, in addition to the P1/N1 components, it was possible to observe the presence of the CAEP P2/N2 components in individuals aged 24 months, confirming the existence of a critical period for the maturation of the auditory pathways in the first 2 years of life.

Transcranial Static Magnetic Field Stimulation Over the Temporal Cortex Modulating the Right Ear Advantage in Dichotic Listening

OBJECTIVE

Transcranial static magnetic field stimulation (tSMS) has proposed a new, promising, and simple non-invasive brain stimulation method. While several studies gained certain evidence about tSMS effects in the motor, somatosensory, and visual domains, there is still a controversial debate about its general effectiveness. In the present study, we investigated potential tSMS effects on auditory speech processing as measured by a dichotic listening (DL) task.

MATERIALS AND METHODS

Fifteen healthy participants received in randomized order on three different days one session of either sham, tSMS over the left, or tSMS over the right auditory cortex (AC). Under stimulation, participants performed a standard DL task with consonant-vowel syllables. Simultaneously, we recorded electroencephalogram from central sites (Fz, Cz, Pz).

RESULTS

TSMS over the left AC changed the behavioral performance and modulated auditory evoked potentials. Stimulation of the left AC significantly reduced the right ear advantage during the DL task and the N1 component of auditory evoked potentials in response to these syllables.

CONCLUSIONS

The preliminary results of the present exploratory study demonstrate the ability of tSMS to modulate human brain activity on a behavioral as well as physiologic level. Furthermore, tSMS effects on acoustic processing may have clinical implications by fostering potential approaches for a treatment of speech-related pathologies associated with hyperexcitability in the AC.

Procedures for central auditory processing screening in schoolchildren

INTRODUCTION

Central auditory processing screening in schoolchildren has led to debates in literature, both regarding the protocol to be used and the importance of actions aimed at prevention and promotion of auditory health. Defining effective screening procedures for central auditory processing is a challenge in Audiology.

OBJECTIVE

This study aimed to analyze the scientific research on central auditory processing screening and discuss the effectiveness of the procedures utilized.

METHODS

A search was performed in the SciELO and PUBMed databases by two researchers. The descriptors used in Portuguese and English were: auditory processing, screening, hearing, auditory perception, children, auditory tests and their respective terms in Portuguese.

INCLUSION CRITERIA

original articles involving schoolchildren, auditory screening of central auditory skills and articles in Portuguese or English.

EXCLUSION CRITERIA

studies with adult and/or neonatal populations, peripheral auditory screening only, and duplicate articles. After applying the described criteria, 11 articles were included.

RESULTS

At the international level, central auditory processing screening methods used were: screening test for auditory processing disorder and its revised version, screening test for auditory processing, scale of auditory behaviors, children's auditory performance scale and Feather Squadron. In the Brazilian scenario, the procedures used were the simplified auditory processing assessment and Zaidan's battery of tests.

CONCLUSION

At the international level, the screening test for auditory processing and Feather Squadron batteries stand out as the most comprehensive evaluation of hearing skills. At the national level, there is a paucity of studies that use methods evaluating more than four skills, and are normalized by age group. The use of simplified auditory processing assessment and questionnaires can be complementary in the search for an easy access and low-cost alternative in the auditory screening of Brazilian schoolchildren. Interactive tools should be proposed, that allow the selection of as many hearing skills as possible, validated by comparison with the battery of tests used in the diagnosis.

Quality of life of children with poor school performance: association with hearing abilities and behavioral issues

The aim of the present study was to investigate the quality of life of children with poor school performance and its association with behavioral aspects and hearing abilities.

METHODS

This cross-sectional observational study, developed in a town in the state of Minas Gerais, Brazil, investigated a random sample of public school children, aged 7-12 years old, who performed poorly in school and received specialized educational assistance. The study comprised two stages: 1) collection of data from parents on their children's health, educational, and socioeconomic profile, and from the Strengths and Difficulties Questionnaire; 2) administration of a quality of life evaluation scale to the schoolchildren. For the assessment of auditory function, transient otoacoustic emissions were used and auditory processing was tested. The following tests were used: verbal sequential memory, nonverbal sequential memory, sound localization, dichotic digits, duration pattern test (flute) and random gap detection. The collected data were analyzed using Excel and STATA 11.0 software. Quality of life was considered the response variable. The explanatory variables were grouped for univariate and multivariate logistic regression analysis with the level of significance set at 5%.

RESULTS

A statistically significant association was found between impaired quality of life, altered pro-social behavior, and the absence of parental complaints about the children's written language development.

CONCLUSIONS

Quality of life is impaired in children with poor school performance. The lack of parental complaints about written language and changes in social behavior increased the likelihood of a child having a poor quality of life.

P300 development from infancy to adolescence

This article provides an overview of P300 research from infancy through adolescence. First, a brief historical overview is provided highlighting seminal studies that began exploration of the P300 component in developmental groups. Overall, these studies suggest that the P300 can be detected in children and appears to reflect similar cognitive processes to those in adults; however, it is significantly delayed in its latency to peak. Second, two striking findings from developmental research are the lack of a clear P300 component in infancy and differential electrophysiological responses to novel, unexpected stimuli in children, adolescents, and adults. Third, contemporary questions are described, which include P300-like components in infancy, alteration of P300 in atypically developing groups, relations between P300 and behavior, individual differences of P300, and neural substrates of P300 across development. Finally, we conclude with comments regarding the power of a developmental perspective and suggestions for important issues that should be addressed in the next 50 years of P300 research.

Questionnaires and checklists for central auditory processing screening used in Brazil: a systematic review

Introduction

The action of listening involves a complex interaction between the peripheral and central auditory systems. Central auditory processing disorder can be described as any problem in one or more auditory abilities. Literature reports that behavioral questionnaires and checklists can be applied to screen individuals at risk for central auditory processing disorder.

Objective

To identify and analyze in the national literature questionnaires and checklists for the screening of central auditory processing available in Brazil for the Portuguese language.

Methods

The research was carried out in electronic databases and “gray literature”. The search strategy was: “questionnaires OR surveys and questionnaires AND auditory OR hearing tests OR auditory perception AND Brazil”. The research was carried out between June and August of 2017. Study selection followed inclusion and exclusion criteria. The criteria adopted included Brazilian studies, without date and design restriction, that were carried out, translated, adapted and/or validated to Brazilian Portuguese or European Portuguese, as tools for central auditory processing screening. International studies that were not adapted to the Portuguese language were excluded, as well as the ones that were not available in full.

Results

A total of 3664 publications were found and seven articles were selected for this systematic review, according to the established criteria.

Conclusions

There is scarce national literature for central auditory processing screening and the only tool validated to Brazilian Portuguese, published as a monograph, is the auditory processing domains questionnaire. It is suggested that new studies with greater methodological stringency related to the processes of tool adaptation and validation be developed and published in the usual scientific databases, aiming at greater diffusion and clinical applicability.

P300 event-related potentials in children with dyslexia

To elucidate the timing and the nature of neural disturbances in dyslexia and to further understand the topographical distribution of these, we examined entire brain regions employing the non-invasive auditory oddball P300 paradigm in children with dyslexia and neurotypical controls. Our findings revealed abnormalities for the dyslexia group in (i) P300 latency, globally, but greatest in frontal brain regions and (ii) decreased P300 amplitude confined to the central brain regions (Fig. 1). These findings reflect abnormalities associated with a diminished capacity to process mental workload as well as delayed processing of this information in children with dyslexia. Furthermore, the topographical distribution of these findings suggests a distinct spatial distribution for the observed P300 abnormalities. This information may be useful in future therapeutic or brain stimulation intervention trials.

Resolução temporal e potenciais corticais em diferentes níveis de proficiência da língua inglesa

RESUMO Objetivos: investigar e comparar as habilidades auditivas entre normo-ouvintes bilíngues estudantes de diferentes níveis de proficiência do inglês por meio de teste comportamental e eletrofisiológico. Métodos: este estudo tem caráter descritivo, quantitativo e transversal. A amostra foi composta por 39 sujeitos (alunos de escolas de idiomas: 13 no nível avançado (GA); 13 no nível intermediário (GI); 13 no nível básico (GB)), com idade entre 18 a 35 anos, limiares auditivos tonais dentro dos limites da normalidade e sem queixas de habilidades de processamento auditivo. Foram submetidos aos testes comportamentais: teste de detecção de gap (RGDT); e ao teste eletrofisiológico potencial evocado auditivo de longa latência (PEALL), com estímulos verbais (sílabas /ba/ - frequente - e /di/ - raro) Resultados: verificou-se diferença estatisticamente significante entre as orelhas para: o GB, para a amplitude de N1 e P2, com maiores valores para a orelha esquerda; o GI, para a amplitude de P1, N1 e P2, com maiores valores para a orelha esquerda, o GA, para a latência do componente N1, com maiores valores para a orelha esquerda, e, para as amplitudes dos componentes P2, N2 e P3, com maiores valores para a orelha esquerda. Entre os grupos, o teste RGDT mostrou menores valores para GA e para latência do componente N1, com maiores valores para o GB. Conclusões: pode-se concluir que o nível de proficiência avançado da língua inglesa estimula a velocidade de conexões neurais desencadeando a ocorrência mais rápida do potencial N1, assim a habilidade de resolução temporal é significantemente melhor à medida que o tempo de estudo aumenta.

Temporal auditory aspects in children with poor school performance and associated factors

PURPOSE

To investigate the auditory temporal aspects in children with poor school performance aged 7-12 years and their association with behavioral aspects, health perception, school and health profiles, and sociodemographic factors.

METHODS

This is an observational, analytical, transversal study including 89 children with poor school performance aged 7-12 years enrolled in the municipal public schools of a municipality in Minas Gerais state, participants of Specialized Educational Assistance. The first stage of the study was conducted with the subjects' parents aiming to collect information on sociodemographic aspects, health profile, and educational records. In addition, the parents responded to the Strengths and Difficulties Questionnaire (SDQ). The second stage was conducted with the children in order to investigate their health self-perception and analyze the auditory assessment, which consisted of meatoscopy, Transient Otoacoustic Emissions, and tests that evaluated the aspects of simple auditory temporal ordering and auditory temporal resolution. Tests assessing the temporal aspects of auditory temporal processing were considered as response variables, and the explanatory variables were grouped for univariate and multivariate logistic regression analyses. The level of significance was set at 5%.

RESULTS

Significant statistical correlation was found between the auditory temporal aspects and the variables age, gender, presence of repetition, and health self-perception.

CONCLUSION

Children with poor school performance presented changes in the auditory temporal aspects. The temporal abilities assessed suggest association with different factors such as maturational process, health self-perception, and school records.

Systematic Review of the Effectiveness of Frequency Modulation Devices in Improving Academic Outcomes in Children With Auditory Processing Difficulties

This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children's ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting.

Alterações de linguagem e processamento auditivo: revisão de literatura

RESUMO Há interdependência entre os processos auditivos e de linguagem, e o bom desempenho de um deles contribui para o adequado funcionamento do outro. O objetivo do presente artigo foi realizar uma revisão de literatura baseada em estudos nacionais e internacionais de forma sistemática. Tal revisão buscou verificar a relação entre alterações do processamento auditivo e alterações de linguagem. A pesquisa bibliográfica utilizou como bases de dados Pubmed e Web of Science, no período de maio a junho de 2014. Os critérios de inclusão utilizados foram: artigos que respondiam à pergunta norteadora e atendiam à temática estabelecida pelos descritores. Excluíram-se os estudos com animais, laboratoriais, artigos de opinião/autoridade, série de caso e relato de caso. A escolha dos artigos se deu por meio de um protocolo criado para a elaboração do presente estudo. Para isto, utilizaram-se os seguintes aspectos: autor, ano, local, delineamento, amostra, faixa etária, testes utilizados e resultados. A busca realizada por meio de descritores e termos livres revelou 259 artigos nas bases de dados pré-estabelecidas. Na Pubmed a pesquisa resultou em 187 estudos e 67 na Web of Science. Do total, 161 foram excluídos pelo título e resumo e 36 pela leitura do texto completo. Isso possibilitou a análise de 11 artigos. Foi observado que crianças com prejuízos no desenvolvimento linguístico apresentaram desempenho inferior nos testes auditivos, quando comparadas àquelas com desenvolvimento típico.

Impact of Educational Level on Performance on Auditory Processing Tests

Research has demonstrated that a higher level of education is associated with better performance on cognitive tests among middle-aged and elderly people. However, the effects of education on auditory processing skills have not yet been evaluated. Previous demonstrations of sensory-cognitive interactions in the aging process indicate the potential importance of this topic. Therefore, the primary purpose of this study was to investigate the performance of middle-aged and elderly people with different levels of formal education on auditory processing tests. A total of 177 adults with no evidence of cognitive, psychological or neurological conditions took part in the research. The participants completed a series of auditory assessments, including dichotic digit, frequency pattern and speech-in-noise tests. A working memory test was also performed to investigate the extent to which auditory processing and cognitive performance were associated. The results demonstrated positive but weak correlations between years of schooling and performance on all of the tests applied. The factor “years of schooling” was also one of the best predictors of frequency pattern and speech-in-noise test performance. Additionally, performance on the working memory, frequency pattern and dichotic digit tests was also correlated, suggesting that the influence of educational level on auditory processing performance might be associated with the cognitive demand of the auditory processing tests rather than auditory sensory aspects itself. Longitudinal research is required to investigate the causal relationship between educational level and auditory processing skills.

Potencial evocado auditivo de longa latência: diferenças na forma de contagem do estímulo raro

RESUMO Objetivo: identificar se existe diferença nos achados do Potencial Evocado Auditivo de Longa Latência em relação à latência e amplitude, em diferentes modos de contagem do estimulo raro, sendo contando mentalmente ou marcando no papel (sem memorizar). Métodos: esse estudo teve caráter prospectivo e transversal. A amostra foi composta por conveniência sendo constituída por 49 indivíduos, sendo 29 do gênero feminino e 20 do gênero masculino. Foram realizados os seguintes procedimentos: Inspeção Visual do Meato Acústico Externo, Audiometria Tonal Liminar, Medidas de Imitância Acústica e Potencial Evocado Auditivo de Longa Latência, o qual foi realizado duas vezes, uma após a outra, com os indivíduos atentando ao estímulo raro, começando sempre contando mentalmente e após marcando em um papel. Resultados: houve diferença estatisticamente significante entre as orelhas para as latências de P1, P2 e amplitude de N1 para o método de marcação no papel, da latência de N1 para o método de contagem mental dos estímulos raros, e da amplitude de P2 em ambos os métodos, porém com todos os valores dentro da faixa de normalidade. Além disso, a diferença estatisticamente significante também foi evidente na comparação entre os gêneros, sendo encontrados valores de latência maiores de P2 e N2 para o gênero masculino em ambos os métodos de contagem dos estímulos raros. A amplitude de P1, P2 e P3 foi menor no gênero masculino nas diferentes formas de contagem, sendo no P2 a diferença apenas no método contando mentalmente. Ao compararmos os métodos, houve diferença estatisticamente significante apenas para a latência de P2, a qual foi maior para o método marcando no papel. Conclusão: não houve diferença para as latências e amplitudes dos potenciais evocados auditivos de longa latência na comparação da contagem do estímulo raro (contando mentalmente e marcando no papel) para quase todos os potenciais, com exceção do potencial P2 em relação à latência e amplitude.

Fatores na infância e adolescência que podem influenciar o processamento auditivo: revisão sistemática

Resumo: Há consenso na literatura da importância do sistema auditivo para o desenvolvimento da linguagem oral e escrita. O Distúrbio do Processamento Auditivo refere-se à dificuldade no processamento de informações auditivas, não sendo devido à perda auditiva, nem ao déficit intelectual. O objetivo desta revisão sistemática da literatura foi analisar quais fatores ocorridos na infância e adolescência podem influenciar no processamento auditivo, não necessariamente sendo a causa ou consequência do distúrbio. Foram utilizadas as bases SciELO e PUBMed por duas pesquisadoras de forma independente. Os descritores utilizados foram: processamento auditivo; percepção auditiva; crianças; adolescentes, em combinações variadas. Dentre os 205 artigos identificados, 30 artigos corresponderam aos critérios de inclusão, sendo analisados. Apenas dois estudos demonstraram fatores positivos influenciando a habilidade do processamento auditivo: a influência da estimulação musical na infância e o uso de Metilfenidato, como tratamento doTranstorno de Déficit de Atenção e Hiperatividade. As influências são, em sua maioria, negativas ao processamento auditivo, destacando-se a relação do distúrbio com a dislexia, dificuldades escolares, distúrbio específico de linguagem, nível socioeconômico baixo, Transtorno de Déficit de Atenção e Hiperatividade, nascimento pré-termo, desvio fonológico, deficiência visual, respiração oral, gagueira, otite média, fissura labiopalatina, anemia, exposição ao mercúrio metálico, síndrome da apnéia/hipopnéiaobstrutiva do sono, acidente vascular cerebral, crianças em vulnerabilidade social e crianças disfônicas. O Processamento Auditivo mostra-se sensível as influências negativas de fatores ambientais, químicos, condições socioeconômicas, alterações de linguagem, auditivas, e neurológicas. A exposição à música e o uso de Metilfenidato foram os únicos fatores, com influência positiva nas habilidades do processamento auditivo.

Auditory evoked potential: a proposal for further evaluation in children with learning disabilities

The information presented in this paper demonstrates the author’s experience in previews cross-sectional studies conducted in Brazil, in comparison with the current literature. Over the last 10 years, auditory evoked potential (AEP) has been used in children with learning disabilities. This method is critical to analyze the quality of the processing in time and indicates the specific neural demands and circuits of the sensorial and cognitive process in this clinical population. Some studies with children with dyslexia and learning disabilities were shown here to illustrate the use of AEP in this population.