5/8/2016 1 Hearing with Your Brain: Auditory Processing Disorder in Children Christine Rota-Donahue, PhD Lehman College of the City University of New York FLASHA, 2016 Disclosure • Employed by the City University of New York • Grant from the American Hearing Research Foundation • Author of several articles and presentations on auditory perception Introduction to Auditory Processing Detection Discrimination Identification Comprehension Vision Working memory Language Cognitive skills Attention Motivation Emotions
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5/8/2016
1
Hearing with Your Brain: Auditory Processing Disorder in Children
Christine Rota-Donahue, PhD
Lehman College of the City University of New York
FLASHA, 2016
Disclosure
• Employed by the City University of New York
• Grant from the American Hearing Research Foundation
• Author of several articles and presentations on auditory perception
Introduction to Auditory Processing
Detection
Discrimination
Identification
Comprehension
Vision
Working memoryLanguage
Cognitive skills
Attention
Motivation
Emotions
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Outline
Auditory skills development:
- Structural maturation
- Behavioral responses to sounds
Definition:
- How is Auditory Processing Disorder (APD) defined today?
- Behavioral and brain bases of APD
Assessment and Treatment of pediatric APD:
- Case presentation supporting a multidisciplinary approach
Ascending auditory pathways
Decussation of the auditory pathways
Image from Neuroreille.com
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posterior Superior Temporal Gyrus (pSTG)
Image from Wikipedia
Behavioral auditory milestones
Lynn Werner (2007)What do children hear? How auditory maturation affects speech perception
Images from Google Images
Stage 1: 0-6 months
Newborns and young infants• react to loud sounds • can discriminate between speech sounds• recognize voices However•representations of sound are coarser than adults' •elevated detection thresholds •ability to separate sounds of different frequencies is immature
• limited precision in representation of speech
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Stage 2: 6 months - 5 years
Young children
• show interest in sounds
• follow stories
However
• detection thresholds still elevated
• listen in broad band way
• difficulty listening in noisy environment until age 5
Stage 3: 6 years - adolescence
School-aged children
• have mastered selective listening
• speech perception becomes automatic
However• less consistent than adults in categorization of speech
sounds.
• need multiple cues to identify phonemes
• requires attention
Models of speech perception
• Traditional models
• More recent model
Picture from Google Images
• The McGurk effect
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Processing model
The processing continuum model
Auditory processing Language processing
From: Gail Richard
Auditory skills development:
- Structural maturation
- Behavioral responses to sounds
Definition:
- How is Auditory Processing Disorder (APD) defined today?
- Behavioral and brain bases of APD
Auditory Processing Disorder
•3% of school-aged children (Musiek & Chermak, 2014)
•often associated with language impairment (e.g.
Rota-Donahue, 2014)
•other higher order deficits in attention and memory (e.g. Sharma et al. 2014)
• ‘is a deficit in neural processing of auditory stimuli’ (Musiek and Chermak, 2014)
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Symptoms of APD – ASHA 2005 and AAA 2010
Include difficulty in one or more of the following:
• sound localization and lateralization
• auditory discrimination
• auditory pattern recognition
• temporal aspects of audition
• auditory performance in competing acoustic signals
• auditory performance with degraded acoustic signals
Auditory Processing Disorder is NOT
• Poor sound detection
• Cognitive deficit
• Language impairment
• Age appropriate listening
• Attention deficit
Behavioral assessment
Pediatric APD is typically diagnosed if one of the following skills is affected:
- Perception of physical dimensions of sounds
- Localization or spatial listening
- Dichotic listening
- Speech in noise
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Brain bases of APD
• Electroencephalography (EEG)
P1N1P2 and Mismatch Negativity (MMN)
• fMRI
Pictures from Google Images
What is EEG?
• Recording of electrical activity at the level of the scalp
• Using caps with electrodes
• Spontaneous EEG
• Responses time locked to an event
Spontaneous EEG activity - waveform
From Google Images
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EEG spectral analysis
From pinterest.com
P1-N1-P2 complex
From: Neuroreille.com
ABR MLR P1-N1-P2 complex
P1-N1-P2 waveform in children with APD or SLI
At FCz
Rota-Donahue, 2014
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Differences in the P1N1P2 in children with APD
Rota-Donahue, 2010
AEP responses at FCZ at 500Hz and at 3000Hz for TD children (8-10 y.)
-2
-1
0
1
2
-2
-1
0
1
2
3120Hz
3060Hz
3030Hz
3015Hz
3007Hz
3003Hz
3000Hz
Group 500Hz base frequency 3000Hz base frequency
Latency in milliseconds
Am
plit
ude in m
icro
volts
0 100 200 300 400 500
-3
-2
-1
0
1
2
-3
-2
-1
0
1
2
-3
-2
-1
0
1
2
-3
-2
-1
0
1
2
-3
-2
-1
0
1
2
-3
-2
-1
0
1
2
-3
-2
-1
0
1
2
520Hz
510HZ
505HZ
502HZ
501HZ
500.7HZ
500HZ
0 100 200 300 400 500
-2
-1
0
1
2
- Large ∆ƒ: expected response clearly visible.
- ∆ƒ threshold: between .5 % and 1% of the base frequency
Rota-Donahue, 2010
Comparison ∆ƒ thresholds TD vs. APD
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
∆f
thre
sho
ld (
%)
Behavioral EEG
TD TD APDAPD
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Stimuli
Frequency changes (Rota-Donahue et al., JAAA, 2016)
Frequency discrimination, the detection of ∆ƒ
APD or SLI status affected frequency discrimination
Small ∆ƒ vs. Large ∆ƒ
The literature
Sensitivity index
• Hit rate (H) and false alarm rate (F) calculated for each participant for both tasks
• d’ determined for each participants using the formula d’= z(H) – z(F)
• Bias criterion c also calculated using the formula c = -1/2 [z(H) + z(F)]
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Preliminary data
fMRI
Boscariol et al, 2011
Auditory skills development:
- Structural maturation
- Behavioral responses to sounds
Definition:
- How is Auditory Processing Disorder (APD) defined today?
- Behavioral and brain bases of APD
Assessment and Treatment of pediatric APD:
- Case presentation supporting a multidisciplinary approach
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Test battery used in my lab
• Questionnaire to rule out known neurological deficits such as epilepsy or ASD
• Hearing screening
• Checklist to rule out ADHD based on the Connors’ checklist
• Test of non-verbal intelligence. TONI – 4
• Clinical Evaluation of Language Fundamentals CELF – 5
Word Class, Formulated Sentences, Recalling Sentences and Semantic Relations to get a core language score (CLS)
FOUR TESTS of AUDITORY PROCESSING
• LiSN-S
• DDT
• GIN
• SCAN3-C – A/F ground subtest
Preliminary data for 12 participants
Group TONI-4 CELF-5 CLS LiSN-S Dichotic
Digits (%)
Gaps in Noise
(ms)
SCAN
(AFG)
Typical (TD) 109.9 112.1 9.9 R: 93.6
L: 87.4
R: 4.4
L: 4
10.7
Atypical 99.3 74.7 5.3 R: 67.3
L: 54
R: 12.7
L: 12
8.7
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Case presentation supporting a multidisciplinary approach
Jane Vanessa
Assessment
• Questionnaire: known neurological deficits were ruled, medical history was unremarkable
• Hearing screening: pass bilaterally between 500Hz and 4000Hz
• Checklist to rule out ADHD based on the Connors’ checklist: pass
• Test of non-verbal intelligence. TONI – 4
Assessment (continued)
Clinical Evaluation of Language Fundamentals - CELF 5
Core Language Standard Score: 55Subtests Scaled Scores
Word Classes 3
Formulated Sentences 3
Recalling Sentences 4
Semantic Relations 0
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Assessment (continued)
Tests of Auditory Processing
• LiSN-S: below norms
• DDT: 54%, AD, 44% AS
• GIN: 20ms AU
• SCAN3-C – A/F ground subtest scaled score: 8
Treatment of processing problemsTreating the symptoms at each level: acoustic, phonemic, linguistic
ACOUSTIC
LINGUISTIC
PHONEMIC
Iden
tifi
cati
on
Au
dit
ory
M
emo
ry
Dis
crim
inat
ion
Au
dit
ory
A
tten
tio
n
Differential Processing Training Programby Kerry Winget (LinguiSystem)
Book 1 Acoustic Tasks
• Dichotic Listening
• Temporal Patterning
• Auditory Discrimination
Book 2 Acoustic-Linguistic Tasks
• Phonemic Manipulation
• Phonic Manipulation
Book 3 Linguistic Tasks
• Word Relationships
• Prosodic Interpretation
• Language Organization
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Jane’s first sessions of auditory training
Monaural
in noise
After 2 months of Auditory Training
SOAP notes from the SLP:- Jane is more attentive during sessions
- The mother is more motivated
- Jane is able to follow 3 steps commands (> 80% after 2 months of auditory training)
- However, Jane’s language comprehension and her reading skills are still very poor
- CTOPP, phonological memory (memory for digits and non word repetition), score: 88
- Future goals include working on word relationships and semantics
What can we learn from this case?
• Jane has both APD and SLI
• Auditory perception vs. language processing
• Speech perception
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Conclusion
Brain basis of APD and SLI
References
• American Academy of Audiology (2010) Clinical Practice Guidelines: Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder. Clinical Practice Guidelines, 1-51.
• American Speech-Language Hearing Association (2005) (Central) Auditory Processing Disorders. Technical Report, 1-20.
• Boscariol M, Guimaraes CA, Hage SRV, Garcia VL, Schmutzler KMR, CendesF, Guerreiro MM. (2011) Auditory processing disorder in patients with language-learning impairment and correlation with malformation of cortical development. Brain Develop 33:824-831.
• Musiek FE, Chermak GD. (2014) Handbook of Central Auditory Processing Disorder. Second Edition. San Diego: Plural Publishing.
• Richard G. (2001) The source for processing disorders. LinguiSystems• Rota-Donahue C. (2010) Neurophysiological and Behavioral Processing of
Small Frequency Changes in 8-11 Year-Old Children. AudiologyOnline, 7/12/ 2010.
References (continued)
• Rota-Donahue C. (2014) Neurophysiological Bases of Frequency Discrimination in Children with Auditory Processing Disorder or Specific Language Impairment. Ann Harbor, MI: ProQuest LLC.
• Rota-Donahue C. et al. (2016) in press
• Sharma M, Dhamani I, Leung J, Leung J. (2014). Attention, Memory, and Auditory Processing in 10- to 15-Year-Old Children With Listening Difficulties. J Speech Lang Hear Res 57,2308-2321.
• Werner L. (2007) What do children hear? How auditory maturation affects speech perception. ASHA Leader
• Winget K. (2007) Differential Processing Training Program. LinguiSystems