National Acoustic Laboratories, Sydney, Australia Prevalence and Remediation of Spatial Processing Disorder (SPD) in Aboriginal & Torres Strait Islander.

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National Acoustic Laboratories, Sydney, Australia Prevalence and Remediation of Spatial Processing Disorder (SPD) in Aboriginal & Torres Strait Islander (ATSI) Children in Regional Australia Presented by Sharon Cameron Co-Authors Harvey Dillon, Helen Glyde Sujita Kanthan, Anna Kania XXXII World Congress of Audiology, Brisbane, May 2014 Slide 2 What is Spatial Processing Disorder (SPD)? SPD is a deficiency in the ability to use binaural cues to selectively attend to sounds arriving from one direction while suppressing sounds arriving from other directions. A major cause of difficulty understanding speech in noise in a percentage of normally-hearing children. One type of CAPD. Known cause (COM). 2 Slide 3 Diagnosing SPD with LiSN-S Speech-in-noise test Virtual auditory environment under headphones. Assesses ability to separate target stimuli from distracting stimuli that arrive from other directions. Target sentences (initially) at 62 dB from at 0. Distracter stories at 55 dB from either 0 or 90 in same voice or different voices. Target adjusted adaptively with SRT averaged over maximum of 30 sentences. SPD determined by pattern measure score. 3 Slide 4 LiSN-S Scoring Matrix 4 Slide 5 LiSN-S results profile: SPD 5 Slide 6 Remediating SPD with LiSN & Learn Trains children to attend to a frontal target stimulus (0) and filter out distracting talkers from left and right (90). Adapts to 70% performance level. SRT calculated over 40 sentences. Used in the home or (schools/clinics). Provides rewards, feedback, analysis and reporting. 10 dB improvement in SRT over 50 training sessions - 2 games x 5 days per week for 10 weeks ( Cameron & Dillon, 2011, Cameron et al, 2012). 6 Slide 7 LiSN & Learn- Training games 7 Slide 8 LC SRT p = 0.158 Talker Advantagep = 0.981 HC SRTp = 0.0002 Spatial Advantagep = 0.0002 Total Advantagep = 0.001 LiSN-S Results - Pre- vs. Post-Training Cameron & Dillon (2011) 8 Slide 9 Research Results linking COM and SPD 6 year-olds with history of COM have below-average spatial advantage compared to norms (n = 17, p = 0.012, mean z = 0.1 ; range = -4 to 0.5) (Kapadia et al., 2012). 13-17 year-olds with history of COM have below average spatial advantage compared to norms (n=20; p=0.004, mean z = -0.75) (Kapadia et al, 2014). 6-12 year old children with history of COM were significantly worse on LiSN-S spatial advantage than age-matched controls (n = 35, p 12 Method N=144 ATSI children aged 6;0 to 12;12 years (mean 8;10) recruited from 4 government primary schools in Kempsey NSW. M = 69; F = 75. Additional n=13 excluded: SNHL, intellectual disability; unmedicated ADHD; ear discharge; conductive loss (4FAHL 40 dB; 4FAHL between ears >20 dB). Children with mild conductive loss assessed with LiSN-S PGA. Testing took place at each school in a quiet room (Leq in dB within LiSN-S permissible noise levels for testing). Ten participants (7%) presented with SPD as diagnosed with LiSN-S. Nine children with SPD took part in the LISN & Learn training program. Culturally appropriate rewards offered during training. The Listening Inventory for Education - Teacher (LIFE): -35 - +35 Scale. Slide 13 13 Distribution of Scores on LiSN-S (n=144) Cameron et al. (2014) Slide 14 14 Distribution of Scores on LiSN & Learn (n=9) Cameron et al. (2014) Three children had suspected COM during training. These children were not calibrating the software each day. Once the teacher took over the calibration process the problem was resolved. Slide 15 15 Distribution of Scores on LiSN-S (n=9) Cameron et al. (2014) Slide 16 Post-Training LiSN-S Performance vs. LiSN & Learn Games Played Cameron et al. (2014) 16 N= 9 Mean = 65 games r = 0.71 p = 0.031, 2 = 0.51 Slide 17 17 LiSN & Learn Pre- Training LiSN-S Pattern Z-score Post- Training LiSN-S Pattern Z-score Improvement in LiSN-S Pattern Z-score LIFE Teacher Appraisal IDAge Games Played SD Total Score 3268.698-2.2-0.51.711 4086.342-2.7 -3.4*-0.735 4097.925-2.6 -4.6*-1.935 4186.132-2.4 -5.6*-3.213 5188.782-2.2-0.81.425 5236.790-3.0 -2.3*0.731 5246.490-3.20.94.133 6097.559-2.50.93.413 6226.363-2.20.52.620 LIFE Teacher Appraisal of Listening Ability Post-Training N= 9 Mean rating - +24 (SD 10). No significant correlation between rating and LiSN-S Pattern Z Score improvement (p = 0.797) Slide 18 18 There is a high prevalence of SPD in the ATSI population. LiSN & Learn training is effective in remediating SPD in this population. LiSN & Learn training is considered a beneficial intervention by teachers. However improvement in spatial processing is dependent on training program uptake. Achieving the prescribed amount of training is challenging. Middle ear status and calibration procedure should be monitored during training. Conclusions Slide 19 National Acoustic Laboratories, Sydney, Australia Questions Visit the NAL CAPD website at: http://capd.nal.gov.au