Testing for Central Auditory Processing Disorders Harvey Dillon With thanks to: Sharon Cameron Helen Glyde Wayne Wilso n Pia Gyldenkae rne Mridu la Sharm a Dani Tomli n 1
Mar 30, 2015
1
Testing for Central Auditory Processing Disorders
Harvey Dillon
With thanks to:
Sharon Cameron
Helen Glyde
Wayne Wilson
Pia Gyldenkaerne
Mridula Sharma
Dani Tomlin
2
On the basis of evidence, what should CAPD testing and remediation services consist of?
4
A clinician’s question
• Does this child have a problem hearing or understanding sound that adversely affects him or her, and that I or anyone else can do something about?• What is the specific nature of the problem?• Is there a specific remediation for that problem?• What general management techniques will minimize its
effects?• What tests should I use to determine the child’s problems?
5
Problems with current definitions
1. Requirement for modality specificity and absence of other problems.
Auditory processing
neurons
Deficient auditory skill
Life consequences
Trauma or failure to develop Visual
processing neurons
Deficient visual skill
Life consequences
Consequent disabilities
Hearing loss
Language processing
neurons
Deficient language skill
Life consequences
6
Problems with current definitions2. Arbitrariness of fail criterion
– Which tests to include in battery?– How many tests have to be failed, in how many
ears, in what combinations? – What is a fail on each test?
7
Impact of criterion on diagnosis of CAPD
Fail ≥2 tests [ASHA (2005), AAA (2010)]
Fail ≥1 tests [ASHA (2005), AAA (2010)]
Fail ≥1 non-speech [McArthur, 2009]
Fail ≥1 speech + ≥1 non-speech [BSA(2011)]
Reported sympotoms [Ferguson (2011)]
0 10 20 30 40 50 60 70 80 90 100
Percent of children “with CAPD”
Binaural failMonaural fail
Wayne Wilson
Problems with a Large Test Battery
Impact on child’s attention
(The tests are often very boring!!)
Relevance of the normative data
Statistical implications of presenting multiple tests - inflating Type II error rate.
So …. how do we solve this problem??8
Possible, but not very good, solutions….
1. Tighten the pass-fail criteria on each test (e.g. 3 SD):
have to be very aberrant to fail
2. Require that the individual fail more than one test:
Only logical if CAPD is a “generalized disorder”
3. Repeat any test that produces a failed result:
Not consistent with normative data
An inefficient use of time
9
History Audiometry
Is there a problem that CAPD
might explain?
Exclude CAPD;Refer elsewhere
No
Current approach to CAPD testing
Detailed test battery
Yes
Test result interpretationNon-specific remediation and management:• Classroom placement• FM use• Instruction style• Soundfield amplification• Auditory training software
Questionnaire / history Audiometry Measured disability
Is there a problem that CAPD
might explain?
Detailed test battery
Exclude CAPD;Refer elsewhere
No
Dealing with problems in understanding speech
Master test battery
Yes
Non-specific remediation and management:• Classroom placement• FM use• Instruction style• Soundfield amplification
Test result interpretation leading toa disorder-specific diagnosis
Disorder-specific remediation
Questionnaire / history Audiometry Measured disability
Is there a problem that CAPD
might explain?
Detailed test battery
Exclude CAPD;Refer elsewhere
No
Dealing with problems in understanding speech
Master test battery
Yes
Non-specific remediation and management:• Classroom placement• FM use• Instruction style• Soundfield amplification
Test result interpretation leading toa disorder-specific diagnosis
Disorder-specific remediationLiSN& Learn
LiSN-S High Cue
LiSN-S Spatial
Advantage
LiSN-S Talker
Advantage
LiSN-S Low Cue
SPDUndiag-nosed deficit
Pitch deficit
FPT Verbal
FPT Hum
SPINHi Cont
SPINLo Cont
Closure skill
deficits?
Top-down training?
13
What is a fail on one test?
40 60 80 100 120 140 160
-4 -3 -2 -1 0 1 2 3 4
Z-score
Prop
ortio
n of
chi
ldre
n
Test score
14
Test score sensitivity relative to functional listening ability
• Can estimate from correlation between test scores and functional ability– Questionnaire scores of listening ability– Educational attainment scores
-3 -2 -1 0 1 2 30
50
100
150
CAPD test z-score
Func
tiona
l lis
teni
ng a
bilit
y
Test A
Test B
15
Test score sensitivity relative to functional ability:
• Sensitivity
-3 -2 -1 0 1 2 30
50
100
150
CAPD test z-score
Func
tiona
l lis
teni
ng a
bilit
y
Test A
Test B
16
Criteria for adopting a CAPD test
• Test is associated with variation in functional ability – High sensitivity )– Deviant results common in clinical population– Attributes tested minimally shared with other tests in battery
• Test result indicates specific remediation necessary (and remediation affects real life)
• Time taken is small• Test is minimally affected by attention, intelligence, motivation,
working memory• Associated with a known anatomical site and neural
mechanism
17
Experiment 1
Dani Tomlin current PhD study• Two subject recruitment groups:
– Children referred to Uni of Melbourne Audiology Clinic due to suspected APD (n=65) • Teachers, parent, speech pathologist referral
– Normative group (n=47)• School enrolment, open invitation
• Age range of 7–12 years• Both groups to complete full test battery• Results converted to Z scores (derived using age specific
norms)
18
Measures obtained• Dichotic Digits Test (DDT): Binaural integration (Musiek, 1993)
• Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990)
• Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005)
• MLD: Binaural interaction (Bellis, 2003)
• LiSN-S: Binaural integration – spatial listening ability (Cameron & Dillon, 2006)
• Memory CELF-4: Forward and reverse digits • Attention: BrainTrain®: Continuous Performance Test: Sustained auditory and visual
attention • Cognition -TONI-4: Nonverbal cognitive assessment
• Questionnaires and interview:– Child completed LIFE questionnaire & recorded interview– Parent completed Fisher checklist & written interview– Teacher Evaluation of Auditory Performance (TEAP) & written interview
• Academic Performance - NAPLAN & WARP (reading fluency)
19
Relations between questionnairesLif e (c hildren)
Fis her (parents )
TEA P ( teac hers )
Listening Capabilities Score
20
Relations between outcome variablesLis tening Capability Sc ore
NA PLA N Literac y Z s c ore
W A RP Z SCORE
Test score sensitivity relative to functional abilitiesDichotic digits - left
List
enin
g ca
pabi
lities
Dani Tomlin
L istening C apab ility S core = 0 .2085+0.2417*x
-10 -8 -6 -4 -2 0 2 4
LD D Z S core
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Liste
nin
g C
ap
ab
ility Sco
re
Test score sensitivity relative to functional abilitiesDichotic digits - left
List
enin
g ca
pabi
lities
Dani Tomlin
L istening C apab ility S core = 0 .2085+0.2417*x
-10 -8 -6 -4 -2 0 2 4
LD D Z S core
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Listening C
apability S
core
23
Test score sensitivity relative to functional abilitiesDichotic digits - left
List
enin
g ca
pabi
lities
Dani Tomlin
Read
ing
fluen
cyLi
tera
cy
A verage NA P LA N L ite racy Z score = 0 .6834+0.2485*x
-10 -8 -6 -4 -2 0 2 4
LD D A S IN Z S core
-3
-2
-1
0
1
2
Ave
rag
e N
AP
LA
N L
itera
cy Z sco
re
W A RP Z S C ORE = 0 .2969+0.2647*x
-10 -8 -6 -4 -2 0 2 4
LD D A S IN Z S core
-3
-2
-1
0
1
2
WA
RP
Z S
CO
RE
L istening C apab ility S core = 0 .2085+0.2417*x
-10 -8 -6 -4 -2 0 2 4
LD D A S IN Z S core
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0.0
0.5
1.0
1.5
2.0
Liste
nin
g C
ap
ab
ility Sco
re
Dichotic digits - right Freq pattern - left Freq pattern - right
A verage NA P LA N L ite racy Z score = 0 .4145+0.1672*x
-10 -8 -6 -4 -2 0 2 4
RD D A S IN Z S core
-3
-2
-1
0
1
2
Ave
rag
e N
AP
LA
N L
itera
cy Z sco
re
A verage NA P LA N L ite racy Z score = 0 .5726+0.265*x
-10 -8 -6 -4 -2 0 2 4
LF P T A S IN Z S C ORE
-3
-2
-1
0
1
2
Ave
rag
e N
AP
LA
N L
itera
cy Z sco
re
A verage NA P LA N L ite racy Z score = 0 .5054+0.1976*x
-10 -8 -6 -4 -2 0 2 4
R F P T A S IN Z S C ORE
-3
-2
-1
0
1
2
Ave
rag
e N
AP
LA
N L
itera
cy Z sco
re
W A RP Z S C ORE = 0 .0871+0.2002*x
-10 -8 -6 -4 -2 0 2 4
R F P T A S IN Z S C ORE
-3
-2
-1
0
1
2
WA
RP
Z S
CO
RE
W A RP Z S C ORE = 0 .1039+0.2143*x
-10 -8 -6 -4 -2 0 2
LF P T A S IN Z S C ORE
-3
-2
-1
0
1
2
WA
RP
Z S
CO
RE
W A RP Z S C ORE = 0 .0602+0.205*x
-10 -8 -6 -4 -2 0 2 4
RD D A S IN Z S core
-3
-2
-1
0
1
2
WA
RP
Z S
CO
RE
L istening C apab ility S core = -0 .0343+0.2005*x
-10 -8 -6 -4 -2 0 2 4
RD D A S IN Z S core
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Liste
nin
g C
ap
ab
ility Sco
re
L istening C apab ility S core = -0 .0218+0.1664*x
-10 -8 -6 -4 -2 0 2 4
LF P T A S IN Z S C ORE
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Liste
nin
g C
ap
ab
ility Sco
re
L istening C apab ility S core = -0 .068+0.1102*x
-10 -8 -6 -4 -2 0 2 4
R F P T A S IN Z S C ORE
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Liste
nin
g C
ap
ab
ility Sco
re
24
Test score sensitivity relative to functional abilitiesGaps in noise - left Gaps in noise - right Digit span - Forward Digit span - Reversed
List
enin
g ca
pabi
lities
Read
ing
fluen
cy
Dani Tomlin
Lite
racy
L istening C apab ility S core = -0 .124+0.2894*x
-1 .6-1 .4
-1 .2-1 .0
-0 .8-0 .6
-0 .4-0 .2
0 .00 .2
0 .40 .6
0 .81 .0
1 .2
L G in Z score
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Listening Capability S
core
L istening C apab ility S core = -0 .1261+0.2162*x
-3 .0 -2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5
R Gin Z score
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Liste
nin
g C
ap
ab
ility Sco
re
L istening C apab ility S core = -0 .0312+0.4149*x
-2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5 2 .0
D S F W Z S C ORE
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Listening Capability S
core
L istening C apab ility S core = -0 .0199+0.5467*x
-2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5 2 .0
D S Rev Z S core
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Liste
nin
g C
ap
ab
ility Sco
re
A verage NA P LA N L ite racy Z score = 0 .4358+0.6129*x
-2 .0 -1 .5 -1 .0 -0 .5 0.0 0.5 1.0 1.5 2.0
D S Rev Z S core
-2 .0
-1 .5
-1 .0
-0 .5
0.0
0.5
1.0
1.5
2.0
NA
PL
AN
Lite
racy Z
score
A verage NA P LA N L ite racy Z score = 0 .454+0.5643*x
-2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5
D S F W Z S C ORE
-2.0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Ave
rag
e N
AP
LA
N L
itera
cy Z sco
re
A verage NA P LA N L ite racy Z score = 0 .3701-0 .1306*x
-3 .0 -2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5
R Gin Z score
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Ave
rag
e N
AP
LA
N L
itera
cy Z sco
re
A verage NA P LA N L iteracy Z score = 0 .3754-0.2565*x
-0 .6 -0 .4 -0 .2 0.0 0.2 0.4 0.6
L Gin Z score
-2 .0
-1 .5
-1 .0
-0 .5
0.0
0.5
1.0
1.5
2.0
Average N
AP
LAN
Literacy Z score
W A RP Z S C ORE = -0 .006+0.5397*x
-1 .6-1 .4
-1 .2-1 .0
-0 .8-0 .6
-0 .4-0 .2
0.00.2
0.40.6
0.81.0
1.2
L G in Z score
-3
-2
-1
0
1
2
3
WA
RP
Z S
CO
RE
W A RP Z S C ORE = 0 .0099+0.3944*x
-3 .0 -2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5
R Gin Z score
-3
-2
-1
0
1
2
3
WA
RP
Z S
CO
RE
W A RP Z S C ORE = 0 .0673+0.541*x
-2 .5 -2 .0 -1 .5 -1 .0 -0 .5 0.0 0.5 1.0 1.5 2.0
D S FW Z S C ORE
-3
-2
-1
0
1
2
3
WA
RP
Z S
CO
RE
W A RP Z S C ORE = 0 .0897+0.7375*x
-2 .0 -1 .5 -1 .0 -0 .5 0 .0 0 .5 1 .0 1 .5 2 .0
D S Rev Z S core
-3
-2
-1
0
1
2
3
WA
RP
Z S
CO
RE
25
Test score sensitivity relative to functional abilitiesLiSN-S Low Cue LiSN-S High cue attention
List
enin
g ca
pabi
lities
Read
ing
fluen
cy
Dani Tomlin
Lite
racy
W A RP Z S C ORE = 0 .0719+0.2626*x
-5 -4 -3 -2 -1 0 1 2 3
LC S dev from avg
-3
-2
-1
0
1
2
WA
RP
Z S
CO
RE
W A RP Z S C ORE = 0 .1186+0 .3258*x
-5 -4 -3 -2 -1 0 1 2 3
HC S dev from avg
-3
-2
-1
0
1
2
WA
RP
Z S
CO
RE
A verage NA P LA N L ite racy Z score = 0 .4274+0.3453*x
-5 -4 -3 -2 -1 0 1 2 3
LC S dev from avg
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Ave
rag
e N
AP
LA
N L
itera
cy Z sco
re
A verage NA P LA N L ite racy Z score = 0 .4454+0.3003*x
-5 -4 -3 -2 -1 0 1 2 3
HC S dev from avg
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Ave
rage
NA
PL
AN
Litera
cy Z sco
re
L istening C apab ility S core = 0 .0843+0.56*x
-5 -4 -3 -2 -1 0 1 2 3
LC S dev from avg
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Liste
nin
g C
ap
ab
ility Sco
re
L istening C apab ility S core = 0 .0332+0.3098*x
-5 -4 -3 -2 -1 0 1 2 3
HC S dev from avg
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Liste
nin
g C
ap
ab
ility Sco
re
MLD z score
Listening C apability S core = -0 .0792-0 .0256*x
-3 -2 -1 0 1 2 3 4 5
MLD Z score
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0.0
0.5
1.0
1.5
2.0
Liste
nin
g C
ap
ab
ility Sco
re
W A RP Z S C ORE = 0 .0107+0.0001*x
-3 -2 -1 0 1 2 3 4 5
M LD Z score
-3
-2
-1
0
1
2
WA
RP
Z S
CO
RE
A verage NA P LA N L ite racy Z score = 0 .3523+0.0132*x
-3 -2 -1 0 1 2 3 4 5
M LD Z score
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Ave
rag
e N
AP
LA
N L
itera
cy Z sco
re
A verage NA P LA N L ite racy Z score = 0 .4196+0.274*x
-6 -5 -4 -3 -2 -1 0 1 2
A ttention Quotient Z score
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Ave
rag
e N
AP
LA
N L
itera
cy Z sco
re
W A RP Z S C ORE = 0 .2157+0.2121*x
-6 -5 -4 -3 -2 -1 0 1 2
A ttention Quotient Z score
-3
-2
-1
0
1
2
WA
RP
Z S
CO
RE
L istening C apab ility S core = 0 .188+0.2352*x
-6 -5 -4 -3 -2 -1 0 1 2
A ttention Quotient Z score
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5
2 .0
Liste
nin
g C
ap
ab
ility Sco
re
26
Sensitivity: Effect on outcome variable of being 1 SD below the mean on test score
TONI
Digit Span Rev
Digit Span Fwd
LiSN-S Low cue
L GIN
Lisn-S High cue
L DD
R GIN
Attention
L FPT
R DD
R FPT
MLD
-0.2 0 0.2 0.4 0.6 0.8 1
Reading abilityLiteracyListening capabilities
27
FPT results highly correlated between ears
-1 2 -1 0 -8 -6 -4 -2 0 2
L P P Z sco re
-1 2
-1 0
-8
-6
-4
-2
0
2
Rp
p Z
Sco
re
c l i n i c sch o o l
28
Dichotic digit results less correlated
-12 -10 -8 -6 -4 -2 0 2
LDD Zs c ore
-12
-10
-8
-6
-4
-2
0
2
RD
D Z
score
C linic S c hool
30
Correlations – outcomes and test scoresLiter
acyWAR
PListe
n Cap
L DD R DD L FPT R FPT MLD L GIN R
GINLiSN
LCLiSN
HCLiSN
SADS
FwdDS
Rev TONI Att
Literacy - 0.60 0.77 0.66 0.41 0.49 0.46 0.03 -0.12 -0.07 0.39 0.34 -0.03 0.56 0.67 0.62 0.49
WARP 0.60 - 0.64 0.47 0.33 0.34 0.37 0.00 0.25 0.22 0.21 0.34 0.09 0.44 0.56 0.51 0.32
Listening Cap 0.77 0.64 - 0.47 0.37 0.34 0.26 -0.04 0.14 0.13 0.43 0.32 0.15 0.34 0.43 0.53 0.35
L DD 0.66 0.47 0.47 - 0.47 0.46 0.37 -0.12 0.08 0.14 0.28 0.25 0.13 0.53 0.48 0.49 0.27
R DD 0.41 0.33 0.37 0.47 - 0.27 0.35 -0.17 0.09 0.11 0.22 0.14 0.14 0.33 0.33 0.30 0.22
L FPT 0.49 0.34 0.34 0.46 0.27 - 0.87 -0.12 0.00 -0.03 0.12 0.07 0.17 0.29 0.42 0.38 0.19
R FPT 0.46 0.37 0.26 0.37 0.35 0.87 - -0.12 0.11 0.01 0.12 0.11 0.22 0.26 0.36 0.37 0.08
MLD 0.03 0.00 -0.04 -0.12 -0.17 -0.12 -0.12 - -0.17 -0.19 0.03 -0.08 0.06 0.05 -0.07 -0.02 -0.03
L GIN -0.12 0.25 0.14 0.08 0.09 0.00 0.11 -0.17 - 0.73 -0.02 0.02 0.12 0.04 0.04 -0.04 -0.09
R GIN -0.07 0.22 0.13 0.14 0.11 -0.03 0.01 -0.19 0.73 - -0.05 0.02 0.18 0.05 0.09 0.08 -0.04
LiSN LC 0.39 0.21 0.43 0.28 0.22 0.12 0.12 0.03 -0.02 -0.05 - 0.26 -0.04 0.30 0.21 0.28 0.08
LiSN HC 0.34 0.34 0.32 0.25 0.14 0.07 0.11 -0.08 0.02 0.02 0.26 - 0.43 0.09 0.16 0.24 0.06
LiSN SA -0.03 0.09 0.15 0.13 0.14 0.17 0.22 0.06 0.12 0.18 -0.04 0.43 - 0.02 0.08 0.14 -0.02
DS Fwd 0.56 0.44 0.34 0.53 0.33 0.29 0.26 0.05 0.04 0.05 0.30 0.09 0.02 - 0.59 0.30 0.11
DS Rev 0.67 0.56 0.43 0.48 0.33 0.42 0.36 -0.07 0.04 0.09 0.21 0.16 0.08 0.59 - 0.38 0.31
TONI 0.62 0.51 0.53 0.49 0.30 0.38 0.37 -0.02 -0.04 0.08 0.28 0.24 0.14 0.30 0.38 - 0.23
Attention 0.49 0.32 0.35 0.27 0.22 0.19 0.08 -0.03 -0.09 -0.04 0.08 0.06 -0.02 0.11 0.31 0.23 -
P<0.01
NAPLAN literacy
1 2 3 4 5 6 7 8 9 10 11 12
L DD * * * * * * * * * * *
R DD * * * * * *
L FPT * * * * * * * *
R FPT * * * * * * * * *
MLD *
L GIN * * * *
R GIN * * * * * * * * * *
DS Fwd * *
DS Rev * * * * * * * * * * * *
LiSN LC * * * * *
LiSN HC * * * * *
LiSN SA * * * * *31
What is affecting listening capabilities?TONI
DS Fwd
DS Rev
Att
LDDListening
capabilities
0.27
0.10
0.19
0.10
0.20
32
N=59Adj R2 = 0.31
What is affecting literacy?TONI
DS Fwd
DS Rev
Att
LDD NAPLAN Literacy
0.24
0.30
0.18
0.16
0.29
But only 14 clinic participants with NAPLAN so far.
33
N=35Adj R2 = 0.64
34
Importance of the presenting symptoms?
FO
LL
OW
ING
INS
T
no
ne
LE
AR
NIN
G D
IFF
IC.
AT
TN
/CO
NC
Atte
ntio
n
RE
AD
ING
LA
NG
UA
GE
Sp
ellin
g/W
riting
P rim ary C oncern
05
101520253035404550
No
of o
bse
rvatio
ns
35
Importance of presenting symptoms
LDD A SIN Z Sc ore LFPT A SIN Z SCORE L Gin Z s c ore DS FW Z SCORE DS Rev Z Sc ore LC Sdev f rom av g TONI Z Sc ore
FOL L OW IN G IN STL EAR N IN G D IFFIC .
ATTN /C ON CR EAD IN G
P rim ary C oncern
-4 .0
-3 .5
-3 .0
-2 .5
-2 .0
-1 .5
-1 .0
-0 .5
0 .0
0 .5
1 .0
1 .5MANOVA analysis: p=0.94
36
Importance of presenting symptoms
Child fails to understand an
instruction
Acts (inappropriately) based on what
was heard
Asks for repetition of instruction
Does nothing
Misbehaves
Event Response by child
Interpretation by observer
Daydreams
Badly behaved
Can’t follow instructions
Is not very smart
Poor concentration
37
Experiment 2
Pia Gyldenkaerne current PhD study• Children referred to Macquarie Uni
Audiology Clinic due to suspected APD (n=119)
• Teachers, parent, speech pathologist referral• Age range of 7–13 years
38
Measures obtained• Dichotic Digits Test (DDT): Binaural integration (Musiek, 1993)
• Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990)
• Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005)
• MLD: Binaural interaction (Bellis, 2003)
• Memory CELF-4: Forward and reverse digits • Attention: BrainTrain®: Continuous Performance Test: Sustained auditory
and visual attention • Cognition -TONI-4: Nonverbal cognitive assessment
• Questionnaire:– Purpose designed – yes/no answers to 18 questions asking about difficulties in listening
and its possible consequences
• Academic Performance: WARP (reading fluency)
39
Test score sensitivity relative to functional ability: Reported difficulties and reading fluency
-1 2 -1 0 -8 -6 -4 -2 0 2
FP T _ R_ S D
-2
0
2
4
6
8
1 0
1 2
1 4
Re
po
rted
Difficu
lties
-1 2 -1 0 -8 -6 -4 -2 0 2
FP T _ L _ S D
-2
0
2
4
6
8
1 0
1 2
1 4
Re
po
rted
Difficu
lties
-5 -4 -3 -2 -1 0 1 2
DDT _ R_ S D
-2
0
2
4
6
8
1 0
1 2
1 4
Re
po
rted
Difficu
lties
-7 -6 -5 -4 -3 -2 -1 0 1 2
DDT _ L _ S D
-2
0
2
4
6
8
1 0
1 2
1 4
Re
po
rted
Difficu
lties
Dichotic digits - left Dichotic digits - right Freq pattern - left Freq pattern - right
Repo
rted
diffi
culti
esRe
adin
g sp
eed
-1 2 -1 0 -8 -6 -4 -2 0 2 4
FP T _ R_ S D
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0
WA
RP
Ave
rag
e
-1 2 -1 0 -8 -6 -4 -2 0 2
FP T _ L _ S D
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0
WA
RP
Ave
rag
e
-6 -4 -2 0 2 4
DDT _ R_ S D
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0
WA
RP
Ave
rag
e
-7 -6 -5 -4 -3 -2 -1 0 1 2 3
DDT _ L _ S D
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0
WA
RP
Ave
rag
e
Pia Gyldenkaerne and Mridula Sharma
40
Test score sensitivity relative to functional ability: Reported difficulties and reading speed
Gaps in noise - right
-7 -6 -5 -4 -3 -2 -1 0 1 2
M L D_ S D
-2
0
2
4
6
8
1 0
1 2
1 4
Re
po
rted
Difficu
lties
Binaural masking level difference
0 2 0 4 0 6 0 8 0 1 0 0 1 2 0
B T Re sp o n se Co n tro l Q u o ti e n t
-2
0
2
4
6
8
1 0
1 2
1 4
Re
po
rted
Difficu
lties
0 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0
B T A tte n ti o n Q u o ti e n t
-2
0
2
4
6
8
1 0
1 2
1 4
Re
po
rted
Difficu
lties
234567891 01 1
G IN Rig h t
-2
0
2
4
6
8
1 0
1 2
1 4
Re
po
rted
Difficu
lties
Brain Train attention quotient
Brain Train response control quotient
-7 -6 -5 -4 -3 -2 -1 0 1 2
M L D_ S D
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0
WA
RP
Ave
rag
e
0 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0
B T Re sp o n se Co n tro l Q u o ti e n t
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0W
AR
P A
vera
ge
0 2 0 4 0 6 0 8 0 1 0 0 1 2 0 1 4 0
B T A tte n ti o n Q u o ti e n t
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0
WA
RP
Ave
rag
e
234567891 01 1
G IN Rig h t
0
2 0
4 0
6 0
8 0
1 0 0
1 2 0
1 4 0
1 6 0
1 8 0
2 0 0
2 2 0
WA
RP
Ave
rag
e
Repo
rted
diffi
culti
esRe
adin
g sp
eed
Pia Gyldenkaerne and Mridula Sharma
42
Simple correlation matrix – outcome scores and test scores
Reported Difficulties
WARP L DDT R DD L FPT R FPT R GIN MLD TONIBT
Attention Quotient
Reported Difficulties
- -0.57 -0.49 -0.24 -0.42 -0.44 0.28 0.11 -0.55 -0.35
WARP -0.57 - 0.41 0.20 0.35 0.41 -0.33 -0.07 0.35 0.50
L DDT -0.49 0.41 - 0.43 0.42 0.49 -0.20 0.01 0.31 0.36
R DDT -0.24 0.20 0.43 - 0.22 0.23 -0.11 -0.00 0.07 0.27
L FPT -0.42 0.35 0.42 0.22 - 0.86 -0.28 -0.05 0.34 0.22
R FPT -0.44 0.41 0.49 0.23 0.86 - -0.33 -0.06 0.33 0.26
R GIN 0.28 -0.33 -0.20 -0.11 -0.28 -0.33 - 0.01 -0.05 -0.02
MLD 0.11 -0.07 0.01 -0.00 -0.05 -0.06 0.01 - 0.12 0.04
TONI -0.55 0.35 0.31 0.07 0.34 0.33 -0.05 0.12 - 0.41
BT Attention Quotient
-0.35 0.50 0.36 0.27 0.22 0.26 -0.02 0.04 0.41 -
P<0.01
43
No. of predictors
DDT_L_SD DDT_R_SD
FPT_L_SD
FPT_R_SD
MLD_SD
GIN_R
BT.AttQuot
TONI.Quot
1 *2 * *3 * * *4 * * * *5 * * * * *6 * * * * * *7 * * * * * * *8 * * * * * * * *
No. of predictors
DDT_L_SD
DDT_R_SD
FPT_L_SD
FPT_R_SD
MLD_SD
GIN_R
BT.AttQuot
1 * 2 * * 3 * * *4 * * * *5 * * * * *6 * * * * * *7 * * * * * * *
Reported Difficulties
Criteria for adopting a CAPD test• Test is associated with variation in functional ability
– High sensitivity )
– Deviant results common in clinical population
– Attributes tested minimally shared with other tests in battery
• Leads to a specific diagnosis, for which remediation exists, and remediation affects real life functional ability
• Time taken is small
• Test is minimally affected by attention, intelligence, motivation, working memory, and language ability
• Known high reliability and critical differences
• Associated with a known anatomical site and/or neural mechanism 44
45
Comparison of tests against criteriaLiSN-S LC/SA
Dichotic digits
Freq Patt Test
GIN Digit span fwd
Digit span
reverse
MLD
Sens: slope re functional 4 3 2 3 5 6 0Sens: deviant results common 2 7 5 2 2 2 0Uniqueness re other tests 3 6.5 2 2.5 0 12 0Specific diagnosis leading to effective proven remediation
0/10 4 0 0 0 0 0
Time taken
Minimal effect of attention, working memory, intelligence, motivation, language ability
5/15 3 3 16 3 5 25
Known high reliability and small critical differences
10 ? ? ? ? ? ?
Known anatomical site and neural mechanism
0 1 0 0 0 0 5
46
Diagnosis and intervention
• Spatial processing disorder LiSN & Learn
• Auditory working memory (digit span fwd and reverse) Memory booster or Cog Med
• Any other disorder causing speech in noise difficulties dichotic digits Remote microphone hearing aids (Hornickel and Krauss), dichotic training (DIID or ARIA)