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This study examined the relationship between sensory processing (SP) differences and behavioral problems in children with autism spectrum disorder (ASD). We also investigated whether audiological test results could objectively detect auditory processing differences. Forty-six children with ASD, ages 3–9 years, were enrolled in the study. Problematic behaviors and sensory processing of children were assessed using scales. The otolaryngologist performed a detailed head and neck examination and a formal audiological examination was performed by an audiologist. Stereotypy, hyperactivity, and irritability were related to sensation seeking. Stereotypy was also associated with visual processing. Touch processing differences was related to irritability and inappropriate speech. Lethargy was associated with auditory processing. There were no differences in SP and behavior problems in the children whose audiological profiles could be measured between those who passed or failed the test. There was an association between SP differences and behavioral problems in children with ASD, supporting previous studies. Audiological test results did not reveal the SP differences documented in the parent forms. [ABSTRACT FROM AUTHOR]

Background and Aim: Central auditory processing disorder (CAPD) is seen in a wide array of populations, including children and adults. CAPD is characterized by deficits in one or more auditory abilities, causes difficulties in auditory discrimination, temporal and binaural processing although hearing thresholds are in the normal range. Children's auditory performance scale (CHAPS) is a screening instrument. This study examined the reliability and validity of the Arabic version of children's auditory performance scale. Methods: In this cross-sectional study, 50 healthy children were included. The children's ages ranged from seven to nine years, and they passed the screening test using distortion product otoacoustic emissions before administering the scale in the translation process, the backtranslation method was used, in addition to the face validity procedure. Teachers fulfilled the questionnaire in the presence of an audiologist. After two weeks, the scale was re-administrated, and then the statistical analysis was done to examine the reliability and validity of Arabic version of CHAPS (CHAPS-AR). Results: The internal consistency was examined with Cronbach's a (a=0.997), for testretest reliability, Pearson›s (r) was examined (r=0.994) and when executing the face validity, five experts agreed that the CHAPS-AR has a clear structure, syntax and it is easy to understand and use. Conclusion: The Arabic version of CHAPS can be considered a reliable and valid screening instrument for clinical and research use. [ABSTRACT FROM AUTHOR]

Background Interesting data and theories have emerged regarding auditory hallucinations (AHs) in patients with schizophrenia. The possibility that these patients may have changes in the anatomy of the auditory cortex and/or subcortical structures of the central auditory nervous system and present with deficits on audiological tests is important information to the audiology community. However, it seems clear that, in general, audiologists are not sufficiently aware of these findings. Purpose There are two main purposes of this article: (1) to educate audiologists about AHs related to schizophrenia and related issues, and (2) to encourage audiologists and hearing scientists to become involved in the evaluation and research of AHs. This fascinating disorder is one in which audiologists/hearing scientists are well suited to make a significant contribution. Research Design A review and synthesis of the literature was conducted. Relevant literature was identified through PubMed, Google Scholar, as well as independent book chapters and article searches. Keywords driving the searches were AHs, auditory illusions, verbal and musical hallucinations, schizophrenia, and central auditory disorders. Given the currency of the topic, the information collected was primarily between 1990 and 2020. Study Sample The review is organized around categorization, prevalence, models, mechanisms, anatomy, pathophysiology, and audiological correlates related to AHs. Data Collection and Analysis Searches were conducted using well-known search engines and manual searches by each author. This information on AHs was then analyzed collectively by the authors for useful background and relevance, as well as important for the field of audiology. Results Several anatomical, physiological, and functional imaging studies have shown compromise of the auditory cortex in those with schizophrenia and AHs. Potentially related to this, are studies that demonstrated sub-par performance on behavioral audiologic measures for this unique clinical population. These findings align well with the kind of hearing disorder for which audiologists are well-trained to make significant contributions. Conclusion Neurobiological and audiological evidence is accumulating on patients with schizophrenia and AH potentially rendering it as both an auditory and psychiatric disorder. Audiologists should consider expanding their horizon and playing a role in the clinical investigation of this disorder. [ABSTRACT FROM AUTHOR]

Objective: Distortion product otoacoustic emissions (DPOAEs) are sensitive to early indices of cochlear pathology. Pathology to the cochlea is in part mediated by ischaemic related mechanisms. We propose that DPOAEs may provide an objective measure of cardiovascular risk. Design: Cross-sectional. Study sample: The relationships between stroke risk and DPOAEs of 1,107 individuals from the Jackson Heart Study (JHS), an all-African-American cohort, were assessed. Linear regression models were used for analysis among all participants and delimited to normal hearing, defined as either a pure-tone threshold average of 500, 1000, 2000, and 4000 Hz (PTA4) ≤ 25 dBHL or pure-tone thresholds for all individual tested frequencies for each ear (500, 1000, 2000, 4000, and 8000 Hz) ≤ 25 dBHL. Results: We observed a significant inverse relationship between DPOAE amplitudes and stroke risk scores in the pooled cohort and in the subgroups with normal hearing defined by pure tone thresholds. Participants in the high-risk group had significantly lower DPOAE amplitudes than those in the low stroke risk group. Conclusions: Our results indicate that auditory dysfunction as measured by DPOAEs are related to stroke risk. Further prospective studies are needed to determine if DPOAEs could be used as a predictive tool for cardiovascular disease. [ABSTRACT FROM AUTHOR]

Objective: The suppression of evoked otoacoustic emissions (EOAE) may serve as a clinical tool to evaluate the medial olivocochlear (MOC) reflex, which is thought to aid speech discrimination (particularly in noise) by selectively inhibiting cochlear amplification. The present study aimed to determine if contralateral transient evoked otoacoustic emission (TEOAE) suppression was present in a clinical sample of children with listening difficulties with and without auditory processing disorder (APD). Design: A three-group, repeated measure design was used. Study sample: Forty three children aged 8-14 years underwent an auditory processing assessment and were divided into three groups: children with reported listening difficulties with APD, children with reported listening difficulties without APD, and children with normal hearing. APD was defined as per British Society of Audiology. Results: TEOAE suppression was present in all three participant groups. No significant group, age or ear effects were observed for TEOAE suppression in dB or as a normalised index. Conclusion: Contralateral TEOAE suppression method could not be used as a clinical tool to identify APD in this study's participating children and did not support the hypothesised link between reduced MOC function and general listening difficulties in background noise in children with or without APD. [ABSTRACT FROM AUTHOR]

Objective: The objectives were to investigate the function of central auditory pathways and of the medial efferent olivocochlear system (MOCS). Design: Event-related potentials (ERP) were recorded following the delivery of the stimulus /da/ in quiet and in ipsilateral, contralateral, and binaural noise conditions and correlated to the results of the auditory processing disorders (APD) diagnostic test battery. MOCS function was investigated by adding ipsilateral, contralateral, and binaural noise to transient evoked otoacoustic emission recordings. Auditory brainstem responses and pure tone audiogram were also evaluated. Study Sample: Nineteen children (7 to 12 years old) with APD were compared with 24 age-matched controls. Results: Otoacoustic emissions and ABR characteristics did not differ between groups, whereas ERP latencies were significantly longer and of higher amplitudes in APD children than in controls, in both quiet and noise conditions. The MOCS suppression was higher in APD children. Conclusions: Findings indicate that children with APD present with neural deficiencies in both challenging and nonchallenging environments with an increase in the timing of several central auditory processes correlated to their behavioural performances. Meanwhile, their modulation of the auditory periphery under noisy conditions differs from control children with higher suppression. [ABSTRACT FROM AUTHOR]

Background: Associations between vascular health-related factors and hearing loss defined using audiometric pure-tone thresholds have been found. Studies have not focused on a potential relationship between vascular health-related factors and central auditory processing. Purpose: The aim of this study was to evaluate, on a population level, the relationship of vascular health-related factors with central auditory function. Research Design: A cross-sectional, population study. Study Sample: Subjects were participants in the Epidemiology of Hearing Loss Study (EHLS) or the Beaver Dam Offspring Study (BOSS)--prospective studies of aging and sensory loss. BOSS participants were the adult offspring of participants in the EHLS. Participants who completed the Dichotic Digits Test (DDT) during the fourth examination period of the EHLS (2008-2010) or the second examination period of the BOSS (2010-2013) were included (n = 3,655, mean age = 61.1 years). Data Collection and Analysis: The DDT-free recall test was conducted using 25 sets of triple-digit pairs at a 70 dB HL presentation level. The total number of correctly repeated digits from the right and left ears was converted to a percentage correct and used as an outcome. The percentage correct in the left ear was subtracted from the percentage correct in the right ear and used as an outcome. Vascular health-related measures obtained during the examination included blood pressure, mean carotid intima-media thickness, femoral pulse wave velocity (PWV), hemoglobin A1C, and non-high-density lipoprotein (HDL) cholesterol, and, in the EHLS participants, C-reactive protein and interleukin-6. Information on vascular health-related history and behaviors was self-reported. General linear modeling produced estimates of the age- and sex-adjusted least squares means for each vascular factor, and multiple linear regression was used for multivariable modeling of each outcome. Results: After multivariable adjustment, participants with diabetes had a significantly lower (worse) mean DDT-free recall total score (22.08 percentage points, p < 0.001) than those without diabetes. Participants who exercised at least once per week had a significantly higher (better) mean DDT-free recall total score (+1.07 percentage points, p < 0.01) than those who did not exercise at least once per week. Alcohol consumption was associated with a higher DDT-free recall total score (+0.15 percentage points per +25 g ethanol, p < 0.01). In multivariable modeling of the right-left ear difference in DDT-free recall scores, participants with a history of cardiovascular disease (CVD) or higher PWV demonstrated significantly larger differences (CVD: +3.11 percentage points, p = 0.02; PWV: +0.36 percentage points per 1 m/sec, p < 0.01). Higher levels of non-HDL cholesterol were associated with smaller right-left ear differences (-0.22 percentage points per 10 mg/dL, p = 0.01). Adjustment for handedness did not affect the results. Conclusions: Vascular health-related factors may play a role in central auditory function. [ABSTRACT FROM AUTHOR]

Auditory verbal hallucinations (AVHs) are a core symptom of schizophrenia, and resistant to antipsychotic medication in a substantial proportion of patients. This study aimed to investigate the neural correlates of AVHs in schizophrenia patients and its response to a modified continuous theta-burst stimulation (cTBS) by transcranial magnetic stimulation. In a cross-sectional experiment, resting-state functional magnetic resonance images were collected from 31 AVH schizophrenia patients, 26 non-AVH schizophrenia patients, and 33 sex-/age-matched healthy controls (HCs). Functional connectivity strength (FCS) maps were compared among groups by 1-way analysis of variance (ANOVA). In a longitudinal experiment, 16 and 11 AVH patients received real and sham cTBS treatment for 15 days, respectively. Notably, this was not a randomized control trail. Changes in AVH and FCS were analyzed by 2-way ANOVA and 2-sample t -test, respectively. In the cross-sectional experiment, comparison of FCS maps identified 8 clusters among groups, but only one cluster (in left cerebellum) differed significantly in AVH patients compared to both HCs and non-AVH patients. In the longitudinal experiment, the real cTBS group showed a greater improvement in symptoms and a larger FCS decrease in left cerebellum than the sham group. Pearson's correlation analysis indicated that baseline FCS of the overlapping cerebellum cluster (between the cross-sectional and longitudinal findings) was negatively correlated with symptom improvement in the real treatment group. These findings emphasize the role of the left cerebellum in both the pathophysiology and clinical treatment of AVHs in schizophrenia patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the prevalence of hearing loss and ear problems in Pacific children, and investigate current and past demographic, health and social factors potentially associated with hearing and ear problems. Design: A cross-sectional observational study design nested within a birth cohort was employed. Study sample: Nine-hundred-twenty Pacific children aged 11 years were audiologically assessed. Using average hearing thresholds at 500, 1k and 2k Hz, 162 (18%) right and 197 (21%) left ears had ≥20 dB hearing loss. Hearing loss was mild (20-39 dB) in most cases; 2% of ears had moderate to moderate-severe (40-69 dB) hearing loss. However, only 101 (11%) children had normal peripheral hearing defined by passing hearing threshold, tympanogram and distortion product otoacoustic emission assessments. Those with confirmed middle ear disease at age 2 years had significantly increased odds of a non-Type A tympanogram (adjusted odds ratio: 2.00; 95% confidence interval: 1.56, 2.50) when re-assessed at age 11 years. Conclusions: Hearing loss, abnormal tympanograms, and auditory processing difficulties were present in many Pacific children. Interventions are also urgently needed to mitigate the effect of the longstanding ear disease likely to be present for many Pacific children. [ABSTRACT FROM AUTHOR]

The Marcus Institute for Brain Health (MIBH) provides interdisciplinary care for adults struggling with persistent effects of mild traumatic brain injury and accompanying changes in behavioral health, with specific emphases on Veterans and retired elite athletes. The cognitive, physical, and behavioral symptoms associated with mild traumatic brain injury are interrelated, with neurobiopsychosocial modeling encompassing the factors related to recovery from a traumatic brain injury. The diffuse impacts of chronic concussive injuries require multiple clinical providers to address the breadth of symptoms, facilitating both interdisciplinary and transdisciplinary care models. By implementing integrated practice units, patients receive advanced medical care, imaging, speech-language pathology, physical therapy, behavioral health, neuropsychology, and clinical pharmacy for a cohesive diagnostic and intervention plan. Nationally, speech-language pathologists report challenges with best-practice options for concussion, particularly in the domain of assessment practices. At the MIBH, speech-language pathologists begin their assessment with a structured clinical interview that focuses on patients' needs and concerns. Evaluation modalities focus on hearing, communication, and functional cognition to guide therapeutic treatment planning. The intensive outpatient care program at MIBH incorporates both individual sessions targeting patient-centered goals and group care, where speech-language pathologists work transdisciplinarily to generalize care from all disciplines out into the community. Care practices for concussive injuries continue to evolve rapidly; speech-language pathology at the MIBH offers one such vision for excellence in clinical care. [ABSTRACT FROM AUTHOR]

Since Hans Asperger's first description (Arch Psych Nervenkrankh 117:76-136, 1944), through Lorna Wing's translation and definition (Psychol Med 11:115-129, 1981), to its introduction in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM, 1994), Asperger Syndrome has always aroused huge interest and debate, until vanishing in the DSM fifth edition (2013). The debate regarded its diagnostic validity and its differentiation from high functioning autism (HFA). The present study aimed to examine whether AS differed from HFA in clinical profiles and to analyze the impact of DSM-5's innovation. Differences in cognitive, language, school functioning and comorbidities, were revealed when 80 AS and 70 HFA patients (3-18 years) were compared. Results suggested that an AS empirical distinction within autism spectrum disorder should be clinically useful. [ABSTRACT FROM AUTHOR]

Objective: To determine whether children aged 7 to 12 years with listening difficulties show objective evidence for efferent auditory function based on measurements of medial olivo-cochlear and middle ear muscle reflexes. Design: Click-evoked otoacoustic emissions recorded with and without contralateral broadband noise and ipsilateral and contralateral tonal (1000, 2000 Hz) middle ear muscle reflex thresholds were examined. Study sample: 29 children diagnosed with suspected auditory processing disorder (APD) and a control group of 34 typically developing children participated in this study. Results: Children with suspected APD had poorer performance on auditory processing tests than the control group. Middle ear muscle reflex thresholds were significantly higher at 2000 Hz in the suspected APD group for contralateral stimulation. MOC inhibition effects did not differ between APD and control groups. Conclusions: This research supports earlier studies showing altered acoustic reflexes in children with APD. No group differences were found for the MOC reflex measures, consistent with some earlier studies in children with APD. [ABSTRACT FROM AUTHOR]

Objectives Sometimes there is no hearing impairment, but it is possible to have an auditory disorder. This is known as a central auditory processing disorder (CAPD). Speech dichotic tasks are useful tools to evaluate CAPD, but there is almost no tool to assess this for Azeri people in their native language. The aim of this study was to evaluate central auditory processing of Azeri participants by Azeri dichotic digit test (ADDT). Materials & Methods Participants were 52 normal Iranian Azeri students (mean age 23.27± 4.71; 26 females, 26 males) in the Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Science, Tehran, Iran in 2016. They were chosen by convenient sampling. ADDT was constructed and administered in free recall conditions along with a Persian dichotic digit test (PDDT). After two to four weeks, reliability was performed. Results The mean of the right ear score of PDDT and ADDT was 98.90% and 99.09%, respectively. ADDT was reliable in almost all scores. There was no significant difference in performance between men and women in any score of both tests (P>0.05). The results showed a significant difference between both ears' scores in PDDT (P<0.02) as well as in ADDT (P=0.00). The right ear advantage was seen in both tests. Conclusion All participants performed significantly better on digits presented in the right ear than the left ear in both tests. Central auditory processing of Azeri participants for Azeri is similar to that for Persian. [ABSTRACT FROM AUTHOR]

Aim: To determine the relationship between the Test of Infant Motor Performance (TIMP) at 3 months and cognitive, language, and motor outcomes on the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 2 years of age in high-risk infants born preterm.Method: One hundred and six infants (47 females, 59 males) born at earlier than 31 weeks gestational age were prospectively tested with the TIMP at 10 to 15 weeks after term age and were assessed again with the Bayley-III at 2 years corrected age. Sensitivity and specificity were calculated for various cut points of the TIMP z-score and Bayley-III composite scores of no more than 85.Results: The TIMP z-scores at 10 to 15 weeks of age were significantly associated with all three subscales on the Bayley-III at 2 years of age (p<0.001). Using a TIMP z-score cutoff of -0.5, specificity was relatively high for cognitive (87%), language (88%), and motor (89%) outcomes, but sensitivity was low (cognitive 41%, language 49%, motor 57%).Interpretation: This study demonstrates that the TIMP is related to cognitive, language, and motor outcomes on the Bayley-III at 2 years of age in high-risk infants born preterm.What This Paper Adds: The Test of Infant Motor Performance (TIMP) predicts Bayley Scales of Infant and Toddler Development, Third Edition outcomes at 2 years of age. The TIMP is relatively good at discriminating between children who will and will not have typical development. [ABSTRACT FROM AUTHOR]

Abstract: Nosology is the science of defining and classifying diseases. Meta‐nosology is the study of how we do this, on what principles nosological practices are based, the quality of the resulting medical taxonomy, and primarily whether/how diseases can be defined better than they are now. In modern Western medicine, there are a wide variety of ways in which diseases are defined and categorized. Examples include by the symptoms they present with (syndromic), their underlying causes (etiological), the biological mechanisms involved (pathogenetic), available treatments, historical precedent, and through diagnostic exclusion. Here, I explore the hypothesis that how we define diseases has an impact on how (and how effectively) we research and treat them. I explore the philosophical implications of this thesis and suggest a direction that the underlying metaphysics of disease definition might follow. I conclude that further research is warranted into whether our current disease definitions could be improved upon. [ABSTRACT FROM AUTHOR]

Background: Auditory processing (AP) is commonly regarded as the perceptual processing of auditory information in the central nervous system. However, the degree to which higher level cognitive processes are involved in AP or its disorders is contentious. Furthermore, there is little evidence regarding the effects of nonauditory cognitive processes on the various tests of AP in common clinical usage and thus on clinical diagnoses of auditory processing disorder. Purpose: To determine the effects of increased cognitive demand, generated by using a dual-task paradigm, on performance on different AP tests and types of AP tests in common clinical usage. In addition, to investigate the relationship between executive function and changes in AP test performance associated with increased cognitive demand. Research Design: Counterbalanced repeated measures design, with assessment of AP test performance both on its own and in a dual-task paradigm designed to increase cognitive demand. Study Sample: Twenty-nine young adults, with no reported hearing, learning, language or attention difficulties, English as first language, and hearing and middle-ear status within normal limits. Data Collection and Analysis: Testing was completed within a single 90-min session. A selection of standard AP tests, representing both adaptive and nonadaptive tests, as well as tests employing difference scores, was administered. These were Competing Sentences Test, Dichotic Digits Test, Frequency Pattern Test (nonadaptive tests); and Listening in Spatialized Noise-Sentences test, conditions "same-voice, 0°", "different-voice, 0°", and "same-voice, 90°" (adaptive tests), from which the difference scores "talker advantage" and "spatial advantage" were also derived. Each AP test was completed on its own (alone condition), and simultaneously with a visually presented task (dual-task condition). Executive function was assessed using the phonemic subtest of the Verbal Fluency Test. Nonparametric statistical test procedures were used. Results: All five AP measures obtained from the nonadaptive tests showed a significant performance decrement in the dual-task condition compared with the alone condition, with one exception because of a strong ceiling effect. By contrast, none of the three AP measures obtained from the adaptive tests showed a significant performance decrement in the dual-task condition. Furthermore, neither of the two AP measures based on difference scores showed a significant performance decrement, but this finding simply reflects the lack of significant decrements in the relevant raw scores. Consistent with past reports of associations between executive function and AP performance, a significant positive correlation was found between executive function scores and performance on the Dichotic Digits Test. However, there were no significant correlations between executive function scores and changes in AP test scores between alone and dual-task conditions. Conclusions: Performance on commonly used nonadaptive tests of AP was significantly compromised by the increased cognitive demand resulting from the dual-task paradigm. By contrast, performance on AP measures obtained by adaptive test procedures was not significantly affected. Further investigation of the resilience to increased cognitive demand of the adaptive tests used here, and other adaptive tests of AP, is warranted. Results from this study support the further development of computerized adaptive tests of AP for use in clinical test batteries. [ABSTRACT FROM AUTHOR]

Introduction: Prevalence of central auditory processing disorders (CAPD) increases with age. Central auditory dysfunction is also more prevalent in older people with mild memory impairment compared with cognitively normal older people. These findings suggest that CAPD could be a marker of subtle cognitive dysfunction. A logical question is whether tests of CAPD have a potential role in evaluation of possible cognitive decline in elderly people with hearing complaints. This question has direct clinical relevance because tests for CAPD are widely available, easy to administer in a short time. Methods: Fifty-one patient having cognitive impairment (diagnosed according Diagnostic and Statistical Manual of Mental disorders, fifth edition 2013 (DSM-V) comprise the study group. The control group includes twenty age and gender matched individuals. A detailed neuropsychological assessment of both groups with tests from various cognitive domains (Visuospatial functions, executive function, short-term memory and verbal episodic memory). Behavioural central auditory tests included the Arabic versions of speech in noise test (SPIN) and/or synthetic sentence identification (SSI) test according to education of patient, the dichotic digits test (DDT), The auditory fusion test (AFT) and auditory memory tests. Results: There was a statistically significant difference between both groups in the behavioural central auditory tests. Conclusions: The relation of some measures of auditory processing to deficits in cognitive function might enable the early identification of cognitive decline with such measures in the older population. Aging can contribute to changes in central auditory processing (CAP) in the elderly especially in Speech understanding in background noise, Dichotic listening and Temporal Processing. [ABSTRACT FROM AUTHOR]

Purpose: Our goal is to present the relationships between working memory (WM) and auditory processing abilities in school-age children. Review and Discussion: We begin with an overview of auditory processing, the conceptualization of auditory processing disorder, and the assessment of auditory processing abilities in children. Next, we describe a model of WM and a model of auditory processing followed by their comparison. Evidence for the relationships between WM and auditory processing abilities in school-age children follows. Specifically, we present evidence for the association (or lack thereof) between WM/attention and auditory processing test performance. Clinical Implications: In conclusion, we describe a new framework for understanding auditory processing abilities in children based on integrated evidence from cognitive science, hearing science, and language science. We also discuss clinical implications in children that could inform future research. [ABSTRACT FROM AUTHOR]

Purpose: The pediatric and adult versions of the SCAN-3 test (Keith, 2009a, 2009b) are widely used to screen and diagnose auditory processing disorders. According to the instruction manual, the test administration is flexible in that it may be administered through an audiometer at 50 dB HL or a portable CD player at the patient or administrator's most comfortable listening level (MCL). Because MCL may vary across individuals, even in those with normal hearing sensitivity, this study explored whether the presentation level affected scores on the SCAN-3 for both pediatric and adult populations. Method: Twenty-two young adults and 23 children with normal hearing sensitivity and middle ear function were administered the SCAN-3 three different times at 1-month intervals, at 40, 50, and 60 dB HL. The stimulus level of the SCAN-3 was counterbalanced across participants to eliminate test order effects. In addition, MCL was measured in the pediatric participants during each session. Results: MCL varied significantly across children as well as between test sessions, ranging from 40 to 75 dB HL. Performance on 3 of the 4 subtests administered, as well as composite scores, was significantly different across presentation levels (based on scaled scores). Effect sizes were also calculated and found to be strong. The number of composite scores interpreted as within normal limits versus borderline or disordered was also statistically different across presentation levels. Conclusions: Presentation level appears to affect performance on auditory figure ground, monaural lowredundancy, and binaural integration types of auditory processing tasks that are measured by the SCAN-3. In children, MCL was found to vary significantly both between and within individuals. Although several professions outside audiology are qualified to administer the SCAN-3, it is likely that many of these individuals administer the test without an audiometer and would use an MCL to determine presentation level. It is recommended that SCAN-3 users administer the test through an audiometer at 50 dB HL, rather than with a portable CD player, using MCL values to avoid any presentation level effects. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to determine a criterion to diagnose the presence of auditory processing disorder (APD) in children. Method: Using a standard comparison design, 280 children "not at risk" for APD and 100 children "at risk" for APD were evaluated on 4 different tests: Speech-in-Noise Test in Indian English (Yathiraj, Vanaja, & Muthuselvi, 2010), Dichotic Consonant--Vowel (Yathiraj, 1999), Duration Pattern Test (Musiek, Baran, & Pinheiro, 1990), and the Revised Auditory Memory and Sequencing Test in Indian English (Yathiraj, Vanaja, & Muthuselvi, 2010). The age of the children ranged from 6 to 10 years. Results: With a cutoff criterion of 1 SD below the mean of the test scores, 8% of the children "at risk" for APD passed all the tests, whereas 28% passed with a criterion of 2 SDs below the mean scores. The tests most frequently failed by these children were Speech-in-Noise Test in Indian English and Dichotic Consonant--Vowel. Conclusions: A cutoff criterion of 2 SDs below the mean scores of typically developing children is recommended to diagnose children as having APD if they performed poorly on only one test. For children who performed poorly on more than one test, a cutoff criterion of 1 SD below the mean scores of typically developing children is recommended. [ABSTRACT FROM AUTHOR]

There is a growing awareness that children may experience hyperacusis, a condition that is often associated with behavioral and developmental disorders. This preliminary study was aimed to investigate the effects of hyperacusis alone on various components of speech and language in children without developmental disorders. This study was conducted on 109 children aged between 4 and 7 years attending kindergarten and primary school. Hyperacusis was assessed through behavioral observation of children and questionnaires for parents. Different components of speech and language were assessed through specific tests. Hyperacusis was diagnosed in fifteen children (13.8%); ten (66.7%) were attending primary school and five (33.3%) kindergarten. A significant difference between children with and without hyperacusis was found for tests evaluating the average number of words in a sentence and phonemic fluency; older children appeared to have more difficulties. Several differences in education profiles were found: parents of children with hyperacusis spent less time with their children compared to parents of children without hyperacusis. Our preliminary results suggest some difficulties in lexical access and the use of shorter sentences by children with hypersensitivity to sound; however, the small size of our sample and the largely unknown interactions between hyperacusis and developmental disorders suggest caution when interpreting these results. Further studies on larger samples are necessary to gain additional knowledge on the effects of hyperacusis on speech and language in children without developmental disorders. [ABSTRACT FROM AUTHOR]

Aim To compare the performance in temporal auditory ordering and resolution tests and the latency and amplitude in the records of middle latency auditory evoked potential and P3 of prematurely born children with the performance of full-term children undergoing the same assessment protocol.Study Design: Cross-sectional observational study.Subjects: Fifty-two children, aged 8 to 10 years, participated in the study and were divided into two groups: study group: 16 prematurely born children, and control group: 36 born full-term, at low risk for developmental alteration and without scholastic or hearing difficulties.Outcome Measures: All subjects underwent ordering tests (Frequency and duration pattern tests) and temporal auditory resolution tests (Gaps in noise test) and had their middle-latency auditory evoked potential and P3 recorded by using an Intelligent Hearing System unit.Results: Prematurely born children had worse performance in the temporal ordering and resolution tests as compared with children born full-term. With regard to middle-latency auditory evoked potential and P3, prematurely born children had higher mean values of latencies and poorer morphology, a statistical significance was evidenced for P3 in the right ear.Conclusions: A prematurity effect was found in the temporal auditory processing measurements and in the P3. [ABSTRACT FROM AUTHOR]

Background: Children referred to audiology services with otherwise unexplained academic, listening, attention, language, or other difficulties are often found to be audiometrically normal. Some of these children receive further evaluation for auditory processing disorder (APD), a controversial construct that assumes neural processing problems within the central auditory nervous system. This study focuses on the evaluation of APD and how it relates to diagnosis in one large pediatric audiology facility. Purpose: To analyze electronic records of children receiving a central auditory processing evaluation (CAPE) at Cincinnati Children's Hospital, with a broad goal of understanding current practice in APD diagnosis and the test information which impacts that practice. Research Design: A descriptive, cross-sectional analysis of APD test outcomes in relation to final audiologist diagnosis for 1,113 children aged 5-19 yr receiving a CAPE between 2009 and 2014. Results: Children had a generally high level of performance on the tests used, resulting in marked ceiling effects on about half the tests. Audiologists developed the diagnostic category "Weakness" because of the large number of referred children who clearly had problems, but who did not fulfill the AAA/ASHA criteria for diagnosis of a "Disorder." A "right-ear advantage" was found in all tests for which each ear was tested, irrespective of whether the tests were delivered monaurally or dichotically. However, neither the side nor size of the ear advantage predicted the ultimate diagnosis well. Cooccurrence of CAPE with other learning problems was nearly universal, but neither the number nor the pattern of cooccurring problems was a predictor of APD diagnosis. The diagnostic patterns of individual audiologists were quite consistent. The number of annual assessments decreased dramatically during the study period. Conclusions: A simple diagnosis of APD based on current guidelines is neither realistic, given the current tests used, nor appropriate, as judged by the audiologists providing the service. Methods used to test for APD must recognize that any form of hearing assessment probes both sensory and cognitive processing. Testing must embrace modern methods, including digital test delivery, adaptive testing, referral to normative data, appropriate testing for young children, validated screening questionnaires, and relevant objective (physiological) methods, as appropriate. Audiologists need to collaborate with other specialists to understand more fully the behaviors displayed by children presenting with listening difficulties. To achieve progress, it is essential for clinicians and researchers to work together. As new understanding and methods become available, it will be necessary to sort out together what works and what doesn't work in the clinic, both from a theoretical and a practical perspective. [ABSTRACT FROM AUTHOR]

Purpose: This is a response to a letter to the editor from Drs. Chermak, Iliadou, Bamiou, and Musiek regarding "The Gold Standard and Auditory Processing Disorder" (Vermiglio, 2018). Chermak et al. have taken issue with several of the concepts presented in this article. This response addresses their key criticisms and expands the discussion on the poor understanding of diagnostic accuracy research in the area of auditory processing disorder (APD). Conclusions: The concept of the diagnostic system provides clarity for critical reviews of the diagnostic accuracy literature on APD. The lack of clarity in the APD construct is fueled by the ambiguity of the definitions. The "evidence" for an APD, irrespective of the presence of a lesion of the central auditory system, is derived through the logical fallacy of equivocation. A recommended alternative approach is to identify legitimate clinical entities within the APD construct, which will lead to the procurement of reasonable gold or reference standards for diagnostic accuracy research. [ABSTRACT FROM AUTHOR]

Purpose and Conclusion: This letter to the editor is a rebuttal to Vermiglio's "The Gold Standard and Auditory Processing Disorder" (2018). We identify several faulty premises, inconsistent use of terminology, and several key errors and omissions that undermine Vermiglio's assertions. We conclude that the definition of auditory processing disorder (APD) is not ambiguous; a clinically useful and widely adopted gold standard for the diagnosis of APD is in use across the world; and this efficient test battery leads to verifiable diagnosis of APD and deficit-specific, individualized intervention that leads to the provision of enhanced opportunities in academic, work, and social environments for children and adults diagnosed with APD. We note that Vermiglio's flawed assertions may serve to discourage clinical services for patients with APD and propose that those who take issue with the research base of APD contribute original research that advances diagnostic and treatment services for this population. [ABSTRACT FROM AUTHOR]

Diagnostic accuracy research plays a lead role in evidence-based medicine for physicians and evidence-based practice for speech-language pathologists and audiologists. A key component in diagnostic accuracy research is the "gold standard" also known as the reference standard test. This test is used as the best method for the identification of the presence and absence of a target disorder. A review of the literature reveals a poor understanding of this concept, especially in the area of auditory processing disorder. It is important to approach the topic of the gold standard in the context of a diagnostic system. The overall purpose of this article is to provide guidance for reviewers of diagnostic accuracy literature regarding lesions of the central auditory nervous system and an auditory processing disorder. [ABSTRACT FROM AUTHOR]

Background: Evaluation of dichotic listening to digits is a common part of many studies for diagnosis and managing auditory processing disorders in children. Previous researchers have verified test--retest relative reliability of dichotic digits results in normal children and adults. However, detecting interventionrelated changes in the ear scores after dichotic listening training requires information regarding trial-totrial typical variation of individual ear scores that is estimated using indices of absolute reliability. Previous studies have not addressed absolute reliability of dichotic listening results. Purpose: To compare the results of the Persian randomized dichotic digits test (PRDDT) and its relative and absolute indices of reliability between typical achieving (TA) and learning-disabled (LD) children. Research Design: A repeated measures observational study. Study Sample: Fifteen LD children were recruited from a previously performed study with age range of 7-12 yr. The control group consisted of 15 TA schoolchildren with age range of 8-11 yr. Data Collection and Analysis: The Persian randomized dichotic digits test was administered on the children under free recall condition in two test sessions 7-12 days apart. We compared the average of the ear scores and ear advantage between TA and LD children. Relative indices of reliability included Pearson's correlation and intraclass correlation (ICC2,1) coefficients and absolute reliability was evaluated by calculation of standard error of measurement (SEM) and minimal detectable change (MDC) using the raw ear scores. Results: The Pearson correlation coefficient indicated that in both groups of children the ear scores of test and retest sessions were strongly and positively (greater than 10.8) correlated. The ear scores showed excellent ICC coefficient of consistency (0.78-0.82) and fair to excellent ICC coefficient of absolute agreement (0.62--0.74) in TA children and excellent ICC coefficients of consistency and absolute agreement in LD children (0.76-0.87). SEM and SEM% of the ear scores in TA children were 1.46 and 1.44% for the right ear and 4.68 and 5.47% for the left ear. SEM and SEM% of the ear scores in LD children were 4.55 and 5.88% for the right ear to 7.56 and 12.81% for the left ear. MDC and MDC% of the ear scores in TA children varied from 4.03 and 3.99% for the right ear to 12.93 and 15.13% for the left ear. MDC and MDC% of the ear scores in LD children varied from 12.57 and 16.25% for the right ear to 20.89 and 35.39% for the left ear. Conclusions: The LD children indicated test--retest relative reliability as high as TA children in the ear scores measured by PRDDT. However, within-subject variations of the ear scores calculated by indices of absolute reliability were considerably higher in LD children versus TA children. The results of the current study could have implications for detecting real training-related changes in the ear scores. [ABSTRACT FROM AUTHOR]

Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. And yet, persistent AH are not synonymous with having a psychotic disorder, and should therefore not be uncritically treated as such. Many people who seek treatment for persistent AH have no other psychotic symptoms, have preserved realitytesting capacities, and will never develop a schizophrenia spectrum disorder. Instead, hallucinations may be the result of many different causes, including borderline personality disorder, post-traumatic stress disorder (PTSD), hearing loss, sleep disorders or brain lesions, and they may even occur outside the context of any demonstrable pathology. In such cases, the usage of the DSM-5 diagnosis of OSSSOPD would be incorrect, and it may prompt unwarranted treatment with antipsychotic medication. We therefore argue that a DSM-5 diagnosis of Schizophrenia Spectrum Disorder (or any other type of psychotic disorder) characterized by AH should require at least one more symptom listed under the A-criterion (i.e. delusions, disorganized speech, disorganized or catatonic behavior or negative symptoms). Adhering to these more stringent criteria may help to distinguish between individuals with persistent AH which are part of a psychotic disorder, for whom antipsychotic medication may be helpful, and individuals with AH in the absence of such a disorder who may benefit from other approaches (e.g. different pharmacological interventions, improving coping style, trauma-related therapy). [ABSTRACT FROM AUTHOR]

Objective: The main purpose of this research was to obtain normative data for auditory processing tests for Norwegian speaking children.Design: Participants were administered routine audiological tests and an auditory processing test-battery consisting of Filtered Words, Competing Words, Dichotic Digits, Gaps In Noise, Duration– and Frequency Pattern, Binaural Masking Level Difference and HIST Speech in Noise test. A group of 10-year-old children were retested after two weeks. The effects ear, age and gender and the test–retest reliability were investigated.Study sample: There were 268 normal hearing children aged 7–12 years who participated in the study.Results: Results revealed no differences between genders. The children showed improving performance by age on all tests, except from the Gaps In Noise and Binaural Masking Level Difference. As expected, the children showed a right ear advantage on dichotic speech tests that decreased with age. The test–retest reliability for the tests was good, with a small learning effect on the Filtered Words test.Conclusion: Normative data were established and the preferred tests for diagnosing Auditory Processing Disorder were suggested for Norwegian children aged 7–12 years. [ABSTRACT FROM AUTHOR]

Background: Previous research suggests that a proportion of children experiencing reading and listening difficulties may have an underlying primary deficit in the way that the central auditory nervous system analyses the perceptually important, rapidly varying, formant frequency components of speech. Purpose: The Phoneme Identification Test (PIT) was developed to investigate the ability of children to use spectro-temporal cues to perceptually categorize speech sounds based on their rapidly changing formant frequencies. The PIT uses an adaptive two-alternative forced-choice procedure whereby the participant identifies a synthesized consonant-vowel (CV) (/ba/ or/da/) syllable. CV syllables differed only in the second formant (F2) frequency along an 11-step continuum (between 0% and 100%--representing an ideal /ba/ and /da/, respectively). The CV syllables were presented in either quiet (PIT Q) or noise at a 0 dB signal-to-noise ratio (PIT N). Research Design: Development of the PIT stimuli and test protocols, and collection of normative and test-retest reliability data. Study Sample: Twelve adults (aged 23 yr 10 mo to 50 yr 9 mo, mean 32 yr 5 mo) and 137 typically developing, primary-school children (aged 6 yr 0 mo to 12 yr 4 mo, mean 9 yr 3 mo). There were 73 males and 76 females. Data Collection and Analysis: Data were collected using a touchscreen computer. Psychometric functions were automatically fit to individual data by the PIT software. Performance was determined by the width of the continuum for which responses were neither clearly /ba/ nor /da/ (referred to as the uncertainty region [UR]). A shallower psychometric function slope reflected greater uncertainty. Age effects were determined based on raw scores. Zscores were calculated to account for the effect of age on performance. Outliers, and individual data for which the confidence interval of the UR exceeded a maximum allowable value, were removed. Nonparametric tests were used as the data were skewed toward negative performance. Results: Across participants, the median value of the F2 range that resulted in uncertain responses was 33% in quiet and 40% in noise. There was a significant effect of age on the width of this UR (p < 0.00001) in both quiet and noise, with performance becoming adult like by age 9 on the PIT Q and age 10 on the PIT N. A skewed distribution toward negative performance occurred in both quiet (p = 0.01) and noise (p = 0.006). Median UR scores were significantly wider in noise than in quiet (T = 2041, p < 0.0000001). Performance (z scores) across the two tests was significantly correlated (r = 0.36, p = 0.000009). Test-retest z scores were significantly correlated in both quiet and noise (r = 0.4 and 0.37, respectively, p < 0.0001). Conclusions: The PIT normative data show that the ability to identify phonemes based on changes in formant transitions improves with age, and that some children in the general population have performance much worse than their age peers. In children, uncertainty increases when the stimuli are presented in noise. The test is suitable for use in planned studies in a clinical population. [ABSTRACT FROM AUTHOR]

Objective: This study examined adaptive responses to auditory perturbation of fundamental frequency (fo) in speakers with Parkinson’s disease (PD) and control speakers. Method: Sixteen speakers with PD and nineteen control speakers produced sustained vowels while they received perturbed auditory feedback (i.e., fo shifted upward or downward). Speakers’ pitch acuity was quantified using a just-noticeable-difference (JND) paradigm. Twelve listeners provided estimates of the speech intelligibility for speakers with PD. Results: Fifteen responses from each speaker group for each shift direction were included in analyses. While control speakers generally showed consistent adaptive responses opposing the perturbation, speakers with PD showed no compensation on average, with individual PD speakers showing highly variable responses. In the PD group, the degree of compensation was not significantly correlated with age, disease progression, pitch acuity, or intelligibility. Conclusions: These findings indicate reduced adaptation to sustained fo perturbation and higher variability in PD compared to control participants. No significant differences were seen in pitch acuity between groups, suggesting that the fo adaptation deficit in PD is not the result of purely perceptual mechanisms. Significance: These results suggest there is an impairment in vocal motor control in PD. Building on these results, contributions can be made to developing targeted voice treatments for PD. [ABSTRACT FROM AUTHOR]

Background: Despite the well-established relationship between aging and auditory processing decline, identifying the extent to which age effect is the main factor on auditory processing performance remains a great challenge due to the co-occurrence of age-related hearing loss and age-related cognitive decline as potential confounding factors. Purpose: To investigate the effects of age-related hearing loss and working memory on the clinical evaluation of auditory processing of middle-aged and elderly. Research Design: Cross-sectional study. Study Sample: A total of 77 adults between 50 and 70 yr of age were invited to participate in the study. Data Collection and Analysis: The participants were recruited from a larger study that focused on the assessment and management of sensory and cognitive skills in elderly participants. Only participants with normal hearing or mild-to-moderate age-related hearing loss, with no evidence of cognitive, psychological, or neurological conditions were included. Speech-in-noise, dichotic digit, and frequency pattern tests were conducted as well as a working memory test. The hearing loss effect was investigated using an audibility index, calculated from the audiometric threshold. The performance on the digit span test was used to investigate working memory effects. Both hearing loss and working memory effects were investigated via correlation and regression analyses, partialling out age effects. The significance level was set at p < 0.05. Results: The results demonstrated that, while hearing loss was associated to the speech-in-noise performance, working memory was associated to the frequency pattern and dichotic digit performances. Regression analyses confirmed the relative contribution of hearing loss to the variance in speech-in-noise and working memory test to the variance in frequency pattern and dichotic digit test performance. Conclusions: The performance decline of the elderly in auditory processing tests may be partially attributable to the working memory performance and, consequently, to the cognitive decline exhibited by this population. Mild-to-moderate hearing loss seems to affect performance on specific auditory processing tasks, such as speech in noise, reinforcing the idea that auditory processing disorder in the elderly might also be associated to auditory peripheral deficits. [ABSTRACT FROM AUTHOR]

To gain more insight into central hearing loss, we investigated the relationship between cortical thickness and surface area, speech-relevant resting state EEG power, and above-threshold auditory measures in older adults and younger controls. Twenty-three older adults and 13 younger controls were tested with an adaptive auditory test battery to measure not only traditional pure-tone thresholds, but also above individual thresholds of temporal and spectral processing. The participants' speech recognition in noise (SiN) was evaluated, and a T1-weighted MRI image obtained for each participant. We then determined the cortical thickness (CT) and mean cortical surface area (CSA) of auditory and higher speech-relevant regions of interest (ROIs) with FreeSurfer. Further, we obtained resting state EEG from all participants as well as data on the intrinsic theta and gamma power lateralization, the latter in accordance with predictions of the Asymmetric Sampling in Time hypothesis regarding speech processing (Poeppel, Speech Commun 41:245-255, 2003). Methodological steps involved the calculation of age-related differences in behavior, anatomy and EEG power lateralization, followed by multiple regressions with anatomical ROIs as predictors for auditory performance. We then determined anatomical regressors for theta and gamma lateralization, and further constructed all regressions to investigate age as a moderator variable. Behavioral results indicated that older adults performed worse in temporal and spectral auditory tasks, and in SiN, despite having normal peripheral hearing as signaled by the audiogram. These behavioral age-related distinctions were accompanied by lower CT in all ROIs, while CSA was not different between the two age groups. Age modulated the regressions specifically in right auditory areas, where a thicker cortex was associated with better auditory performance in older adults. Moreover, a thicker right supratemporal sulcus predicted more rightward theta lateralization, indicating the functional relevance of the right auditory areas in older adults. The question how age-related cortical thinning and intrinsic EEG architecture relates to central hearing loss has so far not been addressed. Here, we provide the first neuroanatomical and neurofunctional evidence that cortical thinning and lateralization of speech-relevant frequency band power relates to the extent of age-related central hearing loss in older adults. The results are discussed within the current frameworks of speech processing and aging. [ABSTRACT FROM AUTHOR]

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Objective: This study investigated the perspectives of professionals from the Dutch audiological centres on the definition and care pathways of children with suspected auditory processing disorders (susAPD).Design: focus group interviews.Study sample: In total, 45 professionals from 6 disciplines, representing 22 different audiological centres and one ambulatory service, participated in five parallel focus group interviews. Participants had a variety of experience in diagnosing and advising children with suspected APD.Results:Qualitative analysis (open and thematic) identified four themes (“Definition”, “Causes”, “Diagnostic Procedures” and “Clinical Reasoning”) expressing a variety of perspectives. Differences in perspectives were mainly affected by two debates: (1) whether or not APD exists as a pure (auditory) disorder and (2) whether or not current AP-tests are suitable in diagnosing children with listening difficulties. They also expressed a need for more guidance from the literature in their clinical decision making process.Conclusions: Professionals from the Dutch audiological centres share a broad perspective on children with APD. The ICF framework supports this perspective, thereby diminishing the need for a clear definition. The use of AP-tests should be limited to children where broader developmental disorders are first ruled out; a possible “pure” APD could then be diagnosed in a limited number of children. [ABSTRACT FROM PUBLISHER]

This study aimed to (a) explore the roles of cognitive and language variables in predicting reading abilities of two groups of individuals with reading disabilities (i.e., dyslexia and specific language impairment) and (b) examine which variable(s) is the most predictive in differentiating two groups. Inclusion/exclusion criteria applied to categorize the two groups yielded a total of 63 participants (n = 44 for the dyslexia; n = 19 for the specific language impairment). A stepwise multiple regression approach was conducted to examine which cognitive and/or language variables made the largest contribution to reading abilities (i.e., Phonetic Decoding Efficiency, Word Attack, Sight Word Efficiency, and Passage Comprehension). Results revealed that there were significant differences in which measures of cognitive and language ability predicted individuals with dyslexia and speech and language impairments reading ability, showing that the cognitive and language variables underlying their difficulty with reading abilities were not the same across the two groups. A discriminant function analysis showed that a measure of Verbal Comprehension, Phonological Awareness, and Phonetic Decoding Efficiency can be used to differentiate the two groups. These findings support the tenet that dyslexia and specific language impairment are two subgroups of reading disabilities and that thorough diagnostic evaluations are needed to differentiate between these two subgroups. Distinctions of this nature are central to determining the type and intensity of language-based interventions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article was to provide multiple examples of how (central) auditory processing disorder ([C]APD) is being evaluated and treated at various audiology clinics throughout the United States. Method: The authors present 5 cases highlighting the diagnosis and treatment of (C)APD in children and adults. Similarities and differences between these cases have been showcased through detailed histories, evaluation protocol, and treatment options. When possible, the rationale for evaluation procedures and intervention processes were described and compared with guidelines and findings within the literature. Results and Conclusions: These cases illustrate the varied processes and clinical protocols by which children and adults are evaluated, diagnosed, counseled, and treated for (C)APD. In addition, similarities and differences between the referral source, evaluation team, developmental history, comorbidities, test battery, recommendations, and remediations were described. The multiple clinic sites, diversity of clinical philosophies, variety of test measures, and diversity of patient populations make these cases ideal for showcasing the assortment of methodologies used with patients who present with histories and characteristics consistent with (C)APD. [ABSTRACT FROM AUTHOR]

Background: Pediatric central auditory processing disorder (CAPD) is frequently comorbid with other childhood disorders. However, few studies have examined the relationship between commonly used CAPD, language, and cognition tests within the same sample. Purpose: The present study examined the relationship between diagnostic CAPD tests and "gold standard" measures of language and cognitive ability, the Clinical Evaluation of Language Fundamentals (CELF) and the Wechsler Intelligence Scale for Children (WISC). Research Design: A retrospective study. Study Sample: Twenty-seven patients referred for CAPD testing who scored average or better on the CELF and low average or better on the WISC were initially included. Seven children who scored below the CELF and/or WISC inclusion criteria were then added to the dataset for a second analysis, yielding a sample size of 34. Data Collection and Analysis: Participants were administered a CAPD battery that included at least the following three CAPD tests: Frequency Patterns (FP), Dichotic Digits (DD), and Competing Sentences (CS). In addition, they were administered the CELF and WISC. Relationships between scores on CAPD, language (CELF), and cognition (WISC) tests were examined using correlation analysis. Results: DD and FP showed significant correlations with Full Scale Intelligence Quotient, and the DD left ear and the DD interaural difference measures both showed significant correlations with working memory. However, ~80% or more of the variance in these CAPD tests was unexplained by language and cognition measures. Language and cognition measures were more strongly correlated with each other than were the CAPD tests with any CELF or WISC scale. Additional correlations with the CAPD tests were revealed when patients who scored in the mild-moderate deficit range on the CELF and/or in the borderline low intellectual functioning range on the WISC were included in the analysis. Conclusions: While both the DD and FP tests showed significant correlations with one or more cognition measures, the majority of the variance in these CAPD measures went unexplained by cognition. Unlike DD and FP, the CS test was not correlated with cognition. Additionally, language measures were not significantly correlated with any of the CAPD tests. Our findings emphasize that the outcomes and interpretation of results vary as a function of the subject inclusion criteria that are applied for the CELF and WISC. Including participants with poorer cognition and/or language scores increased the number of significant correlations observed. For this reason, it is important that studies investigating the relationship between CAPD and other domains or disorders report the specific inclusion criteria used for all tests. [ABSTRACT FROM AUTHOR]

Background: Many audiologists believe that auditory processing testing must be carried out in a soundproof booth. This expectation is especially a problem in places such as elementary schools. Research comparing pure-tone thresholds obtained in sound booths compared to quiet test environments outside of these booths does not support that belief. Auditory processing testing is generally carried out at above threshold levels, and therefore may be even less likely to require a soundproof booth. The present study was carried out to compare test results in soundproof booths versus quiet rooms. Purpose: The purpose of this study was to determine whether auditory processing tests can be administered in a quiet test room rather than in the soundproof test suite. The outcomes would identify that audiologists can provide auditory processing testing for children under various test conditions including quiet rooms at their school. Research Design: A battery of auditory processing tests was administered at a test level equivalent to 50 dB HL through headphones. The same equipment was used for testing in both locations. Study Sample: Twenty participants identified with normal hearing were included in this study, ten having no auditory processing concerns and ten exhibiting auditory processing problems. All participants underwent a battery of tests, both inside the test booth and outside the booth in a quiet room. Order of testing (inside versus outside) was counterbalanced. Data Collection and Analysis: Participants were first determined to have normal hearing thresholds for tones and speech. Auditory processing tests were recorded and presented from an HP EliteBook laptop computer with noise-canceling headphones attached to a y-cord that not only presented the test stimuli to the participants but also allowed monitor headphones to be worn by the evaluator. The same equipment was used inside as well as outside the booth. Results: No differences were found for each auditory processing measure as a function of the test setting or the order in which testing was done, that is, in the booth or in the room. Conclusions: Results from the present study indicate that one can obtain the same results on auditory processing tests, regardless of whether testing is completed in a soundproof booth or in a quiet test environment. Therefore, audiologists should not be required to test for auditory processing in a soundproof booth. This study shows that audiologists can conduct testing in a quiet room so long as the background noise is sufficiently controlled. [ABSTRACT FROM AUTHOR]

Objective: Review and critique of the clinical value of the AAA CAPD guidance document in light of criteria for credible and useful guidance documents, as discussed by Field and Lohr.Design: A qualitative review of the of the AAA CAPD guidelines using a framework by Field and Lohr to assess their relative value in supporting the assessment and management of CAPD referrals.Study sample: Relevant literature available through electronic search tools and published texts were used along with the AAA CAPD guidance document and the chapter by Field and Lohr.Results: The AAA document does not meet many of the key requirements discussed by Field and Lohr. It does not reflect the current literature, fails to help clinicians understand for whom auditory processing testing and intervention would be most useful, includes contradictory suggestions which reduce clarity and appears to avoid conclusions that might cast the CAPD construct in a negative light. It also does not include input from diverse affected groups. All of these reduce the document’s credibility.Conclusions: The AAA CAPD guidance document will need to be updated and re-conceptualised in order to provide meaningful guidance for clinicians. [ABSTRACT FROM PUBLISHER]

Background: This study studied the effect of extending the response window on the auditory processing (AP) test performance of children with a learning disability or reading disability (LD/RD). The study also investigated whether subject practice affected test performance. Material and methods: Twenty-four children with an LD and 12 typically developing (TD) age-matched peers between 9 and 13 years of age participated in the study. The participants were administered three AP tests - the dichotic digit (DD), duration pattern sequence (DPS), and random gap detection (RGD) test - under two conditions: standard response window and extended response window. Results: The performance of the LD group on the DD and DPS tests significantly improved using an extended time window whereas the performance of the TD group did not change. Conclusions: The findings suggest that some children with an LD achieve higher scores on auditory processing tasks if given a longer response window. This has implications for diagnosis and for providing a potential differential diagnosis tool. [ABSTRACT FROM AUTHOR]

Objective: This study presents a Danish test battery for auditory processing disorder (APD). The tests were evaluated as to normative cut-off values (pass-fail criteria) and their test–retest reliability.Design: The battery consists of four behavioural tests: the filtered words (FW) test, the dichotic digits (DD) test, the gap detection (GD) test and the binaural masking level difference (BMLD) test. The tests were evaluated through listening experiments on children with no known history of auditory problems.Study sample: The normative cut-off values were obtained from 158 children (75 boys and 83 girls, aged 6–16 years), whereas the test–retest reliability was obtained from 20 children (10 boys and 10 girls, aged 6–11 years).Results: For each of the four tests one to four different cut-off values were determined depending on whether the scores from the two ears and the different age groups could be pooled. For each of the four tests the test–retest reliability was found to be satisfactory. The test–retest reliability was highest for the FW and the DD test.Conclusions: A Danish APD test battery is now available for clinical use with normative data. [ABSTRACT FROM PUBLISHER]

Background: A proportion of patients with behavioural variant frontotemporal dementia (bvFTD) develop amyotrophic lateral sclerosis (ALS). It is currently unknown whether the behavioural and cognitive syndrome in bvFTD with ALS (ALS-FTD) is indistinguishable from that of bvFTD alone.Methods: A retrospective cohort of 241 patients with clinical diagnoses of bvFTD (n=185) or ALS-FTD (n=56) was examined with respect to behavioural, cognitive and neuropsychiatric symptoms. Features were rated as present or absent based on information recorded from clinical interviews and detailed neuropsychological assessment.Results: A number of behavioural and affective changes were reported more frequently in bvFTD than ALS-FTD: social disinhibition (p<0.001), inertia (p<0.001), loss of sympathy and empathy (p=0.008), repetitive behaviours (p<0.001) and dietary changes (p<0.001). Warmth of affect demonstrated in the clinic setting was reported more often in ALS-FTD than bvFTD (p<0.001). Executive impairments occurred equally in both groups. Language impairments were more common in ALS-FTD than bvFTD: agrammatism (p<0.017) and impaired sentence comprehension (p<0.036). Psychotic features were relatively rare and did not distinguish the groups.Conclusions: Our findings suggest differences between bvFTD and ALS-FTD. In particular, while changes in social behaviour are prominent in bvFTD alone, there may be a comparatively greater degree of language impairment in ALS-FTD. Prospective exploration of the pattern of differences between these groups will be essential. Identification of a distinct neuropsychological phenotype in ALS-FTD may have clinical implications for early diagnosis, disease management and care planning and theoretical implications for our understanding of the relationship between ALS and FTD. [ABSTRACT FROM AUTHOR]

Objective: To provide audiologists with strategies to minimise confounding cognitive and language processing variables and accurately diagnose central auditory processing disorder (CAPD).Design:Tutorial.Study sample: None.Results: Strategies are reviewed to minimise confounding cognitive and language processing variables and accurately diagnose CAPD.Conclusions: Differential diagnosis is exceedingly important and can be quite challenging. Distinguishing between two or more conditions presenting with similar symptoms or attributes requires multidisciplinary, comprehensive assessment. To ensure appropriate interventions, the audiologist is a member of the multidisciplinary team responsible for determining whether there is an auditory component to other presenting deficits or whether one condition is responsible for the symptoms seen in another. Choice of tests should be guided both by the symptoms of the affected individual, as established in an in-depth interview and case history, the individual’s age and primary language, and by the specific deficits reported to be associated with specific clinical presentations. Knowing which tests are available, their strengths and limitations, the processes assessed, task and response requirements, and the areas of the central auditory nervous system (CANS) to which each test is most sensitive provides the audiologist with critical information to assist in the differential diagnostic process. [ABSTRACT FROM AUTHOR]

Background: Stroke survivors may suffer from a range of hearing impairments that may restrict their participation in postacute rehabilitation programs. Hearing impairment may have a significant impact on listening, linguistic skills, and overall communication of the affected stroke patient. However, no studies sought to systematically characterize auditory function of stroke patients in detail, to establish the different types of hearing impairments in this cohort of patients. Such information would be clinically useful in understanding and addressing the hearing needs of stroke survivors. Purpose: The present study aimed to characterize and classify the hearing impairments, using a detailed audiological assessment test battery, in order to determine the level of clinical need and inform appropriate rehabilitation for this patient population. Research Design: A case-control study. Study Sample: Forty-two recruited stroke patients who were discharged from a stroke unit and 40 control participants matched for age. Data Collection and Analysis: All participants underwent pure-tone audiometry and immittance measurements including acoustic reflex threshold, transient-evoked otoacoustic emissions, auditory-evoked brainstem response, and a central auditory processing assessment battery, performed in a single session. Hearing impairments were classified as peripheral hearing loss (cochlear and neural type), central auditory processing disorder (CAPD), and as a combination of CAPD and peripheral hearing loss. Results: Overall mean hearing thresholds were not significantly different between the control and stroke groups. The most common type of hearing impairment in stroke patients was the combination type, "peripheral and CAPD," in the 61- to 80-yr-old subgroup (in 55%), and auditory processing deficits in 18- to 60-yr-olds (in 40%), which were both significantly higher than in controls. Conclusions: This is the first study to examine hearing function in detail in stroke patients. Given the importance of hearing for the efficiency of communication, it is essential to identify hearing impairments and differentiate peripheral and central deficits to define an appropriate intervention plan. [ABSTRACT FROM AUTHOR]

Objective: Aside from features associated with risk of neurogenetic syndromes in general (e.g., cognitive impairment), limited progress has been made in identifying phenotype-genotype relationships in autism spectrum disorder (ASD). The objective of this study was to extend work in the Simons Simplex Collection by comparing the phenotypic profiles of ASD probands with or without identified de novo loss of function mutations or copy number variants in high-confidence ASD-associated genes or loci.Method: Analyses preemptively accounted for documented differences in sex and IQ in affected individuals with de novo mutations by matching probands with and without these genetic events on sex, IQ, and age before comparing them on multiple behavioral domains.Results: Children with de novo mutations (N=112) had a greater likelihood of motor delay during early development (later age at walking), but they were less impaired on certain measures of ASD core symptoms (parent-rated social communication abnormalities and clinician-rated diagnostic certainty about ASD) in later childhood. These children also showed relative strengths in verbal and language abilities, including a smaller discrepancy between nonverbal and verbal IQ and a greater likelihood of having achieved fluent language (i.e., regular use of complex sentences).Conclusions: Children with ASD with de novo mutations may exhibit a "muted" symptom profile with respect to social communication and language deficits relative to those with ASD with no identified genetic abnormalities. Such findings suggest that examining early milestone differences and standardized testing results may be helpful in etiologic efforts, and potentially in clinical differentiation of various subtypes of ASD, but only if developmental and demographic variables are properly accounted for first. [ABSTRACT FROM AUTHOR]

Aim: We investigated how accurate observations of canonical babbling (CB) were and explored predictive babbling measures in children with and without medical diagnoses of conditions that can lead to speech and language problems.Methods: From 2012 to 2014 this Stockholm-based study recruited 38 children aged nine months to 21 months with medical diagnoses and 30 children aged 10 months without diagnoses and included 21 previously studied 12-month-old children without medical diagnoses. CB and consonant sound production were directly observed by video recording natural play with a caregiver. The percentage of CB was calculated from each recording, and a validated observation form was used. How accurately the children with and without CB were classified was investigated with sensitivity and specificity. The groups were compared using predictive babbling variables.Results: The observation method identified children with and without CB well, with a specificity of 0.89 and sensitivity of 0.93, respectively. Children with predictive babbling measures were identified in the clinical group (specificity 0.93-0.97), and a lack of these measures indicated a risk of being in the clinical group (odds ratios > 10). The sensitivity was low (0.32-0.42).Conclusion: Observation effectively identified a lack of CB and supported the importance of assessing babbling measures. [ABSTRACT FROM AUTHOR]

The aim of the present study is to explore whether those with Specific Language Impairment (SLI) and dyslexia display distinct or overlapping cognitive profiles with respect to learning outcomes. In particular, we were interested in two key cognitive skills associated with academic performance - working memory and IQ. We recruited three groups of children - those with SLI, those with dyslexia, and a control group. All children were given standardized tests of working memory, IQ (vocabulary and matrix), spelling, and math. The pattern of results suggests that both children with dyslexia and SLI are characterized with poorer verbal working memory and IQ compared to controls, but preserved nonverbal cognitive skills. It appears that that these two disorder groups cannot be distinguished by the severity of their cognitive deficits. However, there was a differential pattern with respect to learning outcomes, where the children with dyslexia rely more on visual skills in spelling, while those with SLI use their relative strengths in vocabulary. These findings can have important implications for how intervention is tailored in the classroom, as disorder-specific support could yield important gains in learning. [ABSTRACT FROM AUTHOR]