APD & ANSD

Question 1

What is auditory processing disorder?

Answer 1

APD is an auditory deficit that is not the result of
other higher-order cognitive, language, or related disorder.
Must be auditory in nature
HOW the CNS uses the auditory information

Question 2

Disorders to rule out when considering APD

Answer 2

1. ADHD
2. Autism
3. Severe language impairment
4. Intellectual disability and sensory integration dysfunction

Question 3

ADHD and ADP

Answer 3

Poor listeners
Difficulty understanding/and remembering verbal info
ADHD is what causes the symptoms

Question 4

Autism vs APD

Answer 4

Difficulty with spoken comprehension
Cause is autism

Question 5

Severe language impairment vs APD

Answer 5

SLI is a language impairment, not auditory processing issue

Question 6

ADP individuals MUST have

Answer 6

Normal intelligence
Normal hearing

Question 7

Challenges for individuals with APD

Answer 7

Noisy backgrounds
Poor acoustic environments
Great distances from speaker
Speakers with fast speaking rate
Speakers with foreign accents

Question 8

APD symptoms

Answer 8

-act like they have hearing loss
-can’t understand in noisy environment
-multi-step directions difficulty
-difficulty discriminating similar speech sounds
-request repetition or clarification
-difficulty spelling
-difficulty reading
-verbal info in classroom
-history of middle ear infection - if during critical period brain never learned how to process auditory sounds

Question 9

Academic characteristics of APD

Answer 9

-poor expressive and receptive language abilities
-poor reading, writing, and spelling
-poor phonics and speech sound discrimination
-difficulty taking notes
-difficulty learning foreign language
-weak short-term memory
-behavioral problems

Question 10

Multi-disciplinary team and roles

Answer 10

Physicians
Teachers - shed light on academic difficulties
Parents - description of behavior at home
Audiologist makes diagnosis
SLP-evaluates perception of speech
Pscyhologist- evaluate cognitive functioning

Question 11

Audiologist role

Answer 11

Assess PNS and CNS with battery of tests including electrophysiological and behavioral
Assess central auditory system under different conditions such as auditory signal distortion and competition
Absent acoustic reflex
Speech testing in quiet and noise

Question 12

Age a child can be tested for APD

Answer 12

7
Do not have neurological maturation before 7

Question 13

Is there a cure for APD?

Answer 13

There is not one, cure-all method
Treatment must be highly individualized and deficit specific
Key to appropriate treatment: accurate and careful diagnosis

Question 14

3 primary areas of focus for treatment of APD

Answer 14

1. Change learning/communication environment
2. Recruit higher order skills to compensate
3. Remediation of the deficit itself

Question 15

What are some environmental modifications for APD

Answer 15

1. Use electronic assist listening devices (FM system)
2. Teacher instructions how to improve delivery of information
3. Other Methods of altering environment so APD can increase focus

Question 16

Compensatory strategies for APD

Answer 16

Suggestions for assisting listeners in strengthening CNS resources (cognitive skills)
Teach to take responsibility for their listening success

Question 17

Direct treatment of APD

Answer 17

Remediate disorder itself
Computer assisted
1-1 training
Home based programs or clinics or schools
Type, frequency, intensity of therapy needs to be individualized

Question 18

Can a child grow out of APD?

Answer 18

Yes

Question 19

What is ANSD?

Answer 19

Clinical syndrome characterized by electrophysiological evidence of
normal or near normal cochlear function and absent or abnormal auditory pathway conduction

Question 20

Why is it called auditory neuropathy spectrum disorder?

Answer 20

Because it can have the same presentation but different site of lesion

Question 21

Audiologist findings for ANSD

Answer 21

Normal OAE (cochlea is functioning correctly) - present OAE OR presence of wave I (cochlear microphonic - CM)
Abnormal ABR - absent or abnormal-**have to have ABR to diagnose
Acoustic reflexes are absent

Question 22

Reported Clinical characteristics of ANSD

Answer 22

1. Pure tone thresholds from normal to profound
2. Poor speech recognition compared to degree of hearing loss
3. Difficulty hearing in noise
4. Impaired temporal processing
5. Hearing fluctuation
6. May have little to no communication issues to functionally deaf
7. Individuals symptoms vary

Question 23

Possible causes/associations from ANSD

Answer 23

Genetic Etiologies: Syndromic: Charcot-Marie-Tooth disease; Friedrich’s Ataxia; Hereditary motor and sensory neuropathy
(HSMN)
• Non-syndromic: Recessive genetic mutations: Otoferlin (OTOF), Pejvakin (PJVK)
• Autosomal dominant mutations: AUNA1 (onset of auditory symptoms in late teens)
• Perinatal Conditions: Hyperbilirubinemia
• Hypoxia
• Low birth weight
• More common in premature infants
• Congenital Conditions: Cochlear Nerve Deficiency
• Infectious Processes
• Viral Infections (e.g. mumps, meningitis)
• Head injury e.g. Shaken baby syndrome

Question 24

Tests used to diagnose ANSD

Answer 24

ABR
Tympanometry (Acoustic Immittance measures)
Acoustic Reflex testing
OAE
Pure tone testing (VRA, BOA, play audiometry, etc)
Speech recognition testing
ASSR

Question 25

What is ANSD

Answer 25

ANSD is a condition in which the ABR is desynchronized
OAEs are (or once were) present and normal
Middle ear muscle reflexes are elevated or absent (acoustic reflex)

Question 26

Common causes of ANSD (in order)

Answer 26

1. Compromised or damage inner hair cells
2. Damaged auditory nerve fibers
3. Damage to both

Question 27

Hallmark audiological signs of ANSD

Answer 27

presence of outer hair cells (normal OAE)
Absent ABR
90-95% are bilateral

Question 28

Rehabilitation for ANSD

Answer 28

Controversial

Question 29

Factors that affect outcome for ANSD

Answer 29

Age at diagnosis and treatment
Appropriateness of device fitting
Consistency of use
Quality of intervention
Extent of family involvement
Cognitive abilities of child
Presence of other medical conditions

Question 30

ANSD and therapy

Answer 30

Takes time!