Assessment and Scoring CAPD Flashcards
CAPD Evaluation Team
Audiologist
speech and language pathologist
psychologist
social worker
parents
physician
What is a test battery?
includes a number of tests to diagnose a certain condition
why use test battery and not single sensitive diagnostic test to diagnose CAPD
CAPD is not unitary disorder
- clinical presentations vary from number of mechanisms and auditory processes affected
- different measures are required for accurate assessment of central auditory processes
Test Battery Approach: questions asked to ensure diagnostic accuracy and usefulness
1) does the battery improve sensitivity and specificity over using individual tests
2) How many tests are needed to obtain optimal sensitivity and specificity
3) which combination if tests give the best sensitivity and specificity
how many tests can provide maximum sensitivity
2-3 tests in CAPD Battery or 4
lax criterion will yield better but poorer
better sensitivity but poorer specificity
strict criterion will yield better but poorer
better specificity but poorer sensitivity
reason behind lax criterion trend
as size of test battery increases greater probability that a patient will fail any single test
- normal patients have increased change of being incorrectly identified
reason behind the strict criterion trend
as size of test battery increases, less probability that a patient will fail all tests
patient more likely to fail all tests when a battery has 2 to 3 tests compared to when it has 10 (more opportunities to pass)
Intermediate criterion
most reliable
abnormal performance on at least 2 tests (>2SD below mean)
-abnormal performance on at least 1 tests (>3SD below mean)
CAPD Test Battery Consideration
Test sensitivity
Test reliability
ease of administration
population characteristics
Tests sensitivity and specificity
tests with relatively low sensitivity/specificity are not useful diagnostic indicators of CAPD
Tests reliability
test should demonstrate test retest consistency and age appropriate norms
ease of demonstration
tests requiring extensive training, time and client practice are not appropriate for most clinical settings
population characteristics
age appropriate
location appropriate
cultural and linguistic diversity
symptom specific considerations
test battery process should not be test driven it should be motivated by the referring complaint and the relevant information available to audiologist
patient specific considerations
patient developmental maturity to complete auditory tasks
- language development, motivation level, attention and cognitive factors, cultural influences, native language
auditory processes umbrella terms
dichotic processes
temporal processes
binaural interaction
-monaural low redundancy speech auditory closure processes
examples of dichotic processes
dichotic digits
competing sentences
SSI - CCM
SSW
example of Temporal Processes
Gaps in noise
random gap detection test
duration pattern test
pitch pattern test
example of binaural interaction
auditory fusion
masking level difference
example of monaural low redundcy speech/auditory closure processes
Nu-6 filtered words
time compresses words
SSI-ICM
Speech in noise tests
Dichotic processes test
different speech stimuli presented to each simultaneously (CVC or monosyllabic words, digits, or sentences)
dichotic processes tests may assess either
divided attention:
Selective attention:
binaural integration or binaural separation
DA= repeat stimuli heard in both ears
SA = Ignore what is heard in one ear repeat what is heard in the target ear
dichotic process
free call is used because and what it is
to prevent attention factors for contaminating results
- repeating back words back without regard to which ear heard it
Dichotic tests are sensitive to lesions of
Corpus callosum and cerebral cortex
temporal processes and pattern tests
monotic presentation to assess each ear independently
stimulus is often tones rather than speech
temporal processes and Patten tests
temporal pattern test assess pattern perception and temporal functioning abilities including
feature detection abilities
frequency/duration discrimination
- acoustical pattern and contour recognition
temporal pattern tests are more sensitive to a compromised
right hemisphere
if the test requires verbal response , it is sensitive to left hemisphere lesions
binaural interaction/fusion processes
test are binaural, stimuli presented to each ear at the same time
assess integration between to ears
binaural interaction/fusion processes
unification of disparate information as a s single perceptual event takes place at the auditory brainstem
monaural low redundancy speech/auditory closure processes
- speech is redundant signal
speech test involve modification (distortion) of acoustic signal to reduce amount of redundancy
monaural low redundancy speech/ auditory closure processes
degraded speech stimuli are presented by modifying frequency, temporal, or intensity characteristic to reduce redundancy and are
sensitive to auditory closure abilities
moderately sensitive to cortical lesions
NOT BRAIN STEM LESIONS
What is CDA and what does it include
statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests
- sensitivity and specificity
- receiver operant curves
- factor analysis (reduce large number of variables into fewer numbers of factors)
Recommended CAPD Evalution
- Case history
- pre test standardized questionnaires
- behavioral measures
- electrophysiologic measures
- psychoeducational evaluation
- speech and language evaluation
case history components
Prenatal/postnatal
developmental
medical
academic
family
social
results of other evaluations
work history
Screening tests Questionnaires
3 names
CHAPS (children’s auditory performance scale)
SIFTER (screening instrument for targeting educational risk)
Fishers Auditory Problem Checklist
Screening tests typically have advantages over diagnostic tests
- more accesible
less invasive/dangerous
less time consuming
less expensive
less physically and psychologically uncomfortable for patients
CHAPS age range
7 years and older
CHAPS items
36 item checklist divided into six listening conditions and functions
each item scores on a 7 point scale
CHAPS objective (3) and used by
parents and teachers
- evaluates listening behaviors in diverse listening situations
- assess child’s ability in comparison to child’s peers
- used as part of screening process to identify children experiencing listening difficulties because of HL and CAPD
CHAPS SCORING
- PASS
- AT RISK RANGE
+36 to -11
-12 to -130
SIFTER
Screening Instrument for targeting educational risk
age range?
completed by?
first through 5t grade
teacher
Items of SIFTER
(5)
15 questions three in each of five categorical areas
1) academics
2) Attention
3) communication
4) class participation
5) social behavior
Objective of SIfter
educationally screening students with known or suspected hearing loss
classroom teacher compares childs functional ability to peers
can be used to track childs performance over time
Fishers Auditory Problem Checklist
provides good information on children functional listening abilities in the classroom
Itemized behaviors in fishers auditory checklist
failure to attend to instructions
need for repeated instructions
easy distraction by auditory stimuli
degrading processing in a competing acoustic environment
also addresses attention and memory issues
several questions related to language based deficits such as discrimination ability
fishers checklist contains? with value of
how is it scored
25 items each with value of 4% each
items not selected are multiplied by 4 for total percentage
fishers auditory problem checklist cut off score
72% at or below warrant a referral for further CAPD testing
what should be used to highlight concerns about a child but not determine wether a diagnostic capd assessment is warranted
CHAPS
SIFTER
TAPS-R
what tools from scan 3c screening test better predicted diagnosis of CAPD
Auditory figure ground
Competing words free recall
gap detection
electrophysiologic tests
oae
immitance
ABR (early latency response)
Mid latency auditory evoked response
late latency auditory evoked response
auditory evoked responses measures
neuromaturation and neuroplasticity of central auditory pathways
electrophysiologic tests provide additional information about
integrity of the CNS
