Computer-Based Auditory Training (CBAT)

Question 1

Does the complex organization of the brain allow for opportunities for intervention?

Answer 1

Yes
Because it is all interconnected, you don’t just need to do auditory training

Question 2

What can be used to complement direct auditory skills training?

Answer 2

Cognitive (processes involved in knowing)
Metacognitive (use of knowledge)
Language resources

Question 3

What does bottom-up intervention include?

Answer 3

Auditory training
Signal enhancement (assistive listening systems, clear speech)
Environmental modifications (reduce noise and reverberation)

Question 4

What does top-down intervention include?

Answer 4

Language strategies
Cognitive strategies
Metacognitive strategies
Classroom instructional and learning strategies

Question 5

What are metacognitive strategies?

Answer 5

Self-instruction
Assertiveness training (form of behavior therapy designed to help people stand up for themselves)
Cognitive problem solving
Self-control
Cognitive strategy training (a type of learning strategy that learners use to learn more successfully, includes repetition, organizing new language, summarizing meaning, guessing meaning from context, using imagery for memorization) - involve deliberate manipulation of language to improve learning
Reciprocal teaching (students become the teacher in small groups, teachers model and then help students learn to guide group)
Cognitive style and reasoning (how users process information, and how systems can be better built to accommodate the diversity of the users)

Question 6

What does a CBAT require?

Answer 6

Some form of auditory input which could be naturally or electronically produced
Considerations:
Is the signal natural or synthetic; speech or non-speech?
Does it require an active (focused) or passive (unfocused) interaction from the child?
The frequency of training (the more frequent the better)

Question 7

Does the use of most CBAT software yield benefits?

Answer 7

No
Use of most CBAT software is shown to have little effect on language, spelling, and reading abilities

Question 8

What is the easiest speech to produce and is the most meaningful?

Answer 8

Natural speech
Synthetic speech allows for more accurate control of parameters such as duration and intensity
Natural non-speech sounds (environmental) are used less frequently because there is no cognitive challenge and it is difficult to maintain the interest of the listener

Question 9

What are synthetic non-speech sounds?

Answer 9

Tones or noise bursts

Question 10

What does auditory training for children with CAPD include?

Answer 10

Central integration
Dichotic listening
Phonemic synthesis
Temporal processing
*training in these areas involve more precise stimulus control (synthetic speech or non-speech materials) and adaptive technology

Question 11

What is the suzuki method of learning music?

Answer 11

Uses natural nonspeech
Includes daily listening to recordings of songs played on the instrument that is being learned
Commonly used to teach music to children with autism
Currently, the Suzuki method is not incorporated in CBATs

Question 12

What does synthetic non-speech training involve?

Answer 12

More precise training in discrete frequency, intensity, temporal domains
Lacks inherent meaningfulness so often accompanied by attractive pictures
*Research shows that this can help with cortical reorganization after hearing loss, no long term benefits for CAPD have been documented

Question 13

Do CBATs need to consider the role of attention?

Answer 13

Yes
Auditory training with focused attention requires the listener to actively direct attention to specific information in the stimuli (provides reward for attending which increases likelihood of active attention)
Examples: Nonspeech gap detection and speech comprehension of stories

Question 14

What is passive learning?

Answer 14

Unfocused
Example: Incidental language learning

Question 15

What is active learning?

Answer 15

Focused learning
Requires attention

Question 16

Does perception improve with focused auditory attention?

Answer 16

Yes, for everyone
If the task is too redundant or uninteresting, attention may be lost, and it becomes an unfocused task

Question 17

How long is CBAT training?

Answer 17

Two to three times/week
Multiple weeks

Question 18

What are some benefits for CBATs over traditional therapy?

Answer 18

Precise stimulus control by the clinician/teacher/parent
Access to levels and games
Youths’ natural interest in computers
Convenience of training (can be done at home)
Standardization of training

Question 19

What needs to be considered when designing a CBAT?

Answer 19

Designated training areas (where will the training occur, i.e., home, classroom, etc.)
Type of training stimuli used (e.g., active vs. passive; speech vs. non-speech)
Training hierarchy (levels of training)
Adaptive difficulty levels
Reinforcement (important to maintain motivation and attention)

Question 20

What is Fast ForWord?

Answer 20

Popular CBAT
Computer based reading program that provides extra academic support and learning opportunities in reading and language for struggling students
Designed to be used for 40-60 hours for any learner
Aims to build cognitive skills such as memory, attention, and processing sequencing, as well as language and reading skills (listening accuracy, phonological awareness, knowledge of language structures, vocabulary, and comprehension)

Question 21

Why is Fast ForWord a controversial program?

Answer 21

Most research shows that is had no discernible effects on alphabetics and general literacy achievement domains
Potentially positive effects on the reading fluency and comprehension domains for adolescent learners

Question 22

What is earobics?

Answer 22

Popular software that built phonemic awareness, auditory processing, and phonic skills
Developed by language-learning and literacy specialists
Taught the skills necessary to learn how to speak, read, and spell
Often touted as a tool for CAPD management
No longer available (retired in 2017)

Question 23

What is lindamood bell?

Answer 23

Been around for about 30 years
It used a typical paper and pencil SLP strategy
Now has a computerized program available
It claims that its programs develop the skills necessary for reading and comprehension
Aims to affect a positive change even in students previously diagnosed with dyslexia, ADHD,autism spectrum disorder, or general learning challenges

Question 24

What is sound storm auditory training?

Answer 24

Previously called LiSN and Learn
Developed by NAL and Hearing Australia (Australia’s largest provider of government-funded hearing by Dillon and Cameron)
Program was bought out by Nomad Agency Pty Limited in 2019 (created sound storm)
Designed to train children who are experiencing listening difficulties in the classroom, due to spatial processing disorder (SPD), to suppress background noise and attend to target acoustic stimuli
Designed to specifically improve binaural processing skills in children with suspected CAPD who may have SPD

Question 25

What is spatial processing disorder?

Answer 25

A condition when individuals are deficit in their ability to use binaural cues to selectively attend to sounds arriving from one direction while simultaneously suppressing sounds arriving from another direction
Children with SPD, therefore, have difficulty understanding speech in noisy environments, such as in the classroom

Question 26

How does sound storm work?

Answer 26

Sound Storm auditory training software (Cameron & Dillon, 2016), produces a three-dimensional auditory environment under headphones on the user’s iPad or computer
The child’s task is to identify words/sentences from a target sentence presented in background noise
A weighted up-down adaptive procedure is used to adjust the signal level of the target based on the participant’s response

Question 27

What is CAPDOTS?

Answer 27

It is a dichotic integration listening training program used to treat CAPD, specifically binaural integration deficits (at the cortical level)
Age 5+
It is being used successfully on those with learning disabilities, dyslexia, autism and head injuries
It is also uniquely appropriate for those with hearing impairment
No research data on this test

Question 28

What is angel sound?

Answer 28

An interactive, adaptive, auditory training, and hearing assessment program
Includes:
Phonemic-based minimal acoustic and perceptual contrasts training protocol
Psychoacoustic-based adaptive speech-in-noise training protocols
Binaural training procedures
Etc.
*Also no research behind it to back up the claims

Question 29

What did research reveal about CBATs?

Answer 29

Apart from the phonological awareness skills, the FFW and Earobics programs appeared to have little effect on the language, spelling, and reading skills of children
Non-speech and simple speech sounds training may be effective in improving children’s reading skills, but only if it is delivered by an audio-visual method
Further research of these with CAPD children is needed

Question 30

Have Fast ForWord, academic enrichment, computer-assisted language intervention, and individualized language intervention by SLP been proven to show gains at a 6 month follow up?

Answer 30

Yes
All of them made clinically relevant gains on measures of language and temporal auditory processing
Some level of strong intervention with some evidence will have positive results

Question 31

What is sensory integration?

Answer 31

The process by which the brain organizes and interprets external stimuli such as touch, movement, body awareness, sight, sound and gravity
It has been hypothesized that certain behavioral and emotional problems result from the malfunctioning of this process

Question 32

What is sensory integration therapy (SIT)?

Answer 32

A type of treatment typically performed by occupational or physical therapists who provide various sensory stimulation to the patient
It is often performed in combination with and within the context of purposeful muscle activities, to improve how the brain processes and organizes sensory information
Does not teach higher level skills, but enhances sensory processing abilities of the subject to acquire them

Question 33

Has it been suggested that auditory integration training is experimental?

Answer 33

Yes
No evidence that it works for communication issues

Question 34

Does Aetna reimburse for CAPD testing and management?

Answer 34

No
They state that there is a lack of data specifically addressing the efficacy of interventions for auditory processing disorder
Many of the recommendations commonly made are based on theory or inferred from approaches validated in other populations, e.g. specific language impairment and dyslexia
There is a lack of studies evaluating formal auditory training programs for persons with the diagnosis of auditory processing disorder
Other programs and methods have no or a very low level of evidence or conflicting expert opinion

Question 35

Can you use medical management to treat CAPD?

Answer 35

Maybe
There have been some reports in the literature about stimulants (e.g., Ritalin) and psychotropic drugs used to treat (C)APD
Psychotropic drugs cross the blood–brain barrier and act primarily upon the CNS where they affect brain function resulting in alterations in perception, mood, consciousness, cognition, and behavior
There is no evidence to suggest that any of these drugs are effective for (C)APD or provide any educational gain
Currently, there also is no evidence to suggest that dietary changes improve (C)APD