Exam 1 (Assessment Part 1) Flashcards
describe the CAPD eval team
audiologists
SLPs
psychologists
social workers
parents
physician
audiologists role
manage & coordinate evaluations; performs audiologic assessment to rule out peripheral hearing loss
SLP role
assesses receptive/expressive language skills, phonological skills & written language abilities
psychologists role
assesses cognitive skills & capacity for learning
social worker roel
serves as a liaison between home and school if needed
parents role
proved prenatal and neonatal history, informational about developmental milestones, auditory behavior and medical and academic history
physician role
rules out a medical pathology that may affect learning abilities
Who is responsible for evaluating and diagnosing CAPD?
audiologists
is it best to use a test battery or one test for diagnosing CAPD
test battery
Why should CAPD testing use a test battery and not a single sensitive diagnostic test?
CAPD is not one disorder
Clinical presentations can vary resulting from a number of mechanisms and auditory processes affected
Different measures are required for accurate assessment of central auditory processes
Multiple assessment measures can also help to establish more appropriate management for CAPD
what is a test battery
Includes a # of tests used to diagnose a certain condition
Questions to ask to ensure diagnostic accuracy & usefulness
Does the battery improve sensitivity & specificity over using individual tests
How many tests are needed to obtain optimal sensitivity/specificity
How many tests are needed to obtain optimal sensitivity/specificity
Max sensitivity requires 2-3 tests in a CAPD test battery
lax criteria
better sensitivity and poor specificity
strict criteria
better specificity and poor sensitivity
what is the reason behind lax criteria
As the test batter sizes increases it leads to a greater probability that a PT will fail any single test
It improves sensitivity but can undermine specificity as normal patients have an increased chance of being incorrectly identified
for ex: PT is more likely to fail one test when a battery has 10 tests as compared to when it has 2-4 tests
reason behind the strict criteria
As the test battery size increases there is less probability that a PT will fail all tests
Good to detect normal function & improves specificity but can undermine sensitivity as PTs w/ abnormal function will be less likely to fail the entire battery when more tests are included
For example, a patient is more likely to fail all tests when a battery has 2 to 3 tests as compared to when it has 10 tests
intermediate test criteria
Most reliable criteria
Abnormal performance on at least 2 tests (> 2 SD below mean)
Abnormal performance on at least 1 test (> 3 SD below mean)
tests with relatively low sensitivity/specificity are useful diagnostic indicators of CAPD
false
not useful
CAPD Test Battery Considerations
tests with relatively low sensitivity/specificity are not useful diagnostic indicators of CAPD
tests should demonstrate test-retest consistency and age-appropriate norms
tests requiring extensive training, time & client practice are not appropriate for most clinical settings
age appropriate
Shouldn’t be test driven but motivated by the referring complaint and relevant info available to use
Be sensitive to language development; motivational level; fatigability; attention and other cognitive factors; the influence of mental age; cultural influences; native language; and socioeconomic factors
Individuals who are medicated successfully for attention, anxiety, or other disorders that may confound test performance can be tested when on medication
true
ASHA recommends other tests
Discrimination and electrophysiologic tests like OAEs, ARTs, & AERs
dichotic processes tests
dichotic digits
competing sentences
SSI0CCM
SSW
temporal processes tests
gaps in noise
random gap detection
duration pattern test
pitch pattern test
binaural interaction tests
auditory fusion
masking level difference
monaural low redundancy speech/auditory closure processes tests
NU6 filtered words
time compressed sentences
SSI-ICM
speech in noise tests
dichotic processe
Different speech stimuli is presented to each ear simultaneously (CVC, monosyllabic words, digits, or sentences
Can assess binaural integration or binaural separation
Sensitive to lesions of CC (if CC is involved) & cerebral cortex
divided attention
repeat stimuli heard in both ears
selective attention
ignore what is heard in one ear and repeat back what is heard in the target ear
free recall
used to prevent attention factors from contaminating results
repeating words back without regard to which ear heard it
Temporal processes & pattern tests
Monotic presentation used to assess each ear independently
Stimulus is usually tones not speech
Temporal processing also includes temporal resolution
assess pattern perception & temporal functioning abilities
Temporal pattern tests assess pattern perception & temporal functioning abilities including
Feature detection abilities
Frequency/duration discrimination
Acoustical pattern and contour recognition
Temporal pattern tests are more sensitive to
compromised right hemisphere
If the test requires a verbal response it is then sensitive to
left hemisphere lesions
Binaural interaction/fusion processes
Binaural - stimuli is presented to each ear at the same time
Each ear cannot be independently assessed
presented in either a non-simultaneous, sequential manner or only a portion of the message is presented to each ear
assess integration between two ears
auditory brainstem plays a key role in combining and processing different pieces of auditory information into a cohesive and unified perception
true
binaural fusion
Monaural low redundancy speech/auditory closure processes
These speech tests involve modification (distortion) of the acoustic (extrinsic) signal to reduce the amount of redundancy
The degraded speech stimuli are presented by modifying frequency, temporal, or intensity characteristics to reduce redundancy
These tests are not sensitive to brainstem lesions
The degraded speech stimuli are presented by modifying frequency, temporal, or intensity characteristics to reduce redundancy and are
Sensitive to auditory closure abilities
Moderately sensitive to cortical lesions
Speech is a redundant signal
true
how to decide which tests to include in a test battery?
tests that provide the best diagnostic value individually and in combination should be included
what are clinical decision analysis
statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests
what is clinical decision analysis (CDA)
statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests
what does CDA include
sensitivity and specificity, receiver operant curves (ROC) & factor analysis
what is factor analaysis
technique used to reduce a large number of variables into fewer numbers of factors
what is a gold standard
Best test considered the current preferred method of diagnosing a particular disease
CAPD and gold standard
CAPD - gold standard group has the disorder & control group doesn’t
Logic - if CAPD is a disorder of CANS then it is inferred that individuals with lesions to the system should perform poorly on CAPD tests - reductionist model
what is the reductionist model
CAPD - gold standard group has the disorder & control group doesn’t
Logic - if CAPD is a disorder of CANS then it is inferred that individuals with lesions to the system should perform poorly on CAPD tests - reductionist model
Children suspected of CAPD don’t have diagnosed neurological lesions of the CNS as seen in the experimental group
true
what was the bruton conference
Concluded that 3 test domains for CAPD should be measured using behavioral tests
what were the 3 test domains for CAPD
Auditory pattern/temporal ordering (APTO) tests
Monaural separation closure (MSC)
Binaural integration/binaural separation (BIBS)
what was Binaural integration/binaural separation (BIBS)
can you separate and integrate information from the left and the right ear
what was Auditory pattern/temporal ordering (APTO) tests
pitch pattern sequence test (frequency discrimination), gap detection
what was Monaural separation closure (MSC)
Can you close (noise in the environment) in individual ears
what is Multiple Auditory Processing Assessment (MAPA)
Test battery that was developed in an effort to develop a quas-behavioral gold standard for CAPD
CAPD behavioral tests in 4 important auditory processing areas
Dichotic processes, temporal processes, binaural interaction, & monaural low redundancy speech/auditory closure processes
what are the recommended eval for CAPD
Case hx
Pre-test standardized questionnaires
CHAPS; SIFTER; Fisher etc.
Behavioral measures
Pure tone audiometry
Speech audiometry
CAPD behavioral tests in 4 important auditory processing areas
Other tests as needed like SIN tests
Electrophysiological measures
Immittance audiometry (including acoustic reflex thresholds)
Otoacoustic emissions (TEOAEs or DPOAEs) - done to rule out anything else or if there are issues in the inner ear
ABR, mid- and late-latency auditory evoked responses
Psychoeducational evaluation
Speech and language evaluation
Prenatal and postnatal
Developmental
Medical
academic
failed grades
current academic performance
areas of strength/weakness
special education services
Family
e.g., genetic, medical, first degree relatives with developmental disorders
Social
shy, aggressive, friendly etc.
plays/interacts comfortably with peers; prefers younger children/adults
Results of other evaluations, for example,
psychoeducational; s/l evaluation
Work history; if patient is an adult
advantages to screening tests
Fewer demands on the healthcare system
More accessible
Less invasive & dangerous
Less expensive
Less time-consuming
Less physically & psychologically uncomfortable for the PTs
what does chaps stand for
The Children’s Auditory Performance Scale
what is the The Children’s Auditory Performance Scale (CHAPS)
Ages >/= 7yrs
Includes 36 item checklist divided into 6 listening conditions and functions with each item scored on a 7 point scale
Used by teachers and parents
what is the objective of CHAPS
Evaluates listening behaviors in diverse listening situations
Parents/teachers assess child’s ability in comparison to child’s peers
Used as part of a screening process to identify children experiencing listening difficulties because of
Hearing loss and (C)APD
what does SIFTER stand for
Screening Instrument for Targeting Educational Risk
what is Screening Instrument for Targeting Educational Risk (SIFTER)
Ages 1st-5th grade
Completed by the teater
Includes 15 questions; 3 in each of 5 category areas
Academics, attention, communication, class participation, and social behavior
=
5 category areas of the SIFTER
Academics, attention, communication, class participation, and social behavior
objective of the sifter
Educationally screening students with known or suspected HL
Classroom teacher compares child’s functional ability to peers
Can be used to track child’s performance over time
Fisher’s Auditory Problem Checklist
Provides info on child’s functional listening abilities in a classroom
Completed by teachers
Has 25 items and each is worth 4%
Place a checkmark beside observed behaviors and those that are not selected are multiplied by 4 to determine a total %
how does fishers itemize behaviors
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
when to refer in fishers
<72$
disadvantages of fishers
Small number of listening items
Doesn’t take into account listening behaviors of children with CAPD depending on different listening environments
includes various skills that are part of auditory processing behaviors but it does not specifically question the influence of the environment on these auditory skills
relationship bw 3 screeners
Poor ability of the 3 screening tests to predict the individua lLow-Pass Filtered Speech (LPFS); Competing Sentences (CS); Two-Pair Dichotic Digits (DD); Frequency Patterns with Linguistic Report (FP)
The CHAPS, SIFTER, and TAPS–R should be used to highlight concerns about a child but not to determine whether a diagnostic (C)APD assessment is warranted
The benefits of having effective screening tools includes
overall reduced costs, reduced over-referrals, time savings, and increased efficiency of identification/intervention for (C)APD
why are we pushing for FM systems? what happens when SNR increases
sound is more audible making it easier for them to hear
it keeps their attention, provides direct auditory input so they don’t have to tune out the background noise
the signal that is louder is easier to listen to because they do not have the ability for auditory figure ground
what does PSI stand for
pediatric speech intelligibility test
authors of PSI
Jerger & Jerger
James & Susan:
both audiologists
James is the father of modern audiology & a lot of tests are devised by him
Susan was a ped audiologists
what does psi assess
Auditory figure-ground - ability to hear in noise
Auditory closure - ability to fill in the blanks; context, ability to understand speech by filling in missing or distorted parts of an acoustic signal
Insensitive to normal developmental differences between cognitive skills
Takes into account the normal developmental differences between kids and doesn’t impact the test because typically developing kids all have different skills
Sensitive to the presence of CAPD
Able to pick up CAPD
Able to distinguish between those with central auditory lesions and those with non-auditory central lesions
PSI site of lesion
sensitive to lower BS deficits
Standard MCR condition for psi words
+4 dB MCR
if the signal is 30, the masker would be _____ in PSI words
26 (30-4 MCR)
Moderate to high sensitivity to CAPD
PSI
ages for PSI
3-6yrs
language information for the PSI
Low redundancy speech
speech that has been altered to reduce extrinsic cues, such as competing signals or noise
Time, pitch, intensity
Linguistically loaded
Language based
format I of PSI ages
3-4 yrs
format II of PSI ages
5-6yrs
what is ICM for PSI
psilateral → signal and masker are presented in the same ear
10 dB MCR
0 dB MCR (only perform on one ear)
what is CCM for PSI
Contralateral → signal and masker are presented in different ears
-20 dB MCR
0 dB MCR
PL for PSI
For children >/=3.6yrs PL is 30 dB SL + SRT?
For children </= 3.6yrs PL is 40 dB HL or SL?
scoring for PSI
Stop testing after 5 if
they get a 5/5 or a ⅘ → ceiling
they get either none or ⅕ → floor (worst they can do)
✓ = correct
x = incorrect
ICM PSI norns
0 dB MCR
<80% → outside normal range
>80% → normal range
10 dB MCR
<100% → outside normal range
100% → normal range
CCM RLL I PSI norms
RLL I → Format 1 → -20 dB MCR
<70% → outside normal range
>70% → normal range
CCM RLL II PSI Norms
RLL II → Format 2 → -20 dB MCR
<90% → outside normal range
>90% → normal range
CCM PSI Norms
0 dB MCR
<100% → outside normal range
>100% → normal range
what does ACPT stand for
auditory continuous performance test
author of dog etst
keith 1994
ages for ACPT
6-12 yrs
what is the ACPT
Binaural test
ADHD screening exam
Consists of word identification of the word DOG in a series of familiar monosyllabic words that do not tax a child’s linguistic and cognitive abilities
Like toy, face, teach etc.
what does ACPT test
Selective attention → indicated by correct responses to specific linguistic cues
Can they listen to what they are supposed to
Correct responses to the word dog
Sustained attention → indicated by the child’s ability to attend and concentrate on a task for a prolonged time
Can they maintain their attention for a long period of time
selective attention
indicated by correct responses to specific linguistic cues
Can they listen to what they are supposed to
Correct responses to the word dog
sustained attention
indicated by the child’s ability to attend and concentrate on a task for a prolonged time
Can they maintain their attention for a long period of time
impulsivity
responses to words other than dog
inattention
missed responses to dog
what does SCAN-3:C stand for
screener for central auditory nervous system
what is teh SCAN3-C
Identifies APD in kids in areas of temporal processing, listening in noise, dichotic listening, and listening to degraded speech
author of SCAN
Keith 2009
ages for scan
5-12.11 yrs
Need to have passed screening hearing test at 1,2, & 4kHz bilaterally with normal hearing
NO ME disorders identified by tymps
3 screening tests of SCAN
Gap detection
Ages 8-12.11yrs
Tests temporal resolution
Binaural test → most others are not binaural
Site of lesion
Not linguistically loaded
Auditory figure ground +8dB
Signal and background noise
Hear two sets of words and have to respond to the target words
Competing words-Free Recall
Less attention based
Can repeat the words in any order
dichotic test
Diagnostic tests of SCAN
Auditory figure ground +8dB
Filtered words
Competing words-directed ear
Must repeat the words back in the correct order
Competing sentences
supplementary test for SCAN
Competing words-free recall
Auditory figure ground 0dB
Auditory figure ground +12dB
Time compressed signal
this screening test measures the ability to detect brief silent gaps of variable durations between tone pairs
gap detection
this test is used to assess the ability to process speech in the presence of background noise with signal 8dB greater than the multi-talker speech
used as a screening & diagnostic
AFG +8dB
test used to assess the ability to process competing speech signals by presenting monosyllabic words to each ear simultaneously
used as a screener and supplementary assessment
competing words fre recall
used to assess the ability to process distorted speech by presenting monosyllabic words low-pass filtered at 750Hz
diagnostic test
filtered words
test used to assess ability to process competing speech signals by presenting a monosyllabic word to each ear simultaneously
diagnostic test
competing words directed ear
test used to assess the ability to process competing speech signals by presenting pairs of unrelated sentences to the R & L ears
diagnostic test
competing sentences
used to assess ability to process degraded speech by presenting sentences that have been time compressed at 60%
supplementary test
time compressed sentences
ages for gap detection
8-13yrs
describe the gap detection test in SCAN
screener
Temporal resolution/processing disorders - screens for disorders of timing within the auditory system
Site of lesion → binaural assessment
not linguistically loaded
describe AFG +8
screener
ages 5-12.11
monaural
what are the 3 screeners for SCAN
AFG +8
Gap detection
competing words free recall
describe CWFR
screener
ages 5-12.11
linguistically loaded
binaural - dichotic
assesses auditory maturation or develoipmental delay
Children who fail AF +8 should receiver further assessment for
SIN listening needs (Dichotic listening → BS level @ SOC or central level @ CC)
Children who fail CW-FR should be referred for further assessment
true
dichotic tests → info in regards to maturation of auditory neurological pathways or SCAN-3:C → CW-DE & CS can be done
describe filtered words
Low-pass filtered words
monaural
linguistically loaded
assesses auditory closure skills and auditory processing abilities in poor listening environments
describe competing words directed ear
binaural
linguistically loaded
assesses dichotic listening, developmental and maturation of auditory system
describe competing sentences
binaural
linguistically loaded
assesses Assesses: development and maturation of the auditory system and hemispheric specialization
how do you make speech low redundancy
alter time, pitch or intensity
high redundancy
speech has not been altered
examples of low redundancy
filtering - frequency changes
noise in environment - affecting audibility and snr goes down (intensity)
timing - speed things up (compressed the same words in a shorter time frame)
The higher the difference between presentations 1 & 6 the greater the risk of ADHD
true
what is the scale score? why do we need it
raw - difficult to compare across individuals, what does the score mean for this age?
scale - balances the scoring so you can compare a particular kid or score to that age group
confidence interval
With what confidence can I say these test aresults are valid & correct
allows you to determine with 90% or 95% probability or confidence that a certain range of scores contain a hypothetical “true” score within that range
what is the scaled score chart in SCAN
Helps parents, teachers, etc to interpret the tests
Shows the scores they are supposed to score for each test
results in meaningful interpretation of auditory processing abilities
Interpreting test battery scores carefully
Look at the pattern of test scores
Consider other factors like
Info from parents/caregivers
Behavioral observations during testing
Child’s med hx
Child’s academic performance
what is ear advantage
Mathematical difference between r and l ear raw scores
REA
+ value
LEA
- value
The more extreme/atypical REA the greater the possibility of an auditory based language or learning disorder
true
why is ear advantage important
Determines possible hemispheric dominance for language and neurologically based language learning disorders
what does significant LEA abnormal indicate
Can indicate poor localization of hemispheric function related to language disorder
what are scaled scores
normative scores specifically used to compare child’s performance to their same age peers
typically developing auditory systems & ear advantage
Higher RE scores for all dichotic listening tests on SCAN
CWDE, CWFR, CS
Similar RE & LE scores for all monaural degraded tests on SCAN
AFG, FW, TCS
*higher scores for dichotic because they are utilizing both hemispheres so the CC is integrating information & functioning appropriately
REA is minimal by early adolescents (~12 years) and typically disappears by late adolescence (~18 years)
true
