Exam 1 (Assessment Part 1) Flashcards

1
Q

describe the CAPD eval team

A

audiologists
SLPs
psychologists
social workers
parents
physician

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2
Q

audiologists role

A

manage & coordinate evaluations; performs audiologic assessment to rule out peripheral hearing loss

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3
Q

SLP role

A

assesses receptive/expressive language skills, phonological skills & written language abilities

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4
Q

psychologists role

A

assesses cognitive skills & capacity for learning

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5
Q

social worker roel

A

serves as a liaison between home and school if needed

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6
Q

parents role

A

proved prenatal and neonatal history, informational about developmental milestones, auditory behavior and medical and academic history

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7
Q

physician role

A

rules out a medical pathology that may affect learning abilities

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8
Q

Who is responsible for evaluating and diagnosing CAPD?

A

audiologists

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9
Q

is it best to use a test battery or one test for diagnosing CAPD

A

test battery

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10
Q

Why should CAPD testing use a test battery and not a single sensitive diagnostic test?

A

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

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11
Q

what is a test battery

A

Includes a # of tests used to diagnose a certain condition

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12
Q

Questions to ask to ensure diagnostic accuracy & usefulness

A

Does the battery improve sensitivity & specificity over using individual tests
How many tests are needed to obtain optimal sensitivity/specificity

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13
Q

How many tests are needed to obtain optimal sensitivity/specificity

A

Max sensitivity requires 2-3 tests in a CAPD test battery

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14
Q

lax criteria

A

better sensitivity and poor specificity

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15
Q

strict criteria

A

better specificity and poor sensitivity

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16
Q

what is the reason behind lax criteria

A

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

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17
Q

reason behind the strict criteria

A

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

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18
Q

intermediate test criteria

A

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)

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19
Q

tests with relatively low sensitivity/specificity are useful diagnostic indicators of CAPD

A

false
not useful

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20
Q

CAPD Test Battery Considerations

A

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

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21
Q

Individuals who are medicated successfully for attention, anxiety, or other disorders that may confound test performance can be tested when on medication

A

true

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22
Q

ASHA recommends other tests

A

Discrimination and electrophysiologic tests like OAEs, ARTs, & AERs

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23
Q

dichotic processes tests

A

dichotic digits
competing sentences
SSI0CCM
SSW

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24
Q

temporal processes tests

A

gaps in noise
random gap detection
duration pattern test
pitch pattern test

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25
Q

binaural interaction tests

A

auditory fusion
masking level difference

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26
Q

monaural low redundancy speech/auditory closure processes tests

A

NU6 filtered words
time compressed sentences
SSI-ICM
speech in noise tests

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27
Q

dichotic processe

A

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

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28
Q

divided attention

A

repeat stimuli heard in both ears

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29
Q

selective attention

A

ignore what is heard in one ear and repeat back what is heard in the target ear

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30
Q

free recall

A

used to prevent attention factors from contaminating results
repeating words back without regard to which ear heard it

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31
Q

Temporal processes & pattern tests

A

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

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32
Q

Temporal pattern tests assess pattern perception & temporal functioning abilities including

A

Feature detection abilities
Frequency/duration discrimination
Acoustical pattern and contour recognition

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33
Q

Temporal pattern tests are more sensitive to

A

compromised right hemisphere

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34
Q

If the test requires a verbal response it is then sensitive to

A

left hemisphere lesions

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35
Q

Binaural interaction/fusion processes

A

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

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36
Q

auditory brainstem plays a key role in combining and processing different pieces of auditory information into a cohesive and unified perception

A

true
binaural fusion

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37
Q

Monaural low redundancy speech/auditory closure processes

A

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

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38
Q

The degraded speech stimuli are presented by modifying frequency, temporal, or intensity characteristics to reduce redundancy and are

A

Sensitive to auditory closure abilities
Moderately sensitive to cortical lesions

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39
Q

Speech is a redundant signal

A

true

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40
Q

how to decide which tests to include in a test battery?

A

tests that provide the best diagnostic value individually and in combination should be included

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41
Q

what are clinical decision analysis

A

statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests

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42
Q

what is clinical decision analysis (CDA)

A

statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests

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43
Q

what does CDA include

A

sensitivity and specificity, receiver operant curves (ROC) & factor analysis

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44
Q

what is factor analaysis

A

technique used to reduce a large number of variables into fewer numbers of factors

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45
Q

what is a gold standard

A

Best test considered the current preferred method of diagnosing a particular disease

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46
Q

CAPD and gold standard

A

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

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47
Q

what is the reductionist model

A

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

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48
Q

Children suspected of CAPD don’t have diagnosed neurological lesions of the CNS as seen in the experimental group

A

true

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49
Q

what was the bruton conference

A

Concluded that 3 test domains for CAPD should be measured using behavioral tests

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50
Q

what were the 3 test domains for CAPD

A

Auditory pattern/temporal ordering (APTO) tests
Monaural separation closure (MSC)
Binaural integration/binaural separation (BIBS)

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51
Q

what was Binaural integration/binaural separation (BIBS)

A

can you separate and integrate information from the left and the right ear

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52
Q

what was Auditory pattern/temporal ordering (APTO) tests

A

pitch pattern sequence test (frequency discrimination), gap detection

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53
Q

what was Monaural separation closure (MSC)

A

Can you close (noise in the environment) in individual ears

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54
Q

what is Multiple Auditory Processing Assessment (MAPA)

A

Test battery that was developed in an effort to develop a quas-behavioral gold standard for CAPD

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55
Q

CAPD behavioral tests in 4 important auditory processing areas

A

Dichotic processes, temporal processes, binaural interaction, & monaural low redundancy speech/auditory closure processes

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56
Q

what are the recommended eval for CAPD

A

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

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57
Q

advantages to screening tests

A

Fewer demands on the healthcare system
More accessible
Less invasive & dangerous
Less expensive
Less time-consuming
Less physically & psychologically uncomfortable for the PTs

58
Q

what does chaps stand for

A

The Children’s Auditory Performance Scale

59
Q

what is the The Children’s Auditory Performance Scale (CHAPS)

A

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

60
Q

what is the objective of CHAPS

A

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

61
Q

what does SIFTER stand for

A

Screening Instrument for Targeting Educational Risk

62
Q

what is Screening Instrument for Targeting Educational Risk (SIFTER)

A

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
=

63
Q

5 category areas of the SIFTER

A

Academics, attention, communication, class participation, and social behavior

64
Q

objective of the sifter

A

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

65
Q

Fisher’s Auditory Problem Checklist

A

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 %

66
Q

how does fishers itemize behaviors

A

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

67
Q

when to refer in fishers

A

<72$

68
Q

disadvantages of fishers

A

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

69
Q

relationship bw 3 screeners

A

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

70
Q

The benefits of having effective screening tools includes

A

overall reduced costs, reduced over-referrals, time savings, and increased efficiency of identification/intervention for (C)APD

71
Q

why are we pushing for FM systems? what happens when SNR increases

A

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

72
Q

what does PSI stand for

A

pediatric speech intelligibility test

73
Q

authors of PSI

A

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

74
Q

what does psi assess

A

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

75
Q

PSI site of lesion

A

sensitive to lower BS deficits

76
Q

Standard MCR condition for psi words

A

+4 dB MCR

77
Q

if the signal is 30, the masker would be _____ in PSI words

A

26 (30-4 MCR)

78
Q

Moderate to high sensitivity to CAPD

A

PSI

79
Q

ages for PSI

A

3-6yrs

80
Q

language information for the PSI

A

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

81
Q

format I of PSI ages

A

3-4 yrs

82
Q

format II of PSI ages

A

5-6yrs

83
Q

what is ICM for PSI

A

psilateral → signal and masker are presented in the same ear

10 dB MCR
0 dB MCR (only perform on one ear)

84
Q

what is CCM for PSI

A

Contralateral → signal and masker are presented in different ears

-20 dB MCR
0 dB MCR

85
Q

PL for PSI

A

For children >/=3.6yrs PL is 30 dB SL + SRT?
For children </= 3.6yrs PL is 40 dB HL or SL?

86
Q

scoring for PSI

A

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

87
Q

ICM PSI norns

A

0 dB MCR
<80% → outside normal range
>80% → normal range
10 dB MCR
<100% → outside normal range
100% → normal range

88
Q

CCM RLL I PSI norms

A

RLL I → Format 1 → -20 dB MCR
<70% → outside normal range
>70% → normal range

89
Q

CCM RLL II PSI Norms

A

RLL II → Format 2 → -20 dB MCR
<90% → outside normal range
>90% → normal range

90
Q

CCM PSI Norms

A

0 dB MCR
<100% → outside normal range
>100% → normal range

91
Q

what does ACPT stand for

A

auditory continuous performance test

92
Q

author of dog etst

A

keith 1994

93
Q

ages for ACPT

A

6-12 yrs

94
Q

what is the ACPT

A

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.

95
Q

what does ACPT test

A

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

96
Q

selective attention

A

indicated by correct responses to specific linguistic cues
Can they listen to what they are supposed to
Correct responses to the word dog

97
Q

sustained attention

A

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

98
Q

impulsivity

A

responses to words other than dog

99
Q

inattention

A

missed responses to dog

100
Q

what does SCAN-3:C stand for

A

screener for central auditory nervous system

101
Q

what is teh SCAN3-C

A

Identifies APD in kids in areas of temporal processing, listening in noise, dichotic listening, and listening to degraded speech

102
Q

author of SCAN

A

Keith 2009

103
Q

ages for scan

A

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

104
Q

3 screening tests of SCAN

A

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

105
Q

Diagnostic tests of SCAN

A

Auditory figure ground +8dB
Filtered words
Competing words-directed ear
Must repeat the words back in the correct order
Competing sentences

106
Q

supplementary test for SCAN

A

Competing words-free recall
Auditory figure ground 0dB
Auditory figure ground +12dB
Time compressed signal

107
Q

this screening test measures the ability to detect brief silent gaps of variable durations between tone pairs

A

gap detection

108
Q

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

A

AFG +8dB

109
Q

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

A

competing words fre recall

110
Q

used to assess the ability to process distorted speech by presenting monosyllabic words low-pass filtered at 750Hz
diagnostic test

A

filtered words

111
Q

test used to assess ability to process competing speech signals by presenting a monosyllabic word to each ear simultaneously
diagnostic test

A

competing words directed ear

112
Q

test used to assess the ability to process competing speech signals by presenting pairs of unrelated sentences to the R & L ears
diagnostic test

A

competing sentences

113
Q

used to assess ability to process degraded speech by presenting sentences that have been time compressed at 60%
supplementary test

A

time compressed sentences

114
Q

ages for gap detection

A

8-13yrs

115
Q

describe the gap detection test in SCAN

A

screener
Temporal resolution/processing disorders - screens for disorders of timing within the auditory system
Site of lesion → binaural assessment
not linguistically loaded

116
Q

describe AFG +8

A

screener
ages 5-12.11
monaural

117
Q

what are the 3 screeners for SCAN

A

AFG +8
Gap detection
competing words free recall

118
Q

describe CWFR

A

screener
ages 5-12.11
linguistically loaded
binaural - dichotic
assesses auditory maturation or develoipmental delay

119
Q

Children who fail AF +8 should receiver further assessment for

A

SIN listening needs (Dichotic listening → BS level @ SOC or central level @ CC)

120
Q

Children who fail CW-FR should be referred for further assessment

A

true
dichotic tests → info in regards to maturation of auditory neurological pathways or SCAN-3:C → CW-DE & CS can be done

121
Q

describe filtered words

A

Low-pass filtered words
monaural
linguistically loaded
assesses auditory closure skills and auditory processing abilities in poor listening environments

122
Q

describe competing words directed ear

A

binaural
linguistically loaded
assesses dichotic listening, developmental and maturation of auditory system

123
Q

describe competing sentences

A

binaural
linguistically loaded
assesses Assesses: development and maturation of the auditory system and hemispheric specialization

124
Q

how do you make speech low redundancy

A

alter time, pitch or intensity

125
Q

high redundancy

A

speech has not been altered

126
Q

examples of low redundancy

A

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)

127
Q

The higher the difference between presentations 1 & 6 the greater the risk of ADHD

A

true

128
Q

what is the scale score? why do we need it

A

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

129
Q

confidence interval

A

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

130
Q

what is the scaled score chart in SCAN

A

Helps parents, teachers, etc to interpret the tests
Shows the scores they are supposed to score for each test

131
Q

results in meaningful interpretation of auditory processing abilities

A

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

132
Q

what is ear advantage

A

Mathematical difference between r and l ear raw scores

133
Q

REA

A

+ value

134
Q

LEA

A
  • value
135
Q

The more extreme/atypical REA the greater the possibility of an auditory based language or learning disorder

A

true

136
Q

why is ear advantage important

A

Determines possible hemispheric dominance for language and neurologically based language learning disorders

137
Q

what does significant LEA abnormal indicate

A

Can indicate poor localization of hemispheric function related to language disorder

138
Q

what are scaled scores

A

normative scores specifically used to compare child’s performance to their same age peers

139
Q

typically developing auditory systems & ear advantage

A

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

140
Q

REA is minimal by early adolescents (~12 years) and typically disappears by late adolescence (~18 years)

A

true

141
Q
A