Final Exam Flashcards
why is capd still a controversial issue
Due to the definition, etiology, signs and symptoms, treatment, and outcomes
what complicates the diagnosis of CAPD
Question of whether it is a separate and distinct disorder or a disorder of non-auditory processes
Example: cognition, language, memory, and attention that are not only tightly intertwined, but also closely integrated with auditory perception
what are the results of capd’s uncertain diagnosis
Not in the DSM-V
Not a disability/disorder allowed in Individualized Education Plan (IEP)
Those diagnosed only with CAPD may have accommodations under the 504 plan
what is a 504 plan
Spells out the modifications/accommodations needed for students who have an opportunity to perform at the same level as their peers
This includes wheelchair ramps, blood sugar monitoring, a peanut-free lunch environment, home instruction, a keyboard for taking notes, etc.
Section 504 of the Rehabilitation Act and Americans with Disabilities Act (ADA)
No one with a disability can be excluded from participating in federally funded programs or activities, including elementary, secondary, or postsecondary schooling
what is a disability
refers to a physical/cognitive impairment, which substantially limits one or more major life activities
examples of disabilities
Physical impairments; illnesses or injuries; communicable diseases; chronic conditions like asthma, allergies, diabetes; and learning problems
what is an IEP
individualized education plan
Falls under Individuals with Disabilities Education Act (IDEA), federally mandated, and associated with providing educational services
Those that are eligible are a small subset of all students with disabilities who require more than a level playing field
Need significant remediation and assistance
More likely to work at their own level and pace even in an inclusive classroom
disabilities that are eligible for IEP
Autism
Deaf-blindness
Deafness
Developmental delay
Emotional disturbance
Intellectual disability
Multiple disabilities
Orthopedic impairment
Traumatic brain injury (TBI)
Visual impairment, including blindness
Hearing impairment
Speech or language impairment
Developmental learning disability (DLD)
Other health impairment
Limited strength, vitality, or alertness, with respect to the educational environment that adversely affects educational performance and includes
Chronic or acute health problems such as asthma, ADHD, diabetes, epilepsy, heart conditions, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome
difference between an IEP & 504 plan
504: Falls under Section 504 of the Rehabilitation Act of 1973, a civil rights law that ensures equal access to education by providing accommodations
Broader eligibility; includes any disability that substantially limits one or more major life activities (e.g., learning, walking, concentrating).
Does not require the student to need specialized instruction, only accommodations.
Suitable for students who can succeed in a general education environment with accommodations
IEP: Governed by the Individuals with Disabilities Education Act (IDEA). Provides specialized instruction and services to meet a child’s unique educational needs
More educational needs
Must have 1 of 13 specific disabilities listed under IDEA (autism, hearing impairment, specific learning disabilities, etc.) and must impact their ability to learn in a general education setting requiring specialized instruction
Best for students needing individualized, intensive educational support
No universally agreed-upon criteria for failure of a CAPD test battery
true
lax criteria
Abnormal performance on a single test (> 2 SD below mean)
strict criteria
Abnormal performance on all tests (> 2 SD below mean)
intermediate criteria
Abnormal performance on at least 2 tests (> 2 SD below mean)
Abnormal performance on at least 1 test (> 3 SD below mean)
American Academy of Audiology Guidelines 2010
Abnormal performance on at least one ear for 2 tests (> 2 SD below mean)
Wilson & Arnott 2013 retrospective analysis conclusion of 150 children with normal hearing based on AAA 2010, ASHA 2005 & BSA 2011
Clinicians provide explicit statement of the criteria used for diagnosis
Not enough data supporting use of (C)APD as a global label
how do you score total GIN score and its norms
Total correct number minus false positives ÷ (60 X 100) (one ear)
Total correct number minus false positives ÷ (120 X 100) (two ears)
Total score cut off for percent correct
< 52% (8 to 11 yrs.) (> 52% is normal)
Total score norms not currently reported for 7 y.o.
< 54% (12 yrs. to adults) (> 54% is normal)
norms for gap threshold
Normal = < 4 to 6 ms
Concern = > 8 ms
RGDT norms
normal: < 20 ms
no matter the age
long MLD norms
normal: > 14 dB HL
short MLD normss
Normal: > 10 dB HL
what is the definition of CAPD
CAPD is a complex heterogenous bottom up perceptual disorder affecting the auditory system
it can present differently from child to child
what is sound localization
ability to identify where a sound is coming from in space
duplex theory
ITD
provides localization for low frequency stimulus
ILD
provides localization for high frequency stimulus
what does a deficit look like for sound localization
difficulty in spatial awareness, following multi-speaker conversations and maintaining attention in a classroom
what is temporal processing
ability to process timing aspects of a sound (e.g., the order or rate of sounds)
ability to detect changes over time between two brief stimuli
what does a deficit in temporal processing look like
challenges in auditory discrimination and resolution
affecting reading, spelling, and writing due to difficulty distinguishing phonemes or following rapid speech
ex: distinguishing /pa/ from /ba/
affects reading fluency and comprehension due to impaired phonemic awareness
what is auditory figure ground
ability to focus on a signal of interest in the presence of background noise
deficit in auditory figure ground
difficulty understanding speech in noisy environments
leading to challenges in classroom discussions or group learning
what is auditory closure
ability to fill in the missing pieces of auditory information
fill in the blanks
what does a deficit in auditory closure look like
perform poorly on tests that assess auditory closure
low pass filtered speech tests
speech in nois tests
time compressed speech tests
difficulty understanding speech in noisy or degraded auditory conditions
affects language learning and comprehension
issues with language acquisition and vocabulary development
phonemic decoding may be affected
what is auditory analysis
ability to break down auditory information into its components (e.g., syllables or phonemes)
important for distinguishing verb tenses and other morphological markers that may be acoustically distorted or masked by background noise
why is auditory analysis important
important for distinguishing verb tenses and other morphological markers that may be acoustically distorted or masked by background noise
what does a deficit in auditory analysis look like
challenges with decoding
crucial for reading and spelling
reading difficulties
what is auditory memory
ability to remember auditory information for short or long periods of time
what does a deficit in auditory memory look like
poor ability to follow multi-step verbal instructions or remember sequences
impacts classroom performance
what is auditory sequential memory
recall the order of a series of acoustic stimuli
phone numbers, ID numbers, etc.
what is auditory short term memory
retain and recall auditory information as it is immediately presented
what is frequency resolution
ability of the auditory system to distinguish different frequencies in a sound signal even those that are close together
tested using PPST
what does a deficit in frequency resolution look like
phonemic processing and suprasegmental cues (intonation, stress, rhythm etc.)
crucial for language comprehension and expression
what is auditory binaural integration
ability to combine auditory information received by both ears into a unified perception
enhances sound clarity, localization and understanding especially in noise
relies on the precise timing and intensity cues from both ears to interpret spatial and spectral differences
what does a deficit in auditory binaural integration look like
issues understanding speech in complex auditory environments (noise), poor localization, reduced ability to focus on target speaker in group settings
leads to challenges working in groups or listening in noisy classes, increased listening fatigue, inability to follow multi-speaker discussions
what is dichotic processing
ability to process different auditory stimuli presented simultaneously to each ear.
Requires strong interhemispheric communication via the corpus callosum for effective integration and comprehension.
what tests dichotic processing
dichotic listening tasks, where each ear receives distinct, competing signals (e.g., words, digits).
what does a deficit in dichotic processing look like
Difficulty distinguishing or remembering competing auditory inputs.
Left or right ear suppression during dichotic listening tasks, often reflecting hemispheric dominance or interhemispheric transfer issues
leads to Trouble processing simultaneous auditory information (e.g., teacher talking while classmates converse).
Struggles with tasks requiring split attention or multitasking
CHAPS
Children’s Auditory Performance Scale
ages >/= 7yrs
SIFTER
Screening Instrument for Targeting Educational Risk
ages 1st through 5th grade
PSI
Pediatric Speech Intelligibility
3-6yrs
format I: 3-4 yrs; carrier phrases
format II: 5-6yrs; no carrier phrase
ACPT
Auditory Continuous Performance Test
ages 6-11yrs
SCAN 3C
ages 5-13yrs
gap detection: 8-13 yrs
SCAN 3A
ages 13-51
What are the behavioral screeners
PSI, ACPT, SCAN 3C & SCAN 3A
what are the monaural tests
GIN
PPST
DPT
SSI ICM & CCM
what are the binaural tests
ssw
dichotic digits
RGDT
MLD
LISNS
GIN
Gaps in Noise
ages 7yrs to adults
PPST
Pitch Pattern Sequence Test
ages 7rs to adults
DPT
duration pattern sequence test
ages >9yrs to adults
difficult test for younger children
SSI
synthetic sentence identification - ICM & CCM
ages 8yrs to adults
SSW
Staggered Spondaic Word Test
ages 5 to 70yrs
dichotic digits
ages 7yrs to adults
single digits: 5-7 yrs
RGDT
random gap detection test
ages 5-12yrs
MLD
masking level difference
ages 5yrs to adult???
LISN-S
ages 6 yrs to 30yrs
Listening in Spatialized Noise—Sentences test
what does ACPT assess
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
what tests assess s binaural integration or binaural separation
dichotic digits (cerebral level) - integration
competing sentences
SSW - both integration & separation
SSI-CCM: separation - temporal lobe
sensitive to lesions of the CC and cerebral cortex
left ear deficits for CC involvement
dichotic processes
Temporal pattern tests assess
pattern perception & temporal functioning abilities
temporal processing and temporal resolution tests
GIN - resolution
PPST - sequencing
RGDT - resolution
DPT - sequencing
tests used to assess the integration between two ears
MLD - BS level binaural interaction
Auditory recognition, memory and figure ground
Lower brainstem lesions
SSI ICM
. Monaural Low Redundancy Speech/Auditory Closure Processes
tests
NU-6 Filtered words
Time compressed sentences
SSI-ICM
speech in noise tests
Which (C)APD test result patterns help with a definitive diagnosis of (C)APD
Must rule out other modalities first before CAPD diagnosis
unilateral left ear deficit is more specific and most common pattern on CAPD test battery
what is a test battery
Includes a # of tests used to diagnose a certain condition
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
another definitive test battery pattern
reduced performance only on the ore difficult auditory portion of the test
implies an auditory deficit versus linguistic, cognitive or strictly attention deficits
Does (C)APD qualify for an IEP or a 504 and why?
disorders in DSM V are real disorders and are easy to get reimbursement for but if they are not then it is not easy to do
because we do not have a well defined clinical diagnostic base
singular diagnosis of CAPD = NO IEP but possibly a 504
CAPD in addition to another diagnosis (speech or reading etc.) = IEP & 504
IEP is more educational and created by an interdisciplinary team & 504 is so you can succeed in an educational setting (civil)
is CAPD top down or bottom up
capd is bottom-up
primarily auditory perceptual deficiencies
is adhd top down or bottom up
ADHD is top down
global attention/executive functioning disorder
describe top down processing
conceptually driven processin
Concept-driven, from the “top” (cognition) to the “bottom” (sensory input)
Processing guided by prior knowledge, experience, and expectations to interpret sensory information
occurs any time a higher-level concept influences the interpretation of lower-level sensory data
how does top down processing work
Uses existing knowledge and context to interpret stimuli.
Fills in gaps or disambiguates unclear sensory information.
Auditory: Understanding speech in a noisy room based on context and familiarity with the language.
example of top down processing
reading a partially obscured sentence and filling in missing words based on context
bottom up processing
aka data-driven processing
Data-driven, from the “bottom” (sensory input) to the “top” (higher cognitive processing)
A form of information processing that is guided by input
example of bottom up processing
Auditory: Hearing a new song for the first time and processing its melody and rhythm from scratch.
Reading unfamiliar words or identifying an unfamiliar taste
intervention for top down processing
language skills
cognitive strategies
metacognitive strategies
classroom instructional & learning strategies
how does bottom up processing work
Starts with basic sensory information (e.g., detecting edges, colors, or sounds).
Combines these elements to form a complete perception.
No prior knowledge or expectations are required.
what does modality specific mean
processes information specific to a single sensory modality
processing auditory information only, processing visual information only etc.
brain processes tied to a particular sensory modality (hearing, visual etc.)
what does supramodal mean
processes information that transcends individual sensory modalities, allowing integration across different senses
understanding the meaning of a word whether it is heard or read
brain processes that operate across different sensory modalities (not specific to any one sense and can integrate information from various sources)
like sight and sound
Controversy: Is (C)APD modality-specific or supra-modal?
according to experts, CAPD is modality-specific perceptual dysfunction meaning that the problems are primarily in the auditory system
because of this, it can be differentiated from other conditions where others might be across multiple senses
but there is a controversy that capd has multiple modalities that are impaired arguing for supramodal problem
this would move the disorder from the audiologic to the psychological domain and maybe outside of the scope of practice for audiologists
why is there this controversy
Lack of gold standard
gold standard = error free reference standard
sensitivity & specificity of tests is poo
what is the controversy over
whether capd is a distinct clinical entity that primarily affects the auditory system or if it is a supramodal disorder
whether it primarily is a language deficit or an auditory problem
whether it manifests as non-auditory factors like attention, cognition, memory and executive function rather than a deficit of auditory processes
what is ADHD
ADHD is more global disruption of sensory information and CAPD is associated with disruption of processing of auditory information only
common neurobehavioral childhood disorder that primarily affects children and continues into adulthood
DSM V essential features for ADHD
present before age 12yrs
requires clinical presentation during childhood
can be challenging to confirm if it was present before this age
impairment observable in at least 2 settings
ex: home and school or home and work
Clear evidence of interference with developmentally appropriate social, academic, and/or occupational function
Observed independently of autism spectrum disorder, schizophrenia, or other intellectual disorders
Criterian A1
6 or more symptoms of inattention persisting for at least 6 months that is inconsistent with developmental level and negatively and directly impacts social and academic/occupational activities
symptoms of inattention
fails to give attention to details/makes careless mistakes
difficulty sustaining attention in tasks or play activities (e.g., difficulty remaining focused during lectures, or lengthy reading)
does not seem to listen when spoken to directly
does not follow through on instructions/fails to finish schoolwork, chores
avoids/dislikes tasks requiring sustained mental effort (schoolwork/homework)
easily distracted by extraneous stimuli
has difficulty organizing tasks and activities
criterion A2
6 or more symptoms of hyperactivity-impulsivity persisting for at least 6 months that is inconsistent with developmental level and negatively and directly impacts social and academic/occupational activities
symptoms of Hyperactivity-Impulsivity
fidgets with or taps hands or feet or squirms in seat
Often leaves seat in classroom when remaining seated is expected
Often runs about or climbs in situations where it is inappropriate
Often unable to play or engage quietly in leisure activities
Often talks excessively
Often blurts out answers before questions have been completed
Often has difficulty awaiting turn
Often interrupts/intrudes on others (e.g., during conversations)
combined presentation for ADHD
if both A1 and A2 are met for the past 6 months
Predominantly Inattentive presentation
Predominantly hyperactive-impulsive presentation
what is Predominantly hyperactive-impulsive presentation
If criterion A2 (hyperactivity-impulsivity) is met but criterion A1 (inattention) is not met for the past six months
what is Predominantly Inattentive presentation
If criterion A1 (inattention) is met but criterion A2 (hyperactivity-impulsivity) is not met for the past six months
No diagnostic biological marker for ADHD is currently known
true
risk factors for ADHD
low birth weight - two to three fold risk
history of child abuse/neglect, multiple foster homes
neurotoxin exposure - lead exposure, infections, fetal alcohol syndrome (in-vitro alcohol exposure)
genetic & physiologic - significant increase with first-degree biological relatives, visual and hearing impairments, & epilepsy
treatment for ADHD
usually a combination of medication, therapy & educational interventions
meds: stimulants and non-stimulants to improve focus & reduce hyperactivity
therapy: behavioral therapy for learning coping skills and strategies for managing symptoms
educational interventions: Accommodations and modifications in school can help children with ADHD succeed academically
with appropriate management these individuals can lead successful & fulfilling lives
General profile of children with CAPD
Academic difficulties
Family history
Sporadic results on test batteries
Difficulties exacerbated in adverse listening conditions
Difficulty following multi-step directions
what other conditions can present with similar profiles to CAPD
ADHD
Learning/reading delays
Language delays; dyslexia
Low cognitive skills/IQ
Developmental delays
Executive function disorder
Autism spectrum disorder
perception driven by cognition that uses prior knowledge, experiences, and expectations to interpret sensory information
top down
perception driven by incoming sensory data that starts at the sensor ylevel and moves up to higher cognitive processes
bottom up
what is ANSD
neural dyssynchrony of CN VIII
what is ANSD characterized by
normal function of sensory cochlear cells but abnormal structure/function of auditory neurons/synapses
what would test results look like in ANSD
normal oaes
recordable CM
absent/abnormal - ARTs, ABR, ECochG, & MLDs (all rests involving CN VIII)
pure tones - ranges
AER - generally abnormal
describe AER findings in ANSD
Absent/abnormal ECochG and ABR
Possible abnormal auditory mid latency and late latency responses; P1 maybe a possible biologic marker for ANSD
Possible abnormal P300
measures up to the brainstem
ABR
measures up to the cochlea
ECochG
measure the midbrain to the thalamus
middle latency response
measures cortical areas (Heschl’s etc)
late latency response
what may be a possible biological marker for ANSD
P1 (late latency response)
In many cases of ANSD, ________ may be normal with an abnormal _______
middle & late AERs
ABR
ANSD is _________ and is a problem associated with the auditory system
it is not secondary to cognitive, linguistic or related factors; just like CAPD
modality specific
risk factors for ANSD
family history
hyperbilirubinemia
rubella
CMV
immune disorders
risk factors for CAPD
family history
hyperbilirubinemia
rubella
CMV
ototoxicity
ANSD test resuls for
pure tones
tymps
ARTs
SRT in noise
OAEs
gap detection
ABR
various degrees of loss
normal
elevated/absent
poor
present
abnormal
abs
CAPD test resuls for
pure tones
tymps
ARTs
SRT in noise
OAEs
gap detection
ABR
usually normal
normal
usually within normal limits
variable depends on site of CANS dysfunction
present
often abnormal
usually normal
what is HHL
aan acquired condition that permanently interrupts synaptic communication between sensory IHCs & afferent VIII nerve fibers before HL is diagnosed
seen with NIHL & aging
another term for HHL
cochlear synaptopathy
what are the clinical manifestations for HHL
decreased wave I amp w/ normal ABR thresholds
various suprathreshold abnormalities not seen in audio like
speech in noise difficulties, tinnitus & hyperacusis
they have normal or near to normal audios but they have issues hearing in noise or adverse listening environments
how does HHL differ from CAPD
HHL is developmental
CAPD is congenital
they are both auditory processing disorders
what is the most common cuase of cerebral damage
Cerebrovascular accidents (Strokes)
risk factors for Cerebrovascular accidents (Strokes)
high blood pressure
heart disease
diabetes
cigarette smoking
increasing age
prior stroke
s/s of Cerebrovascular accidents (Strokes)
Sudden numbness or weakness of the face, arm, or leg
Sudden confusion or trouble speaking or understanding others
Sudden trouble seeing in one or both eyes
Sudden dizziness
Trouble walking or loss of balance/coordination
Sudden severe headache with no known cause
what are the causes of Cerebrovascular accidents (Strokes)
ischemia or hemmorhagic
what is ischemia caused by
thrombus
embolus
what is a thrombus
blood clot that can occur in any large cerebral blood vessel that affects blood flow
Single most common cause of CVAs
thrombus
what is an embolus
Small blood clot that has dislodged from a larger blood clot elsewhere in the body
what is a transient ischemic attack
Small clot may pass on and the patient may recover completely from the ischemic attack
These are called transient ischemic attacks (TIAs) (when someone is talking and then they stop and just stare then pick up where they left off again)
Eventually can lead to a full-blown CVA
most common cause of hemorrhages
Uncontrolled significantly high blood pressure
what is a hemorrhage
When a blood vessel in the brain ruptures and bleeds
Less common occurrence than an ischemic stroke but can cause damage
what are the auditory symptoms associated with CVAs
Peripheral tests may be normal just as seen with cortical tumors
Can be significant decrease in speech understanding abilities that may not improve with appropriate amplification
If the PT is a HA user, the HA of the ear opposite the side of the stroke may appear less effective
Reassessment of auditory function with appropriate amplification and auditory rehabilitation may be necessary
what are D/D for CAPD
HL, language disorders (DLD), learning delays, ADHD, ASD, cognitive delays, ANSD, DLD, dyslexia
