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AUDE 6240 (CAPD) > Final Exam > Flashcards

Final Exam Flashcards

1
Q

why is capd still a controversial issue

A

Due to the definition, etiology, signs and symptoms, treatment, and outcomes

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2
Q

what complicates the diagnosis of CAPD

A

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

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3
Q

what are the results of capd’s uncertain diagnosis

A

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

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4
Q

what is a 504 plan

A

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

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5
Q

what is a disability

A

refers to a physical/cognitive impairment, which substantially limits one or more major life activities

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6
Q

examples of disabilities

A

Physical impairments; illnesses or injuries; communicable diseases; chronic conditions like asthma, allergies, diabetes; and learning problems

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7
Q

what is an IEP

A

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

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8
Q

disabilities that are eligible for IEP

A

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

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9
Q

difference between an IEP & 504 plan

A

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

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10
Q

No universally agreed-upon criteria for failure of a CAPD test battery

A

true

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11
Q

lax criteria

A

Abnormal performance on a single test (> 2 SD below mean)

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12
Q

strict criteria

A

Abnormal performance on all tests (> 2 SD below mean)

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13
Q

intermediate criteria

A

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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14
Q

American Academy of Audiology Guidelines 2010

A

Abnormal performance on at least one ear for 2 tests (> 2 SD below mean)

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15
Q

Wilson & Arnott 2013 retrospective analysis conclusion of 150 children with normal hearing based on AAA 2010, ASHA 2005 & BSA 2011

A

Clinicians provide explicit statement of the criteria used for diagnosis
Not enough data supporting use of (C)APD as a global label

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16
Q

how do you score total GIN score and its norms

A

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)

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17
Q

norms for gap threshold

A

Normal = < 4 to 6 ms
Concern = > 8 ms

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18
Q

RGDT norms

A

normal: < 20 ms
no matter the age

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19
Q

long MLD norms

A

normal: > 14 dB HL

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20
Q

short MLD normss

A

Normal: > 10 dB HL

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21
Q

what is the definition of CAPD

A

CAPD is a complex heterogenous bottom up perceptual disorder affecting the auditory system
it can present differently from child to child

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22
Q

what is sound localization

A

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

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23
Q

what does a deficit look like for sound localization

A

difficulty in spatial awareness, following multi-speaker conversations and maintaining attention in a classroom

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24
Q

what is temporal processing

A

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

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25
Q

what does a deficit in temporal processing look like

A

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

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26
Q

what is auditory figure ground

A

ability to focus on a signal of interest in the presence of background noise

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27
Q

deficit in auditory figure ground

A

difficulty understanding speech in noisy environments
leading to challenges in classroom discussions or group learning

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28
Q

what is auditory closure

A

ability to fill in the missing pieces of auditory information
fill in the blanks

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29
Q

what does a deficit in auditory closure look like

A

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

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30
Q

what is auditory analysis

A

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

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31
Q

why is auditory analysis important

A

important for distinguishing verb tenses and other morphological markers that may be acoustically distorted or masked by background noise

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32
Q

what does a deficit in auditory analysis look like

A

challenges with decoding
crucial for reading and spelling
reading difficulties

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33
Q

what is auditory memory

A

ability to remember auditory information for short or long periods of time

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34
Q

what does a deficit in auditory memory look like

A

poor ability to follow multi-step verbal instructions or remember sequences
impacts classroom performance

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35
Q

what is auditory sequential memory

A

recall the order of a series of acoustic stimuli
phone numbers, ID numbers, etc.

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36
Q

what is auditory short term memory

A

retain and recall auditory information as it is immediately presented

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37
Q

what is frequency resolution

A

ability of the auditory system to distinguish different frequencies in a sound signal even those that are close together
tested using PPST

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38
Q

what does a deficit in frequency resolution look like

A

phonemic processing and suprasegmental cues (intonation, stress, rhythm etc.)
crucial for language comprehension and expression

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39
Q

what is auditory binaural integration

A

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

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40
Q

what does a deficit in auditory binaural integration look like

A

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

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41
Q

what is dichotic processing

A

ability to process different auditory stimuli presented simultaneously to each ear.
Requires strong interhemispheric communication via the corpus callosum for effective integration and comprehension.

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42
Q

what tests dichotic processing

A

dichotic listening tasks, where each ear receives distinct, competing signals (e.g., words, digits).

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43
Q

what does a deficit in dichotic processing look like

A

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

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44
Q

CHAPS

A

Children’s Auditory Performance Scale
ages >/= 7yrs

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45
Q

SIFTER

A

Screening Instrument for Targeting Educational Risk
ages 1st through 5th grade

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46
Q

PSI

A

Pediatric Speech Intelligibility
3-6yrs
format I: 3-4 yrs; carrier phrases
format II: 5-6yrs; no carrier phrase

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47
Q

ACPT

A

Auditory Continuous Performance Test
ages 6-11yrs

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48
Q

SCAN 3C

A

ages 5-13yrs
gap detection: 8-13 yrs

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49
Q

SCAN 3A

A

ages 13-51

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50
Q

What are the behavioral screeners

A

PSI, ACPT, SCAN 3C & SCAN 3A

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51
Q

what are the monaural tests

A

GIN
PPST
DPT
SSI ICM & CCM

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52
Q

what are the binaural tests

A

ssw
dichotic digits
RGDT
MLD
LISNS

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53
Q

GIN

A

Gaps in Noise
ages 7yrs to adults

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54
Q

PPST

A

Pitch Pattern Sequence Test
ages 7rs to adults

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55
Q

DPT

A

duration pattern sequence test
ages >9yrs to adults
difficult test for younger children

56
Q

SSI

A

synthetic sentence identification - ICM & CCM
ages 8yrs to adults

57
Q

SSW

A

Staggered Spondaic Word Test
ages 5 to 70yrs

58
Q

dichotic digits

A

ages 7yrs to adults
single digits: 5-7 yrs

59
Q

RGDT

A

random gap detection test
ages 5-12yrs

60
Q

MLD

A

masking level difference
ages 5yrs to adult???

61
Q

LISN-S

A

ages 6 yrs to 30yrs
Listening in Spatialized Noise—Sentences test

62
Q

what does ACPT assess

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

63
Q

what tests assess s binaural integration or binaural separation

A

dichotic digits (cerebral level) - integration

competing sentences

SSW - both integration & separation

SSI-CCM: separation - temporal lobe

64
Q

sensitive to lesions of the CC and cerebral cortex
left ear deficits for CC involvement

A

dichotic processes

65
Q

Temporal pattern tests assess

A

pattern perception & temporal functioning abilities

66
Q

temporal processing and temporal resolution tests

A

GIN - resolution
PPST - sequencing
RGDT - resolution
DPT - sequencing

67
Q

tests used to assess the integration between two ears

A

MLD - BS level binaural interaction

68
Q

Auditory recognition, memory and figure ground
Lower brainstem lesions

A

SSI ICM

69
Q

. Monaural Low Redundancy Speech/Auditory Closure Processes
tests

A

NU-6 Filtered words

Time compressed sentences

SSI-ICM

speech in noise tests

70
Q

Which (C)APD test result patterns help with a definitive diagnosis of (C)APD

A

Must rule out other modalities first before CAPD diagnosis

unilateral left ear deficit is more specific and most common pattern on CAPD test battery

71
Q

what is a test battery

A

Includes a # of tests used to diagnose a certain condition

72
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

73
Q

another definitive test battery pattern

A

reduced performance only on the ore difficult auditory portion of the test
implies an auditory deficit versus linguistic, cognitive or strictly attention deficits

74
Q

Does (C)APD qualify for an IEP or a 504 and why?

A

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)

75
Q

is CAPD top down or bottom up

A

capd is bottom-up
primarily auditory perceptual deficiencies

76
Q

is adhd top down or bottom up

A

ADHD is top down
global attention/executive functioning disorder

77
Q

describe top down processing

A

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

78
Q

how does top down processing work

A

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.

79
Q

example of top down processing

A

reading a partially obscured sentence and filling in missing words based on context

80
Q

bottom up processing

A

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

81
Q

example of bottom up processing

A

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

82
Q

intervention for top down processing

A

language skills
cognitive strategies
metacognitive strategies
classroom instructional & learning strategies

83
Q

how does bottom up processing work

A

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.

84
Q

what does modality specific mean

A

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.)

85
Q

what does supramodal mean

A

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

86
Q

Controversy: Is (C)APD modality-specific or supra-modal?

A

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

87
Q

why is there this controversy

A

Lack of gold standard
gold standard = error free reference standard

sensitivity & specificity of tests is poo

88
Q

what is the controversy over

A

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

89
Q

what is ADHD

A

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

90
Q

DSM V essential features for ADHD

A

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

91
Q

Criterian A1

A

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

92
Q

symptoms of inattention

A

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

93
Q

criterion A2

A

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

94
Q

symptoms of Hyperactivity-Impulsivity

A

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)

95
Q

combined presentation for ADHD

A

if both A1 and A2 are met for the past 6 months
Predominantly Inattentive presentation
Predominantly hyperactive-impulsive presentation

96
Q

what is Predominantly hyperactive-impulsive presentation

A

If criterion A2 (hyperactivity-impulsivity) is met but criterion A1 (inattention) is not met for the past six months

97
Q

what is Predominantly Inattentive presentation

A

If criterion A1 (inattention) is met but criterion A2 (hyperactivity-impulsivity) is not met for the past six months

98
Q

No diagnostic biological marker for ADHD is currently known

A

true

99
Q

risk factors for ADHD

A

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

100
Q

treatment for ADHD

A

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

101
Q

General profile of children with CAPD

A

Academic difficulties
Family history
Sporadic results on test batteries
Difficulties exacerbated in adverse listening conditions
Difficulty following multi-step directions

102
Q

what other conditions can present with similar profiles to CAPD

A

ADHD
Learning/reading delays
Language delays; dyslexia
Low cognitive skills/IQ
Developmental delays
Executive function disorder
Autism spectrum disorder

103
Q

perception driven by cognition that uses prior knowledge, experiences, and expectations to interpret sensory information

A

top down

104
Q

perception driven by incoming sensory data that starts at the sensor ylevel and moves up to higher cognitive processes

A

bottom up

105
Q

what is ANSD

A

neural dyssynchrony of CN VIII

106
Q

what is ANSD characterized by

A

normal function of sensory cochlear cells but abnormal structure/function of auditory neurons/synapses

107
Q

what would test results look like in ANSD

A

normal oaes
recordable CM
absent/abnormal - ARTs, ABR, ECochG, & MLDs (all rests involving CN VIII)
pure tones - ranges
AER - generally abnormal

108
Q

describe AER findings in ANSD

A

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

109
Q

measures up to the brainstem

A

ABR

110
Q

measures up to the cochlea

A

ECochG

111
Q

measure the midbrain to the thalamus

A

middle latency response

112
Q

measures cortical areas (Heschl’s etc)

A

late latency response

113
Q

what may be a possible biological marker for ANSD

A

P1 (late latency response)

114
Q

In many cases of ANSD, ________ may be normal with an abnormal _______

A

middle & late AERs
ABR

115
Q

ANSD is _________ and is a problem associated with the auditory system
it is not secondary to cognitive, linguistic or related factors; just like CAPD

A

modality specific

116
Q

risk factors for ANSD

A

family history
hyperbilirubinemia
rubella
CMV
immune disorders

117
Q

risk factors for CAPD

A

family history
hyperbilirubinemia
rubella
CMV
ototoxicity

118
Q

ANSD test resuls for
pure tones
tymps
ARTs
SRT in noise
OAEs
gap detection
ABR

A

various degrees of loss
normal
elevated/absent
poor
present
abnormal
abs

119
Q

CAPD test resuls for
pure tones
tymps
ARTs
SRT in noise
OAEs
gap detection
ABR

A

usually normal
normal
usually within normal limits
variable depends on site of CANS dysfunction
present
often abnormal
usually normal

120
Q

what is HHL

A

aan acquired condition that permanently interrupts synaptic communication between sensory IHCs & afferent VIII nerve fibers before HL is diagnosed
seen with NIHL & aging

121
Q

another term for HHL

A

cochlear synaptopathy

122
Q

what are the clinical manifestations for HHL

A

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

123
Q

how does HHL differ from CAPD

A

HHL is developmental
CAPD is congenital

they are both auditory processing disorders

124
Q

what is the most common cuase of cerebral damage

A

Cerebrovascular accidents (Strokes)

125
Q

risk factors for Cerebrovascular accidents (Strokes)

A

high blood pressure
heart disease
diabetes
cigarette smoking
increasing age
prior stroke

126
Q

s/s of Cerebrovascular accidents (Strokes)

A

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

127
Q

what are the causes of Cerebrovascular accidents (Strokes)

A

ischemia or hemmorhagic

128
Q

what is ischemia caused by

A

thrombus
embolus

129
Q

what is a thrombus

A

blood clot that can occur in any large cerebral blood vessel that affects blood flow

130
Q

Single most common cause of CVAs

A

thrombus

131
Q

what is an embolus

A

Small blood clot that has dislodged from a larger blood clot elsewhere in the body

132
Q

what is a transient ischemic attack

A

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

133
Q

most common cause of hemorrhages

A

Uncontrolled significantly high blood pressure

134
Q

what is a hemorrhage

A

When a blood vessel in the brain ruptures and bleeds
Less common occurrence than an ischemic stroke but can cause damage

135
Q

what are the auditory symptoms associated with CVAs

A

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

136
Q

what are D/D for CAPD

A

HL, language disorders (DLD), learning delays, ADHD, ASD, cognitive delays, ANSD, DLD, dyslexia

137
Q
A

AUDE 6240 (CAPD) (9 decks)

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