Is CAPD a Clinical Entity? Flashcards
What is a clinical entity?
A disease or condition that has separate and distinct existence and objective or conceptual reality (Meriam Webster dictionary)
Whether the common cold is a clinical entity is debated (not everyone has the same symptoms, and the symptoms are not distinct from other illnesses)
A clinical entity is a condition that is diagnosed and treated
What is nosography?
A systemic description and classification of disease
Is a clinical entity the ultimate reference for the entire field of medicine?
Yes
It is a concept that is created and perpetuated by physicians to facilitate diagnostic and therapeutic approaches to individual patients
Is CAPD a clinical entity?
It depends
The ASHA (2005) working group on (C)APD concluded that there is sufficient evidence to support the neurobiological and behavioral existence of (C)APD as a diagnostic entity
According to the AAA (2010), there are several lines of evidence have accumulated during the last 50 years definitively establishing (C)APD as a “true” clinical disorder
According to the British Society of Audiology (BSA) Position Statement (2011) APD is characterized by poor perception of both speech and nonspeech sounds
What is the view of health insurance companies?
Aetna concluded that APD is not a distinct clinical entity
Blue Cross Blue Shield stated that APD testing is not considered medically necessary as there is insufficient evidence to support validity of the diagnostic tests
HealthNet National Medical Policy said that diagnostic tests or therapies for CAPD are investigational and, therefore, not medically necessary due to lack of scientific evidence to support the validity of any diagnostic test
Did the founder of nosography believe that homogeneity is the key to descriptions of diseases?
Yes
The best way to advance the profession of medicine is to provide a clear description, categorization, and history of disease
For example, if the patient is diagnosed with otosclerosis, every audiologist and otologist immediately knows
The typical etiology and signs/symptoms
The most common patient profile
Typical disease progression
Treatment options
Because of homogeneity in the description of this disorder
What is the Syndenham-Guttentag criteria for a clinical entity?
5 attributes of a clinical entity
1. Does (C)APD possess an unambiguous definition
2. Does (C)APD represent a homogeneous patient group
3. Does (C)APD represent a perceived limitation (of function)
4. Does (C)APD facilitate diagnosis
5. Does (C)APD facilitate intervention
Does CAPD have an unambiguous definition?
No, multiple definitions of (C)APD exist
For example, AAA (2010), ASHA (2005), BSA (2011) and others, neither of which are unambiguous or consistent
Does CAPD represent a homogeneous patient group?
No, by design [by (AAA 2010), (ASHA 2005), (Musiek et al., numerous publications), (Bellis et al., numerous publication), (and others)], individuals with (C)APD represent a heterogeneous population
Does (C)APD represent a perceived limitation (of function)?
Not clear
A failure on behavioral (or even electyrophysiologic) (C)APD tests does not indicate that the patient actually has a problem
If the patient has a problem, then it could be considered a subclinical entity
A subclinical condition is when the patient does not manifest characteristic clinical symptoms
For example, borderline anemia shows up on blood tests, but the patient does not have the characteristic symptoms of fatigue, pallor, weakness, light headedness, etc.
Does (C)APD facilitate diagnosis?
No, because a reference standard is required in order to know if results from an index test is correct
Currently, there is no reference or “gold” standard test or test battery for (C)APD
The diagnosis of (C)APD (AAA 2010) is based on sensitivity and specificity criteria that are based on cut-off values of auditory tests used to diagnose lesions in the CANS
Does (C)APD facilitate intervention?
No, because of the ambiguity in the definition and diagnosis there is no clear intervention
Intervention for (C)APD is often said to be “deficit-specific”
But a typical recommendation for failure on different behavioral tests is “remediation for speech-in-noise problems”
Can a common recommendation be “deficit-specific”
According to Cacace and McFarland, is ambiguity of interpretation, indeterminate diagnoses, and unwanted confounds be avoided?
Yes
Minimizing memory, cognition, language, and attentional demands on the input end
Precluding the use of response-selection strategies that use complex motor processes on the output end
They advocate the use of computer-controlled forced-choice psychophysical paradigms in combination with matched tasks in multiple sensory modalities to enhance the prospect of obtaining a valid diagnosis
What results from ambiguity?
Causes tremendous confusion when explaining this condition to parents/professionals
Children may not get appropriate services for what ails them
Insurance companies refuse to compensate for services involving (C)APD because of the ambiguity of definition and intervention
Why is CAPD (and other disorders) so well accepted despite its ambiguities?
Each disorder is associated with a distinct profession ad practitioner (e.g., audiologist, psychologist)
Only a certified, licensed professional in the discipline is qualified to administer the assessment battery and make the diagnosis audiologists in the case of CAPD)
The label for the disorder is not stigmatizing and is easy to understand, remember, and communicate to others
