Lectures 6 & 7: An Overview of CAPD & Professional Guidelines Flashcards
what is CAPD
Complex & heterogeneous disorder. It is a sensory processing deficit that commonly impacts listening, spoken language, comprehension, and learning. When auditory skills are weak, children may experience auditory overload. CAPD is an input disorder that impedes selective and divided auditory attention. Most Children with auditory processing problems have normal intelligence and normal hearing sensitivity.
ASHA 1996 Defined auditory processing in terms of performance on a specific group of auditory tasks including
Perception of sound (first step)
Clarification of sound
Localization and lateraliztation of sound
Attending to sound
Analyzing, storing, retrieving information (memory)
Integration of message (what is the message, any visuals associated with it)
Auditory performance with competing and degraded acoustic signals
asha 1996 processes of temporal features of sound include
Temporal integration or summation (combing or adding sounds)
Temporal resolution or discrimination (GDT - how big does the gap have to be to recognize there are 2 signals and not one)
Large gap = poorer GD
Smaller gap = better GD
Temporal ordering or sequencing (like with phone numbers, addresses, passwords etc.)
Temporal masking (forward and backward)
what was ASHA’s technical report 2005
CAPD refers to the efficiency and effectiveness in which the CANS utilizes auditory information
how efficiently do you proess sounds you are getting from the periphery
Certain auditory skills develop in a sequence but they are also interconnected and contribute to effective auditory processing as a whole based on
Depends on neuromaturation (auditory skills improve as a child’s brain matures and impacts how they can process sounds)
Children need a 10-15 dB SNR w/ typical hearing
Children with HL needs 20-25dB SNR
what is sensation
ability to identify the presence of sound
Have to realize there is sound in the environment before you can do anything with it
localization
where the sound is coming from
Auditory resolution/discrimination
Ability to discriminate between sounds that differ in frequency, duration, and intensity
Ability to discriminate between sounds that differ in frequency, duration, and intensity
auditory resolution/discrimination
problems with auditory resolution/discrimination
Problems with auditory discrimination can result in academic difficulty such as following directions, reading, spelling, and writing skills
ability to attend to relevant acoustic signals, such as speech and sustain that attention for an age-appropriate amount of time
auditory attention
auditory attention
ability to attend to relevant acoustic signals, such as speech and sustain that attention for an age-appropriate amount of time
ability to identify the primary linguistic or non-linguistic sound source from background noise
auditory figure ground
auditory figure ground
ability to identify the primary linguistic or non-linguistic sound source from background noise
For example, in a classroom, the teacher’s voice is the primary signal other sounds/noises in the room are the competing noise
Ability to understand whole word or message when part is missing
Helps to fill in the blanks and understand the messages
Easier for adults with rich language base/experience than children who are building language skills
auditory closure
auditory closure
Ability to understand whole word or message when part is missing
Helps to fill in the blanks and understand the messages
Easier for adults with rich language base/experience than children who are building language skills
Important for distinguishing verb tenses and other morphological markers that may be acoustically distorted or masked by background noise
auditory analysis
Important for distinguishing verb tenses and other morphological markers that may be acoustically distorted or masked by background noise
auditory analysis
smallest unit of speech sound used to form meaningful contrasts between utterances
phoneme
smallest unit of meaning in a language; doesn’t have to be a word
Morpheme:
fxns as the foundation of language
morphem
Ability to blend phonemes into words
Critical for reading
auditory synthesis
auditory synthesis
Ability to blend phonemes into words
Critical for reading
Ability to attach meaning to sound
Fundamental for developing auditory memory
auditory association
auditory association
Ability to attach meaning to sound
Fundamental for developing auditory memory
Recall of an acoustic signal after it has been labeled and stored
Requires remembering and recalling various acoustic stimuli of different lengths & numbers
Overall memory issues can affect this
auditory memory
auditory memory
Recall of an acoustic signal after it has been labeled and stored
Requires remembering and recalling various acoustic stimuli of different lengths & numbers
Overall memory issues can affect this
auditory sequential memory
ability to recall order of a series of acoustic stimuli
ability to recall order of a series of acoustic stimuli
auditory sequential memory
ability to retain and recall auditory information as it is immediately presented
auditory short term memory
auditory short term memory
ability to retain and recall auditory information as it is immediately presented
temporal integration
ability of the auditory system, specifically the auditory nerve and CANS, to integrate inputs over time, which in a variety of real-world circumstances, enhances the detection and/or discrimination of a sound
ability of the auditory system, specifically the auditory nerve and CANS, to integrate inputs over time, which in a variety of real-world circumstances, enhances the detection and/or discrimination of a sound
temporal integration
Lowest absolute threshold
200-300ms
Tenfold increase in duration
10dB improvement in threshold
Tonal durations >300ms doesn’t improve threshold due to
adaptation
detection of small timing differences when processing speech
temporal resolution
temporal resolution
detection of small timing differences when processing speech
smallest amunt of silence between two signals detected by listener
gdt
GDT
smallest amunt of silence between two signals detected by listener
inability to hear subtle acoustic changes that can impact speech perception
poor GD
what is temporal masking
Delay between masker and signal
Done using louder, longer vowel sounds that can swamp softer, shorter consonant sounds
Forward (signal follows masker; masker first) & backward (signal precede masker; masker second)
(signal follows masker; masker first
forward masking
signal precede masker; masker second)
backward masking
why do we need two ears
Two ears are better than one
Able to detect frequency and intensity differences better
Threshold for spondees and pure tones are better by around 3dB due to binaural summation
Speech intelligibility is better especially in noise (precedence effect, MLD, & perceptual coherence)
Auditory overload is experienced when
auditory skills are weak
Too much auditory stimuli causes this
facotrs that contribute to overload
Fast speaking rate
Increased phonetic complexity (context, syntax, etc.)
Increased acoustic/phonetic similarity
Rhyming words (might not enjoy nursery rhymes)
Reduced context
Linguistic, visual, and/or situational context are reduced
Poor listening conditions
Noisy backgrounds, increased distance from speaker, reverberation
Temporal distortions
Demand for verbatim retention or recall
give someone 3 words and after a period of time they have to repeat them back in the right order
CAPD tests are directed to assess
normal auditory processing function and assess the system when in auditory overload
what are the two opposing views to capd
general auditory hypothesis
language-specific hypothesis
General auditory hypothesis
Deficits in higher order auditory processing of varying acoustic signals; PRIMARILY auditory modality deficit
language specific hypothesis
Processing deficit is phonetic/language-based, not specifically auditory in nature
categories of APD
developmental
acquired
secondary
Cases presenting in childhood with normal hearing (i.e., normal audiometry) and no other known etiology or potential risk factors
Some individuals may retain APD into adulthood
developmental apd
Cases associated with a known post-natal event (e.g., neurological trauma or infection) that could plausibly explain the APD
acquired apd
Cases where APD occurs in the presence, or as a result, of peripheral hearing impairment (e.g., presbycusis or congenital SNHL)
This includes transient hearing impairment after its resolution (e.g., glue ear or surgically corrected otosclerosis)
secondary apd
nonacademic profile
May appear hearing impaired but hearing sensitivity is normal
History of chronic or recurrent OME
Repeatedly saying “huh” or “what” and asking people to repeat
Poor sound localization
May have poor music skills and difficulty learning rhymes and songs (poor phonemic awareness/processing?)
May have problems with fine and gross motors skill
May exhibit behavioral problems
how can any of the nonacademic profiles be exaggerated
can be exaggerated in noise and/or with degraded acoustic stimuli
academic profile
Almost all kids referred for CAPD evals are struggling academically
Child not working up to his/her potential
Doing poorly in schoolwork and/or not testing well
Weakness in spelling, reading, and/or writing
Strong math skills (except when reading is involved)
Difficulty following instruction/multistep instructions
Failed or failing a grade
Significant scatter in ability, intelligence, or performance on achievement, psychological, and language tests often with weakness in auditory domains
Better performance on non-auditory tasks
Verbal IQ score lower than performance IQ
academic struggles
Child receives Cs (if IQ > 95) or Ds and Fs (if IQ > 80)
Does not meet basic curriculum requirements with an IQ > 80 to 85
First or second grader reading well but no comprehension of the material
Works long hours but only gets b or cs
Demonstrates excessive frustration with homework
Average IQ
85-115
what is the SD of IQ
15
CAPD diagnostic criteria for cognition
Cognitive abilities are assessed
Intellegicne shouldn’t be a facoor because a child with reduced intellectual abilities also demonstrates reduced auditory processing skills
CAPD diagnostic criteria for S/L
Minimum language age should be >/= 6yrs or within a year of chronological age of language development
Variability of auditory skill maturity in children < 6 years of age is too diverse, which makes reliable testing and, therefore, diagnosis of (C)APD difficult before age 7
English as a primary language
A diverse language background may affect test interpretation and results
Intelligible speech
Most tests need a verbal response
You have to understand what they are saying in order to reliably test and interpret
hearing sensitivity criteria for CAPD testing
NORMAL in both ears
Significant ME dysfunction (effusion or infection)
Can test after they recover
Affects results
Rule out other disabilities before testing for CAPD
true
The following conditions should be identified
before capd testingg
ADHD or executive function deficits
Language and phonological processing problems
Learning delay/disability
Cognitive impairment
Autism and autism spectrum disorders
(C)APD should be an exclusionary diagnosis
tru
subtypes of CAPD
Lexical Decoding Deficits (most common type)
Tolerance-Fading Memory (TFM) (second most common)
Organizational Deficits or Output-Organization Deficit
Integration Deficits
Lexical Decoding Deficits (most common type)
Issues processing words verbally and written
Difficulty manipulating sound, difficulty decoding accuracy, speed or both
Cannot decode phonemes
Differential diagnosis = ADHD
Site of lesion - left posterior temporal lobe
Tolerance-Fading Memory (TFM) (second most common)
Issues hearing in noise, information fades quickly from short term memory
Weak expressive language and poor handwriting
Weak expressive language and poor handwriting
Comorbidity with CAPD & ADHD (existing together)
Site of lesion: frontal and anterior temporal lobes
Organizational Deficits or Output-Organization Deficit
Issues with anything sequential or planning (numbers)
Disorganized at home or school (messy desk, messy room, etc.)
will be seen with one of the other subtypes and not on its own
Site of lesion - anterior temporal lobe
Integration Deficits
Difficulty integrating acoustic and visual information
Long delays in response to auditory stimuli, writing and use of language
LE deficits in dichotic tests with language based responses
REA larger than normal past 11-12 with verbal tasks
Acoustic and visual deficits
Processing delays
Site of lesion: integration deficits at the CC
REA
first cross-over in the auditory system is at the
SOC
right ear crossed pathway has direct input to the left hemisphere, which is predominant for language
true
REA
Information from the left contralateral pathway (already crossed to the right side) has to cross over again through the corpus callosum to get to the left hemisphere for language processing
true
The REA is normal in children, typically up to ~ years, due to neuromaturation effects
11 to 12
ome evidence to suggest that males have a smaller/not as robust corpus callosum
true
According to some studies, that may be the reason why males may a higher ratio than females for developmental disorders such as
Language problems
Dyslexia
(C)APD
Learning delays
ADHD
Genetic predisposition
multifactorial
incidence
new cases
prevalence
existing cases in a time period or popultation
influence of environment and genetics
more than one gene involved
multifactorial
C)APD is a
neural processing deficit of auditory stimuli
exact etiology of (C)APD is known
false
unk own
Comorbidity is common with
ADHD
Phonological processing and language deficits
Reading and spelling problems
Learning delays
(C)APD is, however, not the result of dysfunction in other modalities
true
Some professionals do not recognize (C)APD as a distinct clinical entity unique to the auditory system
true
Developmental (C)APD is controversial
true
Lax criterion will yield
better sensitivity but poorer specificity
Strict criterion will yield
better specificity but poorer sensitivity
lax criteria
As size of the test battery increases, greater probability that a patient 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
intermediate 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)
strict criteria
As size of the test battery increases, less probability that a patient will fail all tests
Beneficial for detecting normal function and improves specificity but can undermine sensitivity as patients with 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
