Overview of CAPD and Professional Guidelines Flashcards
What is auditory processing?
What the brain does with what the ear hears
The ear picks up sounds and directs them to the central auditory nervous system (CANS)
The CANS, in turn, processes and interprets the signal
What was the ASHA task force (1996)?
They defined auditory processing in terms of performance on a specific group of auditory tasks
Perception of sound, clarification of sound, localization and lateralization of sound, attending to sound, analyzing, storing, and retrieving information, integration of message, auditory performance with competing and degraded acoustic signals
Did the ASHA task force also analyze the processing of temporal features of sound?
Yes
Temporal integration or summation, temporal resolution or discrimination, temporal ordering, temporal masking
Do auditory processes and mechanism just apply to verbal signals?
No, also non-verbal
Do auditory processes have neurophysiologic and behavioral correlates?
Yes
Many neurocognitive mechanisms and processes are engaged in recognition and discrimination tasks
You can test them with behavioral and neurophysiologic tests
You cannot understand speech by just hearing it
Non-acoustic factors (attention, short term memory, long term language representations) also play a huge part in understanding language
What is the ASHA technical report (2005)?
Stated that CAP refers to the efficiency and effectiveness by which the central auditory nervous system (CANS) utilizes auditory information
Are all of the auditory processing skills developed at the same time?
No, but they do overlap with each other
Each are inseparable in their contribution to the efficient and accurate processing of auditory information
Are some of the aspects of normal auditory processing critical to academic skills?
Yes
What is auditory resolution or discrimination?
Ability to discriminate between sounds that differ in frequency, duration, and intensity (high/low, long/short, and soft/loud)
The ability to discriminate between acoustically similar words without reliance on contextual or visual cues (sun/fun, fin/thin)
What is auditory attention?
The ability to attend to relevant acoustic signals, such as speech and sustain that attention for an age-appropriate amount of time
What is auditory figure ground?
The ability to identify the primary linguistic or non-linguistic sound source from background noise
Example: the teacher’s voice is the primary signal in a room of competing noise
What is auditory closure?
It is the ability to understand the whole word or message when a part is missing
In adverse listening environments auditory closure helps to “fill in the blanks” and, therefore, understand the messages
For adults with rich language base/experience this task is much easier than for children who are building language skills
What are phonemes?
The smallest unit of speech sound employed to form meaningful contrasts between utterances
Children need phonemic awareness to learn to read because letters represent phonemes in words
What are morphemes?
The smallest unit of meaning in a language but a morpheme does not necessarily have to be a word
For e.g., Cats has two morpheme; /Cat/ is one morpheme, and /s/ is the second morpheme
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 is auditory synthesis?
Ability to synthesize (merge or blend) phonemes into words
Auditory synthesis is critical to the reading process
What is auditory association?
The ability to attach meaning to sound
It requires identification of an acoustic signal and the ability to associate it with its source or to label a linguistic or non-linguistic sound or experience
Auditory association is a fundamental for developing auditory memory
What is auditory memory?
Recall of an acoustic signal after it has been labeled and stored
Auditory memory also requires remembering and recalling various acoustic stimuli of different lengths and number
Memory issues can affect auditory memory
What is auditory sequential memory?
The ability to recall the order of a series of acoustic stimuli
Some acoustic information must be recalled in exact order to be useful
What is auditory short-term memory?
The ability to retain and recall auditory information as it is immediately presented
What is temporal integration?
The 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
If you don’t get the correct timing, you will have a hard time understanding
Signal duration effects signal detection (too short, won’t detect - 200 to 300 ms absolute shortest)
Pure tone duration of 200 to 300 ms = lowest absolute threshold
A tenfold increase in duration results in 10 dB improvement in threshold
Tonal durations >300 ms does not improve signal threshold
What is temporal resolution?
Detection of small timing differences when processing speech
A common method used to assess temporal resolution is the gap detection threshold (GDT)
It is affected by SNHL, maturational delays, (C)APD?, Aging
Poor GDT task performance suggests an inability to hear subtle acoustic changes that may negatively impact speech perception (especially true in noise when fluctuations in noise can obscure fluctuations in speech)
What is temporal masking?
Masker and test signal do not overlap in time; separation delay b/w signal and masker
Temporal masking by louder, longer vowel sounds can swamp softer, shorter consonant sounds
Are two ears better than one?
Yes
Frequency and intensity difference detection is better with two ears
Threshold for pure-tones and spondees is better by ~ 3 dB with binaural vs. monaural hearing because of binaural summation
Binaural speech intelligibility is better than monaural speech intelligibility especially in noise
Is CAPD a complex and heterogeneous disorder?
Yes
It can have different causes
Can children with CAPD experience auditory overload?
Yes
Because when auditory skills are weak, they can become overwhelmed
Is CAPD an input or output disorder?
Input disorder
Impedes selective and divided auditory attention
Can also impact attention because you will not attend to a signal that you do not have access to
Cognitive effort becomes overwhelming
Do most children with auditory processing problems have normal intelligence and normal hearing sensitivity?
Yes
What are some factors that contribute to auditory overload?
Brevity of signal or signal components, fast speaking rate
Increased phonetic complexity (context, syntax, etc.)
Increased acoustic/phonetic similarity (rhyming words (may 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
How do CAPD tests work?
They assess the system when the patient is in auditory overload
Assess for normal auditory processing
What is the general auditory hypothesis of CAPD?
Deficits specifically in higher order auditory processing of varying acoustic signals; primarily an auditory modality deficit
What is the language-specific hypothesis for CAPD?
The processing deficit is phonetic/language-based, not specifically auditory in nature
What is the likely result of CAPD?
It is likely that (C)APD for speech is a result of higher-order auditory processing deficits and more generalized cognitive processing/language deficits
Why did ASHA say that the C in CAPD should be dropped?
Because the periphery can also affect the central
Now in parenthesis
What was McFarland and Cacace’s definition of CAPD?
A modality-specific perceptual dysfunction that is not due to peripheral hearing loss
It is saying modality specific, but it is not said clearly
Due to the ASHA task force, are some patient presumed to have CAPD as a result of dysfunction of processes and mechanisms dedicated to audition?
Yes
For others, (C)APD may stem from some more general dysfunction, such as an attention deficit or neural timing deficit, which affects performance across modalities
It also is possible for (C)APD to reflect coexisting dysfunction of both sorts (may not be able to say that it is CAPD conclusively)
What did ASHA (2005) say was not included in the definition of CAPD?
Although abilities such as phonological awareness, attention to and memory for auditory information, auditory synthesis, comprehension and interpretation of auditorily presented information, and similar skills may be reliant on or associated with intact central auditory function, they are considered higher order cognitive-communicative and/or language-related functions and, thus, are NOT included in the definition of central auditory processing
According to AAA (2010), is there a specific site of CAPD?
No
More of a diffuse condition
They also state that neurological involvement ranging from degenerative diseases to exposure to neurotoxic substances in CAPD
According to AAA (2010, what are other factors that can impact central auditory processing?
Developmental, communicative, and learning-related problems
Peripheral hearing loss
Aging processes
What are some patient factors and considerations for CAPD testing (AAA, 2010)?
Age
Cognitive ability
General behavior
Speech, language, and hearing status
Attention issues and motivation
What are the 4 areas of the AAA CAPD guidelines?
Patient history and selection criteria
Diagnosis
Intervention
Professional issues, education, and training
Does the British Society of Audiology use the term CAPD?
No, only APD
Does the BSA think that APD affects all sounds and not just speech sounds?
Yes
APD is characterized by poor perception of both speech and nonspeech sounds
What is the BSA position statement on APD?
Perception results from both sensory activation (via the ear) and neural processing that integrates this ‘bottom-up’ information with activity in other brain systems (e.g., vision, attention, & memory)
Difficulties in perceiving and understanding speech sounds could arise from other causes (e.g., language impairment, non-native experience of a particular language)
Therefore, poor perception of speech alone is not sufficient evidence of APD
Takes into account non-native speakers
Does BSA think that APD has origins in impaired neural function?
Yes
The mechanisms underlying APD include both afferent and efferent pathways in the auditory system, as well as higher level processing that provides ‘top-down’ modulation of such pathways
Does BSA think that APD should be a problem only in specific environments?
No, it should be a problem in all environments
Is there currently a gold standard of testing for APD?
No
These are essential to move the field forward
Does BSA think that APD is a collection of symptoms that usually co-occur with other neurodevelopmental disorders?
Yes
Such as poor language, literacy, attention, or autism
What are the three categories of APD?
Developmental APD
Acquired APD
Secondary APD
What is developmental APD?
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
What is acquired APD?
Cases associated with a known post-natal event (e.g., neurological trauma or infection) that could plausibly explain the APD
What is secondary 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)
Had hearing loss in the interim that could have impacted processing abilities
CAPD comes secondary
Are individuals in the acquired and secondary APD categories more likely to require medical and audiological intervention?
Yes
In addition to APD management strategies
Is some evidence for CAPD weak and based on opinion rather than proper scientific evaluation?
Yes
This is the main issue
Only type III and IV (least restrictive)
Just not a lot of high-level data
Do some professionals not endorse the explicit definition of APD?
Yes, they would rather focus on a specific area of concern
or example, listening difficulties in the presence of background noise, which might occur in environments where spatially distinct noise patterns could degrade auditory-related perceptual abilities
What is the well-accepted, but not universal definition of CAPD?
(C)APD is a complex, heterogeneous, bottom-up perceptual disorder affecting the auditory system
What is a non-academic profile of CAPD in school-aged children?
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
*all of the above can be exaggerated in noise and/or with degraded acoustic stimuli
What is an academic profile of CAPD in school-aged children?
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
What confounding variables should be assessed to diagnose CAPD?
Cognitive abilities (a child with reduced intellectual skills would demonstrate reduced auditory processing skills)
Speech and language competence (min language age is 6 years; variability of auditory skills below this age is too diverse)
English as primary language
Intelligible speech (for verbal response understanding)
Hearing sensitivity (WNL bilaterally)
Significant ME dysfunction may affect results (should not be present)
Should no identifiable disability be present in a child suspected of having CAPD?
Yes
By definition, CAPD is not the primary barrier to learning when other disabilities are present
Specifically, which conditions should be identified before diagnosing CAPD?
ADHD or executive function deficits
Language and phonological processing problems
Learning delay/disability
Cognitive impairment
Autism and autism spectrum disorders
Should the assessment of problems associated with CAPD be a multidisciplinary approach?
Yes
We cannot assess everything ourselves
Is there direct evidence to support that CAPD causes severe depression, sociopathy, psychopathy, and criminal behavior?
No
What is lexical decoding deficits?
Subtype of CAPD (most common type)
Difficulties in processing the words of a language, both verbal and written
Difficulty may lie in decoding accuracy, speed, or both
Associated with weak phonemic awareness [auditory closure (decoding) deficit]
Also manifested by difficulty in manipulating sounds
Faulty mental perception of sound (poor reading, spelling, and work finding)
Often mistaken as ADHD
Thought to be located in the left posterior temporal lobe
What is tolerance-fading memory?
CAPD subtype (2nd most common)
Difficulty listening in noise
Difficulty recalling earlier presented information
Weak expressive language and poor handwriting
Some say co-morbidity between CAPD and ADHD is more common with this
Thought to be located in the frontal and anterior temporal lobes and a small region in the parietal lobe
What is organizational deficits or output-organization deficit?
CAPD subtype
Diagnosed when significant corrupted auditory sequencing or planning is noted (difficulty with sequential information, disorganized at home and school)
Not seen in isolation
Thought to be located in the pre- and post-central gyri and areas in the anterior temporal lobe
What is integration deficits?
CAPD subtype
Decreased ability to integrate acoustic and linguistic information across different processing modalities (acoustic and visual)
Long delays in response to auditory stimuli, writing, and use of language
Deficits in left ear in dichotic tests requiring language-based responses
Larger than normal right ear advantage past age 11 to 12 on verbal tasks
Inferior RE performance on nonverbal tasks
Increased difficulty integrating suprasegmental and linguistic information
Thought to be located in the corpus callosum
Where is the first cross-over in the auditory system?
Superior olivary nucleus
Sound reaches the brain through both ipsi and contra pathways
Crossed or contralateral pathways are, however, more robust than uncrossed or ipsilateral pathways
Explains the right ear advantage (direct input the the left hemisphere)
When is the right ear advantage present?
Normal in children
Typically up to 11 to 12 years old
Due to neuromaturation effects
Is there some evidence to suggest that males have a smaller/not as robust corpus callosum?
Yes
May be the reason why males have a higher ratio for developmental disorders
Language problems
Dyslexia
(C)APD
Learning delays
ADHD
In most instances, does CAPD occur in the absence of neuropathological conditions?
Yes
But it is believed to be associated with dysfunction within the CANS
Can there be a genetic predisposition for CAPD?
Yes, multifactorial
Some genetic conditions cause learning/language deficits; it is common to find a family history of developmental disorders for children with (C)APD
How prevalent is CAPD in children?
Two to three percent
2:1 ratio between boys and girls
A small percentage of these children may have frank neurological problems such as epileptic seizures, cysts, and strokes
What are the primary risk factors for children for CAPD?
Neonatal history (e.g., hypoxia/anoxia, poor antenatal care)
History of neurologic insult
Male gender
Heredity/genetic predisposition (multifactorial)
Delayed neuromaturation (developmental delays)
Auditory deprivation (commonly related to chronic childhood otitis media)
Reading disorder due to auditory-phonological deficits
Attention deficit hyperactivity disorder (ADHD) (comorbidity?)
Pervasive developmental disorder (PDD) or autism spectrum disorder (ASD)
