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Advanced Diagnostic Audiology > w1 > Flashcards

w1 Flashcards

1
Q

Define Central Auditory Processing (CAP).

A

CAP refers to how efficiently and effectively the central nervous system uses auditory information.

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2
Q

Define Central Auditory Processing Disorders (CAPD).

A
  • CAPD is a deficit in the neural processing of auditory stimuli that is not attributed to higher-order language and/or cognitive factors.
  • What we do with what we hear.
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3
Q

Do audiologists believe CAPD is limited to the auditory system?

A

Yes

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4
Q

Does CAPD affect both children and adults?

A

Yes

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5
Q

What are 3 consequences associated with CAPD?

A
  1. Difficulties in communication
  2. Language learning
  3. Understanding speech in challenging listening environments
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6
Q

What is the prevalence of CAPD?

A
  • Around 3-5% of school-aged children
  • Present in adults, with a higher occurrence among individuals over 60
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7
Q

What age range can children be assessed for CAPD?

A

7-12 years

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8
Q

Why can you not test children below 7 years?

A
  • We don’t have the tools to test below age 7
  • Maturation
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9
Q

What 4 things does a CAPD diagnosis include?

A

1) Behavioural measures
2) Electrophysiological measures
3) Observation
4) Case history

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10
Q

Who can make a CAPD diagnosis?

A

The diagnosis should be made by an audiologists trained in CAPD

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11
Q

Who recommends a teamwork approach and why?

A

SLPs recommend a teamwork approach to diagnose APD because there are a lot of different symptoms that affect more than just audiology.

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12
Q

Individuals with CAPD present difficulties and poor performance in one or more of what 4 skills?

A

1) Sound localization and lateralization
2) Auditory discrimination
3) Auditory pattern recognition
4) Temporal aspects of audition

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13
Q

What is sound localization and lateralization?

A

The ability to identify sound source in the sound field/head (under headphones)

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14
Q

What is auditory discrimination?

A

The ability to automatically distinguish one sound from another.

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15
Q

What is auditory pattern recognition?

A

The ability to determine similarities and differences in sound patterns or frequency

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16
Q

What are temporal aspects of audition and what 4 components make it up?

A

The ability to process acoustic stimuli over time, including:
1) temporal masking
2) temporal resolution
3) temporal integration
4) temporal ordering

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17
Q

What is temporal masking?

A

The ability of one sound to mask another that precedes (backwards) or follows (forward) it

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18
Q

What is temporal resolution?

A

The perception of fast-changing signals

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19
Q

What is an example of a temporal resolution test?

A
  • Gap detection
  • When gap is small, cant detect changes
  • Average = 2-5ms
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20
Q

What is temporal integration?

A

The ability to integrate acoustic energy in brief sounds and add information overtime or duration (dichotic test)

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21
Q

What is temporal ordering?

A

The ability to process and perceive a sequence of sounds (intensity, frequency, duration)

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22
Q

Does APD extend beyond the auditory system?

A

Although the auditory systems plays a crucial role in initiating the processing of auditory stimuli, the disorder extends beyond the auditory system and involves spoken language comprehension

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23
Q

CAPD is a disorder that affects the…

A

…ability to clearly perceive and interpret spoken messages

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24
Q

The terms ____ and ____ are used interchangeably.

A

CAPD, APD

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25
Q

____ refers to the entire auditory system

A

APD

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26
Q

____ is specifically focused on the ____ auditory system

A

CAPD, central

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27
Q

APD vs. ANSD vs. CAPD

A

APD = peripheral or central
ANSD = disorder of the peripheral nervous system
CAPD = central nervous system

28
Q

What are the 2 theoretical concepts/frameworks of APD?

A

1) Cognitive driven
2) Auditory driven

29
Q

Explain the cognitive driven framework.

A
  • APD is a component of/secondary to a broader cognitive/developmental disorder
  • APD is not solely an auditory disorder
  • APD co-occurs with other language, learning, and cognitive disorders
  • Psychologists, neurologists, and SLPs support this
  • Top-down processing
30
Q

Explain the auditory driven framework.

A
  • An auditory-modality-specific deficit
  • APD is a disorder primarily affecting the auditory modality
  • Attention and memory difficulties are not the primary causes of APD in children
  • Audiologists support this
    -Bottom-up processing
31
Q

Why is the auditory driven framework less supported?

A
  • Some of the supporting studies have poor research design
  • Parent/teacher report questionnaires are not valid, age-appropriate assessments
32
Q

Understanding the interplay between ____ and ____ is crucial for effective treatment and management.

A

Cognition, sensory processing

33
Q

What is the evidence to support the cognitive driven framework (4)?

A
  • Relationship between CAP test results and cognitive domains (attention, memory, IQ)
  • There is overlap depending on the specific tests and stimuli used
  • When you have better attention and memory, you will do better on the tests
  • Tests are not valid enough to just test AP
34
Q

What 3 tasks show correlation between CAP and other cognitive domains?

A

1) Binaural integration
2) Frequency discrimination
3) Temporal sequencing

35
Q

What 3 tasks do not show correlation between CAP and other cognitive domains?

A

1) Binaural separation
2) Gap detection
3) SIN tasks

36
Q

____ shows the highest comorbidity with APD

A

ADHD

37
Q

What is an approach used to support the auditory driven framework (associated with ADHD)?

A
  • Measure central auditory function before and after administering medication
  • No significant improvement in APD diagnostic tests post medication for ADHD (improved ADHD, but not APD)
38
Q

What do electrophysiological findings show in support of the auditory driven framework?

A
  • Auditory electrophysiological tests are mostly affects in children with APD, and not those identified with difficulties in general cognitive processes, suggesting sensory-based involvement
  • Those with APD show difficulty in eletrophys tests, but those with ADHD do not
39
Q

What electrophys tests support the auditory driven framework?

A

1) Speech ABR
2) MLR
3) ALR, N1-P2 components

40
Q

Some studies report cases of APD without ____, ____, and ____ or common comorbidities.

A

attention, memory, cognitive deficits

41
Q

Can those with HL be identified with APD?

A
  • No
  • We cannot differentiate between HL and APD
42
Q

What are some early childhood indicators for APD?

A

1) Poor rhyming skills
2) Inability to follow songs and melodies
3) Inattention to the speaker or ignoring the speaker
4) Sensitivity to sound or noise
5) Difficulty with complex directions
6) Difficulty formulating sentences
7) Searching for words and having trouble remembering simple commands
8) Poor pragmatic skills
9) Difficulty with early literacy skills

43
Q

What are 8 causes/predisposing factors of APD?

A

1) Inheritable factors (limited research)
2) Auditory neuropathy
3) Chronis/recurrent otitis media and middle ear infections
4) Environmental factors (toxins/infections)
5) Prematurity and low birth weight
6) Perinatal complications during pregnancy or delivery (oxygen deprivation, trauma to auditory system)
7) Ototoxic medication
8) Noise exposure

44
Q

What is the most common/important cause of APD?

A

Chronic OME

45
Q

What are the 3 most common comorbid symptoms/disorders associated with APD?

A

1) ADHD (84%)
2) Speech and language disorders (83%)
3) Reading disorders (47%)

46
Q

What are other disorders associated with APD?

A
  • ASD
  • Asperger’s
  • Tourette’s
  • Auditory neuropathy
  • Depression
47
Q

Prevalence of APD vs ADHD

A

APD
- 2-5% in school-aged children (as much as 20%)
- 10-20% in older adults
-2:1 male-female ratio

ADHD
- 5-9% in school-aged children
- 2-4% in adults
- 4:1 male-female ratio

48
Q

Diagnosis: APD vs. ADHD

A

APD
- Using a battery of standardized audiological tests administered under an acoustically controlled environment

ADHD
-Based on observing a cluster of behaviours (must be manifested in at least 2 settings)

49
Q

APD is a ____ disorder and ADHD is a ____ disorder

A

APD = input disorder
ADHD = output disorder

50
Q

Is APD or ADHD more difficult to diagnose?

A

ADHD
- more difficult to identify because need to use a team approach

51
Q

APD vs. ADHD

A
52
Q

What is executive function (EF)?

A
  • EF is a set of mental processes that enable us to plan, focus attention, remember, and juggle multiple tasks
  • Any complex task is controlled by EF
  • A number of brain networks are involved with EF
53
Q

What are the 4 core components of EF?

A

1) Inhibition/self-control
2) Interference control
3) Working memory
4) Cognitive flexibility

54
Q

What is inhibition/self-control?

A
  • temptations and acting impulsively
  • Impaired in cases of ADHD
  • Inhibition is top-down processing
55
Q

What is interference control?

A

Ability for selective attention and cognitive inhibition

56
Q

What is working memory?

A
  • Ability to remember information over a brief period
  • Less than 30 seconds
57
Q

What is cognitive flexibility?

A

Refers to creatively thinking outside the box, seeing anything from different perspectives, and quickly and flexibly adapting to changed circumstances

58
Q

Who deals most with EF?

A

Occupational therapists

59
Q

What is the recommended diagnostic criterion for APD?

A
  • Performance two standard deviations (2SD) below the norm on at least two different (valid & age-appropriate) auditory processing tests
    • At least in 1 ear for 2 tests
    • Ex) 2 abnormal results for left ear
  • ALSO, 3SD below the norm for only 1 Ax can be diagnosed as APD
60
Q

Should non-auditory assessments be incorporated into APD test batteries? Why?

A

Yes
- Best practice recommendations emphasize the assessment of speech-language and cognitive abilities in the CAP test battery, due to:
- A high comorbidity with APD, in pediatric populations
- Enabling accurate differential diagnosis
- Developing accurate individualized intervention plans

61
Q

Is the use of non-auditory analogs of APD tests recommended to rule out supramodal issues? Why?

A

No
- It is not recommended because of the significant challenges and limitations:
- The processing differences between the auditory and visual systems make it difficult to equate performance in auditory and visual tasks
- Auditory and visual systems have distinct physiological properties, and performance on one modality and may not correspond to performance on the other
- Studies have shown that performance on auditory tasks is significantly better than the same visual tasks
- Lack of correlation between auditory and visual results
- Lack of feasibility

62
Q

Is it recommended to determine sensitivity and specificity of APD tests on patients with APD due to confirmed neurological lesions? Why?

A

No
- This approach is not recommended due to the lack of generalizability
- Not all clinical presentations of APD involve neurological lesions
- We don’t know the place of involvement (it is a functional disorder (could be lower, middle, or upper brainstem)

63
Q

Is relying on parent/teacher reports of listening difficulties for APD diagnosis recommended? Why?

A

No
- These are merely supplemental to the audiological APD test battery
- They provide insufficient information for differential diagnosis
- Not reliable indicators of APD (intra/inter rater reliability)
- Many children referred for APD evaluations based on listening difficulties perform well on CAP tests
- Low agreement between parent/teacher reports and actual performance leads to over-identification and overuse of diagnostic tests (high level of referrals)
- This is the lowest level of evidence

64
Q

What are the benefits of animal models of APD?

A

Gain insight into:
- brain mechanisms involved in APDs
- functional plasticity subsequent to auditory disorders and intervention
- place of involvement
- intervention

65
Q

What are the limitations of animal models of APD?

A
  • lack of generalizability of animal findings to real-life human experiences
  • animal brains cannot be compared cognitively to humans

Advanced Diagnostic Audiology (10 decks)

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