Embed Size (px)
Citation preview
Testing for Central Auditory Processing Disorders
Harvey Dillon
With thanks to:
Sharon Cameron
Helen Glyde
Wayne Wilson
Pia Gyldenkaerne
Mridula Sharma
Dani Tomlin
1
On the basis of evidence, what should CAPD testing and
remediation services consist of?
What gaps in evidence are there that our research should fill in
the future?
Suggestions to Pia and Dani in the interpretation of their data
2
A clinician’s question
• Does this child have a problem hearing or understanding sound that adversely affects him or her, and that I or anyone else can do something about? • What is the specific nature of the problem? • Is there a specific remediation for that problem? • Are there general management techniques that might
minimize its effects?
3
Impact of criterion on diagnosis of CAPD
0 50 100
Fail ≥2 tests [ASHA (2005), AAA (2010)]
Fail ≥1 tests [ASHA (2005), AAA (2010)]
Fail ≥1 non-speech [McArthur, 2009]
Fail ≥1 speech + ≥1 non-speech [BSA(2011)]
Reported sympotoms [Ferguson (2011)]
Percent of children “with CAPD”
Binaural fail Monaural fail
Wayne Wilson 4
What is a fail on one test?
40 60 80 100 120 140 160
-4 -2 0 2 4Z-score
Prop
ortio
n of
chi
ldre
n
Test score
5
Test score sensitivity relative to functional listening ability
• Can estimate from correlation between test scores and functional ability – Questionnaire scores of listening ability – Educational attainment scores
0
50
100
150
-3 -2 -1 0 1 2 3
Func
tiona
l lis
teni
ng a
bilit
y
CAPD test z-score 6
Test score sensitivity relative to functional ability:
• Sensitivity = ∆ 𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹 𝑧−𝑠𝐹𝐹𝑠𝑠∆ 𝐶𝐶𝐶𝐶 𝑧−𝑠𝐹𝐹𝑠𝑠
7
Criteria for adopting a CAPD test
• Test is associated with variation in functional ability – High sensitivity (= ∆ 𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹 𝑧−𝑠𝐹𝐹𝑠𝑠
∆ 𝐶𝐶𝐶𝐶 𝑧−𝑠𝐹𝐹𝑠𝑠)
– Deviant results common in clinical population – Attributes tested minimally shared with other tests in battery
• Test result indicates specific remediation necessary (and remediation affects real life)
• Time taken is small • Test is minimally affected by attention, intelligence,
motivation, working memory • Associated with a known anatomical site and neural
mechanism
8
First a brief background on the LiSN-S
9
Same Voice - 0° Condition Different Voices - 0° Condition
Same Voice - ±90° Condition Different Voices - ±90° Condition
Spatial Advantage
Talker Advantage
(LiSN-S) Conditions
Low cue
High cue
Sharon Cameron 10
Results profile: spatial processing disorder
11
Target: The horse kicked six wet shoes LiSN & Learn training software
Cameron & Dillon, JAAA, 2011 12
Effect of training on LiSN-S scores
Low cueHigh Cue
Talker advantageSpatial advantage
Total advantage
LiSN-S scale
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
LiSN
-S score (popn S
D
Pre
Post
Follow-up
Cameron & Dillon, JAAA, 2011 13
LiSN & Learn - Performance Over Time (n=9) Li
SN
& L
earn
SR
T (d
B)
10 dB
Bet
ter
Cameron & Dillon, JAAA, 2011 14
Randomized Control Trial Earobics Lisn & Learn
N = 5 N = 5
Group: LiSN & Learn
Low CueHigh Cue
Talker AdvSpatial Adv
Total Adv-6
-5
-4
-3
-2
-1
0
1
2
3
LiSN
-S S
core (P
opulation Stand
Group: Earobics
Low CueHigh Cue
Talker AdvSpatial Adv
Total Adv
Pre-training Post-training
Cameron et al 15
Experiment 1 Dani Tomlin current PhD study • Two subject recruitment groups:
– Children referred to Uni of Melbourne Audiology Clinic due to suspected APD (n=65) • Teachers, parent, speech pathologist referral
– Normative group (n=47) • School enrolment, open invitation
• Age range of 7–12 years • Both groups to complete full test battery • Results converted to Z scores (derived using age
specific norms)
16
Measures obtained • Dichotic Digits Test (DDT): Binaural integration (Musiek, 1993) • Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990) • Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005) • MLD: Binaural interaction (Bellis, 2003) • LiSN-S: Binaural integration – spatial listening ability (Cameron & Dillon, 2006)
• Memory CELF-4: Forward and reverse digits • Attention: BrainTrain®: Continuous Performance Test: Sustained auditory and
visual attention • Cognition -TONI-4: Nonverbal cognitive assessment
• Questionnaires and interview: – Child completed LIFE questionnaire & recorded interview – Parent completed Fisher checklist & written interview – Teacher Evaluation of Auditory Performance (TEAP) & written interview
• Academic Performance - NAPLAN & WARP (reading fluency)
17
Relations between outcome variables Matrix Plot (Dani Feb24 data.sta 113v*112c)
Listening Capability Score
Average NAPLAN Literacy Z score
WARP Z SCORE
18
Test score sensitivity relative to functional abilities Dichotic digits - left Dichotic digits - right Freq pattern - left Freq pattern - right
List
enin
g ca
pabi
litie
s Re
adin
g flu
ency
Dani Tomlin
Lite
racy
Average NAPLAN Literacy Z score = 0.4145+0.1672*x
-10 -8 -6 -4 -2 0 2 4RDD ASIN Z Score
-3
-2
-1
0
1
2
Average
Average NAPLAN Literacy Z score = 0.6834+0.2485*x
-10 -8 -6 -4 -2 0 2 4LDD ASIN Z Score
-3
-2
-1
0
1
2
Average
Average NAPLAN Literacy Z score = 0.5726+0.265*x
-10 -8 -6 -4 -2 0 2 4LFPT ASIN Z SCORE
-3
-2
-1
0
1
2
Average
Average NAPLAN Literacy Z score = 0.5054+0.1976*x
-10 -8 -6 -4 -2 0 2 4R FPT ASIN Z SCORE
-3
-2
-1
0
1
2
Average
WARP Z SCORE = 0.0871+0.2002*x
-10 -8 -6 -4 -2 0 2 4R FPT ASIN Z SCORE
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
WARP Z SCORE = 0.1039+0.2143*x
-10 -8 -6 -4 -2 0 2LFPT ASIN Z SCORE
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
WARP Z SCORE = 0.2969+0.2647*x
-10 -8 -6 -4 -2 0 2 4LDD ASIN Z Score
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
WARP Z SCORE = 0.0602+0.205*x
-10 -8 -6 -4 -2 0 2 4RDD ASIN Z Score
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
Listening Capability Score = 0.2085+0.2417*x
-10 -8 -6 -4 -2 0 2 4LDD ASIN Z Score
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
Listening Capability Score = -0.0343+0.2005*x
-10 -8 -6 -4 -2 0 2 4RDD ASIN Z Score
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
Listening Capability Score = -0.0218+0.1664*x
-10 -8 -6 -4 -2 0 2 4LFPT ASIN Z SCORE
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
Listening Capability Score = -0.068+0.1102*x
-10 -8 -6 -4 -2 0 2 4R FPT ASIN Z SCORE
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
19
Test score sensitivity relative to functional abilities Gaps in noise - left Gaps in noise - right Digit span - Forward Digit span - Reversed
List
enin
g ca
pabi
litie
s Re
adin
g flu
ency
Dani Tomlin
Lite
racy
Listening Capability Score = -0.124+0.2894*x
-1.6-1.4
-1.2-1.0
-0.8-0.6
-0.4-0.2
0.00.2
0.40.6
0.81.0
1.2
L Gin Z score
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Cap
Listening Capability Score = -0.1261+0.2162*x
-3.0 -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5R Gin Z score
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
Listening Capability Score = -0.0312+0.4149*x
-2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0DS FW Z SCORE
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
Listening Capability Score = -0.0199+0.5467*x
-2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0DS Rev Z Score
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
Average NAPLAN Literacy Z score = 0.4358+0.6129*x
-2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0DS Rev Z Score
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
NA
PLA
N Lite
Average NAPLAN Literacy Z score = 0.454+0.5643*x
-2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5DS FW Z SCORE
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Average
Average NAPLAN Literacy Z score = 0.3701-0.1306*x
-3.0 -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5R Gin Z score
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Average
Average NAPLAN Literacy Z score = 0.3754-0.2565*x
-0.6 -0.4 -0.2 0.0 0.2 0.4 0.6L Gin Z score
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Average
WARP Z SCORE = -0.006+0.5397*x
-1.6-1.4
-1.2-1.0
-0.8-0.6
-0.4-0.2
0.00.2
0.40.6
0.81.0
1.2
L Gin Z score
-3
-2
-1
0
1
2
3
WA
RP
Z SC
OR
E
WARP Z SCORE = 0.0099+0.3944*x
-3.0 -2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5R Gin Z score
-3
-2
-1
0
1
2
3
WA
RP
Z SC
OR
E
WARP Z SCORE = 0.0673+0.541*x
-2.5 -2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0DS FW Z SCORE
-3
-2
-1
0
1
2
3
WA
RP
Z SC
OR
E
WARP Z SCORE = 0.0897+0.7375*x
-2.0 -1.5 -1.0 -0.5 0.0 0.5 1.0 1.5 2.0DS Rev Z Score
-3
-2
-1
0
1
2
3
WA
RP
Z SC
OR
E 20
Test score sensitivity relative to functional abilities LiSN-S Low Cue LiSN-S High cue attention
List
enin
g ca
pabi
litie
s Re
adin
g flu
ency
Dani Tomlin
Lite
racy
WARP Z SCORE = 0.0719+0.2626*x
-5 -4 -3 -2 -1 0 1 2 3LC Sdev from avg
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
WARP Z SCORE = 0.1186+0.3258*x
-5 -4 -3 -2 -1 0 1 2 3HC Sdev from avg
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
Average NAPLAN Literacy Z score = 0.4274+0.3453*x
-5 -4 -3 -2 -1 0 1 2 3LC Sdev from avg
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Average
Average NAPLAN Literacy Z score = 0.4454+0.3003*x
-5 -4 -3 -2 -1 0 1 2 3HC Sdev from avg
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Average
Listening Capability Score = 0.0843+0.56*x
-5 -4 -3 -2 -1 0 1 2 3LC Sdev from avg
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
Listening Capability Score = 0.0332+0.3098*x
-5 -4 -3 -2 -1 0 1 2 3HC Sdev from avg
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
MLD z score
Listening Capability Score = -0.0792-0.0256*x
-3 -2 -1 0 1 2 3 4 5MLD Z score
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
WARP Z SCORE = 0.0107+0.0001*x
-3 -2 -1 0 1 2 3 4 5MLD Z score
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
Average NAPLAN Literacy Z score = 0.3523+0.0132*x
-3 -2 -1 0 1 2 3 4 5MLD Z score
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Average
Average NAPLAN Literacy Z score = 0.4196+0.274*x
-6 -5 -4 -3 -2 -1 0 1 2Attention Quotient Z score
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Average
WARP Z SCORE = 0.2157+0.2121*x
-6 -5 -4 -3 -2 -1 0 1 2Attention Quotient Z score
-3
-2
-1
0
1
2
WA
RP
Z SC
OR
E
Listening Capability Score = 0.188+0.2352*x
-6 -5 -4 -3 -2 -1 0 1 2Attention Quotient Z score
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
Listening Ca
21
Sensitivity: Effect on outcome variable of being 1 SD below the mean on test score -0.2 0 0.2 0.4 0.6 0.8 1
TONI
Digit Span Rev
Digit Span Fwd
LiSN-S Low cue
L GIN
Lisn-S High cue
L DD
R GIN
Attention
L FPT
R DD
R FPT
MLD
Listening capabilitiesLiteracyReading ability
22
Correlations – outcomes and test scores Liter
acy WAR
P
Listen
Cap L DD R DD L FPT R
FPT MLD L GIN R GIN
LiSN LC
LiSN HC
LiSN SA
DS Fwd
DS Rev TONI Att
Literacy - 0.60 0.77 0.66 0.41 0.49 0.46 0.03 -0.12 -0.07 0.39 0.34 -0.03 0.56 0.67 0.62 0.49
WARP 0.60 - 0.64 0.47 0.33 0.34 0.37 0.00 0.25 0.22 0.21 0.34 0.09 0.44 0.56 0.51 0.32
Listening Cap
0.77 0.64 - 0.47 0.37 0.34 0.26 -0.04 0.14 0.13 0.43 0.32 0.15 0.34 0.43 0.53 0.35
L DD 0.66 0.47 0.47 - 0.47 0.46 0.37 -0.12 0.08 0.14 0.28 0.25 0.13 0.53 0.48 0.49 0.27
R DD 0.41 0.33 0.37 0.47 - 0.27 0.35 -0.17 0.09 0.11 0.22 0.14 0.14 0.33 0.33 0.30 0.22
L FPT 0.49 0.34 0.34 0.46 0.27 - 0.87 -0.12 0.00 -0.03 0.12 0.07 0.17 0.29 0.42 0.38 0.19
R FPT 0.46 0.37 0.26 0.37 0.35 0.87 - -0.12 0.11 0.01 0.12 0.11 0.22 0.26 0.36 0.37 0.08
MLD 0.03 0.00 -0.04 -0.12 -0.17 -0.12 -0.12 - -0.17 -0.19 0.03 -0.08 0.06 0.05 -0.07 -0.02 -0.03
L GIN -0.12 0.25 0.14 0.08 0.09 0.00 0.11 -0.17 - 0.73 -0.02 0.02 0.12 0.04 0.04 -0.04 -0.09
R GIN -0.07 0.22 0.13 0.14 0.11 -0.03 0.01 -0.19 0.73 - -0.05 0.02 0.18 0.05 0.09 0.08 -0.04
LiSN LC 0.39 0.21 0.43 0.28 0.22 0.12 0.12 0.03 -0.02 -0.05 - 0.26 -0.04 0.30 0.21 0.28 0.08
LiSN HC 0.34 0.34 0.32 0.25 0.14 0.07 0.11 -0.08 0.02 0.02 0.26 - 0.43 0.09 0.16 0.24 0.06
LiSN SA -0.03 0.09 0.15 0.13 0.14 0.17 0.22 0.06 0.12 0.18 -0.04 0.43 - 0.02 0.08 0.14 -0.02
DS Fwd 0.56 0.44 0.34 0.53 0.33 0.29 0.26 0.05 0.04 0.05 0.30 0.09 0.02 - 0.59 0.30 0.11
DS Rev 0.67 0.56 0.43 0.48 0.33 0.42 0.36 -0.07 0.04 0.09 0.21 0.16 0.08 0.59 - 0.38 0.31
TONI 0.62 0.51 0.53 0.49 0.30 0.38 0.37 -0.02 -0.04 0.08 0.28 0.24 0.14 0.30 0.38 - 0.23
Attention 0.49 0.32 0.35 0.27 0.22 0.19 0.08 -0.03 -0.09 -0.04 0.08 0.06 -0.02 0.11 0.31 0.23 -
P<0.01
23
NAPLAN literacy
1 2 3 4 5 6 7 8 9 10 11 12
L DD * * * * * * * * * * *
R DD * * * * * *
L FPT * * * * * * * *
R FPT * * * * * * * * *
MLD *
L GIN * * * *
R GIN * * * * * * * * * *
DS Fwd * *
DS Rev * * * * * * * * * * * *
LiSN LC * * * * *
LiSN HC * * * * *
LiSN SA * * * * * 24
What is affecting listening capabilities? TONI
DS Fwd
DS Rev
Att
LDD Listening
capabilities
0.27
0.10
0.19
0.10
0.20
25
N=59 Adj R2 = 0.31
What is affecting literacy? TONI
DS Fwd
DS Rev
Att
LDD NAPLAN Literacy
0.24
0.30
0.18
0.16
0.29
But only 14 clinic participants with NAPLAN so far.
26
N=35 Adj R2 = 0.64
Importance of the presenting symptoms?
FOLL
none
LEAR
ATTN/C
ON
C
Attention
READ
ING
LANG
UAG
E
Spelling/WPrimary Concern
05
101520253035404550
No of observations
27
Importance of presenting symptoms
LDD ASIN Z Score LFPT ASIN Z SCORE L Gin Z score DS FW Z SCORE DS Rev Z Score LC Sdev from avg TONI Z Score
FOLLOWING INSTLEARNING DIFFIC.
ATTN/CONCREADING
Primary Concern
-4.0-3.5-3.0-2.5-2.0-1.5-1.0-0.50.00.51.01.5
MANOVA analysis: p=0.94
28
Importance of presenting symptoms
Child fails to understand an
instruction
Acts (inappropriately) based on what
was heard
Asks for repetition of instruction
Does nothing
Misbehaves
Event Response by child
Interpretation by observer
Daydreams
Badly behaved
Can’t follow instructions
Is not very smart
Poor concentration
29
Experiment 2
Pia Gyldenkaerne current PhD study
• Children referred to Macquarie Uni Audiology Clinic due to suspected APD (n=119)
• Teachers, parent, speech pathologist referral
• Age range of 7–13 years
30
Measures obtained • Dichotic Digits Test (DDT): Binaural integration (Musiek, 1993) • Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990) • Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005) • MLD: Binaural interaction (Bellis, 2003)
• Memory CELF-4: Forward and reverse digits • Attention: BrainTrain®: Continuous Performance Test: Sustained auditory
and visual attention • Cognition -TONI-4: Nonverbal cognitive assessment
• Questionnaire: – Purpose designed – yes/no answers to 18 questions asking about difficulties in listening
and its possible consequences
• Academic Performance: WARP (reading fluency)
31
Test score sensitivity relative to functional ability: Reported difficulties and reading fluency
-12 -10 -8 -6 -4 -2 0 2
FPT_R_SD
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
-12 -10 -8 -6 -4 -2 0 2
FPT_L_SD
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
-5 -4 -3 -2 -1 0 1 2
DDT_R_SD
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
-7 -6 -5 -4 -3 -2 -1 0 1 2
DDT_L_SD
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
Dichotic digits - left Dichotic digits - right Freq pattern - left Freq pattern - right
Repo
rted
diff
icul
ties
Read
ing
spee
d
-12 -10 -8 -6 -4 -2 0 2 4
FPT_R_SD
0
20
40
60
80
100
120
140
160
180
200
220
WA
RP
Average
-12 -10 -8 -6 -4 -2 0 2
FPT_L_SD
0
20
40
60
80
100
120
140
160
180
200
220
WA
RP
Average
-6 -4 -2 0 2 4
DDT_R_SD
0
20
40
60
80
100
120
140
160
180
200
220
WA
RP
Average
-7 -6 -5 -4 -3 -2 -1 0 1 2 3
DDT_L_SD
0
20
40
60
80
100
120
140
160
180
200
220
WA
RP
Average
Pia Gyldenkaerne and Mridula Sharma 32
Test score sensitivity relative to functional ability: Reported difficulties and reading speed
Gaps in noise - right
-7 -6 -5 -4 -3 -2 -1 0 1 2
MLD_SD
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
Binaural masking level difference
0 20 40 60 80 100 120
BT Response Control Quotient
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
0 20 40 60 80 100 120 140
BT Attention Quotient
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
234567891011
GIN Right
-2
0
2
4
6
8
10
12
14
Reported D
ifficulties
Brain Train attention quotient
Brain Train response control quotient
-7 -6 -5 -4 -3 -2 -1 0 1 2
MLD_SD
0
20
40
60
80
100
120
140
160
180
200
220
WA
RP
Average
0 20 40 60 80 100 120 140
BT Response Control Quotient
0
20
40
60
80
100
120
140
160
180
200
220W
AR
P A
verage
0 20 40 60 80 100 120 140
BT Attention Quotient
0
20
40
60
80
100
120
140
160
180
200
220
WA
RP
Average
234567891011
GIN Right
0
20
40
60
80
100
120
140
160
180
200
220
WA
RP
Average
Repo
rted
diff
icul
ties
Read
ing
spee
d
Pia Gyldenkaerne and Mridula Sharma 33
Simple correlation matrix – outcome scores and test scores
Reported Difficulties WARP L DDT R DD L FPT R FPT R GIN MLD TONI
BT Attention Quotient
Reported Difficulties - -0.57 -0.49 -0.24 -0.42 -0.44 0.28 0.11 -0.55 -0.35
WARP -0.57 - 0.41 0.20 0.35 0.41 -0.33 -0.07 0.35 0.50
L DDT -0.49 0.41 - 0.43 0.42 0.49 -0.20 0.01 0.31 0.36
R DDT -0.24 0.20 0.43 - 0.22 0.23 -0.11 -0.00 0.07 0.27
L FPT -0.42 0.35 0.42 0.22 - 0.86 -0.28 -0.05 0.34 0.22
R FPT -0.44 0.41 0.49 0.23 0.86 - -0.33 -0.06 0.33 0.26
R GIN 0.28 -0.33 -0.20 -0.11 -0.28 -0.33 - 0.01 -0.05 -0.02
MLD 0.11 -0.07 0.01 -0.00 -0.05 -0.06 0.01 - 0.12 0.04
TONI -0.55 0.35 0.31 0.07 0.34 0.33 -0.05 0.12 - 0.41
BT Attention Quotient
-0.35 0.50 0.36 0.27 0.22 0.26 -0.02 0.04 0.41 -
P<0.01
34
No.
of p
redi
ctor
s
DDT_
L_SD
DDT_
R_SD
FPT_
L_SD
FP
T_R_
SD
MLD
_SD
GIN
_R
BT.A
ttQ
uot
TON
I.Quo
t
1 * 2 * * 3 * * * 4 * * * * 5 * * * * * 6 * * * * * * 7 * * * * * * * 8 * * * * * * * *
No.
of p
redi
ctor
s
DDT_
L_SD
DDT_
R_SD
FPT_
L_SD
FPT_
R_SD
MLD
_SD
GIN
_R
BT.A
ttQ
uot
1 * 2 * * 3 * * * 4 * * * * 5 * * * * * 6 * * * * * * 7 * * * * * * *
Reported Difficulties
35
History Audiometry
Is there a problem that CAPD
might explain?
Exclude CAPD; Refer elsewhere
No
Current approach to CAPD testing
Detailed test battery
Yes
Test result interpretation Non-specific remediation and management: • Classroom placement • FM use • Instruction style • Soundfield amplification • Auditory training software
Questionnaire Audiometry Measured disability
Is there a problem that CAPD
might explain?
Detailed test battery
Exclude CAPD; Refer elsewhere
No
Dealing with problems in understanding speech
Master test battery
Yes
Non-specific remediation and management: • Classroom placement • FM use • Instruction style • Soundfield amplification
Test result interpretation leading to a disorder-specific diagnosis
Disorder-specific remediation
Questionnaire Audiometry Measured disability
Is there a problem that CAPD
might explain?
Detailed test battery
Exclude CAPD; Refer elsewhere
No
Dealing with problems in understanding speech
Master test battery
Yes
Non-specific remediation and management: • Classroom placement • FM use • Instruction style • Soundfield amplification
Test result interpretation leading to a disorder-specific diagnosis
Disorder-specific remediation LiSN & Learn
LiSN-S High Cue
LiSN-S Spatial
Advantage
LiSN-S Talker
Advantage
LiSN-S Low Cue
SPD Undiag- nosed deficit
Pitch deficit
FPT Verbal
FPT Hum
SPIN Hi Cont
SPIN Lo Cont
Closure skill
deficits ?
Top-down training ?
Criteria for adopting a CAPD test
• Test is associated with variation in functional ability – High sensitivity (= ∆ 𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹𝐹 𝑧−𝑠𝐹𝐹𝑠𝑠
∆ 𝐶𝐶𝐶𝐶 𝑧−𝑠𝐹𝐹𝑠𝑠)
– Deviant results common in clinical population – Attributes tested minimally shared with other tests in battery
• Leads to a specific diagnosis, for which remediation exists, and remediation affects real life functional ability
• Time taken is small • Test is minimally affected by attention, intelligence,
motivation, working memory, and language ability • Known high reliability and critical differences • Associated with a known anatomical site and/or neural
mechanism
39
Comparison of tests against criteria LiSN-S LC/SA
Dichotic digits
Freq Patt Test
GIN Digit span fwd
Digit span
reverse
MLD
Sens: slope re functional 4 3 2 3 5 6 0 Sens: deviant results common
2 7 5 2 2 2 0
Uniqueness re other tests 3 6.5 2 2.5 0 12 0 Specific diagnosis leading to effective proven remediation
0/10 0 0 0 0 0 0
Time taken
Minimal effect of attention, working memory, intelligence, motivation, language ability
5/15 3 3 16 3 5 25
Known high reliability and small critical differences
10 ? ? ? ? ? ?
Known anatomical site and neural mechanism
0 1 0 0 0 0 5 40
Test structure???? Parental / teacher report
of difficulties
LiSN - HC
LiSN remainder
DD
Att TONI
DS rev
Psych
Psych Psych
Low
Strategies, FM
Low Low
Low
SA low: LiSN&Learn HC low: Strategies, FM
Low
Strategies, FM
41
www.NAL.gov.au
42
Auditory processing
neurons
Deficient auditory skill
Life consequences
Trauma or failure to develop Visual
processing neurons
Deficient visual skill
Life consequences
Consequent disabilities
Detection of an APD in the presence of hearing loss
43
LiSN-S Prescribed Gain Amplifier
44
0 10 20 30 40 50 60
4FAHL in worse ear (dB HL)
-22
-20
-18
-16
-14
-12
-10
-8
-6
-4
-2
0
2
4
6
8
Speech reception thre
Different voices 90 Same voices 90 Different voices 0 Same voice 0
Helen Glyde and Sharon Cameron
Bett
er
Changes in LiSN-S scores with hearing loss
45
