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Reasons why some people believe auditory processing disorder do not exit. (4)
- 1) It is a description of functional
- deficits rather than a specific disease entity.
- 2) It is seen in a variety of clinical
- populations from known lesions or pathology in the CNS to others with unconfirmed CNS pathology or a neurodevelopmental disorder, e.g., dyslexia,
- learning disabilities, or attention deficit disorder.
- 3) CAPD can be associated with chronic otitis
- media as well as neurologic changes resulting from the aging process.
- 4) Possible linkage to cognitive,
- linguistic, and social functions related to language learning and use.
HOWEVER, auditory performance deficits associated with CAPD are well documented.
- deficits in dichotic listening, selective attention, and temporal processing
- have been identified.
What are the characteristics of CAPD?
Individuals with CAPD experience difficulty comprehending spoken language in noisy listening situations, in understanding verbal directions, with auditory memory as well as more global cognitive and linguistic functions.
Why is there an association between CAPD and disorders of language learning and use?
because CAP requires attention and language representation.
What is auditory Processing?
What we do with what we hear. (Katz)
the auditory system mechanisms and processes responsible for:
- 1. localization
- 2. lateralization
- 3. auditory discrimination
- 4. auditory pattern recognition
- 5. temporal aspect of audition:
- temporal resolution
- temporal masking
- temporal integration
- temporal ordering
6. auditory performance w/ competing acoustic signals, auditory performance with degraded acoustic signals.
Why doesn't a standard audiological examination identify a APD?
These are discrimination tests that do not measure any of the mechanisms responsible for Auditory processing (sound localization, lateralization,...)
They only measure auditory discrimination in its most basic form. you can tap into these problems with just a standard exam.
They do not measure any of the component that define auditory processing. (refer to ASHA 1996 definition)
Why go from CAPD to APD?
To emphasize that the auditory system and its disorders, involve much more that just the central auditory pathways.
ex. Localization and lateralization are brain stem functions (periphery)
What are the three types of APD? (3)
- 1. Neuromorphological Disorder:
- (65-70%, most common)
- -the system does not develop as it should.
- - misshappen/ misplaced cells
- -most likely in the left hemisphere/ corpus callous
- -not a disease
- -the most difficult to capture and define. ex. case history might appear fine.
- 2. Maturational Delay (25-30%)- diagnosed mostly in kids
- - #1 reason is otitis media
- - due to sensory deprivation
- 3. Neurologic Disorders (less than 5%)- a disease or lesion ex. tumor
- -neuro-degereative disorders associated with LD
- -easy to detect
- - adults can acquire this type of APD
History of APD
-The term CAPD in children became prominent with the 1977 conference and created interest in research in the area.
-Consensus statements have been generated since 1996
History of Test Development for children with APD?
1960's They began to diagnose children using the tool used to diagnose tumors in adults. (lessions Central Auditory Nervous System-CANS)
- Most recently:
- We began incorporating stimuli and procedures that minimize linguistic-cognitive demands while
- emphasizing auditory-perceptual demands.
Management of APD for children
behavioral management programs have been used with a focus on FM technology.
Problems with management of APD?
Very narrow window. Many of the tests used to diagnosed can't be administered until the child is 6 or 7, but it may be too late for treatment to make a difference.
Alternative strategies were given to parents and teacher. ex. FM system
- - the most common is ADHD
- - other: Learning disability and language impairments, dyslexia, Attention deficit disorder
- The primacy of any one of these disorders as causal to another, however, remains unclear.
- However, there is recent evidence that there are distinct characteristics of each of these diagnoses
How to differentiate APD from comorbid conditions?
- you need to tie what you see with the auditory system.
- look at the behavior and ask: Is that behavior caused because they are not processing auditorily?
ex. does the child perform poorly in NOISE when compared in quiet environment?
it is specifically tied to the noisy environment. it is not easy to do.
Prevalence of APD
- Prevalence data are lacking.
- Chermak and Musiek Estimate – 2-3% in children
- - recommended to look at the disorders associated with APD
- - Otitis Media: 30% of people have had 3+
- LD: 5-10%
- - ADHD: 3-5% (2-8yr), 10-20% (school aged)
- *difference in numbers may be due to the way they define ADHD