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General Vs Specialized
screening: not diagnosing, you screen everyone!
types of screening: hearing/vision: screen every body
specialized screening: SLPs come into play here with ADP.
we do not diagnose, but we need to dig further.ask: What do I think this is? (to have maximum efficiency in referrals.
1. look in ear, ask for history. Look for signs of otitis media
2. nothing observed. Come back in 2weeks, most of the time problemis gone.
To prevent over referrals.
3. Critical that we id in a timely manner, it makes a huge difference.
Questions to be answered to determine if specialized screening is needed
Have you ruled out a language or speech problem
Do they have strengths and weakness in other domains.
Is there sufficient evidence of CAPD to support an evaluation.
- is the child capable of doing the testing that will result in reliable data.
- (Must be over 5yrs. If they have other issues such as autism, intellectualdisability, deaf, ,then they can’t even take the tests. So do not refer!)
Will assessment results affect or add to the management of the child's difficulties.
Reasons for screening
1. Many children like to be affected.
2. screening reduces the cost and inappropriate referrals.
3. May help id conditions needing medical intervention (e.x. tumor/ otitis media)
4. Psychological factor and fear of he unknown are minimized.
- 5. allows for insightful educational planning.
- (where true interdisciplinary team takes place)
6. Fosters awareness of CAPD by educational professional and parents. *can be good and bad, it can be the disorder of choice.
The CAPD Team
one professional does not know everything.
there is a lot of comorbidity, so having a team helps differentiate diagnosis.
Audiologist: main coordinator
SLP: asses receptive and expressive abilities, perceptual subtests
Educator: observers of daily listening and learning behaviors, academic performance.
psychologist: cognitive and psycho-educational test
social worker: provides info about family dynamic and socio-economic factors. The link between school and family. (most do not have one)
parents: provide developmental and medical history and observe auditory behaviors.
physician: rules out and treats pathological conditions.
The role of the audiologist
special auditory testing
comprehensive CAP Testing
patient selection Criteria
1. Case history: try to id behaviors.
2. Consider aged: min age 6
3. Cognitive abilities: mental age should be considered
4. language status and proficiecy affect the common verbal stimuli used.
5. Peripheral Hearing Loss: always must be completed prior to APD battery to differentiate. Must be ruled out!
Common Behavioral manifestations
- during interviewing:Difficulty with
- 1. Understanding speech in noise or high reverberation
2.Localize the source of a signal
3. Hearing on the phone
4. Inconsistent responses to requests for information.
5. Difficulty following rapid speech or Directions
6. Frequent requests for repetition/rephrasing of info.
7. Inability to detect the subtle changes in prosody that underlie humor and sarcasm.
8. Difficulty maintaining attention - Easily distracted
9. Poor singing - musical ability
- 10. Academic difficulties, including reading, spelling
- and/or learning problems.
specific questions to ask to see how well a child processing sound.
They DO NOT confirm APD they help rule out other disorders.
they just say APD MIGHT be present.
IMPORTANT: DEFICITS MUST BE LINKED TO THE AUDITORY DOMAIN. MUST ISOLATE
Give one example of a test an SLP can use to screen SPD
TOLD: auditory perception.
test to use to screen auditory Perception and Discrimination
Goldman Fristoe and Lindamood
test to screen Auditory Association Receptive vocabulary
Assessing skill of auditory memory
Test for screening Auditory Closure
CASL and SCAN-3
Test for screening auditory comprehension and auditory cohesion
CELF -5 and CASL
Test for screening Expressive Vocabulary
Test for screening Word retrieval
CELF-5 and CASL
test for screenign auditory speech perception under degraded listening conditions
SCAN-3 and TAPS
What two questions do you ask yourself when determining outcome?
1. Is the child capable of doing the testing that will result in reasonable information.
2. Would assessment results affect or add to the overall management of the child's learning/communication difficulties?
The test battery approach
1. top/down approach (global)
2. need to a variety of mechanisms.
3. multdisciplinary complement of test. Variety of test that focus on specific mechanisms is the best approach.
which test to used is determined by the referral data or results of the CANS if not administered.
procedural variables in test administration
1. Equipment calibration ex. audiometer
2. Practice effects: biggest problem is the deaf community.
3. Ceiling effects/floor effects: too easy or too difficult
4. Use of too few items
Patient variables in test adminisration.
1. age: #1 patient variable to determine if test will be administered.
2. Degree and stability of hearing loss: Otitis media?
3. Overall health
4. Attention to the task
5. Intelligence and linguistic abilities
6. Presence of related disorders: can I tease a APD from a language disorders
scheduling and interviewing for evaluation
- two appointments are usually scheduled.
- 1. hearing test and scans
- Review testing time requirements and compare to patient variables.
Keys to a good case history/interview: Hearing history, focus on hearing history. how are they responding in different hearing environments.
keep terminology in mind. Create leading questions.
Categories Audiologist Evaluate
- 1. Dichotic Listening
- 2. Temporal Processing
- 3. Binaural Interaction
- 4. Speech-Sound Discrimination
the 4 areas in which we are trying to find where the problems are.
Happens in the posterior portion of the corpus callous.
auditory stimuli presented to both ears, simultaneously, with the different stimulus to each ear.
language dominant left hemisphere creates a right ear advantage. which facilitates evaluation of right, left and inter hemispheric function.
the ipsilateral pathways will be suppressed.
a temporal lobe function with interaction though the corpus callosum.
helps to confirm a normal right ear advantage and helps id the location of the lesion. which is typically found in the temporal lobe or corpus callosum.
temporal ordering takes place in wernicke's area. can be significantly affected by temporal lobe lessions, but less affects with brainstem pathology cause it is not a brain stem function.
The time related aspects of the acoustic signal, (e.g., voice onset time)
most stimuli requires at least 20+ ms for detections
pathogies that effect temporal processing are generally in the temporal lobe and in the corpus callosum.
the way the 2 ears work together. a primary brainstem functions, in the superior olivary Complex.
- improvement of speech in the presence of masking noise.
- helps with sound localization, but actual perception of localization happens in the cortex.
worst: when noise and speech are in phase at the same time.
you want compression (in phase) in one ear, and rerafraction (out of phase) in the other ear.
- best situation: noise is in phase, but speech is out of phase, speech intelligibility will be improved.
- there is a canceling effect, stereo effect.
- stereo effect: different signals to each ear.
the out of phase enhances the signal.
Binaural Release from Masking
- a release or improvement in threshold and identification of speech in the presence of masking.
- aka: Masking Level Difference.
Not affect affected by cortical lesion, or high brainstem lesions, but rather LOW brain stem lesions.
when you have two good ears, you have a improvement in auditory processing. We want to identify if kids difficulty with this.
Signal Detection in Noise
two ears are better than noise.
binaural advantage is effected by unilateral or asymmetrical hearing loss.
we are looking at binaural interaction and binaural fusion.
if no binaural advantage, signal detection in noise becomes more difficult.
portions of a signal are presented to each ear separately and then fused together to perceive the signal.
happens in the brain stem.
Speech Sound Discrimination
cortical lesion affect this because this is a high end processing task.
generally, consonants will be affected more by lesions in the cortex, than vowels or glides.
what categories does binaural interaction affect?
1. localization and lateralization: via internal time delay and phase differences
2. binaural release from masking: these differences between signal and noise.
3. Signal and noise: two ears are better than one.
4. binaural fusion: different portion are presented separately to teach.
each of these can be affected by brain stem lesions and unaffected by temporal lobe lesions.
What happens during hearing test?
- • Air/Bone, Speech, Immittance Testing
- • Standard/Special Tests – OAE, Quick-SIN (sentences in a noisy environment), ABR
What is the SCAN -3?
- Screening Test for Auditory Processing
- Disorders in Children (2009)
- Filtered words, Auditory figure-ground (say a word with background noise), competing
- words (measures binaural integration), & competing sentences
The SCAN has a screening test and a a diagnostic test.
Order of things done in an evaluation:
1. Standard audiological eval
2. screening (SCAN-3)
3. Behavioral Checklist ex. CHAPS and qualitative scales of listening behaviors
Audiology Battery for APD align with AAA and Bellis
- A. Dichotic Speech Tests
- B. Temporal Processing Tests (Patterning
- and Gap Detection)
- C. Monaural Low-Redundancy Tests
- D. Binaural Interaction Tests
- E. Auditory Discrimination Tests
- F. Electrophysiologic Measures
test for binaural intergration
- A. Dichotic Digits
- B. Dichotic Consonant-Vowels
- C. Staggered-Spondaic Words (SSW)
Test for Binaural seperation
D. Competing Sentence Test
- E. Synthetic Sentence Identification with
- Contralateral Message (SSI-CCM)
Temporal processing tests:
- A. Random Gap Detection Test (RGDT)
- B. Frequency Patterns (Pitch Pattern)
- Test (FPT)
- C. Duration Patterns Test (DPT)
give you a good measure of ability to process in the cortex and inter hemispheric function through the corpus callosum. all three measure time.