Central auditory processing disorder (CAPD) in children with specific language impairment (SLI). Central auditory tests

The aim of this project is to use central auditory tests for diagnosis of central auditory processing disorder (CAPD) in children with specific language impairment (SLI), in order to confirm relationship between speech-language impairment and central auditory processing. We attempted to establish special dichotic binaural tests in Czech language modified for younger children. Tests are based on behavioral audiometry using dichotic listening (different auditory stimuli that presented to each ear simultaneously). The experimental tasks consisted of three auditory measures (test 1-3)-dichotic listening of two-syllable words presented like binaural interaction tests. Children with SLI are unable to create simple sentences from two words that are heard separately but simultaneously. Results in our group of 90 pre-school children (6-7 years old) confirmed integration deficit and problems with quality of short-term memory. Average rate of success of children with specific language impairment was 56% in test 1, 64% in test 2 and 63% in test 3. Results of control group: 92% in test 1, 93% in test 2 and 92% in test 3 (p<0.001). Our results indicate the relationship between disorders of speech-language perception and central auditory processing disorders.     

Association between language development and auditory processing disorders

IntroductionIt is crucial to understand the complex processing of acoustic stimuli along the auditory pathway; comprehension of this complex processing can facilitate our understanding of the processes that underlie normal and altered human communication.AimTo investigate the performance and lateralization effects on auditory processing assessment in children with specific language impairment (SLI), relating these findings to those obtained in children with auditory processing disorder (APD) and typical development (TD).Material and methodsProspective study. Seventy-five children, aged 6-12 years, were separated in three groups: 25 children with SLI, 25 children with APD, and 25 children with TD. All went through the following tests: speech-in-noise test, Dichotic Digit test and Pitch Pattern Sequencing test.ResultsThe effects of lateralization were observed only in the SLI group, with the left ear presenting much lower scores than those presented to the right ear. The inter-group analysis has shown that in all tests children from APD and SLI groups had significantly poorer performance compared to TD group. Moreover, SLI group presented worse results than APD group.ConclusionThis study has shown, in children with SLI, an inefficient processing of essential sound components and an effect of lateralization. These findings may indicate that neural processes (required for auditory processing) are different between auditory processing and speech disorders.     

Development of auditory processing in 6-12-year-old children: a longitudinal study

The development of auditory processing in children was investigated in a longitudinal study. A group of 20 children with normal cognitive and language development underwent several auditory tests at the ages of 6, 7, 8, 10 and 12 years. At the age of 10 years, three subjects were lost to follow-up, as was one more subject at the age of 12 years. The auditory performance of the children was compared to the performance of a group of 20 adults. The auditory test battery consisted of a speech-in-noise test, a filtered speech test, a binaural fusion test and two auditory sequencing tests. At the ages of 6, 7 and 8 years, data on the performance on an auditory word discrimination test, an auditory synthesis test, an auditory closure test and a number recall test were also obtained. All auditory tests except the speech-in-noise test showed a clear effect of age on the performance of children. Our data suggest that maturational effects play an important role in auditory processing (at least) up to an age of 12-13 years. Correlations between the tests are in general not indicative of large amounts of overlap between the different tests. Factor analysis shows that three factors account for 68-70% of explained variance, with the three factors contributing equally. A composite score obtained by averaging all (sub)test scores can be used next to the individual test scores to describe the development of auditory processing abilities in children.     

Auditory frequency discrimination in children with specific language impairment: a longitudinal study.

It has been proposed that specific language impairment (SLI) is caused by an impairment of auditory processing, but it is unclear whether this problem affects temporal processing, frequency discrimination (FD), or both. Furthermore, there are few longitudinal studies in this area, making it hard to establish whether any deficit represents a developmental lag or a more permanent deficit. To address these issues, the authors retested a group of 10 children with SLI and 12 control children first tested 42 months previously. At Time 1, the children with SLI (between 9 and 12 years of age) had significantly elevated FD thresholds compared to the matched controls. At Time 2, the thresholds of both groups had improved, but the children with SLI still had poorer FD thresholds than those of the controls. To assess temporal resolution, auditory backward masking was measured and it was found that most of the children with SLI performed as well as the controls, but 2 children had exceptionally high thresholds. There was also greater variability among the children with SLI compared to that measured among the controls on the FD task. These studies indicate considerable heterogeneity in auditory function among children with SLI and suggest that, as with auditory temporal deficits, difficulties in FD discrimination are important in this population.     

Auditory processing disorders in adults and children: evaluation of a test battery

A Dutch test battery comprising six different tests for auditory processing disorders was evaluated in a group of 49 adults and children (age 8-57 years) with auditory complaints despite normal audiometric thresholds. Percentile scores were derived from normal control groups (n = 132) to determine whether a subject passed or failed a test. A composite score was computed to reflect a general score on all the auditory processing tests. In order to gain insight into underlying auditory processes, factor analysis was performed. Normal scores on all the tests were seen in five subjects. The remaining 44 subjects had at least one test score that was below the cut-off point (10th percentile). Factor analysis provided evidence for a model comprising four auditory components: auditory sequencing, word recognition in noise, auditory closure, and auditory patterning. This model could be useful in the interpretation of scoring patterns. Although there were some differences in scoring patterns between the children and adults, the test battery proved to be useful in both groups.     

Basic auditory processing skills and specific language impairment: a new look at an old hypothesis.

PURPOSE: To explore the sensitivity of children with specific language impairment (SLI) to amplitude-modulated and durational cues that are important for perceiving suprasegmental speech rhythm and stress patterns. METHOD: Sixty-three children between 7 and 11 years of age were tested, 21 of whom had a diagnosis of SLI, 21 of whom were matched for chronological age to the SLI sample, and 21 of whom were matched for language age to the SLI sample. All children received a battery of nonspeech auditory processing tasks along with standardized measures of phonology and language. RESULTS: As many as 70%-80% of children diagnosed with SLI were found to perform below the 5th percentile of age-matched controls in auditory processing tasks measuring sensitivity to amplitude envelope rise time and sound duration. Furthermore, individual differences in sensitivity to these cues predicted unique variance in language and literacy attainment, even when age, nonverbal IQ, and task-related (attentional) factors were controlled. CONCLUSION: Many children with SLI have auditory processing difficulties, but for most children, these are not specific to brief, rapidly successive acoustic cues. Instead, sensitivity to durational and amplitude envelope cues appear to predict language and literacy outcomes more strongly. This finding now requires replication and exploration in languages other than English.     

Auditory-visual integration for speech by children with and without specific language impairment.

PURPOSE: It has long been known that children with specific language impairment (SLI) can demonstrate difficulty with auditory speech perception. However, speech perception can also involve the integration of both auditory and visual articulatory information. METHOD: Fifty-six preschool children, half with and half without SLI, were studied in order to examine auditory-visual integration. Children watched and listened to video clips of a woman speaking [bi] and [gi]. They also listened to audio clips of [bi], [di], and [gi], produced by the same woman. The effect of visual input on speech perception was tested by presenting an auditory [bi] combined with a visually articulated [gi], which tends to alter the phoneme percept (the McGurk effect). RESULTS: Both groups of children performed at ceiling when asked to identify speech tokens in auditory-only and congruent auditory-visual modalities. In the incongruent auditory-visual condition, a stronger McGurk effect was found for the normal language group compared with the children with SLI. CONCLUSION: Responses by the children with SLI indicated less impact of visual processing on speech perception than was seen with their normal peers. These results demonstrate that the difficulties with speech perception by SLI children extend beyond the auditory-only modality to include auditory-visual processing as well.     

Auditory middle latency responses in children with specific language impairment

Auditory-evoked potentials represent the response of the auditory pathway to an auditory stimulus. Specific language impairment (SLI) children have delayed language development with difficulties in both understanding and producing spoken language. Hence, the purpose of this study was to determine whether a group of children with SLI had abnormal changes in the auditory middle latency response (AMLR). AMLR was obtained for 19 SLI children and they were studied and compared to normal. Audiological assessment and speech language tests were done for the study group. The results revealed no significant statistical differences between SLI children and the normal with regard to AMLR (P > 0.05). Our results suggest that children with SLI do not have abnormal auditory system response at the level measured by AMLR casting doubt on affection of the hypnotized origin of AMLR, mainly primary auditory cortex, as a cause for delayed language development in those children.     

Behavioral profiles associated with auditory processing disorder and specific language impairment

PurposeTo describe and compare behavioral profiles associated with auditory processing disorder (APD) and specific language impairment (SLI) in school-age children.MethodThe participants in this cross-sectional observational study were 64 children (mean age 10.1 years) recruited through clinician referrals. Thirty-five participants had a clinical diagnosis of APD and 29 were receiving services for language impairment. Participants completed 18 behavioral measures of spoken language, auditory processing, reading, memory, and motor speed. Responses were used to classify children as affected/not affected with APD, and affected/not affected with SLI. Comparisons were made between children with and without an APD diagnosis, and between children assigned to the APD/not APD and SLI/not SLI groups. Agreement between clinical status and test-based classifications is also reported.ResultsThere were no group mean differences between children with and without a clinical diagnosis of APD. Group mean differences on Cube Design and reading fluency were observed for children classified as APD/not APD; and group mean differences on nonword repetition, spatial working memory, and two auditory processing tests were observed for children classified as SLI/not SLI.ConclusionsThe behavioral profiles of children with APD and SLI were very similar. Although group mean differences were found, they were difficult to interpret in terms of current theories.Learning outcomes: The reader will be able to: (1) describe similarities and differences found between children with SLI and children with APD and (2) discuss assessment problems posed by overlapping behavioral characteristics of SLI and APD.     

Visuospatial immediate memory in specific language impairment.

PURPOSE: Investigations of the cognitive processes underlying specific language impairment (SLI) have implicated deficits in verbal short-term and working memory and in particular the storage and processing of phonological information. This study investigated short-term and working memory for visuospatial material for a group of children with SLI, to test whether the verbal memory impairments already established extend to the visuospatial domain. METHOD: Fifteen children with SLI and control groups of children matched on chronological age and language age completed tests of visuospatial short-term and working memory. RESULTS: The SLI group performed comparably with age-matched control children on all measures and at a higher level than the language-age control group on several measures. CONCLUSIONS: The visuospatial short-term and working memory abilities were at age-appropriate levels in this SLI group. This contrasts markedly with their impairments on tests of verbal short-term and working memory.     

Predicting word decoding and word spelling development in children with Specific Language Impairment

This longitudinal investigation on Dutch children with Specific Language Impairment (SLI) aimed at determining the predictive value of statistically uncorrelated language proficiencies on later reading and spelling skills in Dutch. Language abilities, tested with an extensive test battery at the onset of formal reading instruction, were represented by four statistically uncorrelated factors: lexical-semantic abilities, auditory perception, verbal-sequential processing, and speech production. All factors contributed significantly to the prediction of word reading and spelling development seven months later. Verbal-sequential processing was the strongest predictor for both word decoding and spelling. Furthermore, autoregression effects of word decoding and spelling were strong and verbal-sequential processing had predictive value on word spelling nineteen months later when pre-existing spelling abilities were accounted for. Children with SLI and normal literacy skills performed better on most of the language and language-related measures than children with SLI and poor literacy skills. Learning outcomes: As a result of this activity, readers will describe four language domains that are related to later literacy skills in children with Specific Language Impairment (SLI). As a result of this activity, readers will recognize the predictive value of each of these language domains and the important role of verbal-sequential processing in learning to decode and writing words for children with SLI. As a result of this activity, readers will recall the differences in language proficiencies between children with SLI who develop normal literacy skills and those who encounter literacy problems.     

Predicting reading problems in at-risk children

This study was designed to determine early predictors of reading problems in children at risk for such problems. Three groups of children participated in the study: those with a specific language impairment; those who presumably had a language delay or disorder early in life and had no or a mild disorder at present; and a group of premature children. The data collected were standard speech and language test measures, given as the children entered the study, measures of language meta-processing abilities on an experimental battery, given 6 months after they entered the study; and standard measures of reading, given when the children were aged 80 to 96 months. Many significant relations were found between measures of oral language ability and meta-processing ability at an earlier age and reading ability in first and second grade. The language processing battery scores accounted for a somewhat greater amount of variance on the reading tests than did the scores on the standard language tests. Three ability groups, comparatively high, middle, and low, were found in the population as a result of cluster analysis. Some premature children and some children with early language disorder or mild language disorder at entry into the study, as well as most SLI children, were members of the low language-ability group. These data were then examined to see if membership in the low language-ability group, as measured by either standard speech and language tests or the language meta-processing battery predicted at-risk reading performance on the WRAT. Forty-six children were found to be at risk by this test. Twenty-one of the children were identified by either set of measures, an additional 10 were identified by the language meta-processing measures alone, an additional 3 by the intake measures alone, and 12 of the children were not identified by either set of measures as potential problem readers. The results indicate that early measures of language awareness are good predictors of later reading performance but that different measures of this awareness are good predictors for different children.     

A comparison of the SSW and language test results

The purpose of this paper is to determine the relationship between the SSW and a battery of auditory-language tests in a group of children suspected of auditory processing problems. Thirty-one children between the ages of 6.2 and 10.4 were referred by their classroom teachers. All children were administered a pure tone and an acoustic immitance battery, the SSW test, selected subtests of the Clinical Evaluation of Language Functions, the Goldman-Fristoe-Woodcock Auditory Skills Battery, an elicited language sample, and the Observational Profile of Classroom Communication. No significant correlations were found between the SSW right competing and left competing conditions and the auditory-language test battery. The findings suggest that these two test approaches measure different aspects of auditory processing abilities in children, and both are required to adequately describe auditory processing abilities at all levels.     

疑似听觉处理障碍儿童案例研究

目的本文介绍了中枢听觉功能测试方法，探讨了对听觉处理障碍儿童的诊断和处理原则。方法选择3例疑似听觉处理障碍儿童作为研究案例，进行系统的听力学，教育心理学、言语病理学测试和听觉中枢处理评估。结果在随机间隔探测测试和空间噪音听力测试（Iistening in spatializecl noise test，LISN）中，得分低于同龄组的平均值超过5个标准差；高一提示信号的LISN测试结果显示，数值低于平均值超过2个标准差。结论中枢听觉处理测试序列说明此3例儿童存在双耳听觉处理缺陷。通过改善教室的信噪比，应用听觉闭合训练、听觉定位和辨别训练，加强语言处理技能训练，能够使这3名儿童受益。     

Age-related altering temporal processing and binaural interaction functions in normal hearing individuals: Observational and cross-sectional study

ObjectiveThis study aimed to investigate the temporal processing and binaural interaction functions of central auditory processing tests according to the anatomical localizations of young and elderly individuals. It also sought to evaluate the relationships between the same individuals’ central auditory processing tests.MethodsThis observational and cross-sectional study included individuals with normal hearing between 18 and 30 and 60–75 years of age, who were referred to as the young group and the elderly group, respectively. The evaluation of the central auditory processing tests was completed using the frequency pattern test, duration pattern test, masking level difference test, and random gap detection test. Furthermore, speech discrimination and speech in noise scores were analyzed for both groups.ResultsStatistically significant differences were identified between the groups’ scores for the speech in noise test, masking level difference test, random gap detection test, frequency pattern test, and duration pattern test (p < 0.05). A statistically significant relationship was observed between the age and the results of the central auditory processing tests (p < 0.05).ConclusionWhen compared to younger individuals, elderly individuals presented with declined temporal sequences, temporal resolutions, and binaural interaction skills.     

Is processing speed related to severity of language impairment?

Children with specific language impairment (SLI) typically respond more slowly on many tasks than do their typically developing peers. This paper addresses the question of whether speed of response is linearly related to severity of language impairment as measured by standardized test score. To address this question, we performed post hoc analyses of data from a study on lexical processing involving 66 children with SLI (mean age 6 years 9 months) and 66 typically developing children matched for age and nonverbal IQ. Response times derived from a series of tasks were correlated with language test scores. None of the Pearson correlations reached significance when corrected for number of correlations run, nor did a canonical correlation analysis reach significance. If these results are replicated in other studies, then they suggest that there is no direct linear relation between speed of processing and severity of language impairment as it is estimated from scores on standardized tests of language.     

A new CAPD battery--multiple auditory processing assessment: factor analysis and comparisons with SCAN

Based on recommendations by Musiek & Chermak (1994, American Journal of Audiology, 3, 23-27) and ASHA (1996, American Journal of Audiology, 5(2), 41-54), a battery of four commonly used tests was selected and recorded for use in assessing school children. These tests were labeled the Multiple Auditory Processing Assessment (MAPA) and then administered to an initial sample of 81 third grade children, along with the SCAN screening test for auditory processing disorders. Afterward, several exploratory factor analyses were performed on the findings, and comparisons were made between the results for the MAPA and SCAN. Four separate factors emerged from the four MAPA tests, which were linked closely to the components of central auditory processing disorders (CAPDs) defined by ASHA (1996, American Journal of Audiology, 5(2), 41-54). These factors were labeled monaural separation/closure (MSC), auditory pattern/temporal ordering, binaural integration, and binaural separation (BS). SCAN appears to measure two of these factors, MSC and BS. Use of MAPA is encouraging. Our findings suggest it may provide an appropriate multiple-test, CAPD battery for third grade children, and it meets at least some of the objectives described in the consensus document proposed by ASHA (1996, American Journal of Audiology, 5(2), 41-54).