Central Central Auditory Auditory

Management Management ProjectProject

Holly Dircks & Tiffany Holly Dircks & Tiffany ColonColon

Auditory Diagnostics IIAuditory Diagnostics II

Case HistoryCase History

9 Year Old Male9 Year Old Male

Report from Mom:Report from Mom: Possibility of a TBI from a Young AgePossibility of a TBI from a Young Age Developmental Milestones Borderline or DelayedDevelopmental Milestones Borderline or Delayed InitiallyInitially Reported No Positive History of CANS Reported No Positive History of CANS

InvolvementInvolvement

Report from Teachers:Report from Teachers: Poor School Performance in Verbally Based Poor School Performance in Verbally Based

SubjectsSubjects Not Understanding Auditory InformationNot Understanding Auditory Information

Audiogram ResultsAudiogram Results

Results Continued…Results Continued…

Transient Evoked OAEs: WNL for All Transient Evoked OAEs: WNL for All Frequencies BilaterallyFrequencies Bilaterally

CAPD CAPD Test BatteryTest Battery

Children’s Auditory Children’s Auditory Performance Scale Performance Scale

C.H.A.P.S.C.H.A.P.S.

Dichotic Digits TestDichotic Digits Test

*Bellis, 2003 (pg. 243)*Bellis, 2003 (pg. 243)

Right Ear is Within Normal Limits.Right Ear is Within Normal Limits.

Left Ear is Below Normal Limits for this Left Ear is Below Normal Limits for this Specific Test.Specific Test.

Staggered Spondaic Staggered Spondaic WordsWords

C-SSWC-SSW

Total & Ear Total & Ear Scores = MildScores = Mild

Condition Score Condition Score = Moderate= Moderate

A-SSWA-SSW

Total & Ear Total & Ear Scores = Scores = NormalNormal

Condition Score Condition Score = Mild= Mild

*Katz, 1977 (pg. 12)*Katz, 1977 (pg. 12)

Frequency & Duration Frequency & Duration Pattern TestsPattern Tests

*Bellis, 2003 (pg. 252) for age 9;0 *Bellis, 2003 (pg. 252) for age 9;0 to 9;11to 9;11

*Bellis, 2003 (pg. 253) for age 9;0 *Bellis, 2003 (pg. 253) for age 9;0 to 9;11to 9;11

Low-Pass Filtered Low-Pass Filtered SpeechSpeech

*Bornstein et al. 1994 *Bornstein et al. 1994 (pg. 263)(pg. 263)

Right & Left Ears are Within Normal Limits.Right & Left Ears are Within Normal Limits.

Inconsistent with What is Expected.Inconsistent with What is Expected.

Auditory Continuous Auditory Continuous Performance TestPerformance Test

*Keith, 1994 (pg. *Keith, 1994 (pg. 30)30)

The “Total Error Score-The “Total Error Score-Fail” Criterion is Fail” Criterion is 19 or 19 or

MoreMore Errors for a 9 Year Errors for a 9 Year Old.Old.

Summary of Summary of thethe

ResultsResults

Strengths & Strengths & WeaknessesWeaknesses

DDT Right EarDDT Right Ear

Duration Pattern Duration Pattern TestTest

Low-Pass Filtered Low-Pass Filtered SpeechSpeech

DDT Left EarDDT Left Ear

SSW (Especially SSW (Especially LEF)LEF)

Frequency Pattern Frequency Pattern TestTest

ACPTACPT

Within Normal

Below Normal

Additional TestingAdditional Testing

Auditory Brainstem ResponseAuditory Brainstem Response Assess Auditory Pathways & Brainstem Assess Auditory Pathways & Brainstem

FunctionsFunctions

Random Gap Detection TestRandom Gap Detection Test Performed Poorly in FPT; Normal in DPTPerformed Poorly in FPT; Normal in DPT

Behavioral Observations on the ACPTBehavioral Observations on the ACPT Was the child fidgeting?Was the child fidgeting? Moving around in chair?Moving around in chair? Looking around, or distracted?Looking around, or distracted?

Role of Role of Professionals Professionals

in a in a MultidisciplinaMultidisciplina

ry Approachry Approach

Role of the AudiologistRole of the Audiologist

Diagnosis of Central Auditory Processing DisordersDiagnosis of Central Auditory Processing Disorders

Provide an FM System on Trial BasisProvide an FM System on Trial Basis Decrease Signal-to-Noise RatioDecrease Signal-to-Noise Ratio Enhance Speech Signal by 15-20 dB !Enhance Speech Signal by 15-20 dB ! Performed Best on “Ideal Condition” on C.H.A.P.S.Performed Best on “Ideal Condition” on C.H.A.P.S.

Educate the Teacher on Classroom Modifications & Educate the Teacher on Classroom Modifications & StrategiesStrategies

Within the Audiologists Scope of Practice to Conduct Within the Audiologists Scope of Practice to Conduct Auditory TrainingAuditory Training

Facilitate Referrals to Other ProfessionalsFacilitate Referrals to Other Professionals Multidisciplinary ApproachMultidisciplinary Approach

Role of the NeurologistRole of the Neurologist

Following the CAPD evaluation, the child Following the CAPD evaluation, the child was referred to a neurologist for an MRI to was referred to a neurologist for an MRI to rule out a lesion in the CANS. rule out a lesion in the CANS.

Results Revealed:Results Revealed: Atrophy of Right HemisphereAtrophy of Right Hemisphere

Right Parietal LobeRight Parietal Lobe Right Temporal LobeRight Temporal Lobe

Role of the Role of the Developmental Developmental

PediatricianPediatrician A Developmental Pediatrician can make a A Developmental Pediatrician can make a

formal diagnosis to rule out an Attention formal diagnosis to rule out an Attention Deficit Hyperactive Disorder (ADHD). Deficit Hyperactive Disorder (ADHD).

Chermak (2002)

Role of the SLP/Au.D.Role of the SLP/Au.D.

Role of SLP is to “Provide Differential Role of SLP is to “Provide Differential Diagnosis of Language Processing Disorders Diagnosis of Language Processing Disorders from APD” from APD” (DeBonis & Moncrieff, 2008)(DeBonis & Moncrieff, 2008)

Refer to a Speech-Language Pathologist with Refer to a Speech-Language Pathologist with Auditory Training Experience.Auditory Training Experience.

Super Duper Inc.

Can Work on Auditory MemoryCan Work on Auditory Memory ““Go to the end of the hall Go to the end of the hall

and pick up the red book.”and pick up the red book.” ““Go to the end of the hall Go to the end of the hall

and pick up the red book & green hat.”and pick up the red book & green hat.”

Role of the SLP/Au.D.Role of the SLP/Au.D.

Poor Performance on the FPT Warrants Prosody Poor Performance on the FPT Warrants Prosody TrainingTraining Benefits of Music for Prosody TrainingBenefits of Music for Prosody Training

Activates Many Regions of the Brain (Including Activates Many Regions of the Brain (Including Temporal & Frontal Lobes)Temporal & Frontal Lobes)

Enhance Attention, Learning, Communication, & Enhance Attention, Learning, Communication, & MemoryMemory

Stresses Client’s Timing Skills & Temporal PatterningStresses Client’s Timing Skills & Temporal Patterning Combination of Bottom-Up and Top-Down ProcessingCombination of Bottom-Up and Top-Down Processing Very Engaging For ChildrenVery Engaging For Children

Auditory & Visual Attention (Poor Performance on Auditory & Visual Attention (Poor Performance on ACPT)ACPT) BrainTrainBrainTrain

Chermak (2010)

Role of the SLP/Au.D.Role of the SLP/Au.D.

Dichotic Digits Test (DDT) – Poor Performance in Left Dichotic Digits Test (DDT) – Poor Performance in Left EarEar DDT is Subject to Left-Ear DeficitsDDT is Subject to Left-Ear Deficits

Child is Presented with a Story on TapeChild is Presented with a Story on Tape Under Headphones (Presented to Left Ear Only)Under Headphones (Presented to Left Ear Only) SLP/Au.D. Monitors Story Under Their Own HeadphonesSLP/Au.D. Monitors Story Under Their Own Headphones

After 2 Minutes, Child is Asked Basic Questions about After 2 Minutes, Child is Asked Basic Questions about StoryStory

Ex: “What color was his shirt?” or “Who was Arthur Ex: “What color was his shirt?” or “Who was Arthur painting with?”painting with?”

Can Re-Administer the DDT Periodically to Assess Can Re-Administer the DDT Periodically to Assess ImprovementImprovementEnglish et al. (2003)

Role of the TeacherRole of the Teacher

Provide Preferential SeatingProvide Preferential Seating Reduces effect of SNR, Distortion of Signal, & Reduces effect of SNR, Distortion of Signal, &

ReverberationReverberation

Minimize Reverberation with Acoustic MaterialsMinimize Reverberation with Acoustic Materials

Minimize Visual DistractionsMinimize Visual Distractions Talking with hands & Very colorful decorations around Talking with hands & Very colorful decorations around

the roomthe room

Don’t Talk with Back to ChildDon’t Talk with Back to Child Maximize Visual CuesMaximize Visual Cues

In-Service TrainingIn-Service Training

Positive ReinforcementPositive Reinforcement Encourage & Promote effort in listening tasksEncourage & Promote effort in listening tasks Ask if they need repetitions, or have understood Ask if they need repetitions, or have understood

directions.directions.

ReferencesReferences Bellis, T. J. (2003). Assessment and management of central auditory processing disorders Bellis, T. J. (2003). Assessment and management of central auditory processing disorders

in the educational setting from science to practice, (2in the educational setting from science to practice, (2ndnd ed.). Thompson Delmar Learning, ed.). Thompson Delmar Learning, Canada.Canada.

Bornstein, S., Wilson, H., & Cambron, N. (1994). Low and high pass filtered Northwestern Bornstein, S., Wilson, H., & Cambron, N. (1994). Low and high pass filtered Northwestern University auditory test No. 6 for monaural and binaural evaluation. University auditory test No. 6 for monaural and binaural evaluation. Journal of the Journal of the American Academy of AudiologyAmerican Academy of Audiology, , 55, 259-264., 259-264.

Chermak, G. (2010). Music and auditory training. Chermak, G. (2010). Music and auditory training. The Hearing Journal, 63(The Hearing Journal, 63(4), 58.4), 58.

Chermak, G., Tucker, E., & Seikel, J. A. (2002). Behavioral characteristics of auditory Chermak, G., Tucker, E., & Seikel, J. A. (2002). Behavioral characteristics of auditory processing disorder and attention-deficit hyperactivity disorder: Predominantly processing disorder and attention-deficit hyperactivity disorder: Predominantly inattentive type. inattentive type. Journal of the American Academy of Audiology, 13, Journal of the American Academy of Audiology, 13, 332-338.332-338.

DeBonis, D., & Moncrieff, D. (2008). Auditory processing disorders: An update for speech-DeBonis, D., & Moncrieff, D. (2008). Auditory processing disorders: An update for speech-language pathologists. language pathologists. American Journal of Speech-Language Pathology, 17American Journal of Speech-Language Pathology, 17(1), 4-18. (1), 4-18.

English, K., Martonik, J., & Moire, L. (2003). An auditory training technique to improve English, K., Martonik, J., & Moire, L. (2003). An auditory training technique to improve dichotic listening. dichotic listening. The Hearing Journal, 56The Hearing Journal, 56(1), 34-38.(1), 34-38.

Gelfand, S. A., Schwander, T., & Silman, S. (1990). Acoustic reflex thresholds in normal Gelfand, S. A., Schwander, T., & Silman, S. (1990). Acoustic reflex thresholds in normal and cochlear-impaired ears: Effects of no-response rates on 90and cochlear-impaired ears: Effects of no-response rates on 90thth percentiles in a large percentiles in a large sample. sample. The Journal of Speech & Hearing Disorders, 55The Journal of Speech & Hearing Disorders, 55(2), 198-205.(2), 198-205.

References (Cont’d)References (Cont’d)

Katz, J. (1977). The SSW test manual (2Katz, J. (1977). The SSW test manual (2ndnd ed.). St. Louis, ed.). St. Louis, Missouri: AudiTec.Missouri: AudiTec.

Keith, R. W. (1994). ACPT: Auditory continuous performance Keith, R. W. (1994). ACPT: Auditory continuous performance test. San Antonio: The Psychology Corporation.test. San Antonio: The Psychology Corporation.

Musiek, F. E. (1983). Assessment of central auditory Musiek, F. E. (1983). Assessment of central auditory dysfunction: The Dichotic Digit Test revisited. dysfunction: The Dichotic Digit Test revisited. Ear & Hearing, Ear & Hearing, 44(2), 79-83.(2), 79-83.

Musiek, F. (1994). Frequency (pitch) and duration pattern Musiek, F. (1994). Frequency (pitch) and duration pattern tests. tests. Journal of the American Academy of AudiologyJournal of the American Academy of Audiology, , 55, 265-, 265-268.268.

Wilson, R. H., Preece, J. P., Salamon, D. L., Sperry, J. L., & Wilson, R. H., Preece, J. P., Salamon, D. L., Sperry, J. L., & Bornstein, S. P. (1994). Effects of time compression and time Bornstein, S. P. (1994). Effects of time compression and time compression plus reverberation on the intelligibility of compression plus reverberation on the intelligibility of Northwestern University Auditory Test No. 6. Northwestern University Auditory Test No. 6. Journal of the Journal of the American Academy of Audiology, 5,American Academy of Audiology, 5, 269-277. 269-277.