Utility of deficit-specific computer-based training on children with temporal processing deficit.

PURPOSE: Children with temporal processing deficits struggle to detect and discriminate syllables, phonemes, and stress patterns in speech. To overcome these deficits, computer-based auditory training programs have been widely used as one of the rehabilitation alternatives in recent years. The present study aimed to examine the usefulness of one such computer-based temporal processing training (CBTPT) module on children with temporal processing deficits. METHOD: Sixteen children (8-15 years) with temporal processing deficits were enrolled in the study, further divided into active (CBTPT) and placebo (placebo training) groups. Further, 8 typically developing children (no training) were enrolled as a comparison group. The auditory outcome measures included Duration Pattern Test (DPT), Gap Detection Test (GDT), Dichotic CV (DCV), and Speech-in-Noise-Indian English (SPIN-IE) assessed before and after training for all three groups. RESULTS: Wilcoxon-sign rank test showed a statically significant difference between pre and post-test scores of DPT, GDT, and SPIN (p < 0.001) except DCV among the active group. However, no significant differences were noted in the pre and post-test scores among the placebo and TD groups. Mann Whitney U test showed a significant difference in DPT and SPIN post-training scores between active and placebo groups; active and TD group; placebo and TD group. CONCLUSION: From the above finding, it is inferred that the CBTPT module is useful among children having temporal processing deficits.

A Retrospective Study Distinguishing between Hyperacusis and Misophonia in children with Auditory Processing Disorder (APD).

OBJECTIVES: Decreased sound tolerance (DST) is common in children with auditory processing disorder (APD). This study aimed to differentiate between hyperacusis and misophonia in children with APD. DESIGN: A retrospective study evaluating outcomes of structured history and co-morbidity following Research Domain Criteria (RDoC) frame-work. Misophonia was considered as oversensitivity to eating/chewing sounds and hyperacusis as oversensitivity to other sounds. STUDY SAMPLE: Two hundred and seventy-nine children (160 males; 119 females), 6-16 year-olds with NVIQ ≥80, diagnosed with APD between January 2021 and December 2022. RESULTS: One hundred and forty-three out of 279 children with APD had DST, of which 107 had hyperacusis (without misophonia) and 36 had misophonia. Misophonia co-existed with hyperacusis in 35 children (97 %), and in one child misophonia occurred without hyperacusis. Misophonia was prevalent in older children, in females, and those with tinnitus. Fear and being upset were predominant emotional responses in hyperacusis (without misophonia) while disgust and verbal abuse were prevalent in misophonia (with or without hyperacusis). Compared to children without DST, the hyperacusis (without misophonia) and misophonia (with or without hyperacusis) groups had significant higher prevalence of ADHD, anxiety, and language impairment. Educational difficulties were similar in APD irrespective of the presence or absence of DST. Despite higher tinnitus prevalence in misophonia (with or without hyperacusis) along with similar co-morbidities and educational difficulties in both hyperacusis (without misophonia) and misophonia (with or without hyperacusis), the misophonia (with or without hyperacusis) group surprisingly had less support at school which was reflected in fewer Education, Health and Care Plan (EHCP). CONCLUSIONS: In APD misophonia mostly co-exists with hyperacusis, with differences in emotional responses, tinnitus prevalence, and gender distribution when compared to hyperacusis (without misophonia). Increase in awareness about misophonia is needed, as children with misophonia may have unidentified needs. Larger scale prospective study is required to clarify if misophonia evolves from hyperacusis, and to explore the factors underlying 'misophonia with hyperacusis' and 'misophonia without hyperacusis'. For clarity, DST studies need to specify if hyperacusis or misophonia co-existed when referring to hyperacusis or misophonia.

Two-year Prevalence of Central Auditory Processing Disorders in Children.

Introduction: Central auditory processing disorder (CAPD) refers to difficulties in processing audible signals not attributable to impaired hearing sensitivity or mental impairment. The demographic characteristics of pediatric CAPD and its prevalence are still debatable. Due to varied definitions and differences in the diagnostic criteria for CAPD, the approximate prevalence measure varies from 0.5 to 7% of the population. Thus, a retrospective study on prevalence in individuals with CAPD was conducted. Method: A total of 3537 cases with ear-related problems were reported to Audiology OPD at All India Institute of Speech and Hearing from June 2017 to July 2019 between the age range of 6-18 years. Of these, 32 cases were diagnosed with CAPD, and this data was available for review. Results: The prevalence of individuals with CAPD reported in this duration was 0.7%. The results also revealed that the prevalence was higher among males and individuals of lower socio-economic status. Their significant symptoms were poor academic performance and difficulty following commands or instructions. The data also revealed that speech perception in noise was the most affected process, followed by binaural integration in these individuals. Conclusion: The study provides insight into the vulnerable population who can get CAPD (e.g., children and males or people from lower socio-economic backgrounds).

Better education required for professionals in healthcare regarding auditory processing disorder.

BACKGROUND: Global research has revealed inadequate levels of Auditory Processing Disorder (APD) awareness and knowledge among related professionals leading to neglect of this specific type of hearing impairment that is estimated to present in 50% of children with learning disabilities (dyslexia included) and more than 70% of adults with presbycusis or mild cognitive impairment. PURPOSE: The aim of the current study was to record APD awareness and knowledge among professionals working in both Healthcare and Education sectors. METHODS: A 36-question questionnaire was developed and addressed to medical doctors of different specialties (ENTs and non-ENTs), therapists (speech & language therapists, occupational therapists, psychologists), and educators (of both typical and special education). The questionnaire was sent to Professional Societies of interest as well as a University Rectorate where authors are affiliated, requesting the spreading to all members, and was also posted to related private groups in social media. Data concerning APD-training and knowledge were gathered from 522 questionnaires. Level of knowledge was recorded both subjectively (self-rating) and objectively (pre-defined scoring of items). RESULTS: Analysis showed insufficient knowledge concerning APD among specialties. ENTs and/or therapists scored statistically significantly higher compared to other medical specialties and educators, while still lower than 50%. The current level of awareness on APD might negatively affect the way individuals with APD are addressed, all the way from referral to management. Levels of awareness and knowledge among professions which are related to APD either directly or indirectly can be further improved through formal education targeting bachelor, master and PhD programs of medical doctors, therapists and educators. CONCLUSION: We are proposing the development of educational programs that target ENT doctors so that children and adults receive more elaborate services both diagnostically and from a rehabilitation point of view. This will improve quality of life and mental health.

Sensory symptoms associated with autistic traits and anxiety levels in children aged 6-11 years.

BACKGROUND: Autism spectrum conditions (ASC) and quantitative autistic traits (QATs) are associated with sensory symptoms, which may contribute to anxiety and adversely affect social and cognitive development. Although sensory symptoms can occur across all senses, the relative roles of specific sensory modalities as contributors to the autistic phenotype and to anxiety are not well understood. The objective of this study was to examine which sensory symptoms were most predictive of high anxiety. METHODS: We recruited 257 female primary caregivers of children aged 6 to 11 years (49% girls) to a questionnaire study comprising parent-report measures for classical QATs (social, communicative, and rigid), autism-related sensorimotor symptoms (visual, auditory, tactile, olfactory, gustatory, vestibular, proprioceptive, and motor), and anxiety symptoms. First, Bayesian stochastic search variable selection (SSVS) was used to identify the most probable sensorimotor predictors of specific QATs as well as diagnosed ASC. Then, the selected predictors were used in another SSVS, using anxiety symptoms as a dependent variable, to identify which of the autism-relevant sensorimotor symptoms were most robustly predictive of anxiety. Finally, the effect sizes of anxiety-related sensory symptoms were estimated with linear regressions. RESULTS: We found that auditory symptoms and motor difficulties were most predictive of ASC diagnosis. Developmental motor difficulties were also strongly related to all individual QATs, whereas auditory symptoms were more selectively predictive of rigid traits. Tactile symptoms robustly predicted social interaction QATs, and proprioceptive symptoms predicted communicative QATs. Anxiety outcomes were most strongly predicted by difficulties with auditory and olfactory processing. CONCLUSIONS: The results support the clinical importance of being alert to complaints about sounds and hearing in neurodevelopmental populations, and that auditory processing difficulties may be evaluated as an early marker of poor mental health in children with and without diagnosed autism. Olfactory processing differences appeared to be an anxiety marker less strongly associated with ASC or QATs, while motor difficulties were highly autism-relevant but not equally strongly associated with anxiety outcomes. We suggest that future studies may focus on the mechanisms and consequences of neurodevelopmental central auditory processing dysfunction and its potential relationship to anxiety disorders.

Etiology, Diagnostic, and Rehabilitative Methods for Children with Central Auditory Processing Disorders-A Scoping Review.

APD (auditory processing disorders) is defined as difficulties in processing auditory stimuli within the central nervous system, with normative physical hearing and intellectual disabilities excluded. The scale of this phenomenon among children and adolescents and the need to raise awareness of its occurrence prompted the authors to review currently available diagnostic and therapeutic methods, as well as outline future directions for addressing children affected by APD.

Corrigendum: Hearing rehabilitation of adults with auditory processing disorder: a systematic review and meta-analysis of current evidence-based interventions.

[This corrects the article DOI: 10.3389/fnhum.2024.1406916.].

Hearing rehabilitation of adults with auditory processing disorder: a systematic review and meta-analysis of current evidence-based interventions.

Background: For adults with auditory processing disorder (APD), listening and communicating can be difficult, potentially leading to social isolation, depression, employment difficulties and certainly reducing the quality of life. Despite existing practice guidelines suggesting treatments, the efficacy of these interventions remains uncertain due to a lack of comprehensive reviews. This systematic review and meta-analysis aim to establish current evidence on the effectiveness of interventions for APD in adults, addressing the urgent need for clarity in the field. Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search across MEDLINE (Ovid), Embase (Ovid), Web of Science and Scopus, focusing on intervention studies involving adults with APD. Studies that met the inclusion criteria were grouped according to intervention with a meta-analysis only conducted where intervention, study design and outcome measure were comparable. Results: Out of 1,618 screened records, 13 studies were included, covering auditory training (AT), low-gain hearing aids (LGHA), and personal remote microphone systems (PRMS). Our analysis revealed: AT, Mixed results with some improvements in speech intelligibility and listening ability, indicating potential benefits but highlighting the need for standardized protocols; LGHA, The included studies demonstrated significant improvements in monaural low redundancy speech testing (p < 0.05), suggesting LGHA could enhance speech perception in noisy environments. However, limitations include small sample sizes and potential biases in study design. PRMS, Demonstrated the most consistent evidence of benefit, significantly improving speech testing results, with no additional benefit from combining PRMS with other interventions. Discussion: PRMS presents the most evidence-supported intervention for adults with APD, although further high-quality research is crucial for all intervention types. The establishment and implementation of standardized intervention protocols alongside rigorously validated outcome measures will enable a more evidence-based approach to managing APD in adults.

Hearing Loss and Cognitive Decline in the Aging Population: Emerging Perspectives in Audiology.

In this perspective article, the author explores the connections between hearing loss, central auditory processing, and cognitive decline, offering insights into the complex dynamics at play. Drawing upon a range of studies, the relationship between age-related central auditory processing disorders and Alzheimer's disease is discussed, with the aim of enhancing our understanding of these interconnected conditions. Highlighting the evolving significance of audiologists in the dual management of cognitive health and hearing impairments, the author focuses on their role in identifying early signs of cognitive impairment and evaluates various cognitive screening tools used in this context. The discussion extends to adaptations of hearing assessments for older adults, especially those diagnosed with dementia, and highlights the significance of objective auditory electrophysiological tests. These tests are presented as vital in assessing the influence of aging and Alzheimer's disease on auditory processing capabilities and to signal cognitive dysfunction. The article underscores the critical role of audiologists in addressing the challenges faced by the aging population. The perspective calls for further research to improve diagnostic and therapeutic strategies in audiology, and emphasizes the need for a multidisciplinary approach in tackling the nexus of hearing loss, auditory processing, and cognitive decline.

Interventions for School-Aged Children with Auditory Processing Disorder: A Scoping Review.

(1) Background: Auditory processing (AP) disorder is associated with learning difficulties and poses challenges to school-aged children in their daily activities. This scoping review identifies interventions and provides audiologists with protocol insights and outcome measures. (2) Methods: A systematic search of both peer-reviewed and grey literature (January 2006 to August 2023) covered ten databases. Studies included had the following characteristics: (i) published in French or English; (ii) participants were school-aged, and had a normal audiogram, AP difficulties or disorder, and no cognitive, developmental, congenital or neurological disorder (with the exception of learning, attention, and language disabilities); (iii) were intervention studies or systematic reviews. (3) Results: Forty-two studies were included, and they predominantly featured auditory training (AT), addressing spatial processing, dichotic listening, temporal processing and listening to speech in noise. Some interventions included cognitive or language training, assistive devices or hearing aids. Outcome measures listed included electrophysiological, AP, cognitive and language measures and questionnaires addressed to parents, teachers or the participants. (4) Conclusions: Most interventions focused on bottom-up approaches, particularly AT. A limited number of top-down approaches were observed. The compiled tools underscore the need for research on metric responsiveness and point to the inadequate consideration given to understanding how children perceive change.

Exploring the effects of a repair strategies training program among children with auditory processing disorder: A pilot study.

OBJECTIVES: Children with hearing loss, as well as those with auditory processing disorder (APD), experience more communication difficulties than their normal-hearing peers. Receiving training on communication strategies has been shown to be beneficial for children with hearing loss, but little is known on the effect of such training on children with APD. The main purpose of this pilot study was to assess the effects of a repair strategies training program among children with APD. METHODS: Ten school-aged children with APD participated in a ten 60-min weekly repair strategies training program (experimental group) and ten did not receive any training (control group). In pre- and post-intervention, children were filmed while taking part in short scripted conversation situations in which communication breakdowns were introduced. Additionally, questionnaires on communication difficulties and repair skills, on life habits related to communication and education as well as on emotional well-being were filled by the children and their parents. RESULTS: In post-compared to in pre-intervention, children in the experimental group used significantly more of the repair strategies taught right after a communication breakdown occurred, used a greater variety of repair strategies, and overcame more communication breakdowns. The number of strategies needed to overcome a breakdown was not significantly different after the training compared to before. The level of difficulty to accomplish education-related life habits was generally lower, although not significantly, after entering the program than before. The individualized data showed that the studied training was more suited for children aged 9 years and older. The results of the children in the control group were not significantly different between the two measured times on all outcomes. CONCLUSION: Learning how to recognize and overcome communication breakdowns through a training program was beneficial for children with APD. The program enabled them to use a wider variety of repair strategies and to be more proactive in situations where communication is difficult. Studies are needed to further examine these findings in a larger sample of children with APD and in real-life settings.

Normative values for tests of central auditory processing disorder in children aged from 6 to 12 years old.

INTRODUCTION: Central auditory processing disorders (CAPD) can significantly affect the daily functioning of a child, and the first step in determining whether rehabilitation procedures are required is a proper diagnosis. Different guidelines for making diagnoses have been published in the literature, and in various centers normative values for psychoacoustic tests of CAPD have been used internally. The material presented in this paper is based on more than 1000 children and is the largest collection so far published. The aim of this study is to present normative values for tests assessing CAPD in children aged 6 to 12 years, divided by age at last birthday. METHOD: We tested 1037 children aged 6 to 12 years who were attending primary schools and kindergartens. The criteria for inclusion were a normal audiogram, intellectually normal, no developmental problems, and no difficulties in auditory processing. To evaluate auditory processing all children were given three tests on the Senses Examination Platform: the Frequency Pattern Test (FPT), Duration Pattern Test (DPT), and Dichotic Digit Test (DDT). RESULTS: The results from 1,037 children allowed us to determine normative values for FPT, DPT, and DDT in seven different age groups (6 through to 12 years). We developed a newapproach, based on quantile-based norms, to determine normative values in each group. Three categories - average, below-average, and above-average - allow for a broader but more realistic interpretation than those used previously. We compare our results with published standards. CONCLUSIONS: Our study is the largest normative database published to date for CAPD testing, setting a standard for each child by age in years. We used the Senses Examination Platform, a universal tool, to unify standards for the classification of CAPD. Our study can serve as a basis for the development of a Polish model for the diagnosis of CAPD.

Impact of Otitis Media With Effusion in Early Age on Auditory Processing Abilities in Children: A Systematic Review and Meta-Analysis.

Objective: Early-onset otitis media with effusion (OME) can affect the development of the auditory nervous system and thus lead to auditory processing abnormalities. This study aims to review the effect of childhood OME on auditory processing abilities in children. Methods: A systematic review of the literature, restricted to the English language from 1990 to 2022 was conducted using search engines like PubMed, Embase, and Google Scholar. After selecting the articles following predefined inclusion and exclusion criteria, the data were extracted and meta-analysis was performed. Results: A total of 10 articles met the inclusion criteria. Children with a history of OME had poorer performance in most behavioral and electrophysiological tests. Pooled analysis of various tests such as the gap in noise test, frequency pattern test (verbal and nonverbal), and latencies of auditory brainstem response-I, V, I to III, and I to V showed a difference between the 2 groups. Conclusion: Childhood OME can significantly affect auditory processing abilities in children.

Auditory processing disorder: an online survey of hearing healthcare professionals' knowledge and practices.

OBJECTIVE: To investigate (1) the current level of awareness and knowledge on Auditory Processing Disorder (APD) among Audiologists and other hearing healthcare professionals; (2) current practices in screening, diagnosis, and management of APD in children and adults across the UK; (3) professional's acceptance of APD assessment and diagnosis. DESIGN: An online survey was disseminated through the British Academy of Audiology and ENT UK. STUDY SAMPLE: A total of 191 hearing healthcare professionals responded to the survey. RESULTS: Overall, while 63% of the respondents considered themselves to be adequately informed about APD, only 4% viewed themselves as very informed on the topic. Fewer than half of the respondents report screening (31%), diagnosing (14%), or managing (36%) cases of APD. For screening APD, professionals most commonly use auditory processing tests in adults and take case histories in children, whereas routine audiological procedures are the primary method for diagnosing APD in both adults and children. Although modifying the listening environment is a widely recommended management strategy for APD, half of the respondents indicated that a diagnosis of APD has no implications for patient management. CONCLUSIONS: There is a critical need to promote APD-related training to ensure they can provide appropriate referrals and management.

A Survey on Screening and Diagnostic Criteria of Auditory Processing Disorders in India.

The current study aimed to determine the criteria used for screening and diagnosing cases with central auditory processing disorders (CAPD) in India. A cross-sectional questionnaire-based survey design was used in the present study. A questionnaire was developed to determine the criteria used for screening and diagnosing CAPD across clinics in India. Responses were obtained from 83 participants from all over India. Results indicated that 78% of respondents were currently doing CAPD evaluation. In that, the majority of respondents (63%) had a predetermined minimum battery that was relatively adaptable depending on the case history and age of the patient. In screening, most respondents used a screening questionnaire (SCAP, 75%) and a screening test (STAP, 60%). In the diagnostic protocol, the most used tests by the respondents were masking level difference (MLD), repetition of words (RW), gap detection test (GDT), pitch pattern test (PPT), speech perception in noise (SPIN), digit span test (DST), dichotic digit test (DDT), binaural fusion test (BFT), auditory brainstem response (ABR), dichotic CV test (DCVT), and duration pattern test (DPT). The current study's result will help professionals choose the minimum test battery for diagnosing CAPD.

The Prevalence of Central Auditory Processing Disorder in Elementary School Students of Kerman, Iran.

Objectives: This study aimed to determine the prevalence of central auditory processing disorder (CAPD) in elementary school students in Kerman, Iran, during 2018-2019. Materials & Methods: This cross-sectional study was conducted on 1369 elementary school students in Kerman. These students were selected by cluster sampling from different areas of Kerman and then screened using the Buffalo Model Questionnaire (BMQ). Based on the data obtained from the questionnaire, normal children were excluded from the study. Then, children with suspected central auditory processing disorder (CAPD) underwent ear exams and were excluded from the study in case of abnormal results in the tympanic membrane examination (rapture-effusion). The remaining subjects underwent peripheral audiometry evaluation, and children with abnormal audiometry were excluded from the study. Finally, the remaining children with suspicious screening results, a normal examination, and normal audiometry underwent a specific test to detect Central auditory processing disorder. Data analysis was carried out using SPSS software. Results: One thousand three hundred sixty-nine primary school students with a mean age of 9.15 ±2.63 years enrolled in this study. 52%% of students were male. 8.03% of them had CAPD. A statistically significant relationship was found between the prevalence of CAPD and gender (P<0.001), place of residence (P<0.001), history of middle ear inflammation (P<0.001) and history of head injury. Conclusion: The quality of life of these students with CAPD can be improved via timely recognition of CAPD and the provision of appropriate preventive and therapeutic facilities.

A comment on the order of report in two-pair dichotic digit testing in children assessed for auditory processing.

OBJECTIVE: This clinical note aimed to 1) describe the order-of-report (OoR) strategies used by a large sample of children who completed 2pDD testing in the free-recall condition as part of an audiological assessment of auditory processing (AP), and 2) determine if use of OoR correlated with 2pDD test performance. DESIGN: A retrospective (case-review), single observation design. STUDY SAMPLE: A convenient sample of 77 children (50 males and 27 females aged 7.0 to 17.4 years [median = 8.8 years]) referred to audiology for an AP assessment. RESULTS: The participating children used temporal more than ear or sequential OoR and showed decreased test scores with increased use of ear OoR. CONCLUSIONS: These findings suggest children referred for an AP assessment could favour a temporal OoR when completing 2pDD testing for its opportunity to rehearse the first digit pair (possibly strengthening its memory trace) prior to processing the second digit pair, while their use of an ear OoR could come at the cost detrimental ear dominance effects that reduce their test performance. Future research could consider if similar results are observed in other child populations and if preferred dichotic processing strategy could inform auditory training for children with dichotic listening deficits.

Changes in Auditory Evoked Potentials Increase the Chances of Adults Having Central Auditory Processing Disorder.

Introduction Auditory evoked potentials are widely used in clinical practice to complement the assessment of central auditory processing. However, it is necessary to understand whether these potentials are highly accurate, to assist in the diagnosis of auditory processing disorder. Objective To measure the accuracy of middle and long latency auditory evoked potentials in the diagnosis of auditory processing disorder in adults. Methods This is a case-control study, formed by a control group of 30 individuals with normal auditory processing assessment, and a case group composed of 43 individuals with altered auditory processing assessment. Their sensitivities, specificities, accuracies, positive and negative predictive values for the diagnosis of alterations were measured and compared between the potentials. Results The accuracies of the middle and long latency potentials were 51% and 67%, respectively. The P1-N1-P2 and N2-P300 complexes had an accuracy of 57.5% and 58.9%, respectively. The cognitive potential P300 showed an accuracy of 55%. There was no significant result for the middle-latency potential (OR = 1.8; 95% CI: 0.6-5.4, p > 0.42) and for P300 (OR = 2.63, 95% CI: 0.85-8.43, p > 0.11). However, the result was significant for the long-latency potential (OR = 6.3; 95% CI: 2-19.6, p < 0.01). There was a significant result for the P1-N1-P2 complexes (OR = 6.76, 95% CI:1.4-32.5, p = < 0.010) and N2-P300 (OR = 3.60; 95% CI: 10.16-11.20, p < 0.039). Conclusion Individuals with altered long-latency auditory evoked potential are more likely to have auditory processing disorder and, as such, this test can be used as a complementary tool to confirm the diagnosis.

Incidence of Otolaryngological Manifestations in Individuals with Autism Spectrum Disorder: A Special Focus on Auditory Disorders.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by stereotyped and repetitive behavior patterns. In addition to neurological and behavioral problems, individuals with ASD commonly experience otolaryngological comorbidities. Individuals with ASD often have auditory disorders including hearing loss and auditory processing disorders such as central auditory processing disorder (CAPD), as well as both chronic and recurrent otitis media. These challenges negatively impact a person's ability to effectively communicate and may further impact their neurological functioning, particularly when not appropriately treated. Individuals diagnosed with ASD also have difficulty sleeping which contributes to increased irritability and may further aggravate the core behavioral symptoms of autism. The individuals with ASD also have a higher rate of sinusitis which contributes to the worsening of the autism behavior phenotype. The high prevalence of otolaryngological comorbidities in individuals with ASD warrants a better collaboration between their various healthcare providers and otolaryngologists with expertise in auditory, sleep, and sinus disorders in pursuit of improving the quality of life of affected individuals and their families/caregivers.