Auditive Verarbeitungs- und Wahrnehmungsstörungen

[Developmental Speech and Language Disorders According to ICD-11]

Developmental Speech and Language Disorders According to ICD-11 Abstract. In ICD-11, similar to ICD-10, speech and language disorders are classified as neurodevelopmental disorders, which are part of ICD-11 Chapter 6 (Mental, Behavioural and Neurodevelopmental Disorders). The ICD-10 criteria were not well accepted by many professionals in research and clinic who work with children with speech and language disorders. Especially linguists and speech and language therapists see ICD-10 as too crude and lacking specification of individual language problems. Medical professions in turn criticize the missing aspect of organically caused speech and language problems. This paper presents the classification of speech and language problems or disorders according to ICD-11 compared to ICD-10. One essential aspect lies in the differentiation between "primary" and "secondary" neurodevelopmental disorders. In addition, we compare and discuss other recent classification approaches, such as DSM-5, CATALISE-2, and the classification "Auditory Processing Disorder" by pediatric audiologists. We present a classification approach based on ICD-11, supplemented by an additional specification of the respective impaired speech or language area in the individual child and based on a thorough speech and language assessment. We thus hope to pave the path for an interdisciplinary classification of speech and language disorders according to ICD-11, our aim being to establish a common terminology that can be used by all professions. We expect this common terminology to improve clinical care and to allow for the integration and comparability of speech- and language-related research efforts.

Evolving the concept of APD

OBJECTIVE

To consider the evolving concept of auditory processing disorder (APD).

DESIGN

Narrative review and opinion piece.

STUDY SAMPLE

Eight approaches to APD described in the literature and its definitions by ten societies or groups from around the world.

RESULTS

The dominant conceptualisation of APD remains one of disorders (or at least deficits) in the bottom-up processing of sound in the primary auditory nervous system that are not due to higher order (top-down) language or cognitive deficits. Challenges to this conceptualisation question the relevance of (bottom-up) AP to listening, learning and language. These challenges are rejected by some groups who maintain the dominant bottom-up conceptualisation of APD, but accepted by others who suggest APD be reconceptualised to include top-down processing of sound or attempts to define APD be de-emphasised in favour of a hierarchical approach to listening difficulties.

CONCLUSIONS

To reconcile these challenges, the concept of APD could be better evolved by considering it as a spectrum disorder spanning from bottom-up AP to the top-down cognitive processes (particularly attention) that affect it.

Current audiological diagnostics

Today's audiological functional diagnostics is based on a variety of hearing tests, whose large number takes account of the variety of malfunctions of a complex sensory organ system and the necessity to examine it in a differentiated manner and at any age of life. The objective is to identify nature and origin of the hearing loss and to quantify its extent as far as necessary to dispose of the information needed to initiate the adequate medical (conservative or operational) treatment or the provision with technical hearing aids or prostheses. Moreover, audiometry provides the basis for the assessment of impairment and handicap as well as for the calculation of the degree of disability. In the present overview, the current state of the method inventory available for practical use is described, starting from basic diagnostics over to complex special techniques. The presentation is systematically grouped in subjective procedures, based on psychoacoustic exploration, and objective methods, based on physical measurements: preliminary hearing tests, pure tone threshold, suprathreshold processing of sound intensity, directional hearing, speech understanding in quiet and in noise, dichotic hearing, tympanogram, acoustic reflex, otoacoustic emissions and auditory evoked potentials. Apart from a few still existing gaps, this method inventory covers the whole spectrum of all clinically relevant functional deficits of the auditory system.

[Diagnosis of auditory processing disorders in children]

Despite normal hearing thresholds in pure tone audiometry, 0.5-1 % of children have difficulty understanding what they hear. An auditory processing disorder (APD) can be assumed, which should be clarified and treated. Based on a selective literature search in the PubMed and Scopus databases using the term "auditory processing disorder", several consensus papers are discussed. Numerous studies on APD have revealed partially contradicting results, thus fueling critical discussion regarding validity and reliability-of specific audiometric APD methods and the APD construct in particular. In order to correctly advise parents and, where necessary, treat affected children, otorhinolaryngologists, phoniatrists, and pediatric audiologists must understand the psychometric properties of applied tests and have knowledge of current discussion. Diagnosis is generally a multistep interdisciplinary process.

[Acoustic reflexes of children with and without central auditory processing disorders]

BACKGROUND

According to international standards, determination of acoustic reflex thresholds (ART) is one of the established objective measurements in the diagnostic workup of central auditory processing disorders (CAPD). However, there is still no evidence for the significance of ART in CAPD diagnosis.

PATIENTS AND METHODS

This study tested 57 children with proven CAPD and 50 healthy children (control group) with regard to group differences in mean ART (sine tones or bandpass-filtered noise). Additionally, it was investigated whether there were group differences between the mean dissociations of ART for sine tones or bandpass filtered noise.

RESULTS

Neither ipsi- nor contralaterally were significant clinically relevant group differences (p < 0.050) between the mean ART of children with and without CAPD found. After Bonferroni correction, a significant group difference in the percentage of non-triggered reflexes was only observed with left-sided contralateral 2 kHz stimuli. Concerning the number of dissociations ≥20 dB, no significant group differences (p < 0.050) were detected either ipsi- or contralaterally (Fisher's test).

CONCLUSION

The results of the study seem to indicate no clinically relevant ability of ART measurements to distinguish between children with and without CAPD. This renders the benefit of ART measurements for CAPD diagnosis questionable.

Using different criteria to diagnose (central) auditory processing disorder: how big a difference does it make?

PURPOSE

To quantify how 9 different diagnostic criteria affected potential (central) auditory processing disorder ([C]APD) diagnoses in a large sample of children referred for (central) auditory processing ([C]AP) assessment.

METHOD

A file review was conducted on 150 children (94 boys and 56 girls; ages 7.0-15.6 years) with normal peripheral hearing who had completed a (C)AP assessment involving low-pass filtered speech, competing sentences, 2-pair dichotic digits, and frequency patterns with linguistic and nonlinguistic report. Each child was classified as having or not having (C)APD based on 9 different sets of diagnostic criteria drawn from published technical reports, position statements, and selected research.

RESULTS

The rates of potential (C)APD diagnosis ranged from 7.3% for the strictest criteria to 96.0% for the most lenient criteria.

CONCLUSIONS

Until greater consensus is reached, any diagnosis of (C)APD should be qualified by an explicit statement of the criteria used. Calls to abandon the use of (C)APD as a global label should also be supported.

[Auditory processing disorders--differential diagnosis. Guidelines of the German Society for Phoniatry and Pedaudiology]

One prerequisite of diagnosing an auditory processing disorder (APD) is the differential diagnostic exclusion of language comprehension disorders, attention deficit hyperactivity disorders, cognitive impairment, as well as autistic-type diseases. This issue is discussed in detail in the updated guidelines for APD, as well as the logical consequences resulting thereof in terms of interpreting individual test results. This update is based in terms of content on the preceding guidelines of the German Society for Phoniatry and Pedaudiology (DGPP) and aligns itself closely with the Californian Speech-Language-Hearing Association, as well as guidelines of the American Academy of Audiology.

Auditive Verarbeitungs- und Wahrnehmungsstörungen (AVWS) im Kindesalter

Auditive Verarbeitungs- und Wahrnehmungsstörungen (AVWS) sind umschriebene Funktionsdefizite in der auditiven Informationsverarbeitung und Wahrnehmung bei intaktem peripherem Gehör und mindestens durchschnittlicher Intelligenz. Häufig sind Lernstörungen, primäre bzw. sekundäre Spracherwerbsstörungen, supramodale Aufmerksamkeitsprobleme oder tiefgreifende Entwicklungsstörungen mit AVWS im Sinn von Komorbidität assoziiert. Deswegen erscheint Eltern, Lehrern oder Untersuchern das AVWS-Konzept zur Erklärung solcher Entwicklungs- und Lernauffälligkeiten plausibel. Da Sprachsignale zerebral anders als nicht sprachliche Signale ausgewertet werden, kann Sprachwahrnehmung allenfalls als ein Spezialfall der auditiven Verarbeitung und Wahrnehmung betrachtet werden. Kausale Beziehungen zwischen gestörten auditiven Funktionen und klinischen Störungsbildern wurden bislang nicht zuverlässig belegt. Es besteht ein Mangel an kontrollierten bzw. randomisierten Therapiestudien.

[Which phonological memory measure distinguishes children with from children without auditory processing disorders? A group analysis]

AIM

The aim of this study was to compare performance in phonological working memory across children with auditory processing disorders (APD), partly associated with different developmental disorders, and to examine which memory measure distinguishes children with from children without APD.

METHOD

Data from a health care research database were retrospectively analyzed. All children completed three measures of phonological serial recall: one-syllable digits, one-syllable words, and multi-syllabic nonwords of increasing length (2-6 syllables).

PARTICIPANTS

The study included 48 subjects with APD only (mean age: 87.9 months; SD 12.9 months); 35 with co-occurring APD and developmental language disorder (DLD) (mean age: 82.2; SD 13.4); 16 with co-occurring APD and dyslexia (mean age: 109.2; 18.7); 10 with co-occurring slight intelligence reduction and APD (mean age: 102.4; SD 12.5), while 13 were non-affected, typically forming controls (non-APD; mean age: 86.0; SD 16.1). The mean intelligence (T-score) of the first three mentioned APD groups and the controls were significantly different (p<0.0001) from the children with lowered intelligence and APD (35.4; SD 3.1).

RESULTS

Mean performance in all three verbal memory measures was significantly different from the controls in children with DLD+APD (digit span: p=0.0009; word span: p=0.0012; nonwords: p=0.05) and children with APD only (digit span: p=0.0037; word span: p=0.0006; non words: p=0.05). The set of memory measures (excluding the small and older group with lowered intelligence) went into a stepwise discriminate analysis. A significant group separation APD vs. non-APD was made by the subvocal rehearsal component of the phonological loop, as indicated by word span (F=14.40; p=0.0002) and digit span (F=2.87; p=0.0932). The rate of misclassification was 23%.

CONCLUSION

The present results raise the question of the validity of APD diagnostics which includes the phonological working memory on principle. It remains controversial whether the assessment of the cognitive function "phonological memory" should remain part of (C)APD diagnosis. Further research should aim to replicate the study with subjects of the same age and supplementary studies of the "central executive" and processing precision of the phonological store.

[Auditory verbal learning in children with suspected auditory processing deficits]

BACKGROUND

As unanimously found in several consensus papers, other conditions such as learning disorders need to be ruled out prior to labelling a child as having an auditory processing disorder (APD).

METHODS

In a retrospective study data from 386 children (245 boys, 141 girls) aged 6;0-9;11 years were investigated. All children were referred for behavioural problems suspected to be due to APD. The German auditory verbal learning test (Verbaler Lern- und Merkfähigkeitstest, VLMT) was administered. Results in a range of more than one/two standard deviations from the mean were regarded as deviant/pathological, while a test result under 15.8 was considered below normal.

RESULTS

The VLMT short term component was impaired in 202 children, the long term component (loss after interference) in 83 children and the recognition component in 298 children.

DISCUSSION

Compared with previously published results, our results suggest that approximately half of all children referred for APD diagnosis suffer from short-term memory deficit. We suggest the VLMT, and thus testing of short- and long-term memory skills, be administered routinely for thorough APD assessments.

Psychometric profile of children with auditory processing disorder and children with dyslexia

OBJECTIVE

The aim was to address the controversy that exists over the extent to which auditory processing disorder (APD) is a separate diagnostic category with a distinctive psychometric profile, rather than a reflection of a more general learning disability.

METHODS

Children with an APD diagnosis (N=25) were compared with children with dyslexia (N=19) on a battery of standardised auditory processing, language, literacy and non-verbal intelligence quotient measures as well as parental report measures of communicative skill and listening behaviour. A follow-up of a subset of children included a parent report screening questionnaire for Asperger syndrome (Childhood Asperger Syndrome Test).

RESULTS

There were similarly high levels of attentional, reading and language problems in both groups. One peculiarity of the APD group was a discrepancy between parental report of poor communication and listening skill disproportionate to expectations based on standardised test performance. Follow-up assessment suggested high levels of previously unrecognised autistic features within the APD group.

CONCLUSIONS

Children diagnosed by audiological experts as having APD are likely to have broader neurodevelopmental disorders and would benefit from evaluation by a multidisciplinary team.

[Sequential information processing in children with and without auditory processing disorder]

BACKGROUND

It is a controversial issue whether sequential processing in children with auditory processing disorders (APD) is a unimodal auditory impairment.

PATIENTS AND METHODS

Normal achieving controls (n=12; mean age: 101.1 months; SD 20.3) and children referred to clinical facilities for assessment including children with monosymptomatic APD (n=25; mean age: 90.8 months; SD 9.8), children with developmental language disorder (DLD]) + APD (n=11; mean age: 89.5 months; SD 14.9), children with dyslexia + APD (n=10; mean age: 113.8 months; SD 17.1) were compared using the subtest digit recall of the German version of the K-ABC (Melchers & Preuss 2001) and the K-ABC subtest hand movements in the visual modality.

RESULTS

On average all groups tended to perform alike in visual sequential processing and memory (T-score>50). Normal controls (non-APD) showed on average the best test performance (T-score 57.4; SD 10.5), but the mean performance did not differ significantly from children with APD. All groups also presented on average normal test performance in the auditory modality however, children of the clinical groups were below the age mean (DLD + APD: T-W 43.1; SD 6.8; monosymptomatic APD: T-W 45.8; SD 9.8; dyslexia + APD: 46.7; SD5.8). Children with DLD + APD and those with monosymptomatic APD exhibited a significantly lower but not poor performance in auditory processing of sequences compared to their performance in visual sequential processing. The results of auditory and visual processing of sequences were significantly correlated in the clinical groups DLD + APD (0.58) and monosymptomatic APD (0.34), but not in the smallest group dyslexia + APD (0.48) and in normal achieving controls (0.32).

CONCLUSION

On the basis of the results of the present study it may be concluded that a normal test performance on visual measure does not exclude a bimodal or pansensory seriation disorder in children with APD. It does, however, indicate the existence of a primary auditory sequential processing deficit, because at least the processing of phonological and visual stimuli was not separately carried out in children with DLD + APD.

[Gender-dependent differences in auditory verbal learning and memory skills in children?]

BACKGROUND

Girls tend to acquire language skills faster than boys do. Furthermore, specific language impairment and dyslexia are diagnosed more often in males than in females. We investigated whether auditory verbal learning skills in boys are inferior to those of girls as a possible cause for gender dependency in language acquisition.

METHODS

In a retrospective study, data from 386 children (245 male, 141 female) age 6 years to 9 years 11 months were investigated. The Auditory Verbal Learning Test (Verbaler Lern- und Merkfähigkeitstest) was administered.

RESULTS

After gender, age, and IQ matching, girls showed a small advantage in long-term memory and recognition.

DISCUSSION

Our results are in contrast to findings that suggest superior verbal memory and learning in adult females compared with males.

[Significance of auditory perceptual disorders for pediatric and adolescent psychiatric disorders]

The clinical relevance of central auditory processing disorders (CAPD) is highly controversial. The paper explicates different concepts of CAPD and reviews empirical studies of the relationship between auditory deficits and learning or psychiatric disorders. The overview of the available literature reveals that numerous authors have described subnormal auditory abilities in groups of children with developmental language disorders, dyslexia or ADHD. However, little or no relationship between the severity of clinical impairment and auditory deficits has been found. Thus auditory deficits do not appear to be causally related to learning disorders or conduct disorders. With respect to the diagnostic process the review makes clear that the validity of the diagnosis CAPD is low. There is no agreement about diagnostic criteria, and the reliability of most auditory tests in insufficient. Moreover, while an auditory training can only improve the directly trained auditory functions, there is no transfer effect to learning ability of behavior. Altogether there is little evidence for a significant relevance of CAPD in Child and Adolescent Psychiatry.