Auditory frequency discrimination is correlated with linguistic skills, but its training does not improve them or other pitch discrimination tasks

Central Auditory Processing Dysfunction in Service Members and Veterans: Treatment Considerations and Strategies

PURPOSE

Military risk factors such as blast exposure, noise exposure, head trauma, and neurotoxin exposure place Service members and Veterans at risk for deficits associated with auditory processing dysfunction. However, there is no clinical guidance specific to the treatment of auditory processing deficits in this unique population. We provide an overview of available treatments and their limited supporting evidence for use in adults, emphasizing the need for multidisciplinary case management and interdisciplinary research to support evidence-based solutions.

METHOD

We explored relevant literature to inform the treatment of auditory processing dysfunction in adults, with emphasis on findings involving active or former military personnel. We were able to identify a limited number of studies, pertaining primarily to the treatment of auditory processing deficits through the use of assistive technologies and training strategies. We assessed the current state of the science for knowledge gaps that warrant additional study.

CONCLUSIONS

Auditory processing deficits often co-occur with other military injuries and may pose significant risk in military operational and occupational settings. Research is needed to advance clinical diagnostic and rehabilitative capabilities, guide treatment planning, support effective multidisciplinary management, and inform fitness-for-duty standards. We emphasize the need for an inclusive approach to the assessment and treatment of auditory processing concerns in Service members and Veterans and for evidence-based solutions to address complex military risk factors and injuries.

Training allows switching from limited-capacity manipulations to large-capacity perceptual processing

In contrast to perceptual tasks, which enable concurrent processing of many stimuli, working memory (WM) tasks have a very small capacity, limiting cognitive skills. Training on WM tasks often yields substantial improvement, suggesting that training might increase the general WM capacity. To understand the underlying processes, we trained a test group with a newly designed tone manipulation WM task and a control group with a challenging perceptual task of pitch pattern discrimination. Functional magnetic resonance imaging (fMRI) scans confirmed that pretraining, manipulation was associated with a dorsal fronto-parietal WM network, while pitch comparison was associated with activation of ventral auditory regions. Training induced improvement in each group, which was limited to the trained task. Analyzing the behavior of the group trained with tone manipulation revealed that participants learned to replace active manipulation with a perceptual verification of the position of a single salient tone in the sequence presented as a tentative reply. Posttraining fMRI scans revealed modifications in ventral activation of both groups. Successful WMtrained participants learned to utilize auditory regions for the trained task. These observations suggest that the huge task-specific enhancement of WM capacity stems from a task-specific switch to perceptual routines, implemented in perceptual regions.

Training-induced improvement in working memory tasks results from switching to efficient strategies

It is debated whether training with a working memory (WM) task, particularly n-back, can improve general WM and reasoning skills. Most training studies found substantial improvement in the trained task, with little to no transfer to untrained tasks. We hypothesized that training does not increase WM capacity, but instead provides opportunities to develop an efficient task-specific strategy. We derived a strategy for the task that optimizes WM resources and taught it to participants. In two sessions, 14 participants who were taught this strategy performed as well as fourteen participants who trained for 40 sessions without strategy instructions. To understand the mechanisms underlying the no-instruction group's improvement, participants answered questionnaires during their training period. Their replies indicate that successful learners discovered the same strategy and their improvement was associated with this discovery. We conclude that n-back training allows the discovery of strategies that enable better performance with the same WM resources.

Short-term memory capacity and sensitivity to language statistics in dyslexia and among musicians

Poor short-term memory (STM) capacity in individuals with dyslexia (IDDs) and enhanced STM capacity in musicians are well documented, yet their causes are disputed. Previous studies also found poor use of stimuli statistics by IDDs and enhanced use by musicians. We hypothesized that these observations are functionally related, as follows: Enhanced sensitivity to statistics facilitates musicians' benefit from each exposure, and reduced sensitivity to statistics hinders IDDs' benefit. Thus, larger group differences are expected for larger exposure: STM capacity, which is sensitive to item familiarity, will thus be larger among musicians, and smaller among IDDS, particularly for high-frequency items. Testing this hypothesis using syllable span, we found that musicians' advantage and IDDs' difficulty were indeed larger for high-frequency syllables than for low-frequency ones. By contrast, benefits from sequence repetition did not differ between musicians, controls and IDDs, suggesting that online sequence learning is based on a different mechanism. To test this dissociation we recruited, in addition to native Hebrew speakers, native English speakers, matched to the Hebrew-speaking controls. Their spans for high-frequency syllables in Hebrew, which do not have high frequency in English, were small - as expected from reduced exposure to these syllables. Yet, their benefit from sequence repetition was similar to that of the three Hebrew-speaking groups. Taken together, these experiments suggest that different sensitivities to item frequency explain some of the population-related variability in STM tasks. By contrast, benefits from sequence repetition do not depend on item familiarity, and do not differ between groups.