Cluster Analyses Reveals Subgroups of Children With Suspected Auditory Processing Disorders.

Mridula Sharma,Suzanne C Purdy,Peter Humburg

doi:10.3389/fpsyg.2019.02481

Abstract

BackgroundSome children appear to not hear well in class despite normal hearing sensitivity. These children may be referred for auditory processing disorder (APD) assessment but can also have attention, language, and/or reading disorders. Despite presenting with similar concerns regarding hearing difficulties in difficult listening conditions, the overall profile of deficits can vary in children with suspected or confirmed APD. The current study used cluster analysis to determine whether subprofiles of difficulties could be identified within a cohort of children presenting for auditory processing assessment.MethodsNinety school-aged children (7–13 years old) with suspected APDs were included in a cluster analysis. All children had their reading, language, cognition and auditory processing assessed. Parents also completed the Children’s Auditory Performance Scale (CHAPS). Cluster analysis was based on tasks where age-norms were available, including word reading (Castles and Coltheart irregular and non-words test), phonological awareness (Queensland University Inventory of Literacy), language [Comprehensive Language of Assessment-4, Comprehensive Assessment of Spoken Language (CASL)], sustained attention (Continuous Performance Test), working memory (digits forward and backward), and auditory processing [Frequency Pattern Test (FPT), Dichotic Digits Test (DDT)]. Hierarchical cluster analysis was undertaken to determine the optimal number of clusters for the data, followed by a k-means cluster analysis.ResultsHierarchical cluster analysis suggested a four-group solution. The four subgroups can be summarized as follows: children with (1) global deficits, n = 35; (2) poor auditory processing with good word reading and phonological awareness skills, n = 22; (3) poor auditory processing with poor attention and memory but good language skills, n = 15; and (4) poor auditory processing and attention with good memory skills, n = 18.ConclusionThe cluster analysis identified distinct subgroups of children. These subgroups display the variation in areas of difficulty observed across different studies in the literature (e.g., not every child with APD has an attention deficit), highlighting the heterogeneous nature of APD and the need to assess a range of skills in children with suspected APD. It would be valuable for future studies to independently verify these subgroups and to determine whether interventions can be optimized based on these subgroups.

Highlights

Some school-aged children appear to not hear well in difficult listening situations such as the classroom, in the absence of a hearing loss based on pure tone audiometry (Purdy et al, 2018)
Auditory processing includes the ability of the auditory system to localize, discriminate, recognize auditory patterns, and discriminate temporal aspects of sounds (American Speech and Hearing Association [ASHA], 1996; Jerger and Musiek, 2000)
In the current study auditory, cognitive, reading, and language abilities of children with suspected auditory processing disorder (APD) were assessed and cluster analysis was used to determine whether the results revealed distinct subgroups of children

Summary

Introduction

Some school-aged children appear to not hear well in difficult listening situations such as the classroom, in the absence of a hearing loss based on pure tone audiometry (Purdy et al, 2018) These children are often described as having problems hearing in noise, needing to have instructions repeated, being unable to follow verbal instructions and having generally poor listening skills (Chermak et al, 2002). Some of these children show co-existing reading difficulties and/or attention deficits (Richardson et al, 2004; Sharma et al, 2009; Tomlin et al, 2015) These children are initially tested for hearing loss and in the absence of any audiometric hearing loss they should be referred for auditory processing assessment (Jerger and Musiek, 2000). The current study used cluster analysis to determine whether subprofiles of difficulties could be identified within a cohort of children presenting for auditory processing assessment

Methods

Results

Discussion

Conclusion