Diagnosis Of Auditory Processing Disorder Research Articles

Relationship Between Cognitive Abilities and Basic Auditory Processing in Young Adults.

The diagnosis of auditory processing disorder (APD) is controversial particularly due to the influence of higher order factors of language and cognition on the diagnostic APD testing. As a result, there might be a need for testing for other domains (e.g., cognition) along with conducting the diagnostic APD testing to rule out the influence of other domains. In order to make recommendations on whether cognitive testing is needed along with the auditory processing testing, as a starting point, the current study was conducted to examine the relationship between cognitive abilities and basic auditory processing in young adults. A total of 38 young adults with normal audiometric thresholds between 250 and 8000 Hz participated in this study. They were tested on their executive function, language, processing speed, working memory, and episodic memory components of cognitive testing and tests for temporal fine structure and spectrotemporal sensitivity for auditory processing testing. No significant correlation was found between the cognitive tests and the tests for basic auditory processing in young adults. These findings present contrast to the existing findings in children and older adults where a stronger correlation between cognitive abilities and auditory processing has been found. The current findings suggest that testing for cognitive abilities may not be needed when testing for basic auditory processing in young adults.

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.

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.

EPH73 Analyzing Mental Health Outcomes Among Pediatric Patients with Auditory Processing Disorder Caused By Head Trauma Using Real-World Data

Chronic traumatic encephalopathy (CTE) is linked to repeated head trauma, and although not diagnosed until post-mortem, symptoms include irritability, impulsivity, and mood changes. Repeated head trauma is also linked to the development of hearing complications, either by direct injury to the ear or the auditory cortex. Auditory processing disorder (APD) is a deficit in the brain’s ability to understand and interpret auditory stimuli and can result from head trauma. This study aims to ascertain whether the diagnosis of APD, following a specified number of head injuries, influences any subsequent diagnosis of mood or behavior disorders.

An Objective Approach Toward Understanding Auditory Processing Disorder.

Purpose In the field of audiology, auditory processing disorder (APD) continues to be a topic of ongoing debate for clinicians and scientists alike, both in terms of theory and clinical practice. In the current viewpoint, we first lay out the main issues that are central to the controversy surrounding APD, and then suggest a framework toward their resolution. Method The current viewpoint is informed by reviewing existing studies in the field of APD to better understand the issues contributing to the controversies in APD. Results We found that, within the current definition of APD, the two main issues that make the APD diagnosis controversial are (a) comorbidity with other disorders and (b) the lack of domain specificity. These issues remain unresolved, especially with the use of the existing behavioral APD test batteries. In this viewpoint, we shed light on how they can be mitigated by implementing the administration of an objective, physiological test battery. Conclusions By administering an objective test battery, as proposed in this viewpoint, we believe that it will be possible to achieve a higher degree of specificity to the auditory domain that will not only contribute towards clinical practice but also contribute towards strengthening APD as a theoretical construct.

Central Auditory Processing and Cognitive Functions in Children.

Introduction  Nowadays, there is no consensus on whether central auditory processing disorder is a primary or a secondary deficit to other cognitive deficits. A better understanding of the association between cognitive functions and central auditory skills may help elucidate this dilemma. Objective  To investigate possible associations between auditory abilities and cognitive functions in schoolchildren. Methods  Fifty-eight schoolchildren, aged between 8 years and 0 months old and 11 years and 11 months old, who underwent the following tests: masking level difference, gaps in noise, pitch pattern sequence test, dichotic digits test, sustained auditory attention ability test, Wechsler intelligence scale for children – IV, junior Hayling test, five digits test, and behavior rating inventory of executive function. Results  Significant correlations were found between the hearing ability of temporal resolution and executive functions, temporal ordering/sequencing, binaural integration and separation, and sustained auditory attention, operational memory, inhibitory control, and cognitive flexibility; binaural integration was also associated with intelligence. The statistically significant positive correlation found between the ability of binaural interaction and the components of emotional control and behavior regulation of the behavior rating inventory of executive function was unexpected. Conclusion  The associations identified reinforce the complexity of the tasks involved in the evaluation of central auditory processing and the need for multidisciplinary evaluation for the differential diagnosis of auditory processing disorder. Confirmation of the presence or absence of comorbidities between different disorders allows directing the therapeutic behaviors and reducing the impact of possible auditory and/or cognitive deficits in the different daily life situations of children.

Auditory processing disorder in children: the value of a multidisciplinary assessment.

Auditory processing disorder (APD) may affect 0.2-5% of the paediatric population. The diagnosis of APD remains difficult because of polymorphic symptoms possibly entangled with other difficulties. The purpose of this study was to evaluate a new multi-disciplinary assessment in the French language. The battery of tests was composed of: (a) APD targeted speech assessment: speech perception in noise, a dichotic test, temporal processing tests (patterns); (b) Psychometric assessment: sustained auditory attention, sustained visual attention, evaluation of cognitive functions; (c) phonemic identification and discrimination; (d) ENT examination, tonal and vocal audiometry and ABR recordings. The diagnosis was made if two of the targeted speech tests were 2 standard deviations (SDs) below the mean or if only one of the tests was 3 SDs below. The auditory attention tests, as well as the phonemic identification and discrimination tests were complementary to the diagnostic battery. However, they did not allow for the diagnosis of APD. 50 children suspected of APD benefited from this protocol, and 12 were excluded from the study. A diagnosis of APD was confirmed in 17 children (45%). 59% of the patients had associated disorders. The most effective tests for diagnosing APD were dichotic testing (p = 0.001) and pattern recognition (frequency, p = 0.001). The sustained auditory attention test (p = 0.01) and the phonemic identification and discrimination test reinforced the diagnosis of APD. It seems important to evaluate children suspected of APD with a multi-disciplinary protocol. It makes it possible to diagnose APD children, but also to identify attentional difficulties and cognitive disorders that may be associated.

A Digital Filter-Based Method for Diagnosing Speech Comprehension Deficits.

ObjectiveTo improve the diagnostic efficiency of current tests for auditory processing disorders (APDs) by creating new test signals using digital filtering methods.MethodsWe conducted a prospective study from August 1, 2014, to August 31, 2019, using 3 low speech redundancy tests with novel test signals that we created with specially designed digital filters: the binaural resynthesis test and the low pass and high pass filtered speech tests. We validated and optimized these new tests, then applied them to healthy individuals across different age groups to examine how age affected performance and to children with APD before and after acoustically controlled auditory training (ACAT) to assess clinical improvement after treatment.ResultsWe found a progressive increase in performance accuracy with less restrictive filters (P<.001) and with increasing age for all tests (P<.001). Our results suggest that binaural resynthesis and auditory closure mature at similar rates. We also demonstrate that the new tests can be used for the diagnosis of APD and for the monitoring of ACAT effects. Interestingly, we found that patients having the most severe deficits also benefited the most from ACAT (P<.001).ConclusionWe introduce a method that substantially improves current diagnostic tools for APD. In addition, we provide information on auditory processing maturation in normal development and validate that our method can detect APD-related deficits and ACAT-induced improvements in auditory processing.

Validity of the Multiple Auditory Processing Assessment-2: A Test of Auditory Processing Disorder.

Purpose A normative study using the Multiple Auditory Processing Assessment-2 (MAPA-2; Schow et al., 2018) was recently completed. With access to these data, the authors extend that work and support a definite construct for auditory processing disorder (APD). The goal here is to examine MAPA-2 reliability and validity (construct, content, and concurrent). Evidence for the APD construct is further buttressed by measures of sensitivity and specificity. Results of MAPA-2 testing on children diagnosed with learning disability (LD), attention-deficit/hyperactivity disorder (ADHD), and specific language impairment (SLI) are included. Method Normative data (previously published as the MAPA-2) allowing derivation of these findings included a representative sample of 748 children (53% girls) ages 7-14 years tested by 54 speech-language pathologists and audiologists in 27 U.S. states. The authors examined diagnostic accuracy based on the American Speech-Language-Hearing Association (2005) criteria (index test) for confirmed cases of APD. The index was also used to identify listening problems for three other diagnostic categories (LD, ADHD, and SLI). Validated questionnaire responses from parents and school personnel allowed incorporation of functional measures widely supported in APD diagnosis but unavailable with other normative and sensitivity/specificity studies. Results Reliability and validity were both satisfactory, and diagnostic accuracy for an APD group of 18 (28% female) compared to the remaining typical group of 625 yielded 89% sensitivity and 82% specificity. The remaining three groups (LD, ADHD, and SLI), where comorbidity was expected to be about 50%, had APD-type listening problems with a prevalence ranging from 52% to 65%. Conclusions Current results provide important evidence for the construct of APD. The MAPA-2 can be administered by an audiologist or speech-language pathologist. A similar diagnostic protocol in Australia yielded positive therapeutic gains. Further study is encouraged to determine if the present positive findings will be found in future research.

[Central auditory processing in adolescents with communication impairments].

Zusammenfassung Hintergrund  Berufsbildungswerke (BBW) sind Einrichtungen der beruflichen Rehabilitation und Bildung, vergleichbar mit Förderschulen im schulischen Bereich. Das BBW Leipzig registriert seit einigen Jahren eine zunehmende Anzahl von Jugendlichen mit der Diagnose auditive Verarbeitungs- und Wahrnehmungsstörung (AVWS). Für diese Zielgruppe gibt es derzeit nur wenige Testverfahren mit Referenz- oder Normwerten. Ziel war die Untersuchung der auditiven Verarbeitung und Wahrnehmung von peripher hörgesunden Jugendlichen mit vorhandenem Testmaterial. Material und Methoden  35 normalhörende Jugendliche (26 männlich, 9 weiblich, im Mittel 18,1 Jahre) aus dem BBW Leipzig wurden mit folgenden Tests untersucht: dichotisches Hören, Sprachverstehen im Störgeräusch, Verstehen zeitkomprimierter Sprache, Phonem-Differenzierung und -Analyse. Zusätzlich wurden sprachfreie Intelligenz, Konzentration, figurale Merkfähigkeit und die sprachlichen Leistungen getestet. Ergebnisse  25 Jugendliche zeigten zentral-auditive Auffälligkeiten; 5 von ihnen hatten keine AVWS-Diagnose aus der Kindheit. Bei 9 der 25 Jugendlichen konnten die Auffälligkeiten nicht auf übergeordnete Störungen zurückgeführt werden. Diese Jugendlichen waren vor allem in der Wahrnehmung gesprochener Sprache sowie im Halten und Manipulieren sprachlicher Reize im Arbeitsgedächtnis eingeschränkt, obwohl die sprachlichen Fähigkeiten unauffällig waren und die Intelligenz normal bis überdurchschnittlich war. Diskussion  Die Ergebnisse zeigen, dass Jugendliche auffällig im Sinne der AVWS-Kriterien der DGPP sein können und dass nicht zwingend schon eine AVWS-Diagnose aus der Kindheit vorliegen muss. Außerdem wurde deutlich, dass die multiprofessionelle Diagnostik wichtig bleibt. Standardisierte Testverfahren mit entsprechenden Altersnormen werden benötigt.

Auditory processing, co-morbidities, and parental report of sleep disturbance in children with auditory processing disorder (APD)

ObjectivesTo evaluate the prevalence of sleep disturbance and its relationship with auditory processing (AP) and co-morbidities in children diagnosed with auditory processing disorder (APD). MethodsData from 109 children (Males = 59, Females = 50) with mean non-verbal intelligence quotient (NVIQ) of 89.44 (SD:18.16), aged between 6 and 16 years (mean: 10 years 7 months; SD: 2 years 9 months) with a diagnosis of APD were analysed. Participants performed ≤1.33 SD below the mean in two or more out of five SCAN-3 diagnostic APD tests that included ‘Filtered Words’ (FW), ‘Auditory Figure Ground 0 dB’ (AFG0), ‘Competing Words-Directed Ear’ (CW-DE), ‘Competing Sentences’ (CS) and ‘Time Compressed Sentences’ (TCS). Concern about sleep in addition to other symptoms and medical history were documented from structured parental history sheet which forms part of the routine APD assessment. Language impairment (LI), attention-deficit-hyperactivity-disorder (ADHD) and oppositional defiant disorder (ODD), and anxiety were evaluated using the ‘Children's Communication Checklist-2’ (CCC-2), ‘Swanson Nolan and Pelham rating scale’ (SNAP-IV) and ‘Anxiety Scale for Children-Autism Spectrum Disorder’ (ASC-ASD) respectively. ResultsSixty children had sleep disturbance, a prevalence of 55% (95% CI 45.2%–64.6%). The two groups of APD children, with (n = 49) and without sleep (n = 60) disturbance, did not vary in their auditory processing abilities. The sleep disturbed group had significant issues with pragmatic language impairment, hyperactivity/impulsivity, oppositional defiant symptoms and anxiety compared to the group without sleep disturbance when they were analysed separately. After the variables were considered in step wise fashion in binary logistic regression analyses, only pragmatic language impairment and anxiety predicted sleep disturbance (p < .01). ConclusionIn APD the prevalence of sleep disturbance is high, justifying screening within a transdisciplinary APD assessment protocol. Sleep disturbance in APD is predicted by pragmatic language impairment and anxiety, but not by ADHD symptoms or ODD.

Absence of Rhythm Benefit on Speech in Noise Recognition in Children Diagnosed With Auditory Processing Disorder.

Auditory processing disorder (APD) is a specific deficit in the processing of auditory information along the central auditory nervous system. It is characterized mainly by deficits in speech in noise recognition. APD children may also present with deficits in processing of auditory rhythm. Rhythmic neural entrainment is commonly present in perception of both speech and music, while auditory rhythmic priming of speech in noise has been known to enhance recognition in typical children. Here, we test the hypothesis that the effect of rhythmic priming is compromised in APD children, and further assessed for correlations with verbal and non-verbal auditory processing and cognition. Forty APD children and 33 neurotypical ones were assessed through (a) WRRC, a test measuring the effects of rhythmic priming on speech in noise recognition, (b) a battery of auditory processing tests, commonly used in APD diagnosis, and (c) two cognitive tests, assessing working memory and auditory attention respectively. Findings revealed that (a) the effect of rhythmic priming on speech in noise recognition is absent in APD children, (b) it is linked to non-verbal auditory processing, and (c) it is only weakly dependent on cognition. We discuss these findings in light of Dynamic Attention Theory, neural entrainment and neural oscillations and suggest that these functions may be compromised in APD children. Further research is needed (a) to explore the nature of the mechanics of rhythmic priming on speech in noise perception and why the effect is absent in APD children, (b) which other mechanisms related to both rhythm and language are also affected in this population, and (c) whether music/rhythm training can restore deficits in rhythm effects.

[Guideline: Auditory processing and perception disorders: Proposal for treatment and management of APD : S1 guideline of the German Society of Phoniatrics and Pediatric Audiology].

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. In patients with hearing loss, this must first be compensated or resolved. Only hereafter can a suspected APD be confirmed or excluded. Diagnosis of APD requires that a clear discrepancy between the child's performance in individual auditory functions and other cognitive abilities be demonstrated. Combination of therapeutical modalities is considered particularly more beneficial in APD patients than a single modality. Treatment modalities should consider linguistic and cognitive processes (top-down), e.g., metacognitive knowledge of learning strategies or vocabulary expansion, but also address underlying auditory deficits (bottom-up). Almost 50% of children with APD also have a language development disorder requiring treatment and/or dyslexia. Therefore, each therapeutic intervention for a child with APD must be individually adapted according to the diagnosed impairments. Musical training can improve phonologic and reading abilities. Changes and adaptations in the classroom are helpful to support the weak auditory system of children with APD. Architectural planning of classrooms can be a means of ensuring that direct sound is masked by as little diffuse sound as possible. For example, acoustic ceiling tiles are suitable for reducing reverberant and diffuse sound.

Auditory training methods in children with psychiatric diagnosis: an integrative literature review

ABSTRACT Purpose: to identify auditory training approaches used in the pediatric population with psychiatric diagnoses and to characterize the contexts in which the intervention took place, as well as protocols and discernment of the results. Methods: a search was carried out in four databases, using the fixed terms "auditory training" OR "auditory rehabilitation". Regarding the sampling, there was a considerable range of diagnoses, signs and symptoms, including the most common ones. Articles published until August 2018 whose population did not present hearing loss were selected; articles whose subjects had made use of any personal sound amplification products, presented otitis or had any isolated diagnosis of auditory processing disorder, were excluded. Results: 16 articles out of the 103 references found, met the inclusion criteria. The samplings studied were children and adolescents with learning, language or reading disorders, dyslexia, attention deficit hyperactivity disorder, autism spectrum disorder and schizophrenia. The bottom-up intervention and the combined approach (bottom-up and top-down), in the formal context, were the most frequent approaches, whose results led to the improvement in linguistic, metalinguistic and auditory skills. The amount and frequency of sessions, as well as their duration varied. Conclusion: the heterogeneity of auditory training techniques diversified the results. However, it seems there is a potential for recommending auditory training in the reviewed population.

Auditory processing disorders in incarcerated youth: A call for early detection and treatment

BackgroundNumerous reports have linked language impairment, academic underachievement, and attention disorder to misbehavior in adolescence. Recent studies have found an association between deficits in hearing and auditory processing and involvement in the juvenile justice system. In fact, the existence of an auditory processing disorder (APD) is a risk factor for adolescent delinquency even in the presence of normal hearing. The nexus between APD, low academic achievement and offending behavior in teens has prompted recommendation for early screening of school children for abnormalities in auditory processing. Using a variety of diagnostic tools, investigators have found an increase in the frequency of APD in cohorts of confined youthful offenders. The present investigation evaluates the prevalence of APD in a group of incarcerated youth residing in a detention center. MethodsA total of 52 incarcerated adolescents (8 females and 44 males; age range 13–20 (M = 16.0), residing at a juvenile detention center in Pittsburgh, Pennsylvania and determined to have normal auditory acuity were included in the study. All participants were screened for APD using two dichotic listening tests, the Randomized Dichotic Digits Test (RDDT) and the Dichotic Words Test (DWT), evaluative modalities to identify deficits in auditory processing. The prevalence of APD in the study group was compared to previously published normative data for non-offending age-matched youth. ResultsOn the RDDT, 23.1% of participants demonstrated normal auditory processing, while 77% had abnormal test results. On the DWT, 75% of subjects exhibited normal auditory processing, while the scores were abnormal for 24.9%. When the results of the RDDT and the DWT were combined to establish a pattern for the purpose of interpreting a deficit, 21.1% of the participants produced results that were within normal limits, while 17.3% qualified for a diagnosis of APD, with abnormal results on both tests. Previous studies have estimated the prevalence of auditory processing disorder in the general adolescent population as being between 2% and 7%. ConclusionsThis study found a higher prevalence of auditory processing disorder in a cohort of incarcerated youth compared with age-matched controls. Diagnostic screening protocols that identify at-risk children have been developed, as have effective therapies to improve auditory processing function. Teachers, pediatricians and psychologists should consider APD in children and adolescents with behaviors that may increase their risk for juvenile justice involvement. Studies on optimal timing and strategies for assessing and treating APD in children and adolescents are needed, including youth caught up in the juvenile justice system.

Development and standardization of the University of Cincinnati Auditory Processing Inventory (UCAPI)†

Objective: A literature review found that questionnaires for persons with problems of listening seeking assessment of auditory processing skills are not applicable for adolescents and adults. We developed a questionnaire designed for adolescents and adults seeking evaluation of problems with listening or following diagnosis to determine the subject’s status.Design: Following a model described by Del Zoppo, Sanchez, and Lind, a 34-item questionnaire was developed that investigates auditory processing abilities in six common areas of complaint in Auditory processing disorders (APD) (Keith, et al. 2017).Sample:The questionnaire was administered to 278 typically-achieving young adults and normative values of performance were developed. Validation data were acquired from 3 studies of subjects with language-learning or auditory processing disorders.Results:The total UCAPI score found by combining the totals from the six listening conditions provides an overall value to categorise listening abilities. The listening conditions provide an auditory profile for the person being evaluated. Finally, UCAPI scores obtained from subjects with a previous diagnosis of APD were substantially poorer than typical subjects, data that provide evidence of the validity of questionnaire validity.Conclusions: Results from the UCAPI can be useful to professionals in helping to make recommendations when diagnosing problems of learning through listening, as well as aid in developing management strategies.

Auditory processing and neuropsychological profiles of children with functional hearing loss

ObjectivesThis paper compares structured history, auditory processing abilities and neuropsychological findings of children with functional hearing loss (FHL) to those with suspected auditory processing disorder without FHL (control). The main aim was to evaluate the value of a holistic assessment protocol for FHL used in a routine pediatric audiology clinic. The protocol incorporated a commercially available test battery for auditory processing disorder (APD), non-verbal intelligence (NVIQ) and tools to screen for common co-existing neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD), language impairment (LI) and developmental coordination disorder (DCD). The outcome of such holistic assessment was expected to help in understanding the nature of FHL and to provide individualized support to mitigate their difficulties. MethodsThis retrospective study compared two groups, 40 children (M = 17, F = 23) in each group between seven and sixteen years of age, one group with a history of FHL and the other with suspected APD without FHL (control). The groups were matched against age, gender, hand use, diagnosis of APD or non-APD (31 with APD and 9 without APD in each group) and non-verbal intelligence. All the children were healthy English speaking children attending mainstream schools with no middle or inner ear abnormalities. Structured history was obtained from parents regarding different nonacademic and academic concerns. The SCAN-3:C and SCAN-3:A test batteries were used to assess auditory processing abilities; Lucid Ability test for NVIQ; Children's Communication Checklist-2 (CCC-2) for language ability; Swanson Nolan and Pelham-IV Rating Scale (SNAP-IV) for ADHD; and the manual dexterity components of the Movement Assessment Battery for Children-2 (MABC-2) as a screening tool for DCD. ResultsAbout 60% of children in both the groups had concerns regarding listening in noisy background. In the history, poor attention was reported in 45% of children in the FHL group compared to 82.5% in the control group (p < 0.01). Hyperacusis was present in 35% of children in the FHL group and in 62% of children in the control group (p < 0.05). Concerns about overall academic abilities were present in 59% of children in the FHL group and 75% of the controls (p > 0.05). Only 15% of children in the FHL group had concerns with numeracy skills in contrast to 41% of the controls (p < 0.05). Significantly fewer (p < 0.01) children in the FHL group (41%) received additional support at school than the controls (75%). Fewer children performed poorly in Filtered Words (FW) test of the SCAN-3 batteries, 30% in the FHL group and 17.5% in the control group, in contrast to Auditory Figure Ground 0 (AFG0), 85% in FHL and 80% in the control group. The number of children performing poorly in AFG0 was significantly higher compared to all the other SCAN-3 tests in FHL (P < 0.05), in contrast to FW and Competing Sentences (CS) only in the control group (p < 0.05). The control group had higher prevalence of atypical ear advantage (AEA) in left directed Competing Words (CW) (32.5%) and Time Compressed Sentences (TCS) (32.5%) compared to FW (7.5%). In contrast, FHL group had higher prevalence of AEA in AFG0 (48.7%) compared to CS (21%). High proportions of children in both the groups had LI (80% in FHL and 82.5% in the control group), with significantly lower (p < 0.05) levels of ADHD symptoms in the FHL group (39.5%) compared to the control group (72.5%). Impaired manual dexterity was present in 30.7% of children in FHL group and 47.5% in the controls. ConclusionsThe prevalences of APD and language impairment are high compared to ADHD symptoms in children with FHL, and holistic assessment is recommended. Despite some similarities in the auditory and neuropsychological profiles between children with FHL and those with suspected APD without FHL some differences were noted. The results suggest that children with FHL have genuine difficulties that need to be identified and addressed. Future research is required to identify the neural pathways which could explain the similarities and dissimilarities between the two groups.

Response to the Letter to the Editor From Moncrieff (2017) Regarding de Wit et al. (2016), "Characteristics of Auditory Processing Disorders: A Systematic Review".

The purpose of this letter is to respond to Moncrieff's (2017) letter to the editor, "Response to de Wit et al., 2016, 'Characteristics of Auditory Processing Disorders: A Systematic Review,'" published in May 2017 by the Journal of Speech, Language, and Hearing Research. We believe that our original conclusions are valid given the limited evidence that is currently available about the etiology of auditory processing disorders (APD). The focus of our systematic review was to identify the characteristics of children with a diagnosis of APD or a suspicion of APD. The results of our study showed that the characteristics of these children are not specific or limited to the auditory modality but are multimodal instead. In our view, it is incorrect to use the diagnosis APD, because there is not necessarily a specific auditory deficit in a large group of children suffering from listening difficulties. Before we start using any new diagnoses, a better insight into how bottom-up and top-down processes are precisely involved in listening needs to be developed. In addition, more insight is needed with respect to the similarities and differences between the different developmental disorders of children.

Referral and Diagnosis of Developmental Auditory Processing Disorder in a Large, United States Hospital-Based Audiology Service.

Children referred to audiology services with otherwise unexplained academic, listening, attention, language, or other difficulties are often found to be audiometrically normal. Some of these children receive further evaluation for auditory processing disorder (APD), a controversial construct that assumes neural processing problems within the central auditory nervous system. This study focuses on the evaluation of APD and how it relates to diagnosis in one large pediatric audiology facility. To analyze electronic records of children receiving a central auditory processing evaluation (CAPE) at Cincinnati Children's Hospital, with a broad goal of understanding current practice in APD diagnosis and the test information which impacts that practice. A descriptive, cross-sectional analysis of APD test outcomes in relation to final audiologist diagnosis for 1,113 children aged 5-19 yr receiving a CAPE between 2009 and 2014. Children had a generally high level of performance on the tests used, resulting in marked ceiling effects on about half the tests. Audiologists developed the diagnostic category "Weakness" because of the large number of referred children who clearly had problems, but who did not fulfill the AAA/ASHA criteria for diagnosis of a "Disorder." A "right-ear advantage" was found in all tests for which each ear was tested, irrespective of whether the tests were delivered monaurally or dichotically. However, neither the side nor size of the ear advantage predicted the ultimate diagnosis well. Cooccurrence of CAPE with other learning problems was nearly universal, but neither the number nor the pattern of cooccurring problems was a predictor of APD diagnosis. The diagnostic patterns of individual audiologists were quite consistent. The number of annual assessments decreased dramatically during the study period. A simple diagnosis of APD based on current guidelines is neither realistic, given the current tests used, nor appropriate, as judged by the audiologists providing the service. Methods used to test for APD must recognize that any form of hearing assessment probes both sensory and cognitive processing. Testing must embrace modern methods, including digital test delivery, adaptive testing, referral to normative data, appropriate testing for young children, validated screening questionnaires, and relevant objective (physiological) methods, as appropriate. Audiologists need to collaborate with other specialists to understand more fully the behaviors displayed by children presenting with listening difficulties. To achieve progress, it is essential for clinicians and researchers to work together. As new understanding and methods become available, it will be necessary to sort out together what works and what doesn't work in the clinic, both from a theoretical and a practical perspective.

Is there a relationship between perceptual difficulties and auditory functioning at the periphery and the brainstem in children suspected with auditory processing disorder?

The test battery typically used for the diagnosis of auditory processing disorder (APD) is highly heterogeneous, with an emphasis on the central auditory nervous system. As such, the peripheral auditory system is typically only screened for the presence of an overt hearing loss. Our previous work suggested that children suspected of APD (sAPD) have atypically sharp cochlear tuning when measured using stimulus frequency otoacoustic emission (SFOAE) group delay. In the present work, we extend our previous findings and test the hypothesis that cochlear tuning influences auditory brainstem response (ABR) latencies. Our hypothesis is based on filter theory, which suggests that a sharper filter will take longer to build-up and ring longer. We predicted that sharper cochlear filters in sAPD should result in delayed ABR wave latencies and will be associated with poorer performance on speech perception tests. Preliminary data from 16 sAPD and 6 typically developing children show a positive correlation between cochlear tuning and ABR peak I latency. Cochlear tuning explains a significant proportion of the variance in ABR peak I latency (R2 = 0.25). Further behavioral results and implications for inclusion of auditory peripheral examination in APD tests will be discussed.