National Acoustic Laboratories, Sydney, Australia Prevalence and Remediation of Spatial Processing Disorder (SPD) in Aboriginal & Torres Strait Islander (ATSI) Children in Regional Australia Presented by Sharon Cameron Co-Authors Harvey Dillon, Helen Glyde Sujita Kanthan, Anna Kania XXXII World Congress of Audiology, Brisbane, May 2014

What is Spatial Processing Disorder (SPD)? SPD is a deficiency in the ability to use binaural cues to selectively attend to sounds arriving from one direction while suppressing sounds arriving from other directions. A major cause of difficulty understanding speech in noise in a percentage of normally-hearing children. One type of CAPD. Known cause (COM). 2

Diagnosing SPD with LiSN-S Speech-in-noise test Virtual auditory environment under headphones. Assesses ability to separate target stimuli from distracting stimuli that arrive from other directions. Target sentences (initially) at 62 dB from at 0°. Distracter stories at 55 dB from either 0º or ± 90° in same voice or different voices. Target adjusted adaptively with SRT averaged over maximum of 30 sentences. SPD determined by pattern measure score. 3

LiSN-S Scoring Matrix 4

LiSN-S results profile: SPD 5

Remediating SPD with LiSN & Learn Trains children to attend to a frontal target stimulus (0°) and filter out distracting talkers from left and right (±90°). Adapts to 70% performance level. SRT calculated over 40 sentences. Used in the home or (schools/clinics). Provides rewards, feedback, analysis and reporting. 10 dB improvement in SRT over 50 training sessions - 2 games x 5 days per week for 10 weeks ( Cameron & Dillon, 2011, Cameron et al, 2012). 6

LiSN & Learn- Training games 7

LC SRT p = Talker Advantagep = HC SRTp = Spatial Advantagep = Total Advantagep = LiSN-S Results - Pre- vs. Post-Training Cameron & Dillon (2011) 8

Research Results linking COM and SPD 6 year-olds with history of COM have below-average spatial advantage compared to norms (n = 17, p = 0.012, mean z = 0.1 ; range = -4 to 0.5) (Kapadia et al., 2012) year-olds with history of COM have below average spatial advantage compared to norms (n=20; p=0.004, mean z = -0.75) (Kapadia et al, 2014) year old children with history of COM were significantly worse on LiSN-S spatial advantage than age-matched controls (n = 35, p<0.001) (Tomlin & Rance, in press). Spatial advantage score significantly worse with early age of COM onset and increased duration (p=0.02 and p=0.03 respectively) (Tomlin & Rance, in press). 30% of children (15/50) previously diagnosed with COM taking part in a study at University of Melbourne were diagnosed with SPD (Graydon & Rance, ongoing). 10% of a population sample (9/90) of ATSI children from remote Australia diagnosed with SPD. (Unpublished data). 9

10 Interpretation Based on These and Other Studies Chronic otitis media Fluctuating access to binaural cues reduced effectiveness in spatial processing

11 ATSI children have higher rates of middle ear disease than have been described in any other population in the world. 2.6 years vs. 3 months for non-ATSI children. Middle ear abnormalities prevalent in between % of ATSI children. COM in ATSI Populations

12 Method N=144 ATSI children aged 6;0 to 12;12 years (mean 8;10) recruited from 4 government primary schools in Kempsey NSW. M = 69; F = 75. Additional n=13 excluded: SNHL, intellectual disability; unmedicated ADHD; ear discharge; conductive loss (4FAHL 40 dB; 4FAHL between ears >20 dB). Children with mild conductive loss assessed with LiSN-S PGA. Testing took place at each school in a quiet room (Leq in dB within LiSN-S permissible noise levels for testing). Ten participants (7%) presented with SPD as diagnosed with LiSN-S. Nine children with SPD took part in the LISN & Learn training program. Culturally appropriate rewards offered during training. The Listening Inventory for Education - Teacher (LIFE): Scale.

13 Distribution of Scores on LiSN-S (n=144) Cameron et al. (2014)

14 Distribution of Scores on LiSN & Learn (n=9) Cameron et al. (2014) Three children had suspected COM during training. These children were not calibrating the software each day. Once the teacher took over the calibration process the problem was resolved.

15 Distribution of Scores on LiSN-S (n=9) Cameron et al. (2014)

Post-Training LiSN-S Performance vs. LiSN & Learn Games Played Cameron et al. (2014) 16 N= 9 Mean = 65 games r = 0.71 p = 0.031, η 2 = 0.51

17 LiSN & Learn Pre- Training LiSN-S Pattern Z-score Post- Training LiSN-S Pattern Z-score Improvement in LiSN-S Pattern Z-score LIFE Teacher Appraisal IDAge Games Played SD Total Score * * * * LIFE Teacher Appraisal of Listening Ability Post-Training N= 9 Mean rating (SD 10). No significant correlation between rating and LiSN-S Pattern Z Score improvement (p = 0.797)

18 There is a high prevalence of SPD in the ATSI population. LiSN & Learn training is effective in remediating SPD in this population. LiSN & Learn training is considered a beneficial intervention by teachers. However improvement in spatial processing is dependent on training program uptake. Achieving the prescribed amount of training is challenging. Middle ear status and calibration procedure should be monitored during training. Conclusions

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