CAPD: ”Behavioral assessment” Dr Amani shalaby Professor of Audiology Ain Shams university

Definition of CAPD CAPD is the auditory system mechanisms and processes responsible for the following behavioral phenomena: Sound localization and laterlization. Auditory discrimination. Auditory pattern recognition

Definition of CAPD ( cont.) Temporal aspect of audition, including: temporal resolution temporal masking temporal integration temporal ordering Auditory performance decrements with competing acoustic signals. Auditory performance decrements with degraded acoustic signals. (ASHA, 1996, 2005)

Central Auditory abilities Auditory Discrimination. Auditory localization. Auditory closure. Binaural interaction Auditory selective attention. Binaural separation. Binaural integration

Central Auditory abilities (Cont.) Temporal Processing * Temporal ordering * Temporal resolution * Temporal integration * Temporal masking

Other auditory Abilities Attention and memory for auditory information. Auditory synthesis. Phonological awareness. Comprehension and interpretation of auditory information. (higher order cognitive- communicative and /or language related functions.)

When to suspect the presence of CAPD in a child Difficulty in following instructions. Difficulties in understanding speech in background noise. Localization problems. Attention and memory problems. Scholastic underachievement.

Impact of CAPD on Children Communication problems. Academic problems. Social problems. Emotional problems. Behavioral problems.

Diagnosis is challenging Heterogeneous group. One or more ability affected. Tools for testing were not available to test -Children. -Egyptian culture.

Objectives of CAPD Assessment: To detect the presence of CAPD To identify the affected abilities To assess the level of CAPD To identify associated disorders To design an appropriate intervention plan for CAPD

Diagnosis of CAPD Detailed history taking Comprehensive questionnaire Psychosocial evaluation Basic audiological evaluation * Pure tone audiometry * Speech audiometry * Immittancemetry

History and Questionnaire

Age distribution of CAPD children Audiology unit, Ain Shams University statistics (1995-2005)

Gender distribution of CAPD children Audiology unit, Ain Shams University statistics (1995-2005)

Main complaint of CAPD children Audiology unit, Ain Shams University statistics (1995-2005)

Psychophysical or behavioral testing Challenge the intrinsic redundancy of CANS by changing the extrinsic redundancy of the signal.

I= 2tw log S+N / N I= information in a speech signal t= duration of signal w= width of frequency band S= amplitude of the signal N= just noticeable difference of intensity of signal over the background noise or refrence (Calearo and Lazzaroni, 1957)

Diagnosis of CAPD (cont.) Central test battery Psychophysical tests Electrophysiological tests

Diagnosis of CAPD (cont.) Selection criteria of CAP tests Factors affecting CAPD test results Types of CAPD tests

Selection criteria of CAP tests Validity Reliability Specificity and sensitivity Age appropriate Culture appropriate

Development of Arabic test battery for diagnosis Collection of Arabic test materials pertinent to Egyptian children’s vocabulary and culture. Standardization of test materials on normal Egyptian children.

Factors affecting CAPD test results Child Audiologist Test procedure

Child Effect of age Effect of peripheral hearing loss Motivation Communicative competence Effect of socioeconomic status Intellectual abilities

Audiologist Knowledge Training Competence

Test procedure Signal and presentation mode Response mode

Psychophysical tests Monaural low redundancy speech test Dichotic speech tests Auditory temporal processing and patterning tests Binaural interaction tests Auditory discrimination tests

Monaural low redundancy tests Low Pass Filtered speech (LPF) Speech In Noise (SPIN) Synthetic Sentence Identification test with Ipsilateral Competing Message (SSI-ICM) Time Compressed speech (TC)

Dichotic tests

Dichotic tests Dichotic Digits (DDT) Dichotic Consonant Vowels (DCV) Staggered Spondaic words (SSW) Competing Sentence test (CST) Dichotic Rhyme (DR) Dichotic Sentence Identification ( DSI) Synthetic sentence Identification with Contralateral Competing Message (SSI-CCM)

Binaural interaction Masking Level Difference (MLD) Binaural fusion (BF) Rapidly Alternating Speech Perception (RASP)

Auditory discrimination tests Auditory Discrimination tests (ADT) specifically measures auditory discrimination skills for fine differences. * Difference Limen for Frequency * Difference Limen for Intensity

Temporal processing tests Pitch Pattern Sequence test (PPST) Duration Pattern test (DPT) Auditory Fusion test (AF) Time compressed speech (TC)

Central test battery results PPS CST SPIN LPF O X 100% 95 90 O 85 X 80 75 70 65 60 55 50 45 40 35 30 25 20 15 10 5 O: Right ear X: Left ear Shaded area: normal range

Affected central auditory ability Audiology unit, Ain Shams University statistics (1995-2005)

Cognitive abilities Audiology unit, Ain Shams University statistics (2002-2005)

Isolated versus combined Audiology unit, Ain Shams University statistics (1995-2005)

Interpretation of test results Absolute or norm based Relative or patient based -comparison of pattern within a given test -comparison of trends observed across the tests -comparison of results observed across diagnostic test and results from non-audiological disciplines

Multidisciplinary assessment involving other professionals is mandatory in order to: Determine the functional impact of CAPD. Presence of any associated disorders.

Multidisciplinary assessment Speech and language Neuropsychological Educational Investigations Laboratory investigation Genetic evaluation Radiological studies

Associated neuropsychiatry disorders Audiology unit, Ain Shams University statistics (1998-2005)

Summary No one, easy, right answer to the CAPD question exists. The complexity of the “problem” reflects the complexity and heterogeneity of the disorder. Hence, an individual approach must be taken for the selection of diagnostic measures and the interpretation of the results.

Thank You