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

2. 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

3. 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)

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

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

6. 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.)

7. 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.

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

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

10. 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

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

12. History and Questionnaire

14. Age distribution of CAPD children
Audiology unit, Ain Shams University statistics ( )

15. Gender distribution of CAPD children
Audiology unit, Ain Shams University statistics ( )

16. Main complaint of CAPD children
Audiology unit, Ain Shams University statistics ( )

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

18. 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)

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

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

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

22. 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.

23. Factors affecting CAPD test results
Child
Audiologist
Test procedure

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

25. Audiologist
Knowledge
Training
Competence

26. Test procedure
Signal and presentation mode
Response mode

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

28. 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)

29. Dichotic tests

30. 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)

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

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

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

34. 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

35. Affected central auditory ability
Audiology unit, Ain Shams University statistics ( )

36. Cognitive abilities
Audiology unit, Ain Shams University statistics ( )

37. Isolated versus combined
Audiology unit, Ain Shams University statistics ( )

38. 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

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

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

41. Associated neuropsychiatry disorders
Audiology unit, Ain Shams University statistics ( )

42. 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.

43. Thank You