1. Multidisciplinary Diagnosis of (C)APD: Panel Discussion Teri James Bellis, Ph.D. The University of South Dakota Vermillion, SD USA

2. Case #1: Age 4 years, 1 month History of chronic otitis media beginning in first year of life; PE tubes precluded further OAE testing Play skills appropriate Fine and gross motor skills appropriate

3. No apparent developing phonological system in place Could combine 2-3 ASL signs with verbalizations Verbalizations seemed to preserve prosodic qualities of speech Had had SLP intervention for 2 ½ years

4. Imitation and/or approximation of speech sounds when looking at the clinician Significantly better imitation/ use of motor actions, including sign

5. Behavior very similar to a child with a significant hearing impairment Normal peripheral hearing sensitivity confirmed through conditioned play audiometry/OAEs

6. Recommendation: Electrophysiologic evaluation to rule out auditory neuropathy or similar disorder ABR normal bilaterally

7. C4; R & L Ears C3; R & L Ears Pre-training MLR Age: 4 years, 2 months Na Pa

8. Normal Cortical Potentials in Children From: Sharma, Kraus, McGee, & Nicol (1997). Electroenceph. Clin. Neurophys., 104, 540-545.

9. Pre-training Corticals (C3) (C4) P1 N1b

10. Conclusions and Recommendations: Results suggested abnormal neurophysiologic representation of acoustic stimuli, consistent with (C)APD Recommended intensive computer- based auditory training, 45 minutes per day, 5 days per week throughout 8-week summer session Auditory training to focus on both perception and production of auditory stimuli

11. Earobics training daily; Target = verbal imitation of stimuli, mouse controlled by clinician Goals: –Improve phonological awareness (discrimination, synthesis, etc.) and phoneme production/ imitation skills simultaneously

12. Immediate Post-Training (4 years, 4 ½ months) Spontaneous eye contact during conversation 100% of the time Turned to voice 100% of the time Imitation of vowels, CV syllables with 100% accuracy Approximation of CVC words with some final phoneme deletions or appropriate inflection, but incorrect phonemes

13. At 4 years, 6 months Significant improvement in auditory comprehension 100% imitation of sounds, words, gestures Dozens of new words, including verbs, nouns, adjectives Semantic relations with 90% accuracy

14. Plural /s/ and progressive /ing/ with 80% accuracy Use of “in” and “on” with 100% accuracy Imitation of multi-word sentences

15. Post-training MLR 4 years, 9 months Ipsilateral (C4/A2) Contralateral (C3/A2) Pa Na C4; R & L Ears C3; R & L Ears Na Pa Na Pa

16. Post-training Corticals (C4) (C3) P1 N1b P1 N1a

17. By 4 years, 10 months Spontaneous use of multi-word sentences with appropriate syntax Kahn Phonological Analysis: –Phonological development at approximately 3.5 years of age –Errors developmental in nature

18. Conclusions Intensive auditory training combining perception with production resulted in significant, rapid improvement in auditory comprehension and expressive skills.

19. Behavioral observations were accompanied by a concomitant improvement in the neurophysiologic representation of acoustic stimuli.

20. Case #2

21. P300 reduced, other electrophysiology normal Auditory fusion, speech and nonspeech discrimination probably normal, though some inconsistency in performance Continuous performance (auditory and visual) – high error rate Impression: Higher-order, likely attention-based disorder