Exam 1 (Assessment Part 1) Flashcards
1
Q
describe the CAPD eval team
A
audiologists
SLPs
psychologists
social workers
parents
physician
2
Q
audiologists role
A
manage & coordinate evaluations; performs audiologic assessment to rule out peripheral hearing loss
3
Q
SLP role
A
assesses receptive/expressive language skills, phonological skills & written language abilities
4
Q
psychologists role
A
assesses cognitive skills & capacity for learning
5
Q
social worker roel
A
serves as a liaison between home and school if needed
6
Q
parents role
A
proved prenatal and neonatal history, informational about developmental milestones, auditory behavior and medical and academic history
7
Q
physician role
A
rules out a medical pathology that may affect learning abilities
8
Q
Who is responsible for evaluating and diagnosing CAPD?
A
audiologists
9
Q
is it best to use a test battery or one test for diagnosing CAPD
A
test battery
10
Q
Why should CAPD testing use a test battery and not a single sensitive diagnostic test?
A
CAPD is not one disorder
Clinical presentations can vary resulting from a number of mechanisms and auditory processes affected
Different measures are required for accurate assessment of central auditory processes
Multiple assessment measures can also help to establish more appropriate management for CAPD
11
Q
what is a test battery
A
Includes a # of tests used to diagnose a certain condition
12
Q
Questions to ask to ensure diagnostic accuracy & usefulness
A
Does the battery improve sensitivity & specificity over using individual tests
How many tests are needed to obtain optimal sensitivity/specificity
13
Q
How many tests are needed to obtain optimal sensitivity/specificity
A
Max sensitivity requires 2-3 tests in a CAPD test battery
14
Q
lax criteria
A
better sensitivity and poor specificity
15
Q
strict criteria
A
better specificity and poor sensitivity
16
Q
what is the reason behind lax criteria
A
As the test batter sizes increases it leads to a greater probability that a PT will fail any single test
It improves sensitivity but can undermine specificity as normal patients have an increased chance of being incorrectly identified
for ex: PT is more likely to fail one test when a battery has 10 tests as compared to when it has 2-4 tests
17
Q
reason behind the strict criteria
A
As the test battery size increases there is less probability that a PT will fail all tests
Good to detect normal function & improves specificity but can undermine sensitivity as PTs w/ abnormal function will be less likely to fail the entire battery when more tests are included
For example, a patient is more likely to fail all tests when a battery has 2 to 3 tests as compared to when it has 10 tests
18
Q
intermediate test criteria
A
Most reliable criteria
Abnormal performance on at least 2 tests (> 2 SD below mean)
Abnormal performance on at least 1 test (> 3 SD below mean)
19
Q
tests with relatively low sensitivity/specificity are useful diagnostic indicators of CAPD
A
false
not useful
20
Q
CAPD Test Battery Considerations
A
tests with relatively low sensitivity/specificity are not useful diagnostic indicators of CAPD
tests should demonstrate test-retest consistency and age-appropriate norms
tests requiring extensive training, time & client practice are not appropriate for most clinical settings
age appropriate
Shouldn’t be test driven but motivated by the referring complaint and relevant info available to use
Be sensitive to language development; motivational level; fatigability; attention and other cognitive factors; the influence of mental age; cultural influences; native language; and socioeconomic factors
21
Q
Individuals who are medicated successfully for attention, anxiety, or other disorders that may confound test performance can be tested when on medication
A
true
22
Q
ASHA recommends other tests
A
Discrimination and electrophysiologic tests like OAEs, ARTs, & AERs
23
Q
dichotic processes tests
A
dichotic digits
competing sentences
SSI0CCM
SSW
24
Q
temporal processes tests
A
gaps in noise
random gap detection
duration pattern test
pitch pattern test
25
binaural interaction tests
auditory fusion
masking level difference
26
monaural low redundancy speech/auditory closure processes tests
NU6 filtered words
time compressed sentences
SSI-ICM
speech in noise tests
27
dichotic processe
Different speech stimuli is presented to each ear simultaneously (CVC, monosyllabic words, digits, or sentences
Can assess binaural integration or binaural separation
Sensitive to lesions of CC (if CC is involved) & cerebral cortex
28
divided attention
repeat stimuli heard in both ears
29
selective attention
ignore what is heard in one ear and repeat back what is heard in the target ear
30
free recall
used to prevent attention factors from contaminating results
repeating words back without regard to which ear heard it
31
Temporal processes & pattern tests
Monotic presentation used to assess each ear independently
Stimulus is usually tones not speech
Temporal processing also includes temporal resolution
assess pattern perception & temporal functioning abilities
32
Temporal pattern tests assess pattern perception & temporal functioning abilities including
Feature detection abilities
Frequency/duration discrimination
Acoustical pattern and contour recognition
33
Temporal pattern tests are more sensitive to
compromised right hemisphere
34
If the test requires a verbal response it is then sensitive to
left hemisphere lesions
35
Binaural interaction/fusion processes
Binaural - stimuli is presented to each ear at the same time
Each ear cannot be independently assessed
presented in either a non-simultaneous, sequential manner or only a portion of the message is presented to each ear
assess integration between two ears
36
auditory brainstem plays a key role in combining and processing different pieces of auditory information into a cohesive and unified perception
true
binaural fusion
37
Monaural low redundancy speech/auditory closure processes
These speech tests involve modification (distortion) of the acoustic (extrinsic) signal to reduce the amount of redundancy
The degraded speech stimuli are presented by modifying frequency, temporal, or intensity characteristics to reduce redundancy
These tests are not sensitive to brainstem lesions
38
The degraded speech stimuli are presented by modifying frequency, temporal, or intensity characteristics to reduce redundancy and are
Sensitive to auditory closure abilities
Moderately sensitive to cortical lesions
39
Speech is a redundant signal
true
40
how to decide which tests to include in a test battery?
tests that provide the best diagnostic value individually and in combination should be included
41
what are clinical decision analysis
statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests
42
what is clinical decision analysis (CDA)
statistical measures that can be applied to individual and combinations of tests to determine maximum diagnostic value of tests
43
what does CDA include
sensitivity and specificity, receiver operant curves (ROC) & factor analysis
44
what is factor analaysis
technique used to reduce a large number of variables into fewer numbers of factors
45
what is a gold standard
Best test considered the current preferred method of diagnosing a particular disease
46
CAPD and gold standard
CAPD - gold standard group has the disorder & control group doesn’t
Logic - if CAPD is a disorder of CANS then it is inferred that individuals with lesions to the system should perform poorly on CAPD tests - reductionist model
47
what is the reductionist model
CAPD - gold standard group has the disorder & control group doesn’t
Logic - if CAPD is a disorder of CANS then it is inferred that individuals with lesions to the system should perform poorly on CAPD tests - reductionist model
48
Children suspected of CAPD don’t have diagnosed neurological lesions of the CNS as seen in the experimental group
true
49
what was the bruton conference
Concluded that 3 test domains for CAPD should be measured using behavioral tests
50
what were the 3 test domains for CAPD
Auditory pattern/temporal ordering (APTO) tests
Monaural separation closure (MSC)
Binaural integration/binaural separation (BIBS)
51
what was Binaural integration/binaural separation (BIBS)
can you separate and integrate information from the left and the right ear
52
what was Auditory pattern/temporal ordering (APTO) tests
pitch pattern sequence test (frequency discrimination), gap detection
53
what was Monaural separation closure (MSC)
Can you close (noise in the environment) in individual ears
54
what is Multiple Auditory Processing Assessment (MAPA)
Test battery that was developed in an effort to develop a quas-behavioral gold standard for CAPD
55
CAPD behavioral tests in 4 important auditory processing areas
Dichotic processes, temporal processes, binaural interaction, & monaural low redundancy speech/auditory closure processes
56
what are the recommended eval for CAPD
Case hx
Pre-test standardized questionnaires
CHAPS; SIFTER; Fisher etc.
Behavioral measures
Pure tone audiometry
Speech audiometry
CAPD behavioral tests in 4 important auditory processing areas
Other tests as needed like SIN tests
Electrophysiological measures
Immittance audiometry (including acoustic reflex thresholds)
Otoacoustic emissions (TEOAEs or DPOAEs) - done to rule out anything else or if there are issues in the inner ear
ABR, mid- and late-latency auditory evoked responses
Psychoeducational evaluation
Speech and language evaluation
Prenatal and postnatal
Developmental
Medical
academic
failed grades
current academic performance
areas of strength/weakness
special education services
Family
e.g., genetic, medical, first degree relatives with developmental disorders
Social
shy, aggressive, friendly etc.
plays/interacts comfortably with peers; prefers younger children/adults
Results of other evaluations, for example,
psychoeducational; s/l evaluation
Work history; if patient is an adult
57
advantages to screening tests
Fewer demands on the healthcare system
More accessible
Less invasive & dangerous
Less expensive
Less time-consuming
Less physically & psychologically uncomfortable for the PTs
58
what does chaps stand for
The Children’s Auditory Performance Scale
59
what is the The Children’s Auditory Performance Scale (CHAPS)
Ages >/= 7yrs
Includes 36 item checklist divided into 6 listening conditions and functions with each item scored on a 7 point scale
Used by teachers and parents
60
what is the objective of CHAPS
Evaluates listening behaviors in diverse listening situations
Parents/teachers assess child’s ability in comparison to child’s peers
Used as part of a screening process to identify children experiencing listening difficulties because of
Hearing loss and (C)APD
61
what does SIFTER stand for
Screening Instrument for Targeting Educational Risk
62
what is Screening Instrument for Targeting Educational Risk (SIFTER)
Ages 1st-5th grade
Completed by the teater
Includes 15 questions; 3 in each of 5 category areas
Academics, attention, communication, class participation, and social behavior
=
63
5 category areas of the SIFTER
Academics, attention, communication, class participation, and social behavior
64
objective of the sifter
Educationally screening students with known or suspected HL
Classroom teacher compares child’s functional ability to peers
Can be used to track child’s performance over time
65
Fisher’s Auditory Problem Checklist
Provides info on child’s functional listening abilities in a classroom
Completed by teachers
Has 25 items and each is worth 4%
Place a checkmark beside observed behaviors and those that are not selected are multiplied by 4 to determine a total %
66
how does fishers itemize behaviors
Failure to attend to instructions
Need for repeated instructions
Easy distraction by auditory stimuli
Degrading processing in a competing acoustic environment
Also addresses attention and memory issues
Several questions related to language-based deficits such as discrimination ability
67
when to refer in fishers
<72$
68
disadvantages of fishers
Small number of listening items
Doesn’t take into account listening behaviors of children with CAPD depending on different listening environments
includes various skills that are part of auditory processing behaviors but it does not specifically question the influence of the environment on these auditory skills
69
relationship bw 3 screeners
Poor ability of the 3 screening tests to predict the individua lLow-Pass Filtered Speech (LPFS); Competing Sentences (CS); Two-Pair Dichotic Digits (DD); Frequency Patterns with Linguistic Report (FP)
The CHAPS, SIFTER, and TAPS–R should be used to highlight concerns about a child but not to determine whether a diagnostic (C)APD assessment is warranted
70
The benefits of having effective screening tools includes
overall reduced costs, reduced over-referrals, time savings, and increased efficiency of identification/intervention for (C)APD
71
why are we pushing for FM systems? what happens when SNR increases
sound is more audible making it easier for them to hear
it keeps their attention, provides direct auditory input so they don’t have to tune out the background noise
the signal that is louder is easier to listen to because they do not have the ability for auditory figure ground
72
what does PSI stand for
pediatric speech intelligibility test
73
authors of PSI
Jerger & Jerger
James & Susan:
both audiologists
James is the father of modern audiology & a lot of tests are devised by him
Susan was a ped audiologists
74
what does psi assess
Auditory figure-ground - ability to hear in noise
Auditory closure - ability to fill in the blanks; context, ability to understand speech by filling in missing or distorted parts of an acoustic signal
Insensitive to normal developmental differences between cognitive skills
Takes into account the normal developmental differences between kids and doesn’t impact the test because typically developing kids all have different skills
Sensitive to the presence of CAPD
Able to pick up CAPD
Able to distinguish between those with central auditory lesions and those with non-auditory central lesions
75
PSI site of lesion
sensitive to lower BS deficits
76
Standard MCR condition for psi words
+4 dB MCR
77
if the signal is 30, the masker would be _____ in PSI words
26 (30-4 MCR)
78
Moderate to high sensitivity to CAPD
PSI
79
ages for PSI
3-6yrs
80
language information for the PSI
Low redundancy speech
speech that has been altered to reduce extrinsic cues, such as competing signals or noise
Time, pitch, intensity
Linguistically loaded
Language based
81
format I of PSI ages
3-4 yrs
82
format II of PSI ages
5-6yrs
83
what is ICM for PSI
psilateral → signal and masker are presented in the same ear
10 dB MCR
0 dB MCR (only perform on one ear)
84
what is CCM for PSI
Contralateral → signal and masker are presented in different ears
-20 dB MCR
0 dB MCR
85
PL for PSI
For children >/=3.6yrs PL is 30 dB SL + SRT?
For children
86
scoring for PSI
Stop testing after 5 if
they get a 5/5 or a ⅘ → ceiling
they get either none or ⅕ → floor (worst they can do)
✓ = correct
x = incorrect
87
ICM PSI norns
0 dB MCR
<80% → outside normal range
>80% → normal range
10 dB MCR
<100% → outside normal range
100% → normal range
88
CCM RLL I PSI norms
RLL I → Format 1 → -20 dB MCR
<70% → outside normal range
>70% → normal range
89
CCM RLL II PSI Norms
RLL II → Format 2 → -20 dB MCR
<90% → outside normal range
>90% → normal range
90
CCM PSI Norms
0 dB MCR
<100% → outside normal range
>100% → normal range
91
what does ACPT stand for
auditory continuous performance test
92
author of dog etst
keith 1994
93
ages for ACPT
6-12 yrs
94
what is the ACPT
Binaural test
ADHD screening exam
Consists of word identification of the word DOG in a series of familiar monosyllabic words that do not tax a child’s linguistic and cognitive abilities
Like toy, face, teach etc.
95
what does ACPT test
Selective attention → indicated by correct responses to specific linguistic cues
Can they listen to what they are supposed to
Correct responses to the word dog
Sustained attention → indicated by the child’s ability to attend and concentrate on a task for a prolonged time
Can they maintain their attention for a long period of time
96
selective attention
indicated by correct responses to specific linguistic cues
Can they listen to what they are supposed to
Correct responses to the word dog
97
sustained attention
indicated by the child’s ability to attend and concentrate on a task for a prolonged time
Can they maintain their attention for a long period of time
98
impulsivity
responses to words other than dog
99
inattention
missed responses to dog
100
what does SCAN-3:C stand for
screener for central auditory nervous system
101
what is teh SCAN3-C
Identifies APD in kids in areas of temporal processing, listening in noise, dichotic listening, and listening to degraded speech
102
author of SCAN
Keith 2009
103
ages for scan
5-12.11 yrs
Need to have passed screening hearing test at 1,2, & 4kHz bilaterally with normal hearing
NO ME disorders identified by tymps
104
3 screening tests of SCAN
Gap detection
Ages 8-12.11yrs
Tests temporal resolution
Binaural test → most others are not binaural
Site of lesion
Not linguistically loaded
Auditory figure ground +8dB
Signal and background noise
Hear two sets of words and have to respond to the target words
Competing words-Free Recall
Less attention based
Can repeat the words in any order
dichotic test
105
Diagnostic tests of SCAN
Auditory figure ground +8dB
Filtered words
Competing words-directed ear
Must repeat the words back in the correct order
Competing sentences
106
supplementary test for SCAN
Competing words-free recall
Auditory figure ground 0dB
Auditory figure ground +12dB
Time compressed signal
107
this screening test measures the ability to detect brief silent gaps of variable durations between tone pairs
gap detection
108
this test is used to assess the ability to process speech in the presence of background noise with signal 8dB greater than the multi-talker speech
used as a screening & diagnostic
AFG +8dB
109
test used to assess the ability to process competing speech signals by presenting monosyllabic words to each ear simultaneously
used as a screener and supplementary assessment
competing words fre recall
110
used to assess the ability to process distorted speech by presenting monosyllabic words low-pass filtered at 750Hz
diagnostic test
filtered words
111
test used to assess ability to process competing speech signals by presenting a monosyllabic word to each ear simultaneously
diagnostic test
competing words directed ear
112
test used to assess the ability to process competing speech signals by presenting pairs of unrelated sentences to the R & L ears
diagnostic test
competing sentences
113
used to assess ability to process degraded speech by presenting sentences that have been time compressed at 60%
supplementary test
time compressed sentences
114
ages for gap detection
8-13yrs
115
describe the gap detection test in SCAN
screener
Temporal resolution/processing disorders - screens for disorders of timing within the auditory system
Site of lesion → binaural assessment
not linguistically loaded
116
describe AFG +8
screener
ages 5-12.11
monaural
117
what are the 3 screeners for SCAN
AFG +8
Gap detection
competing words free recall
118
describe CWFR
screener
ages 5-12.11
linguistically loaded
binaural - dichotic
assesses auditory maturation or develoipmental delay
119
Children who fail AF +8 should receiver further assessment for
SIN listening needs (Dichotic listening → BS level @ SOC or central level @ CC)
120
Children who fail CW-FR should be referred for further assessment
true
dichotic tests → info in regards to maturation of auditory neurological pathways or SCAN-3:C → CW-DE & CS can be done
121
describe filtered words
Low-pass filtered words
monaural
linguistically loaded
assesses auditory closure skills and auditory processing abilities in poor listening environments
122
describe competing words directed ear
binaural
linguistically loaded
assesses dichotic listening, developmental and maturation of auditory system
123
describe competing sentences
binaural
linguistically loaded
assesses Assesses: development and maturation of the auditory system and hemispheric specialization
124
how do you make speech low redundancy
alter time, pitch or intensity
125
high redundancy
speech has not been altered
126
examples of low redundancy
filtering - frequency changes
noise in environment - affecting audibility and snr goes down (intensity)
timing - speed things up (compressed the same words in a shorter time frame)
127
The higher the difference between presentations 1 & 6 the greater the risk of ADHD
true
128
what is the scale score? why do we need it
raw - difficult to compare across individuals, what does the score mean for this age?
scale - balances the scoring so you can compare a particular kid or score to that age group
129
confidence interval
With what confidence can I say these test aresults are valid & correct
allows you to determine with 90% or 95% probability or confidence that a certain range of scores contain a hypothetical “true” score within that range
130
what is the scaled score chart in SCAN
Helps parents, teachers, etc to interpret the tests
Shows the scores they are supposed to score for each test
131
results in meaningful interpretation of auditory processing abilities
Interpreting test battery scores carefully
Look at the pattern of test scores
Consider other factors like
Info from parents/caregivers
Behavioral observations during testing
Child’s med hx
Child’s academic performance
132
what is ear advantage
Mathematical difference between r and l ear raw scores
133
REA
+ value
134
LEA
- value
135
The more extreme/atypical REA the greater the possibility of an auditory based language or learning disorder
true
136
why is ear advantage important
Determines possible hemispheric dominance for language and neurologically based language learning disorders
137
what does significant LEA abnormal indicate
Can indicate poor localization of hemispheric function related to language disorder
138
what are scaled scores
normative scores specifically used to compare child’s performance to their same age peers
139
typically developing auditory systems & ear advantage
Higher RE scores for all dichotic listening tests on SCAN
CWDE, CWFR, CS
Similar RE & LE scores for all monaural degraded tests on SCAN
AFG, FW, TCS
*higher scores for dichotic because they are utilizing both hemispheres so the CC is integrating information & functioning appropriately
140
REA is minimal by early adolescents (~12 years) and typically disappears by late adolescence (~18 years)
true
141
