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AUDE 6240 (CAPD) > Final Exam > Flashcards

Final Exam Flashcards

1
Q

why is capd still a controversial issue

A

Due to the definition, etiology, signs and symptoms, treatment, and outcomes

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2
Q

what complicates the diagnosis of CAPD

A

Question of whether it is a separate and distinct disorder or a disorder of non-auditory processes
Example: cognition, language, memory, and attention that are not only tightly intertwined, but also closely integrated with auditory perception

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3
Q

what are the results of capd’s uncertain diagnosis

A

Not in the DSM-V
Not a disability/disorder allowed in Individualized Education Plan (IEP)
Those diagnosed only with CAPD may have accommodations under the 504 plan

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4
Q

what is a 504 plan

A

Spells out the modifications/accommodations needed for students who have an opportunity to perform at the same level as their peers
This includes wheelchair ramps, blood sugar monitoring, a peanut-free lunch environment, home instruction, a keyboard for taking notes, etc.

Section 504 of the Rehabilitation Act and Americans with Disabilities Act (ADA)
No one with a disability can be excluded from participating in federally funded programs or activities, including elementary, secondary, or postsecondary schooling

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5
Q

what is a disability

A

refers to a physical/cognitive impairment, which substantially limits one or more major life activities

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6
Q

examples of disabilities

A

Physical impairments; illnesses or injuries; communicable diseases; chronic conditions like asthma, allergies, diabetes; and learning problems

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7
Q

what is an IEP

A

individualized education plan

Falls under Individuals with Disabilities Education Act (IDEA), federally mandated, and associated with providing educational services
Those that are eligible are a small subset of all students with disabilities who require more than a level playing field
Need significant remediation and assistance
More likely to work at their own level and pace even in an inclusive classroom

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8
Q

disabilities that are eligible for IEP

A

Autism
Deaf-blindness
Deafness
Developmental delay
Emotional disturbance
Intellectual disability
Multiple disabilities
Orthopedic impairment
Traumatic brain injury (TBI)
Visual impairment, including blindness
Hearing impairment
Speech or language impairment
Developmental learning disability (DLD)
Other health impairment
Limited strength, vitality, or alertness, with respect to the educational environment that adversely affects educational performance and includes
Chronic or acute health problems such as asthma, ADHD, diabetes, epilepsy, heart conditions, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome

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9
Q

difference between an IEP & 504 plan

A

504: Falls under Section 504 of the Rehabilitation Act of 1973, a civil rights law that ensures equal access to education by providing accommodations
Broader eligibility; includes any disability that substantially limits one or more major life activities (e.g., learning, walking, concentrating).
Does not require the student to need specialized instruction, only accommodations.
Suitable for students who can succeed in a general education environment with accommodations

IEP: Governed by the Individuals with Disabilities Education Act (IDEA). Provides specialized instruction and services to meet a child’s unique educational needs
More educational needs
Must have 1 of 13 specific disabilities listed under IDEA (autism, hearing impairment, specific learning disabilities, etc.) and must impact their ability to learn in a general education setting requiring specialized instruction
Best for students needing individualized, intensive educational support

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10
Q

No universally agreed-upon criteria for failure of a CAPD test battery

A

true

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11
Q

lax criteria

A

Abnormal performance on a single test (> 2 SD below mean)

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12
Q

strict criteria

A

Abnormal performance on all tests (> 2 SD below mean)

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13
Q

intermediate criteria

A

Abnormal performance on at least 2 tests (> 2 SD below mean)
Abnormal performance on at least 1 test (> 3 SD below mean)

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14
Q

American Academy of Audiology Guidelines 2010

A

Abnormal performance on at least one ear for 2 tests (> 2 SD below mean)

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15
Q

Wilson & Arnott 2013 retrospective analysis conclusion of 150 children with normal hearing based on AAA 2010, ASHA 2005 & BSA 2011

A

Clinicians provide explicit statement of the criteria used for diagnosis
Not enough data supporting use of (C)APD as a global label

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16
Q

how do you score total GIN score and its norms

A

Total correct number minus false positives ÷ (60 X 100) (one ear)
Total correct number minus false positives ÷ (120 X 100) (two ears)
Total score cut off for percent correct
< 52% (8 to 11 yrs.) (> 52% is normal)
Total score norms not currently reported for 7 y.o.
< 54% (12 yrs. to adults) (> 54% is normal)

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17
Q

norms for gap threshold

A

Normal = < 4 to 6 ms
Concern = > 8 ms

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18
Q

RGDT norms

A

normal: < 20 ms
no matter the age

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19
Q

long MLD norms

A

normal: > 14 dB HL

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20
Q

short MLD normss

A

Normal: > 10 dB HL

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21
Q

what is the definition of CAPD

A

CAPD is a complex heterogenous bottom up perceptual disorder affecting the auditory system
it can present differently from child to child

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22
Q

what is sound localization

A

ability to identify where a sound is coming from in space
duplex theory
ITD
provides localization for low frequency stimulus
ILD
provides localization for high frequency stimulus

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23
Q

what does a deficit look like for sound localization

A

difficulty in spatial awareness, following multi-speaker conversations and maintaining attention in a classroom

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24
Q

what is temporal processing

A

ability to process timing aspects of a sound (e.g., the order or rate of sounds)
ability to detect changes over time between two brief stimuli

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25
what does a deficit in temporal processing look like
challenges in auditory discrimination and resolution affecting reading, spelling, and writing due to difficulty distinguishing phonemes or following rapid speech ex: distinguishing /pa/ from /ba/ affects reading fluency and comprehension due to impaired phonemic awareness
26
what is auditory figure ground
ability to focus on a signal of interest in the presence of background noise
27
deficit in auditory figure ground
difficulty understanding speech in noisy environments leading to challenges in classroom discussions or group learning
28
what is auditory closure
ability to fill in the missing pieces of auditory information fill in the blanks
29
what does a deficit in auditory closure look like
perform poorly on tests that assess auditory closure low pass filtered speech tests speech in nois tests time compressed speech tests difficulty understanding speech in noisy or degraded auditory conditions affects language learning and comprehension issues with language acquisition and vocabulary development phonemic decoding may be affected
30
what is auditory analysis
ability to break down auditory information into its components (e.g., syllables or phonemes) important for distinguishing verb tenses and other morphological markers that may be acoustically distorted or masked by background noise
31
why is auditory analysis important
important for distinguishing verb tenses and other morphological markers that may be acoustically distorted or masked by background noise
32
what does a deficit in auditory analysis look like
challenges with decoding crucial for reading and spelling reading difficulties
33
what is auditory memory
ability to remember auditory information for short or long periods of time
34
what does a deficit in auditory memory look like
poor ability to follow multi-step verbal instructions or remember sequences impacts classroom performance
35
what is auditory sequential memory
recall the order of a series of acoustic stimuli phone numbers, ID numbers, etc.
36
what is auditory short term memory
retain and recall auditory information as it is immediately presented
37
what is frequency resolution
ability of the auditory system to distinguish different frequencies in a sound signal even those that are close together tested using PPST
38
what does a deficit in frequency resolution look like
phonemic processing and suprasegmental cues (intonation, stress, rhythm etc.) crucial for language comprehension and expression
39
what is auditory binaural integration
ability to combine auditory information received by both ears into a unified perception enhances sound clarity, localization and understanding especially in noise relies on the precise timing and intensity cues from both ears to interpret spatial and spectral differences
40
what does a deficit in auditory binaural integration look like
issues understanding speech in complex auditory environments (noise), poor localization, reduced ability to focus on target speaker in group settings leads to challenges working in groups or listening in noisy classes, increased listening fatigue, inability to follow multi-speaker discussions
41
what is dichotic processing
ability to process different auditory stimuli presented simultaneously to each ear. Requires strong interhemispheric communication via the corpus callosum for effective integration and comprehension.
42
what tests dichotic processing
dichotic listening tasks, where each ear receives distinct, competing signals (e.g., words, digits).
43
what does a deficit in dichotic processing look like
Difficulty distinguishing or remembering competing auditory inputs. Left or right ear suppression during dichotic listening tasks, often reflecting hemispheric dominance or interhemispheric transfer issues leads to Trouble processing simultaneous auditory information (e.g., teacher talking while classmates converse). Struggles with tasks requiring split attention or multitasking
44
CHAPS
Children’s Auditory Performance Scale ages >/= 7yrs
45
SIFTER
Screening Instrument for Targeting Educational Risk ages 1st through 5th grade
46
PSI
Pediatric Speech Intelligibility 3-6yrs format I: 3-4 yrs; carrier phrases format II: 5-6yrs; no carrier phrase
47
ACPT
Auditory Continuous Performance Test ages 6-11yrs
48
SCAN 3C
ages 5-13yrs gap detection: 8-13 yrs
49
SCAN 3A
ages 13-51
50
What are the behavioral screeners
PSI, ACPT, SCAN 3C & SCAN 3A
51
what are the monaural tests
GIN PPST DPT SSI ICM & CCM
52
what are the binaural tests
ssw dichotic digits RGDT MLD LISNS
53
GIN
Gaps in Noise ages 7yrs to adults
54
PPST
Pitch Pattern Sequence Test ages 7rs to adults
55
DPT
duration pattern sequence test ages >9yrs to adults difficult test for younger children
56
SSI
synthetic sentence identification - ICM & CCM ages 8yrs to adults
57
SSW
Staggered Spondaic Word Test ages 5 to 70yrs
58
dichotic digits
ages 7yrs to adults single digits: 5-7 yrs
59
RGDT
random gap detection test ages 5-12yrs
60
MLD
masking level difference ages 5yrs to adult???
61
LISN-S
ages 6 yrs to 30yrs Listening in Spatialized Noise—Sentences test
62
what does ACPT assess
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
63
what tests assess s binaural integration or binaural separation
dichotic digits (cerebral level) - integration competing sentences SSW - both integration & separation SSI-CCM: separation - temporal lobe
64
sensitive to lesions of the CC and cerebral cortex left ear deficits for CC involvement
dichotic processes
65
Temporal pattern tests assess
pattern perception & temporal functioning abilities
66
temporal processing and temporal resolution tests
GIN - resolution PPST - sequencing RGDT - resolution DPT - sequencing
67
tests used to assess the integration between two ears
MLD - BS level binaural interaction
68
Auditory recognition, memory and figure ground Lower brainstem lesions
SSI ICM
69
. Monaural Low Redundancy Speech/Auditory Closure Processes tests
NU-6 Filtered words Time compressed sentences SSI-ICM speech in noise tests
70
Which (C)APD test result patterns help with a definitive diagnosis of (C)APD
Must rule out other modalities first before CAPD diagnosis unilateral left ear deficit is more specific and most common pattern on CAPD test battery
71
what is a test battery
Includes a # of tests used to diagnose a certain condition
72
Why should CAPD testing use a test battery and not a single sensitive diagnostic test?
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
73
another definitive test battery pattern
reduced performance only on the ore difficult auditory portion of the test implies an auditory deficit versus linguistic, cognitive or strictly attention deficits
74
Does (C)APD qualify for an IEP or a 504 and why?
disorders in DSM V are real disorders and are easy to get reimbursement for but if they are not then it is not easy to do because we do not have a well defined clinical diagnostic base singular diagnosis of CAPD = NO IEP but possibly a 504 CAPD in addition to another diagnosis (speech or reading etc.) = IEP & 504 IEP is more educational and created by an interdisciplinary team & 504 is so you can succeed in an educational setting (civil)
75
is CAPD top down or bottom up
capd is bottom-up primarily auditory perceptual deficiencies
76
is adhd top down or bottom up
ADHD is top down global attention/executive functioning disorder
77
describe top down processing
conceptually driven processin Concept-driven, from the "top" (cognition) to the "bottom" (sensory input) Processing guided by prior knowledge, experience, and expectations to interpret sensory information occurs any time a higher-level concept influences the interpretation of lower-level sensory data
78
how does top down processing work
Uses existing knowledge and context to interpret stimuli. Fills in gaps or disambiguates unclear sensory information. Auditory: Understanding speech in a noisy room based on context and familiarity with the language.
79
example of top down processing
reading a partially obscured sentence and filling in missing words based on context
80
bottom up processing
aka data-driven processing Data-driven, from the "bottom" (sensory input) to the "top" (higher cognitive processing) A form of information processing that is guided by input
81
example of bottom up processing
Auditory: Hearing a new song for the first time and processing its melody and rhythm from scratch. Reading unfamiliar words or identifying an unfamiliar taste
82
intervention for top down processing
language skills cognitive strategies metacognitive strategies classroom instructional & learning strategies
83
how does bottom up processing work
Starts with basic sensory information (e.g., detecting edges, colors, or sounds). Combines these elements to form a complete perception. No prior knowledge or expectations are required.
84
what does modality specific mean
processes information specific to a single sensory modality processing auditory information only, processing visual information only etc. brain processes tied to a particular sensory modality (hearing, visual etc.)
85
what does supramodal mean
processes information that transcends individual sensory modalities, allowing integration across different senses understanding the meaning of a word whether it is heard or read brain processes that operate across different sensory modalities (not specific to any one sense and can integrate information from various sources) like sight and sound
86
Controversy: Is (C)APD modality-specific or supra-modal?
according to experts, CAPD is modality-specific perceptual dysfunction meaning that the problems are primarily in the auditory system because of this, it can be differentiated from other conditions where others might be across multiple senses but there is a controversy that capd has multiple modalities that are impaired arguing for supramodal problem this would move the disorder from the audiologic to the psychological domain and maybe outside of the scope of practice for audiologists
87
why is there this controversy
Lack of gold standard gold standard = error free reference standard sensitivity & specificity of tests is poo
88
what is the controversy over
whether capd is a distinct clinical entity that primarily affects the auditory system or if it is a supramodal disorder whether it primarily is a language deficit or an auditory problem whether it manifests as non-auditory factors like attention, cognition, memory and executive function rather than a deficit of auditory processes
89
what is ADHD
ADHD is more global disruption of sensory information and CAPD is associated with disruption of processing of auditory information only common neurobehavioral childhood disorder that primarily affects children and continues into adulthood
90
DSM V essential features for ADHD
present before age 12yrs requires clinical presentation during childhood can be challenging to confirm if it was present before this age impairment observable in at least 2 settings ex: home and school or home and work Clear evidence of interference with developmentally appropriate social, academic, and/or occupational function Observed independently of autism spectrum disorder, schizophrenia, or other intellectual disorders
91
Criterian A1
6 or more symptoms of inattention persisting for at least 6 months that is inconsistent with developmental level and negatively and directly impacts social and academic/occupational activities
92
symptoms of inattention
fails to give attention to details/makes careless mistakes difficulty sustaining attention in tasks or play activities (e.g., difficulty remaining focused during lectures, or lengthy reading) does not seem to listen when spoken to directly does not follow through on instructions/fails to finish schoolwork, chores avoids/dislikes tasks requiring sustained mental effort (schoolwork/homework) easily distracted by extraneous stimuli has difficulty organizing tasks and activities
93
criterion A2
6 or more symptoms of hyperactivity-impulsivity persisting for at least 6 months that is inconsistent with developmental level and negatively and directly impacts social and academic/occupational activities
94
symptoms of Hyperactivity-Impulsivity
fidgets with or taps hands or feet or squirms in seat Often leaves seat in classroom when remaining seated is expected Often runs about or climbs in situations where it is inappropriate Often unable to play or engage quietly in leisure activities Often talks excessively Often blurts out answers before questions have been completed Often has difficulty awaiting turn Often interrupts/intrudes on others (e.g., during conversations)
95
combined presentation for ADHD
if both A1 and A2 are met for the past 6 months Predominantly Inattentive presentation Predominantly hyperactive-impulsive presentation
96
what is Predominantly hyperactive-impulsive presentation
If criterion A2 (hyperactivity-impulsivity) is met but criterion A1 (inattention) is not met for the past six months
97
what is Predominantly Inattentive presentation
If criterion A1 (inattention) is met but criterion A2 (hyperactivity-impulsivity) is not met for the past six months
98
No diagnostic biological marker for ADHD is currently known
true
99
risk factors for ADHD
low birth weight - two to three fold risk history of child abuse/neglect, multiple foster homes neurotoxin exposure - lead exposure, infections, fetal alcohol syndrome (in-vitro alcohol exposure) genetic & physiologic - significant increase with first-degree biological relatives, visual and hearing impairments, & epilepsy
100
treatment for ADHD
usually a combination of medication, therapy & educational interventions meds: stimulants and non-stimulants to improve focus & reduce hyperactivity therapy: behavioral therapy for learning coping skills and strategies for managing symptoms educational interventions: Accommodations and modifications in school can help children with ADHD succeed academically with appropriate management these individuals can lead successful & fulfilling lives
101
General profile of children with CAPD
Academic difficulties Family history Sporadic results on test batteries Difficulties exacerbated in adverse listening conditions Difficulty following multi-step directions
102
what other conditions can present with similar profiles to CAPD
ADHD Learning/reading delays Language delays; dyslexia Low cognitive skills/IQ Developmental delays Executive function disorder Autism spectrum disorder
103
perception driven by cognition that uses prior knowledge, experiences, and expectations to interpret sensory information
top down
104
perception driven by incoming sensory data that starts at the sensor ylevel and moves up to higher cognitive processes
bottom up
105
what is ANSD
neural dyssynchrony of CN VIII
106
what is ANSD characterized by
normal function of sensory cochlear cells but abnormal structure/function of auditory neurons/synapses
107
what would test results look like in ANSD
normal oaes recordable CM absent/abnormal - ARTs, ABR, ECochG, & MLDs (all rests involving CN VIII) pure tones - ranges AER - generally abnormal
108
describe AER findings in ANSD
Absent/abnormal ECochG and ABR Possible abnormal auditory mid latency and late latency responses; P1 maybe a possible biologic marker for ANSD Possible abnormal P300
109
measures up to the brainstem
ABR
110
measures up to the cochlea
ECochG
111
measure the midbrain to the thalamus
middle latency response
112
measures cortical areas (Heschl’s etc)
late latency response
113
what may be a possible biological marker for ANSD
P1 (late latency response)
114
In many cases of ANSD, ________ may be normal with an abnormal _______
middle & late AERs ABR
115
ANSD is _________ and is a problem associated with the auditory system it is not secondary to cognitive, linguistic or related factors; just like CAPD
modality specific
116
risk factors for ANSD
family history hyperbilirubinemia rubella CMV immune disorders
117
risk factors for CAPD
family history hyperbilirubinemia rubella CMV ototoxicity
118
ANSD test resuls for pure tones tymps ARTs SRT in noise OAEs gap detection ABR
various degrees of loss normal elevated/absent poor present abnormal abs
119
CAPD test resuls for pure tones tymps ARTs SRT in noise OAEs gap detection ABR
usually normal normal usually within normal limits variable depends on site of CANS dysfunction present often abnormal usually normal
120
what is HHL
aan acquired condition that permanently interrupts synaptic communication between sensory IHCs & afferent VIII nerve fibers before HL is diagnosed seen with NIHL & aging
121
another term for HHL
cochlear synaptopathy
122
what are the clinical manifestations for HHL
decreased wave I amp w/ normal ABR thresholds various suprathreshold abnormalities not seen in audio like speech in noise difficulties, tinnitus & hyperacusis they have normal or near to normal audios but they have issues hearing in noise or adverse listening environments
123
how does HHL differ from CAPD
HHL is developmental CAPD is congenital they are both auditory processing disorders
124
what is the most common cuase of cerebral damage
Cerebrovascular accidents (Strokes)
125
risk factors for Cerebrovascular accidents (Strokes)
high blood pressure heart disease diabetes cigarette smoking increasing age prior stroke
126
s/s of Cerebrovascular accidents (Strokes)
Sudden numbness or weakness of the face, arm, or leg Sudden confusion or trouble speaking or understanding others Sudden trouble seeing in one or both eyes Sudden dizziness Trouble walking or loss of balance/coordination Sudden severe headache with no known cause
127
what are the causes of Cerebrovascular accidents (Strokes)
ischemia or hemmorhagic
128
what is ischemia caused by
thrombus embolus
129
what is a thrombus
blood clot that can occur in any large cerebral blood vessel that affects blood flow
130
Single most common cause of CVAs
thrombus
131
what is an embolus
Small blood clot that has dislodged from a larger blood clot elsewhere in the body
132
what is a transient ischemic attack
Small clot may pass on and the patient may recover completely from the ischemic attack These are called transient ischemic attacks (TIAs) (when someone is talking and then they stop and just stare then pick up where they left off again) Eventually can lead to a full-blown CVA
133
most common cause of hemorrhages
Uncontrolled significantly high blood pressure
134
what is a hemorrhage
When a blood vessel in the brain ruptures and bleeds Less common occurrence than an ischemic stroke but can cause damage
135
what are the auditory symptoms associated with CVAs
Peripheral tests may be normal just as seen with cortical tumors Can be significant decrease in speech understanding abilities that may not improve with appropriate amplification If the PT is a HA user, the HA of the ear opposite the side of the stroke may appear less effective Reassessment of auditory function with appropriate amplification and auditory rehabilitation may be necessary
136
what are D/D for CAPD
HL, language disorders (DLD), learning delays, ADHD, ASD, cognitive delays, ANSD, DLD, dyslexia
137

AUDE 6240 (CAPD) (9 decks)

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