Stroke in children and adolescents: Analysis of electrophysiological and behavioral assessment findings of auditory processing.

PURPOSE: This study aimed to analyze the auditory processing behavior of children and adolescents diagnosed with stroke and compare it with that of typically developing individuals. METHODS: This was an analytical cross-sectional study involving 48 participants aged between 7 and 17 years with adequate schooling for age and grade, allocated equally to two groups: Stroke (SG) and Control Groups (CG). For the SG, cases identified between 2003 and 2018 were considered. In the CG, school-aged participants with typical development were randomized. After screening for differential audiological assessment and confirmation of auditory pathway integrity at the brainstem level, binaural analyses of the auditory processing behavior were conducted using the Dichotic Digit Test (DDT), Frequency Pattern Test (FPT), and electrophysiological assessment (P300). The Shapiro-Wilk test for normality was conducted, followed by the T and Mann-Whitney tests, with a 95 % confidence level and significance offset at p < 0.05, using the SPSS software (IBM®, v. 22.) RESULTS: The CG performed better in terms of auditory processing. These differences were significant (p < 0.0001) for the binaural integration of DDT, FPT humming and Labeling, and P300 latency. The P300 results were similar; however, with a greater amplitude in the SG. CONCLUSION: This study showed that children and adolescents with stroke performed worse in electrophysiological and behavioral tests of auditory processing assessed using the auditory evoked potentials. These data reinforce the hypothesis that stroke-related lesions compromise the neural mechanisms underlying auditory processing.

Costs and benefits of audiovisual interactions.

A strong temporal correlation promotes integration of concurrent sensory signals, either within a single sensory modality, or from different modalities. Although the benefits of such integration are well known, far less attention has been given to possible costs incurred when concurrent sensory signals are uncorrelated. In two experiments, subjects categorized the rate at which a visual object modulated in size, while they also tried to ignore a concurrent task-irrelevant broadband sound. Overall, the experiments showed that (i) losses in accuracy from mismatched auditory and visual rates were larger than gains from matched rates and (ii) mismatched auditory and visual rates slowed responses more than they were sped up when rates matched. Experiment One showed that audiovisual interaction varied with the difference between the visual modulation rate and the modulation rate of a concurrent auditory stimulus. Experiment Two showed that audiovisual interaction depended upon the strength of the task-irrelevant auditory modulation. Although our stimuli involved abstract, low-dimensional stimuli, not speech, the effects we observed parallel key findings on interference in multi-speaker settings.

Reality and illusion: the assessment of angular separation of multi-modal signallers in a duetting bird.

The spatial distribution of cooperating individuals plays a strategic role in territorial interactions of many group-living animals, and can indicate group cohesion. Vocalizations are commonly used to judge the distribution of signallers, but the spatial resolution of sounds is poor. Many species therefore accompany calls with movement; however, little is known about the role of audio-visual perception in natural interactions. We studied the effect of angular separation on the efficacy of multimodal duets in the Australian magpie-lark, Grallina cyanoleuca. We tested specifically whether conspicuous wing movements, which typically accompany duets, affect responses to auditory angular separation. Multimodal playbacks of duets using robotic models and speakers showed that birds relied primarily on acoustic cues when visual and auditory angular separations were congruent, but used both modalities to judge separation between the signallers when modalities were spatially incongruent. The visual component modified the effect of acoustic separation: robotic models that were apart weakened the response when speakers were together, while models that were together strengthened responses when speakers were apart. Our results show that responses are stronger when signallers are together, and suggest that males were are able to bind information cross-modally on the senders' spatial location, which is consistent with a multisensory illusion.

Preferred music listening is associated with perceptual learning enhancement at the expense of self-focused attention.

Can preferred music listening improve following attentional and learning performances? Here we suggest that this may be the case. In Experiment 1, following preferred and non-preferred musical-piece listening, we recorded electrophysiological responses to an auditory roving-paradigm. We computed the mismatch negativity (MMN - the difference between responses to novel and repeated stimulation), as an index of perceptual learning, and we measured the correlation between trial-by-trial EEG responses and the fluctuations in Bayesian Surprise, as a quantification of the neural attunement with stimulus informational value. Furthermore, during music listening, we recorded oscillatory cortical activity. MMN and trial-by-trial correlation with Bayesian surprise were significantly larger after subjectively preferred versus non-preferred music, indicating the enhancement of perceptual learning. The analysis on oscillatory activity during music listening showed a selective alpha power increased in response to preferred music, an effect often related to cognitive enhancements. In Experiment 2, we explored whether this learning improvement was realized at the expense of self-focused attention. Therefore, after preferred versus non-preferred music listening, we collected Heart-Beat Detection (HBD) accuracy, as a measure of the attentional focus toward the self. HBD was significantly lowered following preferred music listening. Overall, our results suggest the presence of a specific neural mechanism that, in response to aesthetically pleasing stimuli, and through the modulation of alpha oscillatory activity, redirects neural resources away from the self and toward the environment. This attentional up-weighting of external stimuli might be fruitfully exploited in a wide area of human learning activities, including education, neurorehabilitation and therapy.

Replication of a skills assessment for auditory-visual conditional discrimination training.

Auditory-visual conditional discrimination training (e.g., receptive identification training, listener responses; AVCD) is ubiquitous in early intervention and special education programs. Nevertheless, some learners with Autism Spectrum Disorder (ASD) do not appear to benefit from this training despite use of empirically validated treatments. To prevent exposure to extended training that does not lead to learning, a skills assessment that measures skills related to AVCD training will be useful for educators and practitioners. The current study replicated the skills assessment developed and evaluated by Kodak et al. (2015) with 8 participants with ASD who received behavior analytic intervention that included at least 1 goal related to AVCD training. Two of the 8 participants mastered all skills included in the assessment except scanning. In addition, 5 participants' responding failed to reach mastery during subsequent exposure to AVCD training, which further demonstrated the predictive utility of the skills assessment.

The Music of Silence: Part II: Music Listening Induces Imagery Responses.

During music listening, humans routinely acquire the regularities of the acoustic sequences and use them to anticipate and interpret the ongoing melody. Specifically, in line with this predictive framework, it is thought that brain responses during such listening reflect a comparison between the bottom-up sensory responses and top-down prediction signals generated by an internal model that embodies the music exposure and expectations of the listener. To attain a clear view of these predictive responses, previous work has eliminated the sensory inputs by inserting artificial silences (or sound omissions) that leave behind only the corresponding predictions of the thwarted expectations. Here, we demonstrate a new alternate approach in which we decode the predictive electroencephalography (EEG) responses to the silent intervals that are naturally interspersed within the music. We did this as participants (experiment 1, 20 participants, 10 female; experiment 2, 21 participants, 6 female) listened or imagined Bach piano melodies. Prediction signals were quantified and assessed via a computational model of the melodic structure of the music and were shown to exhibit the same response characteristics when measured during listening or imagining. These include an inverted polarity for both silence and imagined responses relative to listening, as well as response magnitude modulations that precisely reflect the expectations of notes and silences in both listening and imagery conditions. These findings therefore provide a unifying view that links results from many previous paradigms, including omission reactions and the expectation modulation of sensory responses, all in the context of naturalistic music listening.SIGNIFICANCE STATEMENT Music perception depends on our ability to learn and detect melodic structures. It has been suggested that our brain does so by actively predicting upcoming music notes, a process inducing instantaneous neural responses as the music confronts these expectations. Here, we studied this prediction process using EEGs recorded while participants listen to and imagine Bach melodies. Specifically, we examined neural signals during the ubiquitous musical pauses (or silent intervals) in a music stream and analyzed them in contrast to the imagery responses. We find that imagined predictive responses are routinely co-opted during ongoing music listening. These conclusions are revealed by a new paradigm using listening and imagery of naturalistic melodies.

Influences of individual, text, and assessment factors on text/discourse comprehension in oral language (listening comprehension).

We investigated the contributions of multiple strands of factors-individual characteristics (struggling reader status, working memory, vocabulary, grammatical knowledge, knowledge-based inference, theory of mind, comprehension monitoring), a text feature (narrative vs. expository genre), and question types (literal and inferential)-to one's performance on discourse comprehension in oral language (listening comprehension), using data from 529 second graders. Results from explanatory item response models revealed that substantial variance in listening comprehension was attributable to differences between items, texts, and children, respectively. Narrative versus expository genre distinctions explained almost all of the variance attributable to text differences. In contrast, literal versus inferential question distinctions did not explain item responses after accounting for text and reading comprehension status. However, there was a moderation between struggling reader status and question type such that struggling readers had a slightly higher (2%) probability of getting inferential questions right compared to typically developing readers, after accounting for individual and text factors. Struggling readers have a lower probability of accurate item responses than typically developing readers, but the difference disappeared once language and cognitive skills (e.g., working memory, vocabulary) were taken into consideration. The effects of text genre and question type on item responses did not differ as a function of children's language and cognitive skills. Overall, these results underscore the importance of considering individual, text, and assessment factors for children's performance in listening comprehension.

Validity of the Multiple Auditory Processing Assessment-2: A Test of Auditory Processing Disorder.

Purpose A normative study using the Multiple Auditory Processing Assessment-2 (MAPA-2; Schow et al., 2018) was recently completed. With access to these data, the authors extend that work and support a definite construct for auditory processing disorder (APD). The goal here is to examine MAPA-2 reliability and validity (construct, content, and concurrent). Evidence for the APD construct is further buttressed by measures of sensitivity and specificity. Results of MAPA-2 testing on children diagnosed with learning disability (LD), attention-deficit/hyperactivity disorder (ADHD), and specific language impairment (SLI) are included. Method Normative data (previously published as the MAPA-2) allowing derivation of these findings included a representative sample of 748 children (53% girls) ages 7-14 years tested by 54 speech-language pathologists and audiologists in 27 U.S. states. The authors examined diagnostic accuracy based on the American Speech-Language-Hearing Association (2005) criteria (index test) for confirmed cases of APD. The index was also used to identify listening problems for three other diagnostic categories (LD, ADHD, and SLI). Validated questionnaire responses from parents and school personnel allowed incorporation of functional measures widely supported in APD diagnosis but unavailable with other normative and sensitivity/specificity studies. Results Reliability and validity were both satisfactory, and diagnostic accuracy for an APD group of 18 (28% female) compared to the remaining typical group of 625 yielded 89% sensitivity and 82% specificity. The remaining three groups (LD, ADHD, and SLI), where comorbidity was expected to be about 50%, had APD-type listening problems with a prevalence ranging from 52% to 65%. Conclusions Current results provide important evidence for the construct of APD. The MAPA-2 can be administered by an audiologist or speech-language pathologist. A similar diagnostic protocol in Australia yielded positive therapeutic gains. Further study is encouraged to determine if the present positive findings will be found in future research.

When processing costs impact predictive processing: The case of foreign-accented speech and accent experience.

Listeners use linguistic information and real-world knowledge to predict upcoming spoken words. However, studies of predictive processing have focused on prediction under optimal listening conditions. We examined the effect of foreign-accented speech on predictive processing. Furthermore, we investigated whether accent-specific experience facilitates predictive processing. Using the visual world paradigm, we demonstrated that although the presence of an accent impedes predictive processing, it does not preclude it. We further showed that as listener experience increases, predictive processing for accented speech increases and begins to approximate the pattern seen for native speech. These results speak to the limitation of the processing resources that must be allocated, leading to a trade-off when listeners are faced with increased uncertainty and more effortful recognition due to a foreign accent.

Feasibility of the Audio Recorded Cognitive Screen in the Assessment of Individuals Undergoing Electroconvulsive Therapy.

BACKGROUND: Monitoring for cognitive deficits during a course of electroconvulsive therapy (ECT) is recommended, but cognitive assessment can be time consuming. The Audio Recorded Cognitive Screen (ARCS) is a cognitive test instrument with good psychometric properties that places minimal demands on clinicians' time, but until now, it has not been formally evaluated for monitoring cognition in the context of ECT treatment. OBJECTIVES: This study aimed to assess the feasibility/utility of using the ARCS in the assessment of depressed patients undergoing ECT. METHODS: Depressed patients undergoing ECT were tested with the ARCS and a comparison instrument, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), in counterbalance order immediately before any ECT and after the sixth ECT treatment episode. Apathy (Apathy Scale) and depression (Profile of Mood states Short Form) were measured on both occasions. Analyses compared performances on the 2 cognitive instruments and examined for associations with the measures of apathy or depression. RESULTS: Twenty-eight individuals (9 male, 19 female) aged 19 to 84 years underwent testing. Performances on the total ARCS were similar to those on the total RBANS, and both showed decline from baseline to follow-up. The total ARCS and RBANS measures correlated well (r = 0.75, P < 0.001). Neither apathy nor depression scores were significantly associated with scores on either the RBANS or ARCS. CONCLUSIONS: The ARCS was acceptable and convenient in the assessment of cognition in patients undergoing treatment with ECT. In light of its practical advantages, further evaluation of the ARCS for detecting cognitive impairment and tracking cognitive changes during ECT seems warranted.

Assessment of auditory working memory in normal hearing adults with tinnitus.

PURPOSE: Tinnitus is characterized by the perception of sound without an existing external stimulus. The presence of tinnitus might be intolerable for many and can be sufficiently troublesome in hearing, sleep, thought processing, and other functional abilities, all of which can negatively impact the quality of life. Individuals with tinnitus may have decreased cognitive efficiency because tinnitus can adversely affect the other tasks being performed. The present study was taken up to evaluate auditory working memory using digit span tasks in adults with tinnitus. METHODS: The tasks administered included forward, backward, ascending, and descending digit span. Tinnitus Handicap Inventory questionnaire was administered on all the individuals with tinnitus, and also, it was attempted to correlate the scores of auditory working memory with that of tinnitus handicap inventory. RESULTS: The results indicated poorer scores for backward, ascending and descending digit span task and no significant difference for the forward digit span task. There was no correlation between auditory working memory tasks and overall tinnitus handicap scores along with its sub-scales. CONCLUSION: It was concluded that tinnitus disrupts the functioning of auditory working memory and is governed by the annoyance caused by tinnitus.

An Interpretable Performance Metric for Auditory Attention Decoding Algorithms in a Context of Neuro-Steered Gain Control.

In a multi-speaker scenario, a hearing aid lacks information on which speaker the user intends to attend, and therefore it often mistakenly treats the latter as noise while enhancing an interfering speaker. Recently, it has been shown that it is possible to decode the attended speaker from the brain activity, e.g., recorded by electroencephalography sensors. While numerous of these auditory attention decoding (AAD) algorithms appeared in the literature, their performance is generally evaluated in a non-uniform manner. Furthermore, AAD algorithms typically introduce a trade-off between the AAD accuracy and the time needed to make an AAD decision, which hampers an objective benchmarking as it remains unclear which point in each algorithm's trade-off space is the optimal one in a context of neuro-steered gain control. To this end, we present an interpretable performance metric to evaluate AAD algorithms, based on an adaptive gain control system, steered by AAD decisions. Such a system can be modeled as a Markov chain, from which the minimal expected switch duration (MESD) can be calculated and interpreted as the expected time required to switch the operation of the hearing aid after an attention switch of the user, thereby resolving the trade-off between AAD accuracy and decision time. Furthermore, we show that the MESD calculation provides an automatic and theoretically founded procedure to optimize the number of gain levels and decision time in an AAD-based adaptive gain control system.

Functional network dynamics in a neurodevelopmental disorder of known genetic origin.

Dynamic connectivity in functional brain networks is a fundamental aspect of cognitive development, but we have little understanding of the mechanisms driving variability in these networks. Genes are likely to influence the emergence of fast network connectivity via their regulation of neuronal processes, but novel methods to capture these rapid dynamics have rarely been used in genetic populations. The current study redressed this by investigating brain network dynamics in a neurodevelopmental disorder of known genetic origin, by comparing individuals with a ZDHHC9-associated intellectual disability to individuals with no known impairment. We characterised transient network dynamics using a Hidden Markov Model (HMM) on magnetoencephalography (MEG) data, at rest and during auditory oddball stimulation. The HMM is a data-driven method that captures rapid patterns of coordinated brain activity recurring over time. Resting-state network dynamics distinguished the groups, with ZDHHC9 participants showing longer state activation and, crucially, ZDHHC9 gene expression levels predicted the group differences in dynamic connectivity across networks. In contrast, network dynamics during auditory oddball stimulation did not show this association. We demonstrate a link between regional gene expression and brain network dynamics, and present the new application of a powerful method for understanding the neural mechanisms linking genetic variation to cognitive difficulties.

The modality switching costs of Chinese-English bilinguals in the processing of L1 and L2.

Modality switching cost indicates that people's performance becomes worse when they judge sequential information that is related to different sensory modalities than judging information that is related to the same modality. In this study, we conducted three experiments on proficient and non-proficient bilingual individuals to investigate the modality switching costs in L1 and L2 processing separately. In Experiment 1, materials were L1 and L2 words that were either conceptually related to a visual modality (e.g., light) or related to an auditory modality (e.g., song). The modality switching costs were investigated in a lexical decision task in both L1 and L2. Experiment 2 further explored the modality switching costs while weakening the activation level of the perceptual modality by adding a set of fillers. Experiment 3 used a word-naming task to explore the modality switching effect in language production in L1 and L2. Results of these experiments showed that the modality switching costs appeared in both language comprehension and production in L1 and L2 conditions. The magnitude of the modality switching costs was conditionally modulated by the L2 proficiency level, such as in the L2 condition in Experiment 1 and in both L1 and L2 conditions in Experiment 3. These results suggest that sensorimotor simulation is involved in not only language comprehension but also language production. The sensorimotor simulation that is acquired in L1 can be transferred to L2.

FreeHear: A New Sound-Field Speech-in-Babble Hearing Assessment Tool.

Pure-tone threshold audiometry is currently the standard test of hearing. However, in everyday life, we are more concerned with listening to speech of moderate loudness and, specifically, listening to a particular talker against a background of other talkers. FreeHear delivers strings of three spoken digits (0-9, not 7) against a background babble via three loudspeakers placed in front and to either side of a listener. FreeHear is designed as a rapid, quantitative initial assessment of hearing using an adaptive algorithm. It is designed especially for children and for testing listeners who are using hearing devices. In this first report on FreeHear, we present developmental considerations and protocols and results of testing 100 children (4-13 years old) and 23 adults (18-30 years old). Two of the six 4 year olds and 91% of all older children completed full testing. Speech reception threshold (SRT) for digits and noise colocated at 0° or separated by 90° both improved linearly across 4 to 12 years old by 6 to 7 dB, with a further 2 dB improvement for the adults. These data suggested full maturation at approximately 15 years old SRTs at 90° digits/noise separation were better by approximately 6 dB than SRTs colocated at 0°. This spatial release from masking did not change significantly across age. Test-retest reliability was similar for children and adults (standard deviation of 2.05-2.91 dB SRT), with a mean practice improvement of 0.04-0.98 dB. FreeHear shows promise as a clinical test for both children and adults. Further trials in people with hearing impairment are ongoing.

Pruebas de fusión auditiva y de detección de gaps: evaluación de la resolución auditiva temporal / Auditory fusion and gap detection tests: assessment of auditory temporal resolution

RESUMEN Dentro de los distintos mecanismos del procesamiento auditivo, los aspectos temporales de la audición se consideran como uno de los más relevantes ya que serían la base para el adecuado funcionamiento del resto de los procesos auditivos centrales. Los aspectos temporales de la audición se definen como los procesos implicados en la percepción del sonido y de sus variaciones en el dominio temporal. Uno de los aspectos temporales más ampliamente estudiados, por su relevancia en la percepción y discriminación de los sonidos del habla, ha sido la resolución auditiva temporal, que se refiere a la mínima cantidad de tiempo necesaria para que un individuo pueda discriminar entre dos estímulos auditivos distintos. En los últimos años, se ha utilizado principalmente metodologías de detección de fusión auditiva y detección de gaps para su evaluación. Ambas han dado origen a una serie de pruebas psicoacústicas, de las cuales destacan tres: la prueba de fusión auditiva revisada, la prueba de detección de gaps aleatorios y la prueba de gaps en ruido. Se recomienda la incorporación de alguna de estas pruebas en la evaluación clínica ante la sospecha de trastornos del procesamiento auditivo.

ABSTRACT Among the different mechanisms of auditory processing, the temporal aspects of hearing are considered as one of the most relevant since they would be the basis for the proper functioning of the rest of the central auditory processes. Temporal aspects of hearing are defined as the processes involved in the perception of sound and its variations in the temporal domain. One of the most widely studied temporal aspects due to its relevance in the perception and discrimination of speech sounds has been the temporal auditory resolution, which refers to the minimum amount of time necessary for an individual to discriminate between two different auditory stimuli. In recent years, the mainly used methodologies for evaluate it are the hearing fusion detection and gaps detection. Both methodologies have given rise to several psychoacoustic tests, of which three have been highlighted: the revised auditory fusion test, the random gap detection test and gaps in noise test. It is recommended the incorporation of any of these tests in the clinical evaluation of suspected auditory processing disorders.

Unpleasantness of Amplified Environmental Sound Used in Tinnitus Sound Therapy: A Preliminary Study of Clinical Assessment.

OBJECTIVES: In this study, our aim was to use environmental sounds amplified in the frequency region corresponding to the tinnitus frequency of individual patients and apply them as sound therapy in tinnitus retraining therapy (TRT). In this pilot study, we 1) investigated the unpleasantness of processed environmental sounds using the amplification, attenuation, and removal in different frequency regions; 2) compared the unpleasantness of processed sounds for older and younger groups of participants; and 3) determined the amplification level appropriate for a clinical test. MATERIALS AND METHODS: We processed the sound of a river with three types of modification (amplified, attenuated, and notched) at a one-octave width of seven central frequencies, in the range 250-8000 Hz. Amplified and attenuated sounds were processed with five positive gains (+6, +12, +15.6, +18, and +20 dB) and two negative gains (-6 and -12 dB). Twenty-three older participants and 23 younger participants rated the unpleasantness of sounds using a visual analog scale. RESULTS: We found that, in the older group, there was no difference in unpleasantness among the three modifications. Older participants rated the level of unpleasantness as lower than younger participants for processed sounds in the high-frequency region. There were no marked differences among the amplification levels in the group of older participants. CONCLUSION: Based on the results, we decided that our clinical study would target older patients who had a tinnitus frequency over 4000 Hz and would compare the effect of an amplified sound with a 20 dB gain at the frequency corresponding to individual tinnitus with notched sound.

Cost of auditory sharpness: Model-Based estimate of energy use by auditory brainstem "octopus" neurons.

Octopus cells (OCs) of the mammalian auditory brainstem precisely encode timing of fast transient sounds and tone onsets. Sharp temporal fidelity of OCs relies on low resting membrane resistance, which suggests high energy expenditure on maintaining ion gradients across plasma membrane. We provide a model-based estimate of energy consumption in resting and spiking OCs. Our results predict that a resting OC consumes up to 2.6 × 109 ATP molecules (ATPs) per second which remarkably exceeds energy consumption of other CNS neurons. Glucose usage by all OCs in the rat is nevertheless low due to their low number. Major part of the OCs energy use results from the ion mechanisms providing for the low membrane resistance: hyperpolarization-activated mixed cation conductance and low-voltage activated K+-conductance. Spatially ordered synapses-a feature of the OCs allowing them to compensate for asynchrony of the synaptic input-brings only a 12% energy saving to OCs excitability cost. Only 13% of total OC energy used for an AP generation (1.5 × 107 ATPs) is associated with the AP generation in the axon initial segment, 64%-with synaptic currents processing and 23%-with keeping resting potential.

Mapping attention during gameplay: Assessment of behavioral and ERP markers in an auditory oddball task.

Video games are enjoyed most when the level and speed of the game match the players' skills. An optimal balance between challenges and skills triggers the subjective experience of "flow," a focused motivation leading to a feeling of spontaneous joy. The present research investigates the behavioral and neural correlates of a paradigm aimed to assess the players' subjective experience during gameplay. Attentional engagement changes were assessed first at the behavioral level and in a second stage by means of EEG recordings. An auditory novelty oddball paradigm was implemented as a secondary task while subjects played in three conditions: boredom, frustration, and flow. We found higher reaction times and error rates in the flow condition. In a second stage, EEG time domain analysis revealed a significantly delayed response-locked frontocentral negative deflection during flow, likely signaling the reallocation of attentional resources. Source reconstruction analyses showed that the brain regions responsible for the genesis of this negativity were located within the medial frontal cortex. Frequency domain analyses showed a significant power increase only in the alpha band for the flow condition. Our results showed that this alpha power enhancement was correlated with faster reaction times. This suggests that frontal alpha changes recorded as maximal at the midfrontal lines during flow might be related to inhibitory top-down cognitive control processes.

Potential Applications of Digital Technology in Assessment, Treatment, and Self-help for Hallucinations.

The field of digital mental health is rapidly expanding with digital tools being used in assessment, intervention, and supporting self-help. The application of digital mental health to hallucinations is, however, at a very early stage. This report from a working group of the International Consortium on Hallucinations Research considers particular synergies between the phenomenon of hallucinations and digital tools that are being developed. Highlighted uses include monitoring and managing intermittently occurring hallucinations in daily life; therapeutic applications of audio and video media including virtual and augmented reality; targeting verbal aspects of hallucinations; and using avatars to represent hallucinatory voices. Although there is a well-established Internet-based peer support network, digital resources for hallucinations have yet to be implemented in routine practice. Implementation may benefit from identifying how to market resources to the broad range of populations who experience hallucinations and identifying sustainable funding models. It is envisaged that digital tools will contribute to improved self-management and service provision for people experiencing hallucinations.