Long Latency Auditory Evoked Responses in the Identification of Children With Central Auditory Processing Disorders: A Scoping Review.

PURPOSE: The long latency auditory evoked responses (LLAERs), originating in the auditory cortex, are often considered a biomarker for maturity in the central auditory system and may therefore be useful in the evaluation of children with central auditory processing disorder (CAPD). However, the characteristics of the LLAERs elicited in this population have not been widely described, and clinical applications remain unclear. The goal of this scoping review was to investigate if LLAERs can be used to identify children with CAPD. METHOD: A systematic search strategy was used to identify studies that analyzed the latencies and amplitudes of P1, N1, P2, and N2 waveforms of the LLAERs. The online databases, including Embase, Web of Science, MEDLINE, PubMed, ProQuest, and CINAHL, as well as the gray literature were searched for papers published in English and French between January 1980 and May 2021. RESULTS: Seventeen papers met the eligibility criteria and were included in the study. Four papers had pre- and posttraining study designs, and the remaining studies were cross-sectional. Several studies reported significant differences in LLAERs between children with CAPD and their normal-hearing peers, and the results tended toward longer latencies and smaller amplitudes regardless of LLAER waves considered. N1 and/or N2 results were most likely to reveal significant differences between children with CAPD and normal-hearing controls and could potentially be considered a biomarker for CAPD. CONCLUSIONS: It seems that LLAER assessments, especially waves N1 and N2, might assist in better identification of CAPD children. However, considering heterogeneity in the methodology among the included studies, the results should be interpreted with caution. Well-designed studies on children with confirmed CAPD using standard diagnostic and assessment protocols are suggested.

Evaluation of mismatch negativity as a marker for language impairment in autism spectrum disorder.

BACKGROUND: The identification of an early and objective marker of language impairment in autism spectrum disorder (ASD) has the potential to lead to earlier language intervention for affected children. The mismatch negativity (MMN), a passive auditory evoked potential, offers insight into the brain's ability to direct attention to novel sounds. Since exposure to speech is necessary for learning to map meaning onto phonemes, we predicted slower MMN responses to speech sounds would indicate presence of language impairment in ASD. METHODS: We explored the relationship between MMN latency in children ages 5-10 with ASD plus language impairment (ASD + LI), ASD minus language impairment (ASD-LI), and typically developing children (TD) during an auditory oddball experiment presenting speech and pure tone sounds. RESULTS: Contrary to our prediction, children with ASD + LI demonstrated decreased MMN latency in the left hemisphere in response to novel vowel sounds compared to children with ASD-LI and TD controls. Parent responses to the Sensory Experiences Questionnaire revealed that all participating individuals with ASD were hypersensitive to sounds. CONCLUSIONS: Our results lend support to the theory that some children with ASD + LI have increased connectivity in primary sensory cortices at the expense of connectivity to association areas of the brain. This may account for faster speech sound processing despite low language scores in these children. Future studies should focus on individuals with language impairment and hyper-or hyposensitivity to sounds.

Long-term effect of middle ear disease on temporal processing and P300 in two different populations of children.

BACKGROUND/OBJECTIVE: The effects of otitis media on the function of the central auditory nervous system in different populations is unknown. Understanding how the history of otitis media affects children from different nations will guide health professionals worldwide on the importance of adequate auditory stimulus in childhood. For this reason, the aim of the present study was to investigate the long-term auditory effects of middle ear disease on temporal processing and P300 in two different populations of children: Australian and Brazilian. METHODS: Temporal processing tests (Frequency Pattern Tests-FPT and Gaps in noise-GIN) and P300 were measured in 68 Brazilian and Australian children, aged between 8 to 14 years. The Brazilian otitis media group (BrOM) and Australian otitis media group (AusOM) consisted of 20 children each who had a documented history of otitis media. Control groups of 14 children (BrControl and AusControl) were also recruited from each country, all with no documented history of otitis media. RESULTS: The BrOM group showed significantly poorer performance (p<0.001) for FPT and the GIN compared to BrControl. The P300 response showed significantly longer mean latencies (p = 0.02) compared to BrControls. The AusOM group also showed significant delayed latency of P300 (p = 0.04) compared to the AusControl. The FPT showed significantly poorer performance (p = 0.04) compared to AusControls. The two otitis media groups showed no significant differences between each other on P300. Significant differences were seen however in temporal processing tests performance between the two cohorts for the otitis media groups. The BrOM group had significantly poorer responses (p<0.001) for FPT and GIN compared to the AusOM group. CONCLUSIONS: These findings support that although differences exist between BrOM and AusOM groups, otitis media can be demonstrated to affect the underlying mechanisms of the P300 measures and behavioral auditory responses in two different populations of children.

A Spectrotemporal Correlate of Language Impairment in Autism Spectrum Disorder.

This study introduces an objective neurophysiological marker of language ability, the integral of event-related desynchronization in the 5-20 Hz band during 0.2-1 seconds post auditory stimulation with interleaved word/non-word tokens. This measure correlates with clinical assessment of language function in both ASD and neurotypical pediatric populations. The measure does not appear related to general cognitive ability nor autism symptom severity (beyond degree of language impairment). We suggest that this oscillatory brain activity indexes lexical search and thus increases with increased search in the mental lexicon. While specificity for language impairment in ASD remains to be determined, such an objective index has potential utility in low functioning individuals with ASD and young children during language acquisition.

Evidence-based pathways to intervention for children with language disorders.

BACKGROUND: Paediatric speech and language therapist (SLT) roles often involve planning individualized intervention for specific children, working collaboratively with families and education staff, providing advice, training and coaching and raising awareness. A tiered approach to service delivery is currently recommended whereby services become increasingly specialized and individualized for children with greater needs. AIMS: To stimulate discussion regarding delivery of SLT services by examining evidence regarding the effectiveness of (1) intervention for children with language disorders at different tiers and (2) SLT roles within these tiers; and to propose an evidence-based model of SLT service delivery and a flowchart to aid clinical decision-making. METHODS & PROCEDURES: Meta-analyses and systematic reviews, together with controlled, peer-reviewed group studies where recent systematic reviews were not available, of interventions for children with language disorders are discussed, alongside the differing roles SLTs play in these interventions. Gaps in the evidence base are highlighted. MAIN CONTRIBUTION: The service-delivery model presented resembles the tiered model commonly used in education services, but divides individualized (Tier 3) services into Tier 3A: indirect intervention delivered by non-SLTs, and Tier 3B: direct intervention by an SLT. We report evidence for intervention effectiveness, which children might best be served by each tier, the role SLTs could take within each tier and the effectiveness of these roles. Regarding universal interventions provided to all children (Tier 1) and those targeted at children with language weaknesses or vulnerabilities (Tier 2), there is growing evidence that approaches led by education services can be effective when staff are highly trained and well supported. There is currently limited evidence regarding additional benefit of SLT-specific roles at Tiers 1 and 2. With regard to individualized intervention (Tier 3), children with complex or pervasive language disorders can progress following direct individualized intervention (Tier 3B), whereas children with milder or less pervasive difficulties can make progress when intervention is managed by an SLT, but delivered indirectly by others (Tier 3A), provided they are well trained and supported, and closely monitored. CONCLUSIONS & IMPLICATIONS: SLTs have a contribution to make at all tiers, but where prioritization for clinical services is a necessity, we need to establish the relative benefits and cost-effectiveness at each tier. Good evidence exists for SLTs delivering direct individualized intervention and we should ensure that this is available to children with pervasive and/or complex language disorders. In cases where service models are being provided which lack evidence, we strongly recommend that SLTs investigate the effectiveness of their approaches.

Thinking Ahead: Incremental Language Processing is Associated with Receptive Language Abilities in Preschoolers with Autism Spectrum Disorder.

In typical development, listeners can use semantic content of verbs to facilitate incremental language processing-a skill that is associated with existing language skills. Studies of children with ASD have not identified an association between incremental language processing in semantically-constraining contexts and language skills, perhaps because participants were adolescents and/or children with strong language skills. This study examined incremental language processing and receptive language in young children with ASD with a range of language skills. Children showed a head start when presented with semantically-constraining verbs (e.g., Read the book) compared to neutral verbs (e.g., Find the book). Children with weaker receptive language showed a smaller head start than children with stronger receptive language skills, suggesting continuity between typical development and ASD.

Correlation between Voice and Auditory Processing.

PURPOSE: To compare and to correlate the performance of women with behavioral dysphonia and without voice disorders in auditory processing tests and in the Voice Tone Reproduction Test (VTRT). METHODS: Forty women aged from 18 to 44 years participated and were divided in two groups: dysphonic (DG) and non-dysphonic (NDG). The participants underwent interview, hearing, otorhinolaryngology and voice assessments (voice record, VTRT through phonetography), and auditory processing assessment-using the Pitch Pattern Sequence (PPS) test and the Duration Pattern Sequence (DPS) test. The statistical analysis compared both groups, and there was a correlation test (P < 0.05). RESULTS: The NDG had a better performance in the PPS test (P = 0.000), in the VTRT test in the first attempt (P = 0.025), and in the total of correct answers (P = 0.017). There was a positive correlation between the PPS and both the first attempt of the VTRT and the total number of attempts. Regarding the DPS, there was a positive correlation for the left ear with the total number of VTRT attempts. CONCLUSIONS: Dysphonic women presented disorders in temporal auditory processing skills, revealing an important relation between vocal production and impairment of some central auditory functions. There was a positive correlation between the performance in the auditory processing assessment and the performance in voice tone reproduction in both groups. The VTRT may assist speech therapists and voice trainers in verifying difficulties of auditory perception of dysphonic women when the cause is due to behavioral tdysphonia.

Symbolic Play in School-Aged Minimally Verbal Children with Autism Spectrum Disorder.

Few interventions exist for school-aged minimally verbal children with autism spectrum disorder (ASD). Even though play skills are associated with children's production of language, few studies have focused on play for minimally verbal children. Fifty-eight minimally verbal children with ASD received a naturalistic developmental behavioral intervention. Children were randomized to receive a speech generating device in the context of the intervention or not. Children in both conditions improved in play skills at exit. Children demonstrated an increase in play skills in proximal (sessions) and distal (during blind assessment) contexts. Minimally verbal children with ASD can improve their play skills within a targeted intervention. Increases in symbolic play were associated with increases in expressive language skills.

Facilitating pragmatic skills through role-play in learners with language learning disability.

BACKGROUND: Role-based learning involves the process whereby learners acquire skills, knowledge and understanding through the assumption of roles within real-life settings. Role-play holds potential as an effective learning strategy for children; however, there is limited research on the use of role-play as a therapy method within the field of speech-language pathology. Children with language learning disability (LLD) typically present with difficulties in social communication, which can negatively affect their social and academic achievement. AIM: The aim of this study was to determine the effectiveness of role-play as a therapy approach targeting the pragmatic skills of stylistic variation and requesting for clarification in learners with LLD. METHOD: The use of combined positivist and interpretivist paradigms allowed for the implementation of an embedded mixed methods design. An experimental pretest-posttest design was implemented. Eight participants, who were learners with a diagnosis of LLD, were purposefully selected. Data collection was conducted over five phases, utilising the Clinical Evaluation of Language Fundamentals (4th Ed.) Pragmatics Profile, discourse completion tasks, session plans and session records. Quantitative data were analysed using descriptive statistics and were supplemented by qualitative data from session records. RESULTS: Results revealed improvements in stylistic variation and requesting for clarification post role-play intervention, with minimal changes in the control group. Limitations of the study have been reported for consideration when interpreting results. CONCLUSION: Role-play as a therapy approach targeting two pragmatic skills, stylistic variation and requesting for clarification, was found to be beneficial for learners with LLD. Recommendations for the implementation of role-play as a therapy approach were made.

[Musical abilities in children with an auditory processing disorder]. / Musikalische Fähigkeiten bei Kindern mit auditiver Verarbeitungs- und Wahrnehmungsstörung.

Objective Difficulties in solving musical tasks are observed in clinical practice in children with an auditory processing disorder (APD). There is a paucity of research on musical ability in children with an APD. Material and Methods To assess musical skills we had 15 children aged 6-11 years with the diagnosis of APD perform a test, and compared them to a control group of 15 children. Results APD children did significantly worse in pitch discrimination, reproduction of rhythm and singing. Correlations between language-based and musical skills in the APD-group were observed. Conclusions Greater attention should be paid to musical skills in APD diagnostics. The positive impact of musical training on language development and cognitive abilities in general has been demonstrated in numerous studies. Musical training should be the focus of further discussion for therapeutic methods of APD in the presence of musical deficits.

Growth-and Documentation-Deficits: Where To Start in Helping Families.

CASE: Pedro is a 2-year 7-month-old boy who was presented for the first time after a visit to a local emergency room (ER) for diarrhea. At the time of his birth, his undocumented mother, Clara, was 20 years old, uninsured, and with limited English proficiency living approximately 400 miles south of our practice in a different state. Although she had been brought to the United States as a child, she had never finished high school. Pedro was born what mother thought was full-term at his parent's home, where a lay midwife assisted during the delivery. Pedro was not brought to a medical facility at birth; therefore, neither medical nor legal documentation of his birth in the United States, or elsewhere, existed.After enduring 4 years of ongoing verbal and physical abuse, Clara fled to her maternal aunt in our community. The child's initial exposure to medical care was during the emergency visit, which ended up in referral to us. The ED physician suggested that the child visit a primary care physician, but establishment of pediatric care was not made until months later. The child received his first vaccines and immediately was referred to the Growth and Nutrition clinic due to mild wasting and stunting based on Waterlow criteria.Pedro speaks both English and Spanish and has no 2-word combinations and a 50-word combined vocabulary in English and Spanish. In addition, a complete blood count was consistent with iron deficiency anemia, but both sickle cell and G6PD screening are negative.The nutritionist from the specialty clinic obtained a detailed history including overall appetite, feeding skills, meal plans, and eating environment noting that the child was a competent finger feeder. The family's meals were distributed throughout the day as a meal at home and a shared fast food meal while accompanying mother, as she worked as a hair stylist 6 days per week. In addition, the diet is supplemented by ricewater mixed with sugar and ground carrots throughout the day.Where would you head next?REFERENCE1. Waterlow JC. Classification and definition of protein-calorie malnutrition. Br Med J. 1972;3:566-569.

[Acoustic reflexes of children with and without central auditory processing disorders]. / Stapediusreflexe von Kindern mit und ohne auditive Verarbeitungs- und Wahrnehmungsstörungen.

BACKGROUND: According to international standards, determination of acoustic reflex thresholds (ART) is one of the established objective measurements in the diagnostic workup of central auditory processing disorders (CAPD). However, there is still no evidence for the significance of ART in CAPD diagnosis. PATIENTS AND METHODS: This study tested 57 children with proven CAPD and 50 healthy children (control group) with regard to group differences in mean ART (sine tones or bandpass-filtered noise). Additionally, it was investigated whether there were group differences between the mean dissociations of ART for sine tones or bandpass filtered noise. RESULTS: Neither ipsi- nor contralaterally were significant clinically relevant group differences (p < 0.050) between the mean ART of children with and without CAPD found. After Bonferroni correction, a significant group difference in the percentage of non-triggered reflexes was only observed with left-sided contralateral 2 kHz stimuli. Concerning the number of dissociations ≥20 dB, no significant group differences (p < 0.050) were detected either ipsi- or contralaterally (Fisher's test). CONCLUSION: The results of the study seem to indicate no clinically relevant ability of ART measurements to distinguish between children with and without CAPD. This renders the benefit of ART measurements for CAPD diagnosis questionable.

A systematic scoping review of speech and language therapists' public health practice for early language development.

BACKGROUND: There have been calls for speech and language therapists (SLTs) to work within a public-health framework to support language development. Innovative practice is reported, but the range of services remains unknown. Furthermore, the potential impact of public health practice in speech and language therapy on early child development is also currently unknown. A new method in SLT research, systematic scoping reviews enable greater breadth of focus than traditional systematic reviews when identifying innovative practice. AIM: To report scope and critically appraise evidence of family-focused health-promotion practice for early language development in this area. METHODS & PROCEDURES: Using the Cochrane Public Health Group scoping review framework, data from reports of health-promotion practice with families of children aged 0-3 years were extracted and critically appraised on service delivery, information, reach and evaluation. MAIN CONTRIBUTION: Group-based service delivery was the most popular form of service delivery. There were limited reports on the information given in services and on their reach. Questionnaires were the most popular reported evaluation method. Quality of evaluations was poor due to lack of replicability and experimental control in the studies reported. CONCLUSIONS & IMPLICATIONS: This method of systematic review has highlighted the scope of health-promotion practice in speech and language therapy and also demonstrated the lack of evidence for its effectiveness on child language development. It is argued that systematic scoping reviews are valuable for scoping innovative practice in areas where either there is a lack of robust evidence or there is a high level of heterogeneity in practice or evaluation. To support clinician appraisal of available evidence, recommendations are given for development of questionnaire appraisal and for categorization of evidence levels on summary databases.

Auditory discrimination predicts linguistic outcome in Italian infants with and without familial risk for language learning impairment.

Infants' ability to discriminate between auditory stimuli presented in rapid succession and differing in fundamental frequency (Rapid Auditory Processing [RAP] abilities) has been shown to be anomalous in infants at familial risk for Language Learning Impairment (LLI) and to predict later language outcomes. This study represents the first attempt to investigate RAP in Italian infants at risk for LLI (FH+), examining two critical acoustic features: frequency and duration, both embedded in a rapidly-presented acoustic environment. RAP skills of 24 FH+ and 32 control (FH-) Italian 6-month-old infants were characterized via EEG/ERP using a multi-feature oddball paradigm. Outcome measures of expressive vocabulary were collected at 20 months. Group differences favoring FH- infants were identified: in FH+ infants, the latency of the N2* peak was delayed and the mean amplitude of the positive mismatch response was reduced, primarily for frequency discrimination and within the right hemisphere. Moreover, both EEG measures were correlated with language scores at 20 months. Results indicate that RAP abilities are atypical in Italian infants with a first-degree relative affected by LLI and that this impacts later linguistic skills. These findings provide a compelling cross-linguistic comparison with previous research on American infants, supporting the biological unity hypothesis of LLI.

Review: Human guanidinoacetate n-methyl transferase (GAMT) deficiency: A treatable inborn error of metabolism.

The creatine biosynthetic pathway is essential for cellular phosphate associated energy production and storage, particularly in tissues having higher metabolic demands. Guanidinoacetate N-Methyl transferase (GAMT) is an important enzyme in creatine endogenous biosynthetic pathway, with highest expression in liver and kidney. GAMT deficiency is an inherited autosomal recessive trait that was the first among creatine deficiency syndrome to be reported in 1994 having characteristic features of no comprehensible speech development, severe mental retardation, muscular hypotonia, involuntary movements and seizures that partly cannot be treated with anti-epileptic drugs. Due to problematic endogenous creatine biosynthesis, systemic depletion of creatine/phosphocreatine and accumulation of guanidinoacetate takes place that are the diagnostic features of this disease. Dietary creatine supplementation alone or along with arginine restriction has been reported to be beneficial for all treated patients, although to various extent. However, none of the GAMT deficient patient has been reported to return to complete normal developmental level.

Central auditory processing in patients with spinocerebellar ataxia.

BACKGROUND: Autosomal dominant spinocerebellar ataxias (SCAs) are a group of rare and heterogeneous neurodegenerative diseases characterized by the presence of progressive cerebellar ataxia. Although the symptomatology of SCAs is well known, information regarding central auditory functioning in these patients is lacking. Therefore, we assessed the central auditory processing disorders (CAPD) in patients with different subtypes of SCA. METHODS: In a retrospective cross-sectional study, we subjected 43 patients with SCAs to otorhinolaryngological, audiological, Brainstem Auditory Evoked Potential (BAEP) and acoustic immittance evaluations as well as CAPD tests, namely the Standard Spondaic Word (SSW) and the Random Gap Detection Test (RGDT). RESULTS: Most patients (83.7%) reported an imbalance when walking; many reported difficulty speaking (48.8%), dizziness (41.8%), and dysphagia (39.5%). In the audiometric test, 14/43 patients (32.5%) presented alterations, including 4/12 patients with SCA3 (33.3%), 1/8 patients with SCA2 (12.5%), 1/1 patient with SCA4 (100%), 1/1 patient with SCA6 (100%), 1/1 patient with SCA7 (100%), 3/6 patients with SCA10 (50%), and 3/14 patients with an undetermined type of SCA (21.4%). In the BAEP test, 20/43 patients (46.5%) presented alterations (11.6% na orelha esquerda e 34.9% bilateralmente), including 7/12 patients with SCA3 (58.3%), 5/8 patients with SCA2 (62.5%), 1/1 patient with SCA4 (100%), 1/1 patient with SCA6 (100%), 1/1 patient with SCA7 (100%), 4/6 patients with SCA10 (66.7%), and 2/14 patients with an undetermined type of SCA (14.2%). In the SSW, 22/40 patients (55%) presented alterations (2.5% in the right ear, 15% in the left ear, and 37.5% bilaterally), including 6/10 patients (60%) with SCA3, 3/8 (37.5%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 4/5 (80%) with SCA10, and 8/14 (57.1%) with an undetermined type SCA. For the RGDT, 30/40 patients (75%) presented alterations, including 8/10 (80%) with SCA3, 6/8 (75%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 4/5 (80%) with SCA10, and 9/14 (64.3%) with an undetermined type of SCA. In immittance testing, 19/43 patients (44.1%) presented alterations, including 6/12 (50%) with SCA3, 4/8 (50%) with SCA2, 1/1 (100%) with SCA4, 1/1 (100%) with SCA6, 1/1 (100%) with SCA7, 2/6 (33.3%) with SCA10, and 4/14 (28.6%) with an undetermined type of SCA. CONCLUSIONS: A majority of patients exhibited SSW test deficits, with a predominance of bilateralism, and three-fourths had impaired RGDT performance, pointing to difficulties with binaural integration and temporal resolution. Assessment of CAPD is important for therapeutic follow ups in patients with SCA.

Emisiones otoacústicas como analizador de la función coclear en niños con problemas de lenguaje / Otoacoustic emissions as cochlear function analyser in children with language disorders

Introducción y objetivos: La percepción del sonido que se lleva a cabo en la cóclea está involucrada en el lenguaje. El objetivo fue describir los hallazgos encontrados en las emisiones otoacústicas transitorias (EOT) en niños con problemas de lenguaje antes y después de 6 meses de terapia. Métodos: A 17 niños diagnosticados como anártricos, se les realizó historia clínica, escala de inteligencia, prueba de lenguaje inicial y estudios audiológicos. Resultados: Al hacer la comparación del inicio y después de 6 meses de terapia, encontramos, en el análisis frecuencial de las EOT una p ≤ 0,05 en 1 kHz en el oído derecho, en la audiometría; se encontró una p ≤ 0,05 en las frecuencias de 0,5, 1,5, 2, 3, 4 y 8 kHz en el oído derecho y en las frecuencias de 2, 3, 4 y 8 kHz en el oído izquierdo. Conclusiones: El análisis del sonido a través de la cóclea está involucrado en el proceso de adquisición del lenguaje. Un mal procesamiento de los sonidos del lenguaje en el sistema periférico podría dar como resultado un mal procesamiento a nivel central. Por esto, es importante tener nuestros resultados en consideración al realizar el diagnóstico y el tratamiento rehabilitador en los niños con trastornos de lenguaje (AU)

Introduction and objectives: Speech perception that takes place in the cochlea is involved in the process of language. The objective was to describe the findings in transient otoacoustic emissions in children with language problems before and after 6 months of speech therapy. Methods: There were 17 children with language problems between 3 and 6 years of age diagnosed with anarthric language delay (expressive and mixed language disorder). They underwent medical history, otoscopy, intelligence level testing, initial language test, tympanometry of 226 Hz, audiometry and transient otoacoustic emission test. Results: We evaluated the 17 patients again after 6 months of attending speech therapy. The percentage of overall reproducibility of transient otoacoustic emissions in both ears was adequate to perform frequency analysis. We found a statistically significant difference (P≤0.01) in the frequency of 1 kHz reproducibility when comparing results before and after therapy in the right ear. There was a significant difference (P≤0.05) when comparing the results of audiometry at frequencies of 0.5, 1.5, 2, 4 and 8 kHz in the right ear and a highly significant difference (P = 0.001) in the frequency of 3 kHz in the left ear. Conclusions: The analysis of sound through the cochlea is involved in the process of language acquisition. A poor processing of speech sounds in the peripheral system could result in poor processing at the central level. Consequently, it is important to consider our results when making a diagnosis and carrying out rehabilitation treatment in children with language disorders (AU)

BioMARK as electrophysiological tool for assessing children at risk for (central) auditory processing disorders without reading deficits.

Biological Marker of auditory processing (BioMARK) is an electrophysiological test tool widely known as Speech-evoked ABR. Several previous investigations have shown the utility of speech-evoked ABR in the diagnosis of language based processing deficits like learning disability and specific language impairment; however missing from literature is a study that has ruled out the existence of comorbidity of such conditions and carefully delineated the efficacy of speech-evoked ABR in children with children with auditory processing disorders sans reading deficits. Hence, the present study aimed at investigating Speech-evoked ABR in children with auditory processing disorders without reading problems. A total of 336 school going children in the age range of 8-12 years were screened for presence of central auditory processing deficits. Among the 51 children who were identified as at risk, 15 were randomly selected and served as experimental group. The control group comprised of fifteen age matched children. The inter-group comparison was done using MANOVA, which revealed significant prolongations of latencies of waves V and A (p = 0.001) along with marginal reductions in V/A slope (p = 0.052) and amplitude of responses to first formant (p = 0.065). The responses to higher frequencies did not differ between the groups. Speech-evoked ABR are affected in children who are at risk of central auditory processing disorders sans reading deficits which probably indicates the presence of abnormal brainstem encoding of speech signal in this population.

Massage therapy improves the development of HIV-exposed infants living in a low socio-economic, peri-urban community of South Africa.

The aim of this study was to assess the effect of massage therapy on the growth and development of infants of HIV-infected mothers in a low socio-economic community in Cape Town. It was a prospective, randomised, controlled intervention trial that included massage therapy and control groups of HIV-infected mothers and their normal birth weight infants who were enrolled in the prevention of mother-to-child transmission (PMTCT) programme. Participants were recruited at the 6-week clinic visit and followed up every 2 weeks until their infants were 9 months of age. Mother-infant pairs in the massage therapy and control groups included 73 and 88 at 6 weeks and 55 and 58 at 9 months, respectively. Mothers in the intervention group were trained to massage their infants for 15 min daily. The socioeconomic status, immunity, relationship with the partner and mental pain of mothers; the infants' dietary intake, anthropometry and development (Griffiths Mental Development Scales); and haematological and iron status of mothers and infants were assessed at baseline and follow-up. Nine infants (5.3%) were HIV-infected on the HIV DNA PCR test at 6 weeks. Despite significantly higher levels of maternal mental pain, infants in the massage therapy compared to control group scored higher in all five of the Griffiths Scales of Mental Development and significantly higher in the mean quotient (p=0.002) and mean percentile (p=0.004) for the hearing and speech scale at 9 months. Based on the mean difference in scores, the massage therapy group showed greater improvement for all five scales compared to the control group. The mean difference in scores was significantly greater for the hearing and speech quotient (21.9 vs. 11.2) (p<0.03) and the general quotient percentile (19.3 vs. 7.7) (p=0.03) in the massage therapy compared to the control group. These scales remained significant when adjusting for the relationship with the partner and maternal mental pain. Both groups had lower scores in the performance scale at 9 months although this was significantly worse in the control compared to the massage therapy group when adjusting for maternal CD4 count, anaemia, relationship with the partner and mental pain. There were no significant differences in the anthropometric measurements between the two groups. In conclusion, based on the Griffiths Scales, massage therapy improved the overall development and had a significant effect on the hearing and speech and general quotient of HIV-exposed infants in this study.

Sensitivity, specificity and efficiency of speech-evoked ABR.

We determined the sensitivity, specificity and efficiency of speech-evoked Auditory Brainstem Response (ABR) as a diagnostic support for Auditory Processing Disorder (APD) and specific language impairment (SLI). Speech-evoked ABRs were elicited using the five-formant syllable/da/. The waveforms V, A, C, D, E, F, and O of all groups were analyzed. The sensitivity and specificity were calculated, and receiver operating characteristic analyses were performed to determine the optimum cut-off. Seventy-five children who were native speakers of Brazilian-Portuguese participated. The participants included 25 children with APD, 25 children with SLI and 25 with typical development. Statistical analysis demonstrated a cut-off for latency values of 6.48, 7.51, 17.82, 22.33, 30.79, 39.54 and 48.00 for V, A, C, D, E, F, and O waves, respectively. The A wave exhibited superior balance for the APD group. For the SLI group, the A, D and O waves exhibited the best balance. Furthermore, when analyzing the APD and SLI groups separately, better sensitivity values were observed for the SLI group than the APD group. Speech-evoked ABR is a useful test to identify auditory processing disorders and language impairment. Furthermore, this study represented an important step forward in establishing the clinical utility of speech-evoked ABR in Brazilian Portuguese-speaking children.