On the definition of APD and the need for a conceptual model of terminology.

Objective: To consider the definition of auditory processing disorder (APD). Design: Narrative review and opinion piece. Study sample: Considerations of definition drawn primarily from the fields of philosophy, audition, learning and language. Results: The problem of defining APD appears genuine. Current and previous definitions of APD are nominal in nature, being both stipulative (offering explicit and arbitrary adoptions of meaning relation between words) and operational (creating rules that stipulate how the terms might apply to particular cases). Such definitions survive by consensus and perceived heuristic value in a manner that fails to achieve closure as arguments about their validity remain relative. Conclusion: A conceptual model of APD terminology is needed that considers nominal, conceptual and real definitions as well as different purposes for defining APD within professional and public domains. A framework for such a conceptual model of APD terminology is offered.

[Indicators for Speech Comprehension in Migrant Children. A comparison of Extreme Groups]. / Indikatoren für Sprachverständnis bei Kindern mit Migrationshintergrund. Ein Extremgruppenvergleich.

Objective Children with migrant background learning German as second language are frequently considered having problems in speech comprehension and speaking; nevertheless, it is very difficult to objectify that for young children. For this purpose risk-factors should be determined empirically. Material and Methods The study comprised 126 children from a developmental longitudinal study in 7 day-care centers in Frankfurt/M and Darmstadt. The sample was sorted into two extreme groups by their achievement in oral German language comprehension: criterion T-score ≥46=age appropriate (N=61) vs. T-score ≤32=poor (N=65). The study used an assumed best-subtests variable-selection (intelligence; grammatical based comprehension; verbal conceptualization; recognition of semantic and grammatical inconsistencies) to examine risk-factors for the quality of development in German as second language. Results Intelligence was average in both groups, however, significantly different (T-score=54.1; SD 6.7 vs. T-score=42.2; SD 8.8; p<0,001). Risk-factors for a separation between rather convenient and less convenient conditions for the development of German as second language could be identified by applying discriminant analyses (in order of descending magnitude): intelligence; recognition of verbal inconsistencies; mother's level of education; grammatical based comprehension. Regarding the group affiliation, 88% of the children with poor and 84% of those with age appropriate oral comprehension could be correctly classified within the selected samples. Conclusions The results provide an acceptable standard to distinguish migrant children with an age appropriate oral comprehension in German as the second language from such with a poorer one.

Semiology of neglect: An update.

Hemispatial neglect is a common disabling condition following brain damage to the right hemisphere. Generally, it involves behavioral bias directed ipsilaterally to the damaged hemisphere and loss of spatial awareness for the contralesional side. In this syndrome, several clinical subtypes were identified. The objective of this article is to provide a nosological analysis of the recent data from the literature on the different subtypes of neglect (visual, auditory, somatosensory, motor, egocentric, allocentric and representational neglect), associated ipsilesional and contralesional productive manifestations and their anatomical lesion correlates. These different anatomical-clinical subtypes can be associated or dissociated. They reflect the heterogeneity of this unilateral neglect syndrome that cannot be approached or interpreted in a single manner. We propose that these subtypes result from different underlying deficits: exogenous attentional deficit (visual, auditory neglect); representational deficit (personal neglect, representational neglect, hyperschematia); shift of the egocentric reference frame (egocentric neglect); attentional deficit between objects and within objects (allocentric neglect), endogenous attentional deficit (representational neglect) and transsaccadic working memory or spatial remapping deficit (ipsilesional productive manifestations). Taking into account the different facets of the unilateral neglect syndrome should promote the development of more targeted cognitive rehabilitation protocols.

The practices, challenges and recommendations of South African audiologists regarding managing children with auditory processing disorders.

Audiologists managing children with auditory processing disorders (APD) encounter challenges that include conflicting definitions, several classification profiles, problems with differential diagnosis and a lack of standardised guidelines. The heterogeneity of the disorder and its concomitant childhood disorders makes diagnosis difficult. Linguistic and cultural issues are additional challenges faced by South African audiologists. The study aimed to describe the practices, challenges and recommendations of South African audiologists managing children with APD. A quantitative, non-experimental descriptive survey was used to obtain data from 156 audiologists registered with the Health Professions of South Africa. Findings revealed that 67% screened for APD, 42% assessed while 43% provided intervention. A variety of screening and assessment procedures were being administered, with no standard test battery identified. A range of intervention strategies being used are discussed. When the relationship between the number of years of experience and the audiologists' level of preparedness to practice in the field of APD was compared, a statistically significant difference (p = 0.049) was seen in that participants with more than 10 years of experience were more prepared to practice in this area. Those participants having qualified as speech-language therapists and audiologists were significantly more prepared (p = 0.03) to practice than the audiologists who comprised the sample. Challenges experienced by the participants included the lack of linguistically and culturally appropriate screening and assessment tools and limited normative data. Recommendations included reviewing the undergraduate audiology training programmes, reinstituting the South African APD Taskforce, developing linguistically and culturally appropriate normative data, creating awareness among educators and involving them in the multidisciplinary team.

[Auditory processing and perception disorders (APPD): summary and updated overview]. / Auditive Verarbeitungs- und Wahrnehmungsstörungen (AVWS): Zusammenfassung und aktualisierter Überblick.

The APD guideline of 2009 was supplemented by the statements listed here. The addition is based on current knowledge and findings. Otherwise, the Guideline 2009 remains valid. Here, a summary of the updated APD guideline is given, thus proving an overview of the definition of APD, diagnosis, differential diagnosis and recommended for APD management.

Auditory Processing Disorder (APD): Progress in Diagnostics So Far. A Mini-Review on Imaging Techniques.

Auditory processing disorder (APD) is a disorder that affects the perception of sound, both verbal and non-verbal. Patients who are generally diagnosed with APD present with abnormal hearing but have normal audiograms. There is no gold standard investigation for APD and no standardized criteria for diagnosis. Because of its disabling effect and the overlap that exists with other neurodevelopmental disorders, there is an urgent need to develop tools and criteria for appropriate diagnosis. There is a current significant focus in research on imaging techniques that can possibly be used in the future for the appropriate diagnosis of APD. Over the years, several imaging techniques have contributed significantly to defining this disorder. To date, no studies have reported the routine use of imaging for the diagnosis of APD.

[Diagnostic Accuracy of a Test Set to Classify Children with Auditory Processing Disorders (APD)]. / Diagnostische Genauigkeit einer AVWS-Testbatterie zur Klassifikation auffälliger Kinder.

OBJECTIVE: To investigate the diagnostic performance of an testbattery. Sensitivity and specificity are measures to evaluate the validity of a test. MATERIAL AND METHODS: These parameters were determined using ROC-curves for a battery of 10 diagnostic tests. The Youden Index, defined as the maximal effectiveness to determine the optimal cutpoint of diagnostic accuracy, was calculated as well. PARTICIPANTS: 91 children diagnosed with APD (51%) visiting 2(nd)-4(th) grade of a primary school; 87 2(nd)-4(th) graders with-out APD. RESULTS: A very good relation of sensitivity and false-positive-rate was found for the Mottier-Test, which measures auditory non-word repetition (Area under the Curve=AUC as a global statistic measure for validity: 0.96; p=0.000; 95%-CI: 0.93-0.99). The cut-off point to distinguish between children with and without APD was 17.5 raw score, according to the max. Youden Index 0.83 (sensitivity: 90.1%; specificity 93.1%; false-positive-rate: 6.9%). The HSET-Subtest "Imitation grammatischer Strukturformen" (measuring auditory short-term sentence memory) exhibited comparable high discriminative power (AUC: 0.94; p=0.000; 95%-CI: 0.90-0.98). At 21.5 raw score (max. Youden Index: 0.82), 84.7% of the children were classified correctly (false-positive-rate: 2.3%; specificity: 97.7%). Eight tests had a moderately diagnostic accuracy, two of them tended to lesser accuracy (phoneme analysis: AUC: 0.72; monaural temporal order judgment AUC: 0.75). CONCLUSIONS: Using certain tests of a defined test set for identification of APDs in primary school children according to the sensitivity improves the possibility to detect APDs. In order to precisely specify the APD and to decide which auditory dimension should be treated the entire combination of 10 diagnostic tests is indispensable.

[Can children with APD be discriminated from those with APD plus SLI by test diagnostic?]. / Sind AVWS mit und ohne Sprachentwicklungsstörung testdiagnostisch trennbar?

BACKGROUND: A small number of variables already permit a reliable diagnostic classification of patients into the group "Auditory Processing Disorder" (APD) or unimpaired (Non-APD) in second-graders of primary schools. MATERIAL AND METHODS: To test whether the separation of children into the diagnostic group APD or SLI (Specific Language Impairment)+APD-symptomatology or Non-APD is possible, stepwise discrimination analysis were performed with 10 variables from the database of the study from Kiese-Himmel & Nickisch (2012). PATIENTS: Two clinically and diagnostically confirmed groups of second-graders: (1) Monosymptomatic APD (n=24; mean age 7.7 [SD 0.75] years); (2) SLI + APD-symptomatology (n=21; mean age 8.0 [SD 0.55] years) and a control group of unimpaired children (Non-APD; n=48; mean age 7.6 [SD 0.49] years). RESULTS: A statistical separation of each clinical group of unimpaired children functioned successfully. Children with APD were differentiated from unimpaired children via 4 variables of which 2 focused on phonological retention (non-words; sentences), and 2 on language comprehension (word understanding in background noise; dichotic word recognition). Children with SLI + APD-symptomatology were separated from unimpaired by 2 phonological retention variables. Children with APD could only be differentiated significantly from those with SLI + APD-symptomatology when introducing a linguistic variable (grammatical structure comprehension). CONCLUSION: Answering the question whether a selective discrimination of children with APD from children with SLI + APD-symptomatology is possible respectively whether it is the same or different requires further attention.

[Symptoms and diagnosis of auditory processing disorder]. / Symptome und Diagnosestellung auditiver Verarbeitungs- und Wahrnehmungsstörungen.

The definition of an auditory processing disorder (APD) is based on impairments of auditory functions. APDs are disturbances in processes central to hearing that cannot be explained by comorbidities such as attention deficit or language comprehension disorders. Symptoms include difficulties in differentiation and identification of changes in time, structure, frequency and intensity of sounds; problems with sound localization and lateralization, as well as poor speech comprehension in adverse listening environments and dichotic situations. According to the German definition of APD (as opposed to central auditory processing disorder, CAPD), peripheral hearing loss or cognitive impairment also exclude APD. The diagnostic methodology comprises auditory function tests and the required diagnosis of exclusion. APD is diagnosed if a patient's performance is two standard deviations below the normal mean in at least two areas of auditory processing. The treatment approach for an APD depends on the patient's particular deficits. Training, compensatory strategies and improvement of the listening conditions can all be effective.

Different patterns of auditory information processing deficits in chronic schizophrenia and bipolar disorder with psychotic features.

With the development of DSM-V and ICD-11 the definitions of psychiatric disorders are under re-evaluation. The emphasis is shifted from distinct disorders to clusters defined not only by symptomatology, but also by underlying neurobiology and cognitive deficits. Bipolar disorder I (BD-I) and schizophrenia (SZ) are of special interest since their differential diagnosis is often problematic and they partially overlap in measures ranging from genetics to neurophysiology. Event-related potentials (ERPs) are one of the most studied factors but the results are still controversial, primarily in BD-I, where ERPs reflecting different stages of auditory information processing have been much less investigated. In this study, we aimed at investigating the changes of five auditory event-related potentials (P50 and N100 suppression, duration and pitch deviant mismatch negativity (MMN) and P3b) in 20 SZ and 20 BD-I patients with a history of psychosis and 21 healthy control subjects. Our data revealed substantial differences between the two patient groups. Only patients with SZ demonstrated impaired N100 suppression, shorter duration deviant MMN latency and attenuated P3b amplitude, while prolonged pitch deviant MMN latency was found to be characteristic of the BD-I group. No shared ERP abnormalities were observed among the patient groups. Our results indicate that SZ and BD-I are characterized by highly different neurophysiological profiles when measured in the same laboratory setting.

[Auditory processing disorders--differential diagnosis. Guidelines of the German Society for Phoniatry and Pedaudiology]. / Auditive Verarbeitungs- und Wahrnehmungsstörungen--Differenzialdiagnose. Leitlinien der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

One prerequisite of diagnosing an auditory processing disorder (APD) is the differential diagnostic exclusion of language comprehension disorders, attention deficit hyperactivity disorders, cognitive impairment, as well as autistic-type diseases. This issue is discussed in detail in the updated guidelines for APD, as well as the logical consequences resulting thereof in terms of interpreting individual test results. This update is based in terms of content on the preceding guidelines of the German Society for Phoniatry and Pedaudiology (DGPP) and aligns itself closely with the Californian Speech-Language-Hearing Association, as well as guidelines of the American Academy of Audiology.

Categorization and timbre perception of environmental sounds in schizophrenia.

Perception of environmental sounds from impacted materials (Wood, Metal and Glass) was examined by conducting a categorization experiment. Stimuli consisted of sound continua evoking progressive transitions between material categories. Results highlighted shallower response curves in subjects with schizophrenia than healthy participants, and are discussed in the framework of Signal Detection Theory and in terms of impaired perception of specific timbre features in schizophrenia.

Childhood auditory processing disorder as a developmental disorder: the case for a multi-professional approach to diagnosis and management.

Auditory processing disorder (APD) is diagnosed when a patient presents with listening difficulties which can not be explained by a peripheral hearing impairment or higher-order cognitive or language problems. This review explores the association between auditory processing disorder (APD) and other specific developmental disorders such as dyslexia and attention-deficit hyperactivity disorder. The diagnosis and aetiology of APD are similar to those of other developmental disorders and it is well established that APD often co-occurs with impairments of language, literacy, and attention. The genetic and neurological causes of APD are poorly understood, but developmental and behavioural genetic research with other disorders suggests that clinicians should expect APD to co-occur with other symptoms frequently. The clinical implications of co-occurring symptoms of other developmental disorders are considered and the review concludes that a multi-professional approach to the diagnosis and management of APD, involving speech and language therapy and psychology as well as audiology, is essential to ensure that children have access to the most appropriate range of support and interventions.

Categorical speech perception deficits distinguish language and reading impairments in children.

We examined categorical speech perception in school-age children with developmental dyslexia or Specific Language Impairment (SLI), compared to age-matched and younger controls. Stimuli consisted of synthetic speech tokens in which place of articulation varied from 'b' to 'd'. Children were tested on categorization, categorization in noise, and discrimination. Phonological awareness skills were also assessed to examine whether these correlated with speech perception measures. We observed similarly good baseline categorization rates across all groups; however, when noise was added, the SLI group showed impaired categorization relative to controls, whereas dyslexic children showed an intact profile. The SLI group showed poorer than expected between-category discrimination rates, whereas this pattern was only marginal in the dyslexic group. Impaired phonological awareness profiles were observed in both the SLI and dyslexic groups; however, correlations between phonological awareness and speech perception scores were not significant. The results of the study suggest that in children with language and reading impairments, there is a significant relationship between receptive language and speech perception, there is at best a weak relationship between reading and speech perception, and indeed the relationship between phonological and speech perception deficits is highly complex.

[(Central) Auditory Processing Disorders in Childhood--a Chimera or are Useful Clinical Diagnostic Tests Missing?]. / Auditive Verarbeitungs- und Wahrnehmungsstörungen im Kindesalter: eine Schimäre--oder fehlen uns klinisch nützliche Verfahren zur Diagnosesicherung?

BACKGROUND: (Central) Auditory Processing Disorders (C)APD are becoming ever more diagnosed in children, though there is no agreement on diagnostic markers (gold standard for (C)APD diagnosis). In Germany, the diagnostics of (C)APD in the paediatric population is based on test measurements including phonological processing rather than on a valid theoretical model to guide clinicians. The evaluation of the clinical significance of central auditory functions as well as the number of the behavioural tests which should be performed are left to the diagnostician. PATIENTS AND METHODS: The present study reviewed retrospectively test scores from a health care research database containing 167 children suspected of having a (C)APD. A total of 51 children participated in the study: 39 children identified with monosymptomatic (C)APD (on the basis of commonly used (C)APD tests with scores > or = 2 SDs below the mean on at least 2 tests) and 12 children who did not receive a (C)APD diagnosis (non-(C)APD). A stepwise discriminant analysis was performed with the five phonological measures of the psychological (C)APD-diagnostics in the German language: Nonword repetition by the Mottier-Test; the subtest "Recall of sentences" by the Heidelberger Sprachentwicklungstest for Language Development; "Digit Recall" by the German version of the K-ABC-subtest; "Auditory Closure" and "Sound Blending" by the subtests of the German version of the Illinois Test of Psycholinguistic Abilities. Next the discriminant function of the model was examined. RESULTS: Performance in the normed tests (K-ABC Digit Recall: T-score 44.2, p = 0.0029; Sentence Recall: T-score 42.4, p = 0.0002; Auditory Closure: T-score 49.9, p = 0.0130; Sound Blending: T-score 47.2 p = 0.0121) and in nonword repetition (Mottier: 15.9 raw scores, p < .0001) was on average significantly reduced in the (C)APD group compared to the non-(C)APD-group, although the mean test results in the standardized tests were in the norm range. Only nonword repetition (F = 21.05; R (2) = 0.30; p < 0.0001) and recall of sentences (F = 3.74; R (2) = 0.07; p = 0.059) differentiated significantly in both groups. The posterior probability to classify the children was 80 % respectively the error-rate estimate was 20 %. CONCLUSIONS: Children with (C)APD have a diminished temporal processing and perception ability which expresses itself in the limited capacity of their phonological short-term memory. A success in the discriminant function of no more than 80 % makes possibly aware of deficits in both validity and reliability of the diagnostic instruments.

[Questionnaire on auditory perception disorders: psychometric correlates in preschool children]. / Anamnesebogen für auditive Verarbeitungs- und Wahrnehmungsstörungen : Psychometrische Korrelate im Vorschulalter.

BACKGROUND: A standardized questionnaire on central auditory processing disorders ["Anamnesebogen zur Erfassung auditiver Verarbeitungs- und Wahrnehmungsstörungen (AVWS)"] was developed by the German Society of Phoniatrics and Pediatric Audiology and standardized for school-age children. This study was designed to elucidate the validity of this questionnaire in preschool children. METHODS: The responses, which were given by the parents of 84 preschool children with respect to auditory discrimination and auditory memory, were correlated with the results of the Heidelberg screening test for preschool children (HVS), and their accuracy of prediction was determined. RESULTS: Similar to the results of other studies in school-age children, weak but significant correlations were found between the questionnaire results regarding auditory discrimination and auditory memory and the respective results of the HVS subtests. With a few exceptions, the questionnaire's accuracy of prediction was low. CONCLUSION: For preschool children, the questionnaire provides a reasonable method to get specific information about a child's history in a standardized and economic way. However, it is not valid as a screening or diagnostic tool.