Psychosocial status of children with auditory processing disorder.

BACKGROUND: Children with hearing loss often exhibit reduced psychosocial status compared to children with normal hearing. It is reasonable to assume that psychosocial function may also be affected in children diagnosed with auditory processing disorder (APD). However, there are no published studies specifically addressing the psychosocial health of children with APD. PURPOSE: This investigation examined relationships between APD and psychosocial status, with an aim to examine nonauditory factors that may influence quality of life of children diagnosed with APD. RESEARCH DESIGN: A two-matched group design was employed. Participants and their mothers completed appropriate versions of the Dartmouth Primary Care Cooperative Information Project Charts for Adolescents (COOP-A), the Behavioral Assessment System for Children, Second Edition (BASC-2), and the Social Skills Rating System (SSRS). STUDY SAMPLE: Participants consisted of 19 children (aged 9.5-17.8 yr; mean = 11.9) diagnosed with APD and 20 gender- and age-matched (mean = 12.8 yr) children with no evidence of APD by history or audiological assessment. Primary caretakers (mothers) of the participants also completed psychosocial questionnaires according to their perception of their participating child's function. DATA COLLECTION AND ANALYSIS: Data were collected at a single visit, following APD diagnosis. Data from each questionnaire were analyzed using appropriate statistical methods for two-group comparisons. RESULTS: Analysis of child reports revealed significantly greater psychosocial difficulty in the APD group on subscales of the COOP-A and BASC-2. Increased problems in the APD group were also reported by parents on subscales of the COOP-A, BASC-2, and SSRS. Eta-squared values for all significant findings indicated moderate to large effect sizes, suggesting findings may be generalized to other children in this age group. No between-group differences were found on any subscale for APD children with or without a confirmed or suspected language disorder. CONCLUSION: We found that children with APD exhibit increased psychosocial difficulty in several areas compared to children without APD.

Multiple benefits of personal FM system use by children with auditory processing disorder (APD).

Children with auditory processing disorders (APD) were fitted with Phonak EduLink FM devices for home and classroom use. Baseline measures of the children with APD, prior to FM use, documented significantly lower speech-perception scores, evidence of decreased academic performance, and psychosocial problems in comparison to an age- and gender-matched control group. Repeated measures during the school year demonstrated speech-perception improvement in noisy classroom environments as well as significant academic and psychosocial benefits. Compared with the control group, the children with APD showed greater speech-perception advantage with FM technology. Notably, after prolonged FM use, even unaided (no FM device) speech-perception performance was improved in the children with APD, suggesting the possibility of fundamentally enhanced auditory system function.

The effect of hearing aids and frequency modulation technology on results from the communication profile for the hearing impaired.

Hearing impairment has been associated with decline in psychosocial function. Previous investigations have reported that the utilization of hearing aids can ameliorate these reductions in psychosocial function. To date, few investigations have examined the effects of frequency modulation technology on hearing handicap, adjustment to hearing loss, and communicative strategies. The purpose of this investigation was to examine these effects and to compare them to the benefits obtained when using hearing aids alone. Subjects ranged in age from 34 to 81 years and had mean pure-tone thresholds consistent with a bilateral moderate to severe sloping sensorineural hearing loss. All subjects wore hearing aids only and hearing aids plus FM system in a randomized fashion. The Communication Profile for the Hearing Impaired (CPHI) was administered prior to fitting the study devices and once a month for three months in each of the two conditions. A statistically significant difference between device conditions was obtained for the Importance of Communication in Work Situations subscale. Additionally, statistically significant differences over time were noted in several CPHI subscales. Despite statistical significance, none of these results were clinically significant. The implications of these results will be discussed.

Speech perception in noise: directional microphones versus frequency modulation (FM) systems.

The major consequence of sensorineural hearing loss (SNHL) is communicative difficulty, especially with the addition of noise and/or reverberation. The purpose of this investigation was to compare two types of technologies that have been shown to improve the speech-perception performance of individuals with SNHL: directional microphones and frequency modulation (FM) systems. Forty-six adult subjects with slight to severe SNHL served as subjects. Speech perception was assessed using the Hearing in Noise Test (HINT) with correlated diffuse noise under five different listening conditions. Results revealed that speech perception was significantly better with the use of the FM system over that of any of the hearing aid conditions, even with the use of the directional microphone. Additionally, speech perception was significantly better with the use of two hearing aids used in conjunction with two FM receivers rather than with just one FM receiver. Directional microphone performance was significantly better than omnidirectional microphone performance. All aided listening conditions were significantly better than the unaided listening condition.

Effects of frequency modulation (FM) transmitter microphone directivity on speech perception in noise.

Frequency modulation (FM) technology can significantly improve the speech perception ability of individuals with sensorineural hearing loss (SNHL) in background noise. Previous investigations have demonstrated that the microphone design of the FM transmitter can have a significant impact on this improved speech perception. The purpose of this investigation was to compare 3 types of FM transmitter microphone designs: (a) wide angle (omnidirectional microphone), which amplifies sounds coming from all directions around the microphone equally; (b) zoom (1 directional microphone), which provides less amplification to signals coming from the rear, and (c) superzoom (2 directional microphones), which provides less amplification to signals originating from the rear and the sides. Fifteen adults with bilateral slight to moderately severe SNHL participated. Speech perception was assessed using the Hearing in Noise Test (M. Nilsson, S. Soli, and J. Sullivan, 1994). Speech spectrum shaped noise served as the noise competition. Results revealed that the best speech perception in noise was obtained when the FM transmitter was used in the zoom setting. The poorest performance was obtained when the FM transmitter was in the wide-angle mode. The clinical implications of these results are discussed.

Knowledge, behaviors, and attitudes about hearing loss and hearing protection among racial/ethnically diverse young adults.

Over 11 million individuals exhibit some degree of permanent noise induced hearing loss (NIHL). Despite such data, there remains a paucity of empirical evidence on the knowledge of noise exposure and hearing protection devices (HPDs) for young adults, particularly those of diverse racial/ethnic backgrounds. This lack of research is unfortunate, as prior research suggests that the incidence of NIHL can be reduced through educational programs, such as hearing conservation programs (HCPs). Moreover, research also indicates that such educational programs are more beneficial when developed for specific age and/or ethnic/racial groups. The primary aim of this investigation was to determine the knowledge base of 200 college-aged young adults aged 18-29, concerning the auditory mechanism, NIHL, and the use of HPDs. The second aim of this study was to identify race and ethnicity differences or similarities in knowledge of these areas among African-American and caucasian young adults. Overall, in many instances, a majority of the young adults in our study demonstrated a high degree of knowledge concerning factors associated with exposure to excessive noise and the risk of hearing loss. Yet, the results also revealed significant racial/ethnic differences in knowledge, behaviors, and attitudes about the use of HPDs. Recent estimates suggest that more than 11 million individuals in the United States exhibit some degree of NIHL. Moreover, 40 million individuals work in environments that contain potentially harmful noise levels, and over 50 million Americans routinely use firearms--a common cause of noise-induced hearing impairment. A specific hallmark manifestation of NIHL is a permanent decrease in hearing sensitivity from 3,000-6,000 Hz, with a characteristic notch at 4,000 Hz. Additional effects of exposure to high noise levels include physiological changes in heart rate and blood pressure, decrease in work productivity, and an interference with communication that results from the masking of speech. With these considerations in mind, the purpose of this study was to investigate the knowledge, behaviors, and attitudes of a young-adult population in the United States concerning the factors that contribute to NIHL and the use of hearing protection. Additionally, this study was interested in whether there were racial/ethnic differences or similarities in knowledge of hearing loss and the use of HPDs among African-American and caucasian young adults.

Comorbid auditory processing disorder in developmental dyslexia.

OBJECTIVE: The primary objective of this study was to investigate the extent of comorbid auditory processing disorder (APD) in a group of adults with developmental dyslexia. An additional objective was to compare performance on auditory tasks to results from standardized tests of reading in an attempt to generate a clinically useful profile of developmental dyslexics with comorbid APD. DESIGN: A group of eleven persons with developmental dyslexia and 14 age- and intelligence-matched controls participated in the study. Behavioral audiograms, 226-Hz tympanograms, and word recognition scores were obtained binaurally from all subjects. Both groups were administered the frequency-pattern test (FPT) and duration-pattern test (DPT) monaurally (30 items per ear) in both the left and right ear. Gap detection results were obtained in both groups (binaural presentation) using narrowband noise centered at 1 kHz in an adaptive two-alternative forced-choice (2-AFC) paradigm. The FPT, DPT, and gap detection results were analyzed for interaural (where applicable), intergroup, and intragroup differences. Correlations between performance on the auditory tasks and the standardized tests of reading were examined. Additive logistic regression models were fit to the data to determine which auditory tests proved to be the best predictors of group membership. RESULTS: The persons with developmental dyslexia as a group performed significantly poorer than controls on both the FPT and DPT. Furthermore, the group differences were significant in both monaural conditions. On the FPT and DPT, five of the eleven participants with dyslexia performed below the widely used clinical criterion for APD of 70% correct in either ear. All five of these participants performed below criterion on the FPT, whereas four of the five additionally performed below 70% on the DPT. The data also were analyzed by fitting a series of stepwise logistic regression models, which indicated that gap detection did not significantly predict group membership, whereas the FPT and DPT were significant predictors. The addition of the FPT score after the DPT did not result in a significant change in the residual deviance. CONCLUSIONS: Approximately half of the participants with developmental dyslexia showed clinically significant diminished performance on the FPT and DPT indicative of APD. These results indicate that the percentage of persons with developmental dyslexia and comorbid APD may be substantial enough to warrant serious clinical considerations.

Hearing loss, hearing handicap, and functional health status between African American and Caucasian American seniors.

This investigation examined the relations among hearing loss, handicap perception, and functional health status of 152 African American and Caucasian American seniors ranging in age from 60 to 89 years. Subjective measures were obtained from self-report scores on the Hearing Handicap Inventory for the Elderly (HHIE), the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and demographic profiles. Results indicated the following: (1) both subject groups exhibited nearly identical degrees of sensorineural hearing loss consistent with presbyacusis; (2) African American seniors reported significantly lower levels of completed education than did Caucasian American seniors; (3) differences between groups in self-report scores of hearing handicap (HHIE) were not statistically significant; (4) differences across groups in self-report scores of functional health status (SF-36) were not statistically significant; and (5) increasing levels of hearing loss produced significantly higher HHIE scores and significantly lower SF-36 scores in each group. These findings are discussed.

Classroom Acoustics for Children With Normal Hearing and With Hearing Impairment.

Past investigations demonstrate that the acoustical environment of a classroom is a critical factor in the academic, psychoeducational, and psychosocial achievement of children with normal hearing and with hearing impairment. This article examines several acoustical variables, such as noise, reverberation, and speaker-listener distance, which can deleteriously affect speech perception in classrooms. Moreover, the discussion examines the effects of these variables on the speech perception abilities of both children with normal hearing and children with hearing loss. Finally, appropriate acoustical criteria are suggested for children in educational settings.

Classroom Amplification Technology: Theory and Practice.

Many children are struggling to listen and learn in noisy and reverberant classrooms. Some of these children have hearing loss; others have essentially normal hearing but are at risk for accurate speech perception. Hearing aid fitting protocols and technology can be effective for children with hearing loss, but the aids must be selected and adjusted for classroom environments. For many children, personal amplification may not provide enough benefit for listening and learning to occur. For children who require more than a hearing aid and for at-risk children who have difficulty separating the teacher's message from background noise, technology that is specifically designed to improve the classroom signal-to-noise ratio (SNR) may be required. In addition to the use of technology, children must learn to listen effectively in order for a meaningful signal to be received and used.