Role of orff music therapy in improving auditory processing skills in children with intellectual disability.

BACKGROUND: Orff Music Therapy improves auditory processing, language, and cognitive functions in children who have Intellectual Disability (ID). AIMS: In literature, there are no studies from the auditory processing skills reviewing perspective. The current study examined the role of Orff Music Therapy in terms of auditory processing skills of children who have ID. METHOD: Twenty-nine children who have ID were subjected in a 6-week Orff Music Therapy program. RESULTS: The mean musical assessment scores improved after Orff Music Therapy. The total Listening Inventory (TLI) scores before Orff Music Therapy were considered to be risky above the cut-off level for children who have ID. The criterion cutoff scores show if the child's behaviors may indicate a disorder or dysfunction. The TLI scores were reduced after Orff Music Therapy, which means there was an improvement in auditory processing skills. CONCLUSION: Auditory processing skills are essential for children who have ID. If a child who has ID has been identified as having auditory processing disorder (APD), there is a need for a proven therapeutic approach, like Orff Music Therapy. It has been considered that ID and APD can be linked in the same category of neurodevelopmental disorders.

[Guideline: Auditory processing and perception disorders: Proposal for treatment and management of APD : S1 guideline of the German Society of Phoniatrics and Pediatric Audiology]. / Leitlinie "Auditive Verarbeitungs- und Wahrnehmungsstörungen": Vorschlag für Behandlung und Management bei AVWS : S1-Leitlinie der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

Despite normal hearing thresholds in pure-tone audiometry, 0.5-1% of children have difficulty understanding what they hear. An auditory processing disorder (APD) can be assumed, which should be clarified and treated. In patients with hearing loss, this must first be compensated or resolved. Only hereafter can a suspected APD be confirmed or excluded. Diagnosis of APD requires that a clear discrepancy between the child's performance in individual auditory functions and other cognitive abilities be demonstrated. Combination of therapeutical modalities is considered particularly more beneficial in APD patients than a single modality. Treatment modalities should consider linguistic and cognitive processes (top-down), e.g., metacognitive knowledge of learning strategies or vocabulary expansion, but also address underlying auditory deficits (bottom-up). Almost 50% of children with APD also have a language development disorder requiring treatment and/or dyslexia. Therefore, each therapeutic intervention for a child with APD must be individually adapted according to the diagnosed impairments. Musical training can improve phonologic and reading abilities. Changes and adaptations in the classroom are helpful to support the weak auditory system of children with APD. Architectural planning of classrooms can be a means of ensuring that direct sound is masked by as little diffuse sound as possible. For example, acoustic ceiling tiles are suitable for reducing reverberant and diffuse sound.

Efficacy of a deficit specific auditory training program for remediation of temporal patterning deficits.

Objective: To determine the efficacy of a targeted auditory training programme as a remediation approach for children diagnosed with a temporal patterning disorder. Design: Temporal Patterning scores were determined at two-time points pre-intervention and again post-training. Measures were then repeated in half of the participants after a further non-training period to determine the sustainability of effects. Cognitive skills and outcome measures were assessed at all time-points. Study Sample: Ten children aged between 7 and 12 years of age, diagnosed with a temporal patterning processing disorder, were enrolled in the training programme. Results: A group mean of 9.2 hours training was completed. Conclusion: Significant, sustainable improvements on the Frequency Pattern Test were found (2.5 SD increase in score relative to mean of age matched-peers) at the completion of training. Duration of training did not predict the degree of improvement. Cognitive skills did not show significant changes in ability. Significant, sustainable improvements in temporal patterning ability were seen after completion of the training programme. No associated changes in cognitive skills were seen, suggesting independence of the skills. Deficit-specific approaches are available across the traditional test battery, however, determining the appropriate management plan for a child diagnosed with an auditory processing disorder requires a patient-centric approach.

Evidence-based interventions of dichotic listening training, compensatory strategies and combined therapies in managing pupils with auditory processing disorders.

OBJECTIVE: The need to develop a measure of managing children with a single profile of auditory processing disorders (APDs), and differentiate between true and artefactual improvements necessitated the study. The study also sought to determine the efficacy of interventions - both single and combined on APD, against no-treatment. DESIGN: A randomised controlled trial of interventions (RCT) was adopted. Participants were randomly allocated to each of the intervention groups or the no intervention group. The 10 weeks intervention included 45 minutes three times a week therapeutic intervention on listening with noise and sound localisation ability in the home and school environments. STUDY SAMPLE: 80 pupils (7-11 years) with a single profile of APD participated in the study. RESULTS: Treatments were effective on the cocktail party and sound localisation. The best result was realised with the combined therapy (CT), and there was no significant difference in performance in the remaining treatment groups. CONCLUSION: The intervention groups were beneficial to pupils with APD and should be adopted by clinicians.

Evidence of binaural integration benefits following ARIA training for children and adolescents diagnosed with amblyaudia.

OBJECTIVE: The purpose of this study was to demonstrate the efficacy of Auditory Rehabilitation for Interaural Asymmetry (ARIA) to improve dichotic listening scores in children and adolescents diagnosed with amblyaudia and other binaural integration deficits. DESIGN: The study is a field experiment without randomisation. STUDY: Participants placed into groups based on dichotic listening test scores received four sessions of ARIA training. Baseline scores were compared to performance during the final session of training and to scores obtained 2 or more months after completion of ARIA. SAMPLE: A total of 125 children participated at five different clinical sites. RESULTS: Dichotic listening scores improved across all participants. Post hoc analyses demonstrated highly significant gains in non-dominant ear performance and reductions of interaural asymmetry among participants diagnosed with amblyaudia at both post-ARIA measurements. Participants in other diagnostic groups also showed significant benefits for some post-ARIA measures. CONCLUSIONS: Results demonstrate that ARIA training is an effective method for improving binaural integration skills among children and adolescents identified with dichotic listening weaknesses during assessments for auditory processing disorder (APD), especially for those diagnosed with amblyaudia. Benefits achieved following ARIA training remain stable across several months.

Perspectives of Dutch health professionals regarding auditory processing disorders; a focus group study.

OBJECTIVE: This study investigated the perspectives of professionals from the Dutch audiological centres on the definition and care pathways of children with suspected auditory processing disorders (susAPD). DESIGN: focus group interviews. STUDY SAMPLE: In total, 45 professionals from 6 disciplines, representing 22 different audiological centres and one ambulatory service, participated in five parallel focus group interviews. Participants had a variety of experience in diagnosing and advising children with suspected APD. RESULTS: Qualitative analysis (open and thematic) identified four themes ("Definition", "Causes", "Diagnostic Procedures" and "Clinical Reasoning") expressing a variety of perspectives. Differences in perspectives were mainly affected by two debates: (1) whether or not APD exists as a pure (auditory) disorder and (2) whether or not current AP-tests are suitable in diagnosing children with listening difficulties. They also expressed a need for more guidance from the literature in their clinical decision making process. CONCLUSIONS: Professionals from the Dutch audiological centres share a broad perspective on children with APD. The ICF framework supports this perspective, thereby diminishing the need for a clear definition. The use of AP-tests should be limited to children where broader developmental disorders are first ruled out; a possible "pure" APD could then be diagnosed in a limited number of children.

Assessing school-aged children's inference-making: the effect of story test format in listening comprehension.

BACKGROUND: Comprehension is critical for classroom learning and educational success. Inferences are integral to good comprehension: successful comprehension requires the listener to generate local coherence inferences, which involve integrating information between clauses, and global coherence inferences, which involve integrating textual information with background knowledge to infer motivations, themes, etc. A central priority for the diagnosis of comprehension difficulties and our understanding of why these difficulties arise is the development of valid assessment instruments. AIMS: We explored typically developing children's ability to make local and global coherence inferences using a novel assessment of listening comprehension. The aims were to determine whether children were more likely to make the target inferences when these were asked during story presentation versus after presentation of the story, and whether there were any age differences between conditions. METHODS & PROCEDURES: Children in Years 3 (n = 29) and 5 (n = 31) listened to short stories presented either in a segmented format, in which questions to assess local and global coherence inferences were asked at specific points during story presentation, or in a whole format, when all the questions were asked after the story had been presented. OUTCOMES & RESULTS: There was developmental progression between age groups for both types of inference question. Children also scored higher on the global coherence inference questions than the local coherence inference questions. There was a benefit of the segmented format for younger children, particularly for the local inference questions. CONCLUSIONS & IMPLICATIONS: The results suggest that children are more likely to make target inferences if prompted during presentation of the story, and that this format is particularly facilitative for younger children and for local coherence inferences. This has implications for the design of comprehension assessments as well as for supporting children with comprehension difficulties in the classroom.

[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.

[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.

Exploring the effects of a repair strategies training program among children with auditory processing disorder: A pilot study.

OBJECTIVES: Children with hearing loss, as well as those with auditory processing disorder (APD), experience more communication difficulties than their normal-hearing peers. Receiving training on communication strategies has been shown to be beneficial for children with hearing loss, but little is known on the effect of such training on children with APD. The main purpose of this pilot study was to assess the effects of a repair strategies training program among children with APD. METHODS: Ten school-aged children with APD participated in a ten 60-min weekly repair strategies training program (experimental group) and ten did not receive any training (control group). In pre- and post-intervention, children were filmed while taking part in short scripted conversation situations in which communication breakdowns were introduced. Additionally, questionnaires on communication difficulties and repair skills, on life habits related to communication and education as well as on emotional well-being were filled by the children and their parents. RESULTS: In post-compared to in pre-intervention, children in the experimental group used significantly more of the repair strategies taught right after a communication breakdown occurred, used a greater variety of repair strategies, and overcame more communication breakdowns. The number of strategies needed to overcome a breakdown was not significantly different after the training compared to before. The level of difficulty to accomplish education-related life habits was generally lower, although not significantly, after entering the program than before. The individualized data showed that the studied training was more suited for children aged 9 years and older. The results of the children in the control group were not significantly different between the two measured times on all outcomes. CONCLUSION: Learning how to recognize and overcome communication breakdowns through a training program was beneficial for children with APD. The program enabled them to use a wider variety of repair strategies and to be more proactive in situations where communication is difficult. Studies are needed to further examine these findings in a larger sample of children with APD and in real-life settings.

Effects of dopaminergic and subthalamic stimulation on musical performance.

Although subthalamic-deep brain stimulation (STN-DBS) is an efficient treatment for Parkinson's disease (PD), its effects on fine motor functions are not clear. We present the case of a professional violinist with PD treated with STN-DBS. DBS improved musical articulation, intonation and emotional expression and worsened timing relative to a timekeeper (metronome). The same effects were found for dopaminergic treatment. These results suggest that STN-DBS, mimicking the effects of dopaminergic stimulation, improves fine-tuned motor behaviour whilst impairing timing precision.

ARIA treatment benefits are related to severity of dichotic listening deficits in children.

PURPOSE: This study investigated the relationship between dichotic listening (DL) benefits from treatment with Auditory Rehabilitation for Interaural Asymmetry (ARIA) and the severity of DL deficits quantified prior to the onset of treatment. We hypothesized that children with more severe DL deficits would demonstrate greater benefits following ARIA. METHOD: A scale that quantifies deficit severity was applied to dichotic listening scores obtained before and after training with ARIA at multiple clinical sites (n = 92). Using multiple regression analyses, we evaluated the predictive effects of deficit severity on DL outcomes. RESULTS: Results demonstrated that deficit severity can predict benefits from ARIA, as measured by improvements in DL scores in both ears. CONCLUSION: ARIA is an adaptive training paradigm for improving binaural integration abilities in children with DL deficits. The results from this study suggest that children with more severe DL deficits achieve greater benefits from ARIA and that a severity scale may provide important clinical information for recommending intervention.

A randomized control trial of interventions in school-aged children with auditory processing disorders.

OBJECTIVE: The primary purpose of the study was to compare intervention approaches for children with auditory processing disorder (APD): bottom-up training including activities focused on auditory perception, discrimination, and phonological awareness, and top-down training including a range of language activities. Another purpose was to determine the benefits of personal FM systems. DESIGN: The study is a randomized control trial where participants were allocated to groups receiving one of the two interventions, with and without personal FM, or to the no intervention group. The six-week intervention included weekly one-hour sessions with a therapist in the clinic, plus 1-2 hours per week of parent-directed homework. STUDY SAMPLE: 55 children (7 to 13 years) with APD participated in the study. Intervention outcomes included reading, language, and auditory processing. RESULTS: Positive outcomes were observed for both training approaches and personal FM systems on several measures. Pre-intervention nonverbal IQ, age, and severity of APD did not influence outcomes. Performance of control group participants did not change when retested after the intervention period. CONCLUSIONS: Both intervention approaches were beneficial and there were additional benefits with the use of personal FM. Positive results were not limited to the areas specifically targeted by the interventions.

Audiovocal integration in adults who stutter.

BACKGROUND: Altered auditory feedback can facilitate speech fluency in adults who stutter. However, other findings suggest that adults who stutter show anomalies in 'audiovocal integration', such as longer phonation reaction times to auditory stimuli and less effective pitch tracking. AIMS: To study audiovocal integration in adults who stutter using the pitch-shift paradigm. METHODS & PROCEDURES: Fourteen adult stuttering participants and 16 normally fluent adults produced the vowel /a/while monitoring their own voice through earphones. Unanticipated pitch-shifts were applied in the upward or downward direction for 500 ms. OUTCOMES & RESULTS: Short latency pitch-shift responses (or pitch-shift responses) were elicited in all participants. In stuttering participants, vocal response onset latency was significantly delayed and amplitude tended to be reduced. CONCLUSIONS & IMPLICATIONS: Atypical audiovocal responses could be associated with stuttering. It is not clear how audiovocal integration influences stuttering, but could signal inadequate activation of internal models.

Efficacy of auditory training using the auditory brainstem response to complex sounds: auditory processing disorder and specific language impairment.

OBJECTIVES: This study verified the efficacy of a formal auditory training (AT) program in children with hearing and language disorders using the auditory brainstem response to complex sounds (c-ABR) with and without background noise. PATIENTS AND METHODS: Thirty children (7-13 years) were distributed into four groups: typical development (TD: n = 7), auditory processing disorder (APD: n = 9) and specific language disorder (SLIa: n = 6, and SLIb: n = 8). All children underwent behavioral assessment of auditory processing and c-ABR with and without background noise. The APD and SLIa groups underwent 8 weeks of formal AT, but all children were reevaluated 12 weeks after the initial assessment. RESULTS: The TD group presented better behavioral performance than the other groups. For c-ABR in silence, no significant differences were observed among groups or assessments, except regarding VA complex measures, which were altered in the APD group. For c-ABR with background noise, however, the APD, SLIa and SLIb groups presented delayed latencies. Groups that underwent formal AT improved behavioral performance and decreased latencies to c-ABR in background noise at final assessment. CONCLUSIONS: These data suggest that efficacy of formal AT can be demonstrated by c-ABR with background noise.

Effect of nonlinguistic auditory training on phonological and reading skills.

OBJECTIVE: To analyze the effect of nonverbal auditory training on reading and phonological awareness tasks in children with dyslexia and the effect of age in relation to post-training learning considering the ages from 7 to 14. METHODS: In experiment 1, one group with dyslexia (total = 12) was trained and compared with a group of untrained dyslexic subjects (total = 28). In experiment 2, the performance of the trained dyslexic group (total = 18) was compared at three different moments: 2 months before, at the beginning, and at the end of training. Training was carried out for 2 months using a computer program responsible for training discrimination skills. RESULTS: The group receiving nonverbal auditory training demonstrated significant improvements (mainly for the group from 7 to 10 years old), not only in the nonverbal auditory skills trained (p < 0.001), but also in phonological awareness syllable tasks (synthesis, segmentation, manipulation and syllable transposition) in experiment 1 (p < 0.003), and phonemic tasks (p < 0.001) and text reading (p < 0.001) in experiment 2. CONCLUSION: The results suggest a link between verbal and nonverbal skills, in addition to corroborating studies regarding the existence of a critical learning period.

Effect of speech in noise training in the auditory and cognitive skills in children with auditory processing disorders.

OBJECTIVES: Speech perception in the presence of background noise is identified as one of the most affected auditory processes in children with auditory processing disorders (APD). Mechanism of speech-in-noise perception is extensively studied and is reported to involve different auditory and cognitive skills. However previous research has reported mixed results investigating the relationship between the cognitive skills and speech-in-noise perception in children with APD. The present study intended to study the correlation between the speech-in-noise perception and other auditory and cognitive skills, and also to find the efficacy of speech-in-noise training in other auditory and cognitive skills in children with APD. METHOD: The study imparted words in noise training utilizing monosyllable and trisyllable words in the presence of speech shaped noise and 4-talker babble. Participants included 20 children with APD, 10 of them in the experimental group who underwent the training and the remaining 10 served as controls. Auditory outcome measures included five behavioural APD tests and four digit span tests to assess cognition. RESULTS: There was a significant improvement in the speech-in-noise perception measures, temporal processing measures (gap detection test and duration pattern test) and the backward, ascending and descending digit span measures after the training in participants in the experimental group. However, Spearman rank order correlation did not reveal a significant correlation between the speech-in-noise perception scores and any of the auditory or cognitive measures. CONCLUSION: Even though there was no correlation within and between auditory and cognitive measures, speech-in-noise training improved the temporal processing skills as well as the working memory skills in children with APD supporting the relationship between the said processes. These relationships with evidence from further research could be utilized to design more effective treatment strategies for children with APD.

Biological changes in auditory function following training in children with autism spectrum disorders.

BACKGROUND: Children with pervasive developmental disorders (PDD), such as children with autism spectrum disorders (ASD), often show auditory processing deficits related to their overarching language impairment. Auditory training programs such as Fast ForWord Language may potentially alleviate these deficits through training-induced improvements in auditory processing. METHODS: To assess the impact of auditory training on auditory function in children with ASD, brainstem and cortical responses to speech sounds presented in quiet and noise were collected from five children with ASD who completed Fast ForWord training. RESULTS: Relative to six control children with ASD who did not complete Fast ForWord, training-related changes were found in brainstem response timing (three children) and pitch-tracking (one child), and cortical response timing (all five children) after Fast ForWord use. CONCLUSIONS: These results provide an objective indication of the benefit of training on auditory function for some children with ASD.

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.

Remediating spatial processing disorder in Aboriginal and Torres Strait Islander children.

OBJECTIVE: Australian Aboriginal and Torres Strait Islander children are much more likely than non-Indigenous children to experience early onset, chronic otitis media and associated hearing loss. This can result in the child developing spatial processing disorder (SPD). The aim of this study was to assess the efficacy of Sound Storm auditory training in remediating SPD in Aboriginal and Torres Strait Islander children at a regional school in Queensland, Australia. METHOD: Fifteen Aboriginal and Torres Strait Islander children (males = 8, females = 7, age range = 6-13 years, mean = 8 years; 6 months) with SPD were tested on audiometry, the Listening in Spatialized Noise - Sentences Test (LiSN-S), and Listening in Spatialized Noise - Universal Test (LiSN-U). Teachers completed the Listening Inventory for Education - Revised Teacher Questionnaire (LIFE-R) and Auditory Processing Domains Questionnaire (APDQ). These measures were taken pre- and post-training with Sound Storm. RESULTS: Children's Sound Storm noise-to-signal ratio improved significantly and was positively correlated with the number of games they played. Eight of the nine children who completed at least 40% of the training were retested on the LiSN-S, LiSN-U, LIFE-R, and APDQ post-training. SPD was remediated in seven children according to the LiSN-S. All five children who were retested on the LiSN-U post-training showed spatial advantage scores within the normal range. Questionnaire results were mixed with only some children showing improved scores on the LIFE-R and APDQ. CONCLUSIONS: Sound Storm auditory training can be used in school with Aboriginal and Torres Strait Islander children to remediate SPD, however, it has its challenges. Maintaining the child's motivation to complete the training can be difficult. Additionally, the impacts of school holidays, events, and absences must be managed, as well as the impacts of the program on the child's school day.