[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.

[Guideline: Auditive Processing and Perception Disorders: Definition : Guideline of the German Society of Phoniatrics and Pediatric Audiology]. / Leitlinie "Auditive Verarbeitungs- und Wahrnehmungsstörungen": Definition : S1-Leitlinie der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

In accordance with international consensus papers, Auditory Processing Disorders are defined here as disorders of central processes of hearing, which enable, among other things, the pre-conscious and conscious analysis, differentiation, and identification of changes in time, frequency, and intensity of acoustic or auditory speech signals as well as processes of binaural interaction (e. g., for localization, lateralization, noise clearance, and summation) and dichotic processing. Following the establishment of a commission of experts from the German Society for Phoniatrics and Pediatric Audiology, the existing S1 guideline was revised and updated. In this chapter, a position is taken on the definition of this clinical disorder as well as on the delimitation of similar disorders.

[Guideline: Auditory Processing and Perception Disorders: Diagnostics : S1-Guideline of The German Society of Phoniatrics and Pediatric Audiology]. / Leitlinie: "Auditive Verarbeitungs- und Wahrnehmungsstörungen": Diagnostik : S1-Leitlinie der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

In accordance with international consensus papers, auditory processing disorders (APD) are defined as disorders of central processes of hearing. Following the establishment of a commission of experts from the German Society for Phoniatrics and Pediatric Audiology, the existing S1 guideline was revised and updated. In this chapter, a position is taken on the clinical diagnostics of APD as well as on the delimitation of similar disorders.

[Guideline: Auditory Processing and Perception Disorders: Differential Diagnosis : S1 guideline of the German Society of Phoniatrics and Pediatric Audiology]. / Leitlinie "Auditive Verarbeitungs- und Wahrnehmungsstörungen": Differenzialdiagnose : S1-Leitlinie der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

As a prerequisite for diagnosing auditory processing disorders (APD), differential diagnostic considerations are essential, especially with regard to language comprehension disorders, attention deficit hyperactivity disorder, specific cognitive impairments (e. g., in memory or multi-modal perception performance), specific learning disorders affecting reading and/or spelling, and autistic-type diseases. The current clinical management is presented in detail in the updated APD guidelines, as are the resulting conclusions for the interpretation of individual test results.

[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.

[Correlation of Phonological STM-Performances with Language-Based Dimensions in Children with APD]. / Korrelieren phonologische KZG-Leistungen mit sprachbasierten Dimensionen bei AVWS-Kindern?

OBJECTIVE: Phonological short-term memory (PSTM) is a functional component in language processing. This study investigated the association between some language-based dimensions of an eclectic test battery for auditory processing disorders (APD) and test performance in PSTM (recall for digits, sentences; non-word repetition). MATERIAL AND METHODS: Correlation analyses in control-group comparisons. PARTICIPANTS: n=178 children; 91 children diagnosed with APD (51%) visiting 2nd-4th grade of a primary school; 87 second- to fourth-graders with typical development 49%). RESULTS: Different patterns were found not only between pSTM-tests and verbal-acoustic test tasks, but above all between children with and without APD. Neither pSTM for digits, nor for sentences or non-word repetition showed significant associations with a verbal-acoustic task for children without APD. In contrast, this was the case in children with APD in some pSTM measures with phoneme identification, phoneme analysis and dichotic word recognition (r=0.29-0.41; p<0.005, Bonferroni-adjusted). Obviously, pSTM is--besides variance according to the specific test tasks--a functional component which condensed in the verbal-acoustic test performance only in children with APD. CONCLUSIONS: This means that in primary school age, the role of pSTM and verbal-acoustic tasks is influenced by auditory processes in children with APD.

[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.

[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.

[Short-term sentence memory in children with auditory processing disorders]. / Kurzfristiges Satzbehalten bei Kindern mit auditiven Verarbeitungs- und Wahrnehmungsstörungen.

BACKGROUND: Based on the study of Nickisch et al. [1] the 4 discriminatory variables of second-year elementary school-age children with and without APD should now be investigated with respect to the variable "sentence memory". MATERIAL AND METHODS: Retrospective analysis. Sentence memory was tested via the subtest "IS" of the Heidelberger Sprachentwicklungstest [2]. All children were examined with the 4 APD-tests (see results) and the subtest "IS". PARTICIPANTS: n=24 with monosymptomatic APD; n=21 with APD + Specific Language Impairment [SLI]; n=48 controls [developmentally normal]. RESULTS: Mean sentence memory achievement of the clinical groups differed statistically from the control group (p<0.001). The comparison of mean values in the 4 discriminatory variables in each case revealed distinctly significant differences (p<0.001) in favour of the control group (word-comprehension in background noise; dichotic word listening; phonological digit span; nonword repetition). Children with APD, by contrast, did not statistically differ in any meaningful in their mean achievement from those with APD + SLI. Between the mean value of the clinical groups and the control group effect sizes d were calculated. The effects were not only statistically significant but also of clinical and practical relevance given that the CI was small. CONCLUSION: High mean value differences in sentence memory as well as in nonword repetition in children with APD as in those with APD + SLI to normally typically developed control children shed new light on questions regarding a fluent transition between APD and SLI or a comorbid appearance.

[CAPD in 2nd-graders of primary schools: which tests discriminate normal from impaired children?]. / AVWS bei Regelschülern im 2. Schuljahr: Welche Tests trennen auffällige von unauffälligen Kindern?

BACKGROUND: Third- and fourth-graders with (C)APD can be differentiated from non-(C)APD children at best by means of 3 diagnostic tests (Nickisch & Kiese-Himmel, 2009). Now it should be examined which tests discriminate second graders with (C)APD from those without. MATERIAL UND METHODS: 10 audiological and psychometrical tests were used for this purpose. PATIENTS: 33 second-graders of primary schools diagnosed with auditory-specific perceptual deficits (clinical group (C)APD: average age: 7.8; SD 0.7 years) were compared to 48 normally developed children of the same school grade (control group Non-(C)APD: average age: 7.6; SD 0.5 years). RESULTS: With the exception of 3 non-language based tests significant group-differentiations appeared, with the (C)APD-children displaying worse results. The diagnostic classification succeeded in the following test-combination: Word-Understanding in Background Noise (Goettinger Sprachaudiometrie im Freifeld), Dichotic Listening (Uttenweiler Test), Numerical Sequence Memory (Subtest of the German version of the Illinois Test of Psycholinguistic Abilities), Nonword Repetition (Mottier-Test). 97.5% of all children were assigned to the correct diagnostic group (96.3% after cross-validation). CONCLUSION: After the exclusion of neurological disorders, peripheral hearing-disorders as well as intelligence-impairments the diagnostic assurance of (C)APD of second-graders succeeded, permitting very small probability of error. Compared to the preliminary study, an additional diagnostic test on second-graders is necessary; classification, as a result, will be more precise.

[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.

[Deviant language development following cochlear implantation? Applicability of the parent questionnaire ELFRA-2]. / Abweichende Sprachentwicklung nach Cochleaimplantation? Zur Anwendbarkeit des Elternfragebogens ELFRA-2.

BACKGROUND: The parent questionnaire ELFRA-2 is considered a valid tool for early detection of delayed language development in 2-year-old children. Applicability for children treated with cochlear implants (CI) is to be investigated. METHODS: By means of the ELFRA-2 we documented longitudinally for up to 24 months post implantation language development in 27 children treated before 3 years of age. The critical developmental criteria (related to age) were applied to CI children (related to duration of CI use) and gender-related normative data were taken as a reference. RESULTS: Only two boys were identified as showing a language delay after 2 years of CI use. However, using normative data 11-44% of the children performed below average. Development in girls was faster than in boys. The influence of preoperative hearing experience declined over time. CONCLUSION: The critical developmental criteria of ELFRA-2 have proved to be unreliable for the identification of varying development after CI. Modified and gender-related evaluation is necessary.

[(Central) Auditory Processing Disorders in 8 - 10-year-old children: which tests distinguish between normal and impaired children?]. / Auditive Verarbeitungs- und Wahrnehmungsleistungen 8- bis 10-Jähriger: Welche Tests trennen auffällige von unauffälligen Kindern?

BACKGROUND: Eclectic test combinations are usually applied for diagnosing (Central) Auditory Processing Disorders (C)APD in school-aged children. METHODS: Children with suspected APD were examined with a combination of 12 audiological and psychometric tests in order to allow the proper allocation to either the APD-group or to the Non-APD-group. PATIENTS: Forty-six 8-10-year-old children diagnosed with auditory-specific perceptual deficits [clinical group (C)APD; average age 9;2 years; SD 0;7 years] were compared to 39 normally developed children of the same age span with no evidence of specific language impairment, developmental dyslexia or learning disorders [control group Non-APD; average age 9;3 years; SD 0;7 years]. RESULTS: Overall, the Non-APD-group scored significantly better than the (C)APD-group with the exception of three non-verbal auditory tests. The clinical group and the control group were successfully differentiated: 94% and (after cross-validation) 91% of the children respectively could be diagnosed correctly by using only three tests (significant discriminant function). Of these, Mottier's Test (nonword repetition) showed the highest discriminatory power followed by speech in noise discrimination and "phoneme differentiation" of the Heidelberger Phoneme Discrimination Test. CONCLUSION: After the differential diagnostic exclusion of peripheral hearing disorders and cognitive impairments, these three tests are sufficient to initially justify the clinical-diagnostic classification "(C)APD" in 8-11-year-old children taking into account only a relatively slight probability of error. Poor results in two of the three differentiating tests (discrepancy criterion of >1 SD of the reference population) are sufficient to support the diagnostic classification of an (C)APD.

[Auditory processing disorders : Consensus statement by the German Society for Phoniatry and Paedaudiology]. / Auditive Verarbeitungs- und Wahrnehmungsstörungen: Konsensus-Statement der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie.

The consensus statement published by the German Society for Phoniatry and Paedaudiology in the year 2000 has been revised and actualized. The revised version takes into account current scientific and clinical findings. Aspects of the definition of auditory processing disorders (APD) are described extensively. These include symptoms, anamnestic information and diagnostic steps (preliminary examinations, subjective and objective audiological procedures). APD can appear in different forms, some of which can be classified within subtypes. Furthermore, factors which need to be considered in order to differentiate between APD and other diseases are specified. Therapeutic intervention possibilities which are rated according to their prognostic values conclude the article.

WITHDRAWN: [Significance of Stapedius Muscle Reflex Measurement in Diagnosing Auditory Processing Disorders.] / Wertigkeit von Stapediusreflexmessungen in der Diagnostik Auditiver Verarbeitungs- und Wahrnehmungsstörungen.

BACKGROUND: Stapedius muscle reflexes (SMR) are among the objective procedures which are used in the diagnostics of auditory processing disorders (APD). The significance of SRM for APD-diagnosis is open up to now. METHOD: Twenty-six children (8 - 10 years) with diagnosed APD and a control group of 17 children the same age were examined in order to determine whether differences with regard to the mean SMR (sine tones or band pass noise) exist between groups. In addition, differences between groups were investigated regarding the mean difference between the reflex thresholds for sine tones and the thresholds for band pass noises. RESULTS: Significant differences between groups existed in the mean value ipsilateral with 500 Hz, 1 kHz, 4 kHz and low bandpass noise as well as contralateral with 500 Hz. The contralateral measurements using sine tones (500 Hz, 1 kHz, 2 kHz and 4 kHz) showed reflex thresholds of about 100 dB only in the APD group. The results of the remaining types of stimulation showed a more or less distinctive area of overlap between the APD-group and the control group without the possibility of definite classification to a particular group. Group differences in the mean value with regard to the reflex thresholds for sine tones and the thresholds for band pass noises appeared only in low frequency stimuli. However, the area of overlap between the APD group and the control group in other frequencies was very large. CONCLUSION: Elevated thresholds measured in contralateral SMRs seem to support the assumption of APD. In contrast, the results of SMRs using ipsilateral measurements as well as low or high pass filtered noises contribute little toward diagnosing an APD. This applies identically to the difference between the reflex thresholds on sine tones and the thresholds on band-pass noises.

[Münchner screening of auditory perception disorders (MAUS)]. / Münchner Auditiver Screeningtest für Verarbeitungs- und Wahrnehmungsstörungen (MAUS).

BACKGROUND: The diagnosis of APD (Auditory Perception Disorder) is a time consuming procedure. In Germany at the present, no screening test for APD exists which makes it possible to differentiate between children who are not likely to suffer from an APD and those who need to be diagnosed in detail. METHOD: The Munich Auditory Screening of Perception Disorders (MAUS) contains the following subtests: Series of Syllables, Words in Noise and Identification and Differentiation of Phonemes (test duration: 15 minutes). PATIENTS: The MAUS was standardized using 359 primary school children between 6 and 11 years of age. Furthermore, the MAUS was used in addition to the complete, extensive APD-diagnostics in testing 52 children (36 with APD and 16 without APD) within the age group mentioned. RESULTS: T-scores for each subtest were established by the standardization of the MAUS. The internal consistency of the test was sufficient. The intercorrelation between subtests was very slight. Therefore, each subtest seems to play an independent part in defining the construct of APD. Because of the results of the pilot study which formed the basis for the development of the screening instrument used, and because of the sensitivity scores reached in testing a group of 36 children with diagnosed APD, it can be expected that the MAUS will show a high sensitivity with regard to APD. CONCLUSION: Using the MAUS, it can be determined if and to what extent the test results of an individual deviate from those of the normal primary school population. The MAUS can identify children at risk of having an APD and can differentiate these children from those who are unlikely to suffer from an APD.