Transcript Testing for Central Auditory Processing Disorders

Testing for Central Auditory
Processing Disorders
Harvey Dillon
With thanks to:
Sharon
Cameron
Helen
Glyde
Dani
Tomlin
Pia
Gyldenkaerne
Mridula
Sharma
Wayne
Wilson
1
On the basis of evidence, what
should CAPD testing and
remediation services consist of?
2
A clinician’s question
• Does this child have a problem hearing or
understanding sound that adversely affects him or her,
and that I or anyone else can do something about?
• What is the specific nature of the problem?
• Is there a specific remediation for that problem?
• What general management techniques will minimize its
effects?
• What tests should I use to determine the child’s problems?
4
Problems with current definitions
1. Requirement for modality specificity and
absence of other problems.
Trauma or
failure to
develop
Auditory
processing
neurons
Deficient
auditory skill
Life
consequences
Visual
processing
neurons
Deficient
visual skill
Life
consequences
Language
processing
neurons
Deficient
language skill
Life
consequences
Consequent
disabilities
5
Problems with current definitions
2. Arbitrariness of fail criterion
– Which tests to include in battery?
– How many tests have to be failed, in how many
ears, in what combinations?
– What is a fail on each test?
6
Impact of criterion on diagnosis of CAPD
0
Percent of children “with CAPD”
50
100
Fail ≥2 tests [ASHA (2005), AAA (2010)]
Fail ≥1 tests [ASHA (2005), AAA (2010)]
Fail ≥1 non-speech [McArthur, 2009]
Fail ≥1 speech + ≥1 non-speech [BSA(2011)]
Reported sympotoms [Ferguson (2011)]
Binaural fail
Monaural fail
Wayne Wilson
7
Problems with a Large Test Battery
Impact on child’s attention
(The tests are often very boring!!)
Relevance of the normative data
Statistical implications of presenting multiple tests inflating Type II error rate.
So …. how do we solve this problem??
8
Possible, but not very good, solutions….
1. Tighten the pass-fail criteria on each test (e.g. 3 SD):
 have to be very aberrant to fail
2. Require that the individual fail more than one test:
 Only logical if CAPD is a “generalized disorder”
3. Repeat any test that produces a failed result:
 Not consistent with normative data
 An inefficient use of time
9
Current approach to CAPD testing
History
Audiometry
No
Exclude CAPD;
Refer elsewhere
Is there a problem
that CAPD
might explain?
Yes
Detailed test battery
Test result interpretation
Non-specific remediation
and management:
• Classroom placement
• FM use
• Instruction style
• Soundfield amplification
• Auditory training software
Dealing with problems in understanding speech
Questionnaire / history
No
Audiometry
Is there a problem
that CAPD
might explain?
Measured disability
Yes
Master test battery
Exclude CAPD;
Refer elsewhere
Detailed test battery
Non-specific remediation
and management:
• Classroom placement
• FM use
• Instruction style
• Soundfield amplification
Test result interpretation leading to
a disorder-specific diagnosis
Disorder-specific remediation
Dealing with problems in understanding speech
Questionnaire / history
No
Audiometry
Measured disability
Is there a problem
that CAPD
might explain?
Yes
LiSN-S
FPT
Verbal
SPIN
Master
test battery
High Cue
Hi Cont
Exclude CAPD;
Refer elsewhere
FPT
Hum
Non-specific remediation
and management:
• Classroom placement
• FM use
• Instruction style
• Soundfield amplification
?
?
SPIN
LiSN-S
Detailed
test battery
Lo Cont
Low Cue
LiSN-S
Spatial
Advantage
UndiagClosure
Test result
interpretation
leadingSPD
to
nosed
skill
deficit
a disorder-specific
diagnosis
deficits
Top-down
LiSN
Disorder-specific
remediation
training
& Learn
LiSN-S
Talker
Advantage
Pitch
deficit
Proportion of children
What is a fail on one test?
40
-4
60
80
-2
100
120
Test score
0
Z-score
140
2
160
4
13
Test score sensitivity relative to
functional listening ability
• Can estimate from correlation between test scores
and functional ability
Functional listening ability
– Questionnaire scores of listening ability
– Educational attainment scores
150
100
50
0
-3
-2
-1
0
1
CAPD test z-score
2
3
14
Test score sensitivity relative to functional ability:
Functional listening ability
• Sensitivity =
∆ 𝐹𝑢𝑛𝑐𝑡𝑖𝑜𝑛𝑎𝑙 𝑧−𝑠𝑐𝑜𝑟𝑒
∆ 𝐶𝐴𝑃𝐷 𝑧−𝑠𝑐𝑜𝑟𝑒
150
100
50
0
-3
-2
-1
0
1
CAPD test z-score
2
3
15
Criteria for adopting a CAPD test
• Test is associated with variation in functional ability
∆ 𝐹𝑢𝑛𝑐𝑡𝑖𝑜𝑛𝑎𝑙 𝑧−𝑠𝑐𝑜𝑟𝑒
– High sensitivity (=
)
∆ 𝐶𝐴𝑃𝐷 𝑧−𝑠𝑐𝑜𝑟𝑒
– Deviant results common in clinical population
– Attributes tested minimally shared with other tests in battery
• Test result indicates specific remediation necessary
(and remediation affects real life)
• Time taken is small
• Test is minimally affected by attention, intelligence,
motivation, working memory
• Associated with a known anatomical site and neural
mechanism
16
Experiment 1
Dani Tomlin current PhD study
• Two subject recruitment groups:
– Children referred to Uni of Melbourne Audiology
Clinic due to suspected APD (n=65)
• Teachers, parent, speech pathologist referral
– Normative group (n=47)
• School enrolment, open invitation
• Age range of 7–12 years
• Both groups to complete full test battery
• Results converted to Z scores (derived using age
specific norms)
17
Measures obtained
•
•
•
•
•
Dichotic Digits Test (DDT): Binaural integration (Musiek, 1993)
Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990)
Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005)
MLD: Binaural interaction (Bellis, 2003)
LiSN-S: Binaural integration – spatial listening ability (Cameron & Dillon, 2006)
•
•
•
Memory CELF-4: Forward and reverse digits
Attention: BrainTrain®: Continuous Performance Test: Sustained auditory and
visual attention
Cognition -TONI-4: Nonverbal cognitive assessment
•
Questionnaires and interview:
– Child completed LIFE questionnaire & recorded interview
– Parent completed Fisher checklist & written interview
– Teacher Evaluation of Auditory Performance (TEAP) & written interview
•
Academic Performance - NAPLAN & WARP (reading fluency)
18
Relations between questionnaires
Life (children)
Fisher (parents)
TEAP (teachers)
Listening Capabilities Score
19
Relations between outcome variables
Listening Capability Score
NAPLAN Literacy Z score
WARP Z SCORE
20
Test score sensitivity relative to functional abilities
Listening capabilities
Dichotic digits - left
Listening Capability Score = 0.2085+0.2417*x
2.0
1.5
1.0
0.5
0.0
-0.5
-1.0
-1.5
Listening Capa
-2.0
-2.5
-10
Dani Tomlin
-8
-6
-4
-2
LDD Z Score
0
2
4
Test score sensitivity relative to functional abilities
Listening Capability Score = 0.2085+0.2417*x
2.0
1.5
1.0
0.5
0.0
-0.5
-1.0
-1.5
Listening Capability Score
Listening capabilities
Dichotic digits - left
-2.0
-2.5
-10
-8
Dani Tomlin
-6
-4
-2
LDD Z Score
0
2
4
Test score sensitivity relative to functional abilities
Freq pattern - right
Freq pattern - left
Listening Capability Score = -0.0343+0.2005*x
Listening Capability Score = -0.068+0.1102*x
Listening Capability Score = -0.0218+0.1664*x
2.0
2.0
2.0
2.0
1.5
1.5
1.5
1.5
1.0
1.0
1.0
1.0
0.5
0.5
0.5
0.5
0.0
0.0
0.0
0.0
-0.5
-0.5
-0.5
-0.5
-1.0
-1.0
-1.0
-1.0
-1.5
-1.5
-1.5
-1.5
-6
-4
-2
0
2
4
LDD ASIN Z Score
Literacy
Average NAPLAN Literacy Z score = 0.6834+0.2485*x
-2.5
-10
-8
-6
-4
-2
0
2
4
RDD ASIN Z Score
Average NAPLAN Literacy Z score = 0.4145+0.1672*x
-2.0
-2.5
-10
-8
-6
-4
-2
0
2
4
LFPT ASIN Z SCORE
Average NAPLAN Literacy Z score = 0.5726+0.265*x
Listening Capability Score
-8
-2.0
Listening Capability Score
-2.5
-10
Listening Capability Score
-2.0
-2.0
-2.5
-10
2
2
1
1
1
1
0
0
0
0
-1
-1
-1
-1
-2
-2
-2
-2
-4
-2
0
2
4
LDD ASIN Z Score
WARP Z SCORE = 0.2969+0.2647*x
-8
-6
-4
-2
0
2
4
RDD ASIN Z Score
WARP Z SCORE = 0.0602+0.205*x
2
2
1
1
-3
-10
-8
-6
-4
-2
0
2
4
LFPT ASIN Z SCORE
WARP Z SCORE = 0.1039+0.2143*x
2
1
Average NAPLAN Literacy Z score
-6
Average NAPLAN Literacy Z score
-8
-3
-10
-3
-10
-1
-1
-1
-1
-2
0
2
4
-3
-10
-8
-6
-4
-2
RDD ASIN Z Score
0
2
4
-3
-10
-8
-6
-4
-2
LFPT ASIN Z SCORE
0
2
WARP Z SCORE
Dani Tomlin
-4
LDD ASIN Z Score
WARP Z SCORE
-6
WARP Z SCORE
WARP Z SCORE
-8
2
4
-8
-6
-4
-2
0
2
4
2
4
1
0
-3
-10
0
WARP Z SCORE = 0.0871+0.2002*x
0
-2
-2
2
0
-2
-4
R FPT ASIN Z SCORE
0
-2
-6
Average NAPLAN Literacy Z score = 0.5054+0.1976*x
2
-3
-10
-8
R FPT ASIN Z SCORE
2
Average NAPLAN Literacy Z score
Average NAPLAN Literacy Z score
Reading fluency
Dichotic digits - right
Listening Capability Score = 0.2085+0.2417*x
Listening Capability Score
Listening capabilities
Dichotic digits - left
-2
-3
-10
-8
-6
-4
-2
0
R FPT ASIN Z SCORE
23
Test score sensitivity relative to functional abilities
Listening Capability Score = -0.0312+0.4149*x
Listening Capability Score = -0.1261+0.2162*x
Listening Capability Score = -0.0199+0.5467*x
2.0
2.0
2.0
1.5
1.5
1.5
1.5
1.0
1.0
1.0
1.0
0.5
0.5
0.5
0.5
0.0
0.0
0.0
0.0
-0.5
-0.5
-0.5
-0.5
-1.0
-1.0
-1.0
-1.0
-1.5
-1.5
-1.5
-1.5
-2.5
-1.6
-1.2
-1.4
-0.8
-1.0
-0.4
-0.6
0.0
-0.2
0.4
0.2
0.8
0.6
1.2
1.0
L Gin Z score
Average NAPLAN Literacy Z score = 0.3754-0.2565*x
2.0
-2.0
-2.5
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
R Gin Z score
-2.0
-2.5
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
DS FW Z SCORE
Average NAPLAN Literacy Z score = 0.454+0.5643*x
2.0
Average NAPLAN Literacy Z score = 0.3701-0.1306*x
2.0
Listening Capability Score
-2.0
Listening Capability Score
Literacy
Digit span - Reversed
Digit span - Forward
2.0
Listening Capability Score
-2.0
-2.5
-2.0
1.5
1.5
1.0
1.0
1.0
0.5
0.5
0.5
0.5
0.0
0.0
0.0
0.0
-0.5
-0.5
-0.5
-0.5
-1.0
-1.0
-1.0
-1.0
-1.5
-1.5
-1.5
-1.5
-0.2
0.0
0.2
0.4
0.6
L Gin Z score
WARP Z SCORE = -0.006+0.5397*x
3
2
1
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
R Gin Z score
WARP Z SCORE = 0.0099+0.3944*x
3
2
1
1.5
Average NAPLAN Literacy Z score
-0.4
-2.0
-2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
DS FW Z SCORE
WARP Z SCORE = 0.0673+0.541*x
3
NAPLAN Literacy Z score
1.5
-2.0
-3.0
-2.0
-2.0
2
1
1
0
0
-1
-1
-1
-1
Dani Tomlin
-0.4
-0.6
0.0
-0.2
L Gin Z score
0.4
0.2
0.8
0.6
1.2
1.0
-3
-3.0
-2.5
-2.0
-1.5
-1.0
-0.5
R Gin Z score
0.0
0.5
1.0
1.5
-3
-2.5
-2.0
-1.5
-1.0
-0.5
0.0
0.5
DS FW Z SCORE
1.0
1.5
2.0
WARP Z SCORE
-0.8
-1.0
WARP Z SCORE
-1.2
-1.4
WARP Z SCORE
WARP Z SCORE
-3
-1.6
0.5
1.0
1.5
2.0
-1.5
-1.0
-0.5
0.0
0.5
1.0
1.5
2.0
WARP Z SCORE = 0.0897+0.7375*x
2
-2
0.0
3
0
-2
-0.5
DS Rev Z Score
0
-2
-1.0
Average NAPLAN Literacy Z score = 0.4358+0.6129*x
2.0
1.0
-2.0
-0.6
-1.5
DS Rev Z Score
1.5
Average NAPLAN Literacy Z score
Average NAPLAN Literacy Z score
Reading fluency
Gaps in noise - right
Listening Capability Score = -0.124+0.2894*x
Listening Capability Score
Listening capabilities
Gaps in noise - left
-2
-3
-2.0
-1.5
-1.0
-0.5
0.0
0.5
DS Rev Z Score
1.0
24
1.5
2.0
Test score sensitivity relative to functional abilities
MLD z score
attention
Listening Capability Score = -0.0792-0.0256*x
Listening Capability Score = 0.0332+0.3098*x
Listening Capability Score = 0.188+0.2352*x
2.0
2.0
2.0
2.0
1.5
1.5
1.5
1.5
1.0
1.0
1.0
1.0
0.5
0.5
0.5
0.5
0.0
0.0
0.0
0.0
-0.5
-0.5
-0.5
-0.5
-1.0
-1.0
-1.0
-1.0
-1.5
-1.5
-1.5
-1.5
Literacy
-3
-2
-1
0
1
2
3
LC Sdev from avg
-2.5
-5
-4
-3
-2
-1
0
1
2
3
HC Sdev from avg
-2.0
-2.5
-3
-2
-1
0
1
2
3
4
5
MLD Z score
Average NAPLAN Literacy Z score = 0.3523+0.0132*x
2.0
Listening Capability Score
-4
-2.0
Listening Capability Score
-2.5
-5
Listening Capability Score
-2.0
-2.0
-2.5
-6
Average NAPLAN Literacy Z score = 0.4454+0.3003*x
2.0
1.5
1.5
1.5
1.5
1.0
1.0
1.0
1.0
0.5
0.5
0.5
0.5
0.0
0.0
0.0
0.0
-0.5
-0.5
-0.5
-0.5
-1.0
-1.0
-1.0
-1.0
-1.5
-1.5
-1.5
-1.5
-3
-2
-1
0
1
2
3
LC Sdev from avg
WARP Z SCORE = 0.0719+0.2626*x
2
1
0
-2.0
-5
-3
-2
-1
0
1
2
3
HC Sdev from avg
WARP Z SCORE = 0.1186+0.3258*x
2
1
0
-1
-2.0
-3
-1
0
LC Sdev from avg
1
2
3
1
2
3
-2.0
5 -6
4
2
1
0
-4
-3
-2
-1
0
HC Sdev from avg
1
2
3
-2
-1
0
1
2
-5
-4
-3
-2
-1
0
1
2
WARP Z SCORE = 0.2157+0.2121*x
2
1
0
-1
-2
-3
-3
-3
Attention Quotient Z score
-1
-2
-3
-5
0
-2
-1
0
1
MLD Z score
2
3
4
5
WARP Z SCORE
Dani Tomlin
-2
-1
WARP Z SCORE = 0.0107+0.0001*x
WARP Z SCORE
-3
WARP Z SCORE
WARP Z SCORE
-4
-2
MLD Z score
-1
-2
-3
-5
-4
-4
Average NAPLAN Literacy Z score = 0.4196+0.274*x
2.0
Average NAPLAN Literacy Z score
-4
Average NAPLAN Literacy Z score
-2.0
-5
-5
Attention Quotient Z score
Average NAPLAN Literacy Z score = 0.4274+0.3453*x
2.0
Average NAPLAN Literacy Z score
Average NAPLAN Literacy Z score
Reading fluency
LiSN-S High cue
Listening Capability Score = 0.0843+0.56*x
Listening Capability Score
Listening capabilities
LiSN-S Low Cue
-2
-3
-6
-5
-4
-3
-2
-1
0
Attention Quotient Z score
25
1
2
Sensitivity: Effect on outcome variable of
being 1 SD below the mean on test score
-0.2
0
0.2
0.4
0.6
0.8
1
TONI
Digit Span Rev
Digit Span Fwd
LiSN-S Low cue
L GIN
Lisn-S High cue
L DD
R GIN
Attention
L FPT
Listening capabilities
R DD
Literacy
R FPT
Reading ability
MLD
26
FPT results highly correlated between ears
2
0
-2
clinic
school
-4
-6
Rpp Z Score
-8
-10
-12
-12
-10
-8
-6
-4
LPP Z score
-2
0
2
27
Dichotic digit results less correlated
2
0
-2
-4
-6
RDD Z score
-8
-10
Clinic
School
-12
-12
-10
-8
-6
LDD Zscore
-4
-2
0
2
28
P<0.01
Correlations – outcomes and test scores
Liter WAR
acy
P
Literacy
WARP
Listening
Cap
L DD
Liste
n L DD R DD L FPT
Cap
R
R LiSN LiSN LiSN DS
MLD L GIN
FPT
GIN
LC HC SA Fwd
DS
TONI Att
Rev
-
0.60
0.77
0.66
0.41
0.49
0.46
0.03 -0.12 -0.07
0.39
0.34 -0.03
0.56
0.67
0.62
0.49
0.60
-
0.64
0.47
0.33
0.34
0.37
0.00
0.25
0.22
0.21
0.34
0.09
0.44
0.56
0.51
0.32
0.77
0.64
-
0.47
0.37
0.34
0.26 -0.04
0.14
0.13
0.43
0.32
0.15
0.34
0.43
0.53
0.35
0.66
0.47
0.47
-
0.47
0.46
0.37 -0.12
0.08
0.14
0.28
0.25
0.13
0.53
0.48
0.49
0.27
R DD
0.41
0.33
0.37
0.47
-
0.27
0.35 -0.17
0.09
0.11
0.22
0.14
0.14
0.33
0.33
0.30
0.22
L FPT
0.49
0.34
0.34
0.46
0.27
-
0.87 -0.12
0.00 -0.03
0.12
0.07
0.17
0.29
0.42
0.38
0.19
R FPT
0.46
0.37
0.26
0.37
0.35
0.87
- -0.12
0.11
0.12
0.11
0.22
0.26
0.36
0.37
0.08
MLD
0.03
0.00 -0.04 -0.12 -0.17 -0.12 -0.12
0.03 -0.08
0.06
0.05 -0.07 -0.02 -0.03
L GIN
-0.12
0.25
0.14
0.08
0.09
0.00
0.11 -0.17
-
0.73 -0.02
0.02
0.12
0.04
0.04 -0.04 -0.09
R GIN
-0.07
0.22
0.13
0.14
0.11 -0.03
0.01 -0.19
0.73
- -0.05
0.02
0.18
0.05
0.09
0.08 -0.04
LiSN LC
0.39
0.21
0.43
0.28
0.22
0.12
0.12
0.26 -0.04
0.30
0.21
0.28
0.08
LiSN HC
0.34
0.34
0.32
0.25
0.14
0.07
0.11 -0.08
0.02
0.02
0.26
-
0.43
0.09
0.16
0.24
0.06
LiSN SA
-0.03
0.09
0.15
0.13
0.14
0.17
0.22
0.06
0.12
0.18 -0.04
0.43
-
0.02
0.08
0.14 -0.02
DS Fwd
0.56
0.44
0.34
0.53
0.33
0.29
0.26
0.05
0.04
0.05
0.30
0.09
0.02
-
0.59
0.30
0.11
DS Rev
0.67
0.56
0.43
0.48
0.33
0.42
0.36 -0.07
0.04
0.09
0.21
0.16
0.08
0.59
-
0.38
0.31
TONI
0.62
0.51
0.53
0.49
0.30
0.38
0.37 -0.02 -0.04
0.08
0.28
0.24
0.14
0.30
0.38
-
Attention
0.49
0.32
0.35
0.27
0.22
0.19
0.08 -0.03 -0.09 -0.04
0.08
0.06 -0.02
0.11
0.31
0.01
- -0.17 -0.19
0.03 -0.02 -0.05
-
0.23
30
0.23
-
NAPLAN literacy
1
L DD
2
3
4
5
6
7
8
9
10
11
12
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
R DD
L FPT
R FPT
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
MLD
*
L GIN
R GIN
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
DS Fwd
DS Rev
*
*
*
*
*
LiSN LC
*
*
*
*
*
LiSN HC
*
*
*
*
*
*
*
*
LiSN SA
*
*
*
*
*
*
*
*
*
31
What is affecting listening capabilities?
TONI
0.27
DS Fwd
0.10
DS Rev
Listening
capabilities
0.19
LDD
0.10
0.20
Att
N=59
Adj R2 = 0.31
32
What is affecting literacy?
TONI
0.24
DS Fwd
0.30
0.18
LDD
DS Rev
But only 14 clinic
participants with
NAPLAN so far.
NAPLAN
Literacy
0.16
0.29
Att
N=35
Adj R2 = 0.64
33
Importance of the presenting symptoms?
Spelling/W
Primary Concern
LANGUAGE
READING
LEARN
FOLLO
ATTN/CONC
Attention
none
No of observations
50
45
40
35
30
25
20
15
10
5
0
34
Importance of presenting symptoms
1.5
MANOVA analysis:
p=0.94
1.0
0.5
0.0
-0.5
-1.0
-1.5
-2.0
-2.5
-3.0
-3.5
-4.0
FOLLOWING INST
ATTN/CONC
LEARNING DIFFIC.
Primary Concern
READING
LDD ASIN Z Score
LFPT ASIN Z SCORE
L Gin Z score
DS FW Z SCORE
DS Rev Z Score
LC Sdev f rom avg
35
TONI Z Score
Importance of presenting symptoms
Event
Response
by child
Acts
(inappropriately)
based on what
was heard
Child fails to
understand an
instruction
Asks for repetition
of instruction
Does nothing
Misbehaves
Interpretation
by observer
Is not very smart
Can’t follow
instructions
Poor
concentration
Daydreams
Badly behaved
36
Experiment 2
Pia Gyldenkaerne current PhD study
• Children referred to Macquarie Uni
Audiology Clinic due to suspected APD
(n=119)
• Teachers, parent, speech pathologist referral
• Age range of 7–13 years
37
Measures obtained
•
•
•
•
Dichotic Digits Test (DDT): Binaural integration (Musiek, 1993)
Frequency Pattern Test (FPT): Temporal sequencing (Musiek et al, 1990)
Gaps in Noise (GIN): Temporal resolution (Musiek et al, 2005)
MLD: Binaural interaction (Bellis, 2003)
• Memory CELF-4: Forward and reverse digits
• Attention: BrainTrain®: Continuous Performance Test: Sustained auditory
and visual attention
• Cognition -TONI-4: Nonverbal cognitive assessment
• Questionnaire:
– Purpose designed – yes/no answers to 18 questions asking about difficulties in listening
and its possible consequences
• Academic Performance: WARP (reading fluency)
38
Test score sensitivity relative to functional ability:
Reported difficulties and reading fluency
-2
-2
-2
0
0
0
0
2
2
2
2
4
4
4
4
6
6
6
6
8
8
8
8
12
14
-7
-6
-5
-4
-3
-2
-1
0
10
12
14
2 -5
1
-4
-3
DDT_L_SD
-1
0
10
12
14
2 -12
1
-10
-8
-6
DDT_R_SD
Dichotic digits - left
-4
-2
10
12
14
2-12
0
220
200
200
180
180
180
180
160
160
160
160
140
140
140
140
120
120
120
120
100
100
100
100
80
80
80
80
60
40
20
0
0
3
-7
-6
-5
-4
-3
-2
-1
0
1
2
WARP Average
220
200
WARP Average
220
20
60
40
DDT_L_SD
Pia Gyldenkaerne and Mridula Sharma
-4
-2
DDT_R_SD
0
2
0
4-12
-4
-2
0
2
60
40
20
20
-6
-6
Freq pattern - right
Freq pattern - left
200
40
-8
FPT_R_SD
220
60
-10
FPT_L_SD
Dichotic digits - right
WARP Average
WARP Average
Reading speed
-2
Reported Difficulties
10
Reported Difficulties
Reported Difficulties
Reported Difficulties
Reported difficulties
-2
-10
-8
-6
-4
FPT_L_SD
-2
0
0
-12
2
-10
-8
-6
-4
-2
0
FPT_R_SD
39
2
4
-2
-2
-2
-2
0
0
0
0
2
2
2
2
4
4
4
4
6
6
6
6
8
8
12
14
11
10
9
8
7
6
5
4
12
14
2
3
0
20
40
GIN Right
60
80
100
120
10
12
14
140
10
12
14
0
20
BT Attention Quotient
Gaps in noise right
40
60
80
100
120
-7
Brain Train response
control quotient
220
200
200
180
180
180
180
160
160
160
160
140
140
140
140
120
120
120
120
100
100
100
100
80
80
80
80
0
11
10
9
8
7
6
5
4
3
60
40
60
40
20
20
0
2
0
140
0
20
GIN Right
Pia Gyldenkaerne and Mridula Sharma
40
60
80
BT Attention Quotient
100
120
WARP Average
220
200
WARP Average
220
20
-4
-3
-2
-1
0
1
2
1
2
Binaural masking
level difference
200
40
-5
MLD_SD
220
60
-6
BT Response Control Quotient
Brain Train
attention quotient
WARP Average
WARP Average
Reading speed
8
8
10
Reported Difficulties
10
Reported Difficulties
Reported Difficulties
Reported Difficulties
Reported difficulties
Test score sensitivity relative to functional ability:
Reported difficulties and reading speed
60
40
20
0
20
40
60
80
BT Response Control Quotient
100
120
0
140 -7
-6
-5
-4
-3
-2
-1
0
MLD_SD
40
Simple correlation matrix –
outcome scores and test scores
P<0.01
BT
TONI Attention
Quotient
Reported
Difficulties
WARP
L DDT
R DD
L FPT
R FPT
R GIN
MLD
-
-0.57
-0.49
-0.24
-0.42
-0.44
0.28
0.11
-0.55
-0.35
-0.57
-
0.41
0.20
0.35
0.41
-0.33
-0.07
0.35
0.50
-0.49
0.41
-
0.43
0.42
0.49
-0.20
0.01
0.31
0.36
R DDT
-0.24
0.20
0.43
-
0.22
0.23
-0.11
-0.00
0.07
0.27
L FPT
-0.42
0.35
0.42
0.22
-
0.86
-0.28
-0.05
0.34
0.22
R FPT
-0.44
0.41
0.49
0.23
0.86
-
-0.33
-0.06
0.33
0.26
R GIN
0.28
-0.33
-0.20
-0.11
-0.28
-0.33
-
0.01
-0.05
-0.02
MLD
0.11
-0.07
0.01
-0.00
-0.05
-0.06
0.01
-
0.12
0.04
TONI
-0.55
0.35
0.31
0.07
0.34
0.33
-0.05
0.12
-
0.41
BT
Attention
Quotient
-0.35
0.50
0.36
0.27
0.22
0.26
-0.02
0.04
0.41
Reported
Difficulties
WARP
L DDT
42
-
DDT_L_SD
1
2
3
4
5
6
7
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
1
2
3
4
5
6
7
8
*
*
*
*
*
*
*
*
*
*
* *
* *
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
43
*
*
TONI.Quot
BT.AttQuot
*
*
*
*
*
GIN_R
MLD_SD
FPT_L_SD
FPT_R_SD
DDT_R_SD
DDT_L_SD
No. of predictors
BT.AttQuot
GIN_R
MLD_SD
FPT_R_SD
FPT_L_SD
DDT_R_SD
No. of predictors
Reported Difficulties
Criteria for adopting a CAPD test
• Test is associated with variation in functional ability
– High sensitivity (=
∆ 𝐹𝑢𝑛𝑐𝑡𝑖𝑜𝑛𝑎𝑙 𝑧−𝑠𝑐𝑜𝑟𝑒
)
∆ 𝐶𝐴𝑃𝐷 𝑧−𝑠𝑐𝑜𝑟𝑒
– Deviant results common in clinical population
– Attributes tested minimally shared with other tests in battery
• Leads to a specific diagnosis, for which remediation exists,
and remediation affects real life functional ability
• Time taken is small
• Test is minimally affected by attention, intelligence,
motivation, working memory, and language ability
• Known high reliability and critical differences
• Associated with a known anatomical site and/or neural
mechanism
44
Comparison of tests against criteria
LiSN-S
LC/SA
Dichotic
digits
Sens: slope re functional
4
3
2
3
5
6
0
Sens: deviant results
common
2
7
5
2
2
2
0
Uniqueness re other tests
3
6.5
2
2.5
0
12
0
0/10
4
0
0
0
0
0
5/15
3
3
16
3
5
25
Known high reliability and
small critical differences
10
?
?
?
?
?
?
Known anatomical site and
neural mechanism
0
1
0
0
0
0
5
Specific diagnosis leading to
effective proven remediation
Freq
Patt
Test
GIN
Digit
span
fwd
Digit
MLD
span
reverse
Time taken
Minimal effect of attention,
working memory,
intelligence, motivation,
language ability
45
Diagnosis and intervention
• Spatial processing disorder
 LiSN & Learn
• Auditory working memory (digit span fwd and
reverse)
 Memory booster or Cog Med
• Any other disorder causing speech in noise
difficulties  dichotic digits
 Remote microphone hearing aids (Hornickel and Krauss),
 dichotic training (DIID or ARIA)
46
http://capd.nal.gov.au/
47