Improving outcomes for children with Central Auditory Processing Disorder

1. Improving outcomes for children with Central Auditory Processing Disorder

2. What are the indicators a child may have an auditory processing disorder? • Central Auditory Processing Disorder (CAPD) is a term that covers a variety of disorders where a person may have normal hearing but for some reason their brain cannot always make sense of what they hear. • For example, the person may have a lot of difficulty understanding speech when it is noisy.

3. What are the indicators a child may have Central Auditory Processing Disorder? • doesn’t pay attention in class • frequently in trouble for talking to classmates • doesn’t follow instructions well • seems to do worse when it’s noise • academic progress is slipping, • parents are confused and upset • says he/she can’t hear the teacher • says he/she gets confused when everyone’s talking at once

4. 2-3% of children have a Central Auditory Processing Disorder (CAPD) • Listening behaviour similar to someone with a hearing loss • But hearing is NORMAL • NOT related to cognitive ability • Occurs in the higher processing sections of the brain • Greatest difficulties listening under adverse conditions • Noise • Reverberation • many different types of disorders • Hearing in noise, auditory memory, speech clarity… • “CAPD testing” can include a range of different tests

5. Spatial Processing Disorder • Spatial processing is the ability to use the cues that tell us where sound is coming from. • This ability allows us to focus on one sound while ignoring sounds coming from other directions. • Spatial Processing Disorder (SPD) is a type of CAPD that lead to a difficulty understanding speech in noisy situations. Australian Hearing’s CAPD program, established in 2012, focuses on identifying SPD, but other areas of CAPD may also be assessed.

6. Sophie’s story http://www.youtube.com/watch?v=kl8xSYU2Z1I

7. CAPD Services at Australian Hearing • Research-based program • Spatial Processing Disorder (SPD) discovered by research at the National Acoustic Laboratories • Hierarchical CAPD test battery • Tailored to an individual child’s listening deficit • Deficit specific remediation options • Auditory training packages • FM systems • Fee for service program for children • Normal hearing • Aged 6 to 16 years of age • No middle ear problems for at least • 4 weeks

8. AH CAPD assessment: test battery Our CAPD assessment battery: Hearing screening Spatial Processing Listening in Spatialized Noise – Sentences test (LiSN-S) Short term memory Number Memory Forward (NMF) Auditory working memory Number Memory reversed (NMR) Binaural integration Dichotic Digits Test

9. Spatial Processing • LiSN-S was developed by the National Acoustic Laboratories – the research division of Australian Hearing • LiSN-S identifies SPD • This is an exciting break through • Many CAPD tests aren’t very specific in the type of problem/s they identify and the results can be affected by other problems. More information on NAL and LiSN-S can be found at http://capd.nal.gov.au

10. Memory • Number memory forward (NMF) subtest of TAPS – 3 assesses short term auditory memory • Number memory reversed subtest of TAPS – 3 assesses auditory working memory. Auditory working memory is the ability to store and manipulate auditory information • Debate over whether auditory memory is within CAPD umbrella • Does affect children’s academic performance and “listening ability” • Approx. 10% of children have memory deficits

11. Binaural integration • Dichotic Digits Test (DDT) used to assess binaural integration. • Can only be tested for children 7 years of age or older. • Poor performance on DDT correlated with greater difficulty listening in the classroom as well as with NAPLAN results • Results can be affected by memory and attention

12. Our results… • Most referrals we receive are for children in early primary school

13. Our results … • 61.3 % of children referred to Australian Hearing have been diagnosed with one of the target auditory processing disorders. • 19.5% had SPD (130 children) • 26.1% had memory deficit (174 children) • 17.6% had binaural integration deficit (104 children) • 27.2% passed all tests (181 children*) • * NB: DDT not tested for children under 7 years of age.

14. Remediation pathways Depending on the results from the assessment appointment, we work with families to develop management options specific for each child. LiSN & Learn • for children diagnosed with Spatial Processing Disorder Memory Booster • for children diagnosed with a memory deficit Personal wireless system (or FM) Compensatory strategies

15. LiSN & Learn • developed by NAL to improve listening ability of children who have a spatial processing disorder. • at-home computer-based auditory training program. • children train with the software for 15-20 minutes per day, five days per week, for 10 weeks. This is one of the few CAPD interventions that has very strong research evidence to prove that it works. NAL & Australian Hearing are working at the cutting edge of CAPD assessment and treatment

16. Memory Booster • to improve listening ability of children who have a short term memory deficit or auditory working memory deficit. • at-home computer-based auditory training program. • children train with the software for 20 mins per day, 3 days per week, for 8 weeks. • teaches children to use memory strategies such as visualisation, rehearsal and story telling and practices these skills.

17. Personal wireless system (or FM) • Recommended for children with a binaural integration disorder and those reporting difficulty listening in noise. • A range of systems are available. • Worn in the classroom to improve the child’s ability to hear the teacher’s voice over classroom noise. • Reduces listening fatigue

18. Strategies Environmental modification and classroom strategies • Practical activities used in the classroom to improve a child's immediate listening environment, e.g providing preferential seating or gaining a child's attention before addressing them. Compensatory strategies • Aim to teach a child skills to operate more effectively in listening and learning situations, e.g. whole-body listening approach, self-regulation and problem solving, and verbal rehearsal.

19. Our results …

20. Our results … Performance in real life, post L&L (n=34)

21. Our results … Memory tests - post-training • NMF (n=18) • NMR (n=18) NB: Excluded scores of children who passed the original test.

22. Our results … Performance in real life (n=26)

23. Our results … Reasons for FM fitting COSI – C final scores

24. Our results … Both auditory training programs led to significantly improved test scores • LiSN-S and NMR both within the normal range after remediation • The majority of children showed significant improvements in real life settings FM fittings • yielded improvements in real-life performance

25. The end result … Australian Hearing wants to give children (like Sophie), the chance to help their CAPD problems so they can get on with their education.

26. Questions? Or want to know more To refer a child to Australian Hearing, call 1300 256 874. For information on Australian Hearing’s CAPD program, visit http://hearing.gov.au We look forward to working with you Please come, get some popcorn and have a chat with our friendly team in the Exhibitors Hall!