Relationship between Auditory Processing and Speech-Language Abilities in Children

Jennifer McCullagh, Au.D., Ph.D., CCC-A Diana Newman, Ph.D., CCC-SLP

Disclosure Statement • We have no relevant financial or nonfinancial

relationship(s) within the products or services described, reviewed, evaluated or compared in this presentation.

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(Central) Auditory Processing “Broadly stated, (Central) Auditory Processing

[(C)AP] refers to the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information. Narrowly defined, (C)AP refers to the perceptual processing of auditory information in the CNS and the neurobiologic activity that underlies that processing and gives rise to electrophysiologic auditory potentials” (ASHA, 2005a, p. 1).

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(Central) Auditory Processing Disorder • (Central) Auditory Processing Disorder [(C)APD] refers to

difficulties in the perceptual processing of auditory information in the CNS as demonstrated by poor performance in one or more of skills: sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals (ASHA, 2005b).

• APD is an auditory deficit that is not the result of other higher-order cognitive, language, or related disorder.

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(Central) Auditory Processing Disorder and Language Impairment • (C)APD may coexist with other disorders such as

LI or LD but is not the result of these other disorders (ASHA, 2005b).

• A language impairment (LI) is a difficulty understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language) (ASHA). o Problems can occur in the form (phonology,

morphology or syntax), content (semantics) and/or function (pragmatics).

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Background • Children with LI often demonstrate difficulty with

auditory skills such as perception, processing, memory, and attention (e.g. Rosen, 2003). • However, not all but only some auditory skills are

impaired in groups of listeners with SLI. • Thus, those with SLI may appear to have normal

auditory processing; further, auditory deficits have been found in those with normal language skills.

• Auditory deficits appear not to be causally related to language disorder but only associated with them (Rosen, 2003). 6

Background • Conflicting evidence regarding the co-

occurrence of (C)APD and LI (e.g. Corriveau, Pasquini, & Goswami, 2007). • As many as 70%–80% of children diagnosed with

SLI were found to perform poorly on auditory processing tasks (Corriveau et al., 2007).

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Background • 76% of those with (C)APD had LI (Sharma et al., 2009)

• Most children with (C)APD had difficulty with following directions, recalling sentences and formulation of sentences, and forward number repetition (a memory task).

• Children diagnosed with both (C)APD and LI all had difficulty on temporal processing tasks.

• Children with similar (C)AP abilities were not necessarily diagnosed as having LI (Sharma et al., 2009). • Confounding was that not all children with LI had (C)APD. • Not possible to predict the presence of LI in children with

(C)APD on the basis of (C)APD tests alone

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Background • Relationships between (C)APD and Language

tests • CELF subtests (Concepts and Following

Directions and Formulated Sentences) have been found to be significantly correlated with Dichotic Digits –Left and Staggered Spondaic Word (SSW) Test (Miller & Uhring, 2007). • Suggested future study to examine patterns of

association among language and (C)AP tests.

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Background • No statistically significant group mean differences of

behavioral variables examined between children who received a diagnosis of APD and children who received services for LI but did not have an APD diagnosis (Miller& Wagstaff, 2011). • Suggests that there may not be a distinct cognitive-

behavioral profile associated with an APD diagnosis. • Further, children who met criterion for SLI had poorer

performance on several behavioral variables including left ear score for Dichotic Digits than did the children who did not meet the criterion (Miller& Wagstaff, 2011). 10

Rationale and Purpose • “Better Together” (McNamara & Richard, 2012)

• “How do auditory processing disorders and deficits in language relate to one another-if at all? It’s a question that spurs endless debate.” • Is (C)APD nothing more than a reflection of

language disorder or delay? • Or does true (C)APD exist, causing problems in

language and academic skills?

• The purpose of this investigation was to determine the relationship between (central) auditory processing and language abilities in children and adolescents.

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Methodology • Study Design

• Retrospective investigation • Review of 134 files of patients evaluated for (C)APD at the

Center for Communication Disorders between 2003 and 2010 • Inclusion/Exclusion Criteria

• (C)APD test battery completed by a CCC-A • Language testing completed by a CCC-SLP • Normal peripheral hearing • IQ • No history of neurological involvement or ASD

• Participants

• 35 children (mean age = 11.56, s.d. = 2.5; range = 8;5 – 17;0) • IQ

• 26/35 had average IQ • 9 had no documentation, but were noted to have normal IQ in

report

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Statistical Analyses • Descriptive Statistics • Pearson Product-Moment Correlations

• Dichotic Digits (Divided & Focused Attention) • Compressed Speech • Frequency Patterns • CELF (Receptive, Expressive, & Core) • TAPS

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Results- Descriptive Statistics

0

5

10

15

20

25

30

35

40

No CAPD CAPD No LI LI Total

Num

ber o

f Par

ticip

ants

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Results- Descriptive Statistics

No CAPD/No LI

23% No CAPD/LI

3%

CAPD/No LI 43%

CAPD/LI 31%

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Results- Inferential Statistics * Significant at 0.05 alpha level

CELF Receptive

CELF Expressive

CELF Core TAPS

DD L Pearson Correlation Significance N

0.398 0.04* 27

0.158 0.414 29

0.161 0.431 26

0.563 0.057 12

DD R Pearson Correlation Significance N

0.369 0.058 27

0.027 0.891 29

0.176 0.389 26

-0.076 0.816 12

Comp Sp. L Pearson Correlation Significance N

0.458 0.032* 22

0.521 0.013* 22

0.435 0.055 20

-0.135 0.749 8

Comp. Sp. R Pearson Correlation Significance N

0.570 0.006* 22

0.535 0.01* 22

0.454 0.044* 20

-0.066 0.877 8

Freq. Patterns Pearson Correlation Significance N

0.350 0.093 24

0.277 0.171 26

0.401 0.058 23

0.541 0.069 12

DD Focused L Pearson Correlation Significance N

0.499 0.021* 21

0.467 0.033* 21

0.323 0.339 19

0.182 0.639 9

DD Focused R Pearson Correlation Significance N

0.256 0.262 21

0.260 0.256 21

0.309 0.198 19

-0.153 0.694 9

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Dichotic Digits (Divided Attn.)

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L ear: r = 0.398, p = 0.04* R ear: r = 0.369, p = 0.058

L ear: r = 0.158, p = 0.414 R ear: r = 0.027, p = 0.891

Dichotic Digits (Focused Attn.)

L ear: r = 0.467, p = 0.033* R ear: r = 0.260, p = 0.256

L ear: r = 0.499, p = 0.021* R ear: r = 0.256, p = 0.262

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Compressed Speech

L ear: r = 0.458, p = 0.032* R ear: r = 0.570, p = 0.006*

L ear: r = 0.521, p = 0.013* R ear: r = 0.535, p = 0.01*

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Discussion • Majority of the individuals included in this study

met criteria for diagnosis of (C)APD, but not LI (43%), while 31% had a diagnosis of (C)APD and LI. • Percentages consistent with those reported by

Miller & Wagstaff, 2011 • Although percentages vary, these findings are

consistent with Corriveau et al., 2007 and Sharma et al., 2009.

• Suggests that (C)APD may or may not co-occur with LI.

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Discussion • Significant low correlations were noted between left ear

scores on dichotic listening tasks and receptive language abilities. • Suggests that poorer left ear performance is related to poorer

receptive language abilities as measured by the CELF. • Miller & Uhring (2007) also demonstrated correlations

between left ear dichotic listening and CELF subtests. • Miller & Wagstaff (2011) also reported left ear deficits on

Dichotic Digits test in children with (C)APD and LI • Significant low - moderate correlations were noted between

the Compressed Speech task for the right ear and the left ear and CELF Expressive and Receptive language abilities. • Suggests that poorer performance on degraded speech tasks is

related to poorer receptive and expressive language abilities. 21

Discussion • Lack of significant correlations between temporal test

(Frequency Patterns) and CELF. • Differs from Sharma et al., 2009 • May be the result of limited sample.

• Lack of significant correlations between the (C)APD tests

and the TAPS • May be related to small sample • May be related to tests evaluating different abilities

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Limitations/Future Directions • Study Limitations

• Retrospective study design • Bias in our sample

• Lack of universally used language test battery in our sample

• Future Directions • Prospective Investigation

• Large sample size • Evaluate the relationship between subtests on language testing that

uses visual displays versus those that use purely auditory stimuli. • Standard language test battery including higher-level language

testing that evaluates expressive language, organization and verbal reasoning, especially in discourse.

• Further investigate the relationship between (C)APD and LI when considering non-verbal IQ. 23

Clinical Implications • Children referred for (C)APD evaluations may not

have co-morbid language impairments (as seen in the majority of the patients in this study).

• Audiologists AND SLPs should consider the

relationship between left ear abilities on Dichotic Listening tasks and receptive language abilities when evaluating children.

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Acknowledgements • Dr. Robert Jirsa • Kevin McNamara, Director, Center for Communication

Disorders • Anu Kurichethu

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References American Speech-Language-Hearing Association. (2005a). (Central) auditory processing disorders—the role of the audiologist [Position Statement]. Available from www.asha.org/policy. American Speech-Language-Hearing Association. (2005b). (Central) auditory processing disorders [Technical Report]. Available from www.asha.org/policy. Corriveau, K., Pasquini, E., & Goswami, U. (2007). Basic auditory processing skills and Specific Language Impairment: A new look at an old hypothesis. Journal of Speech, Language, and Hearing Research, 50, 647–666. McArthur, G., & Bishop, D. (2004). Frequency discrimination deficits in people with Specific Language Impairment: Reliability, validity, and linguistics correlates. Journal of Speech, Language, and Hearing Research, 47, 527-541. McNamara, T. & Richard, G. (2012, March 13). Better Together. The ASHA Leader. Miller, C.A. & Uhring, E.A. (2007, November). Relationships among language, auditory processing, and cognitive test performance. Poster presented at the annual convention of the American Speech Language and Hearing Association, Boston, MA. Retrieved from http://www.asha.org/Events/convention/handouts/2007/0516_Miller_Carol/ Miller, C.A. & Wagstaff, D.A. (2011). Behavioral profiles associated with auditory processing disorder and specific language impairment. Journal of Communication Disorders, 44, 745–763. Rosen, S . (2003). Auditory processing in Dyslexia and Specific Language Impairment. Is there a deficit? What is its nature? Does it explain anything? Journal of Phonetics, 31,509-527. Rosen, S., Adlard, A., & van der Lely H. (2009). Backward and simultaneous masking in children with grammatical specific language impairment: No simple link between auditory and language abilities. Journal of Speech, Language, and Hearing Research, 52, 396 - 411 Sharma, M., Purdy, S., & Kelly, A.S. (2009). Comorbidity of auditory processing, language, and reading disorders. Journal of Speech, Language, and Hearing Research, 52, 706-722.

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Questions?

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