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Short-term memory impairment and unilateral dichotic listening extinction in a child with Landau-Kleffner syndrome: auditory or phonological disorder?

The neuropsychological profile of a child with a Landau-Kleffner syndrome is presented here. The observed cognitive difficulties included verbal short-term memory and seemed partially compensated for when the experimental assessments bypassed the auditory channel. This case study is especially challenging since the child, whose phonological skills were quite efficient and who exhibited a dichotic listening unilateral extinction, had developed average reading and spelling abilities. The fact that B.E.'s performance on memory tasks was quite poor when the stimuli were presented auditorily and more efficient when the stimuli were presented visually, strongly suggests that the observed memory impairment was due to a deficit at the level of cortical auditory processing. B.E.'s phonological skills were efficient, suggesting a neuropsychological dissociation between phonological ability and auditory processing. The fact that B.E. dramatically recovered language and easily acquired reading and spelling accounts for the hypothesis that compensatory strategies allowed him to develop phonological skills from predominantly visual input.

Auditory Perceptual Disorders↗

Brains that are out of tune but in time.

It is estimated that about 4% of the general population may have amusia (or tone deafness). Congenital amusia is a lifelong disability for processing music despite normal intellectual, memory, and language skills. Here we present evidence that the disorder stems from a deficit in fine-grained pitch perception. Amusic and control adults were presented with monotonic and isochronous sequences of five tones (i.e., constant pitch and intertone interval). They were required to detect when the fourth tone was displaced in pitch or time. All amusic participants were impaired in detecting the pitch changes, and showed no sign of improvement with practice. In contrast, they detected time changes as well as control adults and exhibited similar improvements with practice. Thus, the degraded pitch perception seen in the amusic individuals cannot be ascribed to nonspecific problems with the task or to poor hearing in general. Rather, the data point to the presence of a congenital neural anomaly that selectively impairs pitch processing.

Auditory Perceptual Disorders↗

Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor.

On the basis of the analogy between intrusive thoughts and auditory hallucinations established by Morrison et al. [(1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265-280], the present work compares the metacognitive beliefs and processes of five groups of patients (current hallucinators, never-hallucinated people with a diagnosis of schizophrenia, recovered hallucinators, obsessive-compulsive disorder (OCD) patients, and a clinical control group) and a non-clinical group. The results show that of the five metacognitive factors considered in this study, two were found to be different in the current hallucinators group in comparison to any other group in the design. Likewise, it is found that the metacognitive beliefs of the current hallucinators coincide with those of the OCD patients in various factors, particularly that relating to superstition, and this is interpreted as lending support to the model of Morrison et al. (1995). Furthermore, the results are discussed in the light of existing research on Thought-Action Fusion, stressing the role that may be played by superstitious beliefs and magical thinking in auditory hallucinations and OCD.

Adult↗

Auditory processing disorders in adults and children: evaluation of a test battery.

A Dutch test battery comprising six different tests for auditory processing disorders was evaluated in a group of 49 adults and children (age 8-57 years) with auditory complaints despite normal audiometric thresholds. Percentile scores were derived from normal control groups (n = 132) to determine whether a subject passed or failed a test. A composite score was computed to reflect a general score on all the auditory processing tests. In order to gain insight into underlying auditory processes, factor analysis was performed. Normal scores on all the tests were seen in five subjects. The remaining 44 subjects had at least one test score that was below the cut-off point (10th percentile). Factor analysis provided evidence for a model comprising four auditory components: auditory sequencing, word recognition in noise, auditory closure, and auditory patterning. This model could be useful in the interpretation of scoring patterns. Although there were some differences in scoring patterns between the children and adults, the test battery proved to be useful in both groups.

Acoustic Stimulation↗

Interhemispheric suppression: a test of central auditory function.

Two groups of brain damaged adults, those with cerebrocranial injury (CCI) and victims of cerebrovascular accident (CVA) were tested with the competing sentences test of Willeford (In: Central Auditory Dysfunction. New York: Grune and Stratton, 1977: Chap 2). The main purpose was the exposure of functional disorders of communication in such patients who test within normal or near-normal limits on routine audiological testing and also on tests for aphasia. Of 142 serially admitted CCI patients, 43%, many with diffuse lesions, gave abnormal responses, mostly at the left ear, with 19 of them showing total extinction at that ear. On two sound field competing message tests the CCI patients were significantly poorer than normal controls. CVA patients with confirmed right hemisphere lesions tended strongly toward left ear suppression, while left hemisphere damaged patients often showed bilateral drop in scores. It is clear that brain damaged patients can have central dysfunction of auditory processing despite normal findings on routine audiological tests and tests for aphasia. The implications for activities of daily living and for habilitation are discussed.

Adult↗

[Significance of auditory processing deficits for the pathogenesis of reading and spelling disorders].

OBJECTIVE: It has been claimed that children with dyslexia show auditory processing deficits and a training of auditory perception is recommended as a therapy. this study addresses the question whether a causal connection between auditory perception and dyslexia can be proven empirically. METHOD: 27 dyslexic children with average intelligence and normal hearing and 31 controls were examined. The auditory perception ability was judged with non-linguistic (pitch, tone duration, sound discrimination tasks) and verbal (speech in noise, compressed speech) tasks. In addition auditory short-term memory, nonverbal IQ, spelling and language ability were assessed. RESULTS: Group differences were found in tone processing tasks, but not in sound discrimination or auditory verbal tasks. Despite significant main effects in tone processing tasks the individual values of the dyslexic children lay predominantly in the range of the controls. In addition, there was no correlation between tone processing and spelling ability. CONCLUSION: Dyslexic children do not show remarkable deficits in verbal auditory processing. Auditory low level deficits can only be observed within a small subgroup. There is no evidence for central auditory dysfunction as a cause of dyslexia. The relevance of auditory processing training for treatment programmes for dyslexia should be questioned.

Agraphia↗

A comparison between vocal reaction time and word recognition measures of children with APD and age-matched peers using auditory word discrimination test.

The purpose of this study was to investigate the possibility of improving speech recognition testing sensitivity in children with auditory processing disorders (APD) by incorporating response time measures. A group of children identified in a clinical setting as having APD was compared to an age-matched peer group using a vocal reaction time (VRT) format. The participants were between the ages of 5.5 and 15 years. All children were presented spoken monosyllabic words of the clinical Hebrew speech discrimination test. Statistically significant differences were found, with means in the APD children reflecting slower performance than that of their peers. The two groups did not differ in their performance accuracy. These data show that combining response time measures with percent correct scores improved test sensitivity. Such an approach may hold promise for future clinical applications in the assessment of APD.

Adolescent↗

Abnormal monitoring of inner speech: a physiological basis for auditory hallucinations.

Auditory verbal hallucinations ("voices") are thought to arise from a disorder of inner speech (thinking in words). We examined the neural correlates of tasks which involve inner speech in subjects with schizophrenia who hear voices (hallucinators), subjects with schizophrenia who do not (nonhallucinators), and normal controls. There were no differences between hallucinators and controls in regional cerebral blood flow during thinking in sentences. However, when imagining sentences being spoken in another person's voice--which entails both the generation and monitoring of inner speech--hallucinators had a normal left frontal response, but reduced activation in the left middle temporal gyrus and the rostral supplementary motor area, regions which were activated by both normal subjects and nonhallucinators (p < 0.001). These findings suggest that a predisposition to verbal hallucinations is associated with a failure to activate areas concerned with the monitoring of inner speech.

Adult↗

Poor frequency discrimination is related to oral language disorder in children: a psychoacoustic study.

Some children have difficulty in perceiving differences between sounds, even though they have normal hearing sensitivity, and it has been suggested that such problems could lead to difficulties in language and literacy development. Poor ability to distinguish sounds on the basis of frequency (perceived as pitch) has been described in poor readers on a variety of auditory processing tasks. The aim of the present study was three-fold: to determine whether children with specific language impairment (SLI) have difficulty discriminating frequency, whether this deficit is specific to the frequency domain, or part of a more general auditory impairment, and whether it is linked to reading or oral language ability. The performance of a SLI group (N = 15) and a control group with normally developing oral language matched for age and intelligence (N = 18) was compared on a frequency discrimination task and a control task testing intensity discrimination. The children with SLI consistently demonstrated significantly poorer performance on the frequency discrimination task, but not on the intensity discrimination task. Frequency discrimination thresholds were not related to reading ability in either group. This study provides evidence for a basic auditory deficit in children with SLI, regardless of their reading ability.

Auditory Perceptual Disorders↗

Central auditory processes and test measures: ASHA 1996 revisited.

The theoretical issues surrounding central auditory processing disorders (CAPD) are reviewed here, especially with reference to the central auditory behavioral processes and the auditory test measures as prescribed in the ASHA (1996, American Journal of Audiology, 5(2), 41-54) statement on CAPD. A simplified nomenclature is recommended that directly relates process and test measure to facilitate the diagnostic process in CAPD. This new terminology closely follows the ASHA (1996, American Journal of Audiology, 5(2), 41-54) document, but provides some refinement based on recent research in CAPD. To support this recommendation, a confirmatory factor analysis (CFA) was applied to the findings of Domitz and Schow (2000, American Journal of Audiology), who proposed use of a battery of CAPD tests, the Multiple Auditory Processing Assessment (MAPA) for testing school children. The CFA was found to reinforce the four-factor model, which clearly emerged in the exploratory factor analysis of Domitz and Schow. The model was found to be reasonably consistent even when subtests from the SCAN were included in the analysis. Refinement and revision of ASHA (1996, American Journal of Audiology, 5(2), 41-54) is recommended to facilitate diagnosis, subclassification, and intervention for CAPD.

American Speech-Language-Hearing Association↗

[Hearing loss, disorders of sound localization with the preservation ofsmell and taste in diabetics].

Diabetes is often complicated by serious medical conditions which could be related to the development of auditory system and cranial nerves lesions, disorder of sound localisation and decreased olfactory and taste ability. Cranial nerve palsies in diabetes are considered as an integral part of the main disease. Twenty nine children with diabetes and non-diabetics control group, without a history of exposure to noise, ototoxic drugs, or ear disease aged 4-19 years old were examined. Hearing impairment may be present in children with disease duration above 3-5 years and in children with other complications. Sound localisation tests were performed by the method of Zakrzewski from a free auditory field, measuring the angle of directional hearing acuity in 35 diabetics age from 16 to 78 years. Longer duration of diabetes was associated with higher directional hearing acuity. Higher hearing loss was observed with higher directional values in diabetics. The authors investigated smell and taste in 35 diabetics. All patients were treated with insulin. Impairment value of smell identification thresholds was much more frequent than impairment of smell perception. In no case raised threshold of taste perception.

Adolescent↗

Processing of environmental sounds in schizophrenic patients: disordered recognition and lack of semantic specificity.

The recognition of environmental sounds is an important feature of higher auditory processing and essential for everyday life. The present study aimed to investigate the potential impairment of this mental function in schizophrenia. This work on immediate sound recognition is complementary to recent studies on auditory linguistic processing. Fifteen schizophrenic patients and 30 control subjects were asked to identify 43 complex environmental sounds from different categories and rate their familiarity when naïve to the sounds. In consecutive experiments, patients and control subjects rated the sounds according to emotional valence and arousal, as well as imageability. In both groups, correct identification of non-verbal sounds was highly associated with familiarity. Statistical analysis by group demonstrated a significantly higher error rate in identifying sounds in patients suffering from schizophrenia compared to healthy control subjects. In contrast, the affective recognition of the complex sounds was preserved in the schizophrenic patients. These results suggest a disturbance of higher-order, auditory mnemonic processing in schizophrenic patients in the non-linguistic domain. We discuss their abnormal responses in the context of recent theories of auditory physiological and semantic processing deficits in schizophrenia.

Adult↗

An adaptive clinical test of temporal resolution.

PURPOSE: It has been recommended that diagnostic and screening test batteries for auditory processing disorder (APD) include a measure of temporal gap detection using broadband noise stimuli. Although psychophysical laboratory procedures exist for the measurement of temporal resolution, none are clinically feasible. This study was designed to obtain preliminary data on a new clinical measure of gap detection, the Adaptive Test of Temporal Resolution (ATTR). METHOD: The ATTR, a currently available clinical test (Random Gap Detection Test), and a standard psychophysical laboratory procedure were used to measure gap detection thresholds (GDTs) from a group of 30 young adults with normal hearing. RESULTS: Mean ATTR GDTs were 2.2 ms, consistent with GDTs measured using the psychophysical laboratory procedure (3.2 ms) and significantly smaller than those measured using the Random Gap Detection Test (7.0 ms). CONCLUSIONS: Because it incorporates standard adaptive psychophysical methodology in a computer application that can be used on any desktop computer but does not depend on specialized hardware for application, the ATTR promises to be a clinically feasible addition to the APD test battery.

Acoustic Stimulation↗

Age effects and normative data on a Dutch test battery for auditory processing disorders.

A test battery compiled to diagnose auditory processing disorders (APDs) in an adult population was used on a population of 9-16-year-old children. The battery consisted of eight tests (words -in noise, filtered speech, binaural fusion, dichotic digits, frequency and duration patterns, backward masking, categorical perception, digit span) and a questionnaire. Descriptive statistics were computed on data obtained from 75 children from primary school (age 9-12 years) and 30 adolescents from secondary school (age 14-16 years) with normal hearing and normal intelligence. Most test scores did not follow a normal distribution. Age effects were present in most tests, within the group as well as when children and adolescents were compared to adults. This suggests that maturation of auditory processing abilities takes place even during adolescence. Relative measures regarding ear differences and binaural versus monaural scores did not appear to be age-related. These measures might be useful in diagnosing APD, supplementary to the absolute measures. Factor analysis showed four components that address underlying processes. However, these results must be interpreted cautiously because the study did not include any subjects with APD.

Adolescent↗

Semantic memory disorders in Alzheimer's disease: clues from semantic priming effects.

Semantic memory deficits are a common landmark in Alzheimer's disease, but the nature of these impairments remains to be clarified. The tests used to explore this memory system are not specific and involve cognitive processes often disturbed in Alzheimer's disease. A complementary way to investigate semantic memory in neuropsychology is by using the semantic priming paradigm. Here, semantic priming refers specifically to the modification of a stimulus processing behind the presentation of a related stimulus; it is a short-lived phenomenon considered an implicit measure of semantic memory integrity. However, semantic priming studies have yielded contradictory results in Alzheimer's disease, with authors reporting normal priming, less-than-normal priming, or increased priming effects (hyperpriming). The aim of this paper is to review the literature investigating semantic priming in Alzheimer's disease, and to discuss the contradictory results in the context of current models of semantic processing. For a clear comprehension of the semantic priming patterns in this pathology, we will precise the methodology used and the characteristics of the Alzheimer's disease patients examined. Besides, the surprising hyperpriming phenomenon - often observed in Alzheimer's disease at the early stage of dementia--will also be explained in detail. These results from semantic priming represent invaluable clues to widen our knowledge and conceptions about deterioration of the semantic memory in Alzheimer's disease.

Alzheimer Disease↗

Auditory processing assessment in children with obstructive sleep apnea syndrome.

INTRODUCTION: The obstructive sleep apnea syndrome (OSAS) is a respiratory disorder that occurs during sleep and it is relatively common in children. AIM: The goal of this paper is to verify if there is a relationship between the obstructive sleep apnea syndrome (OSAS) and auditory processing. METHODS: In order to do that, three groups of children ranging in age from 5 to 11 were studied, including a normal group. Twenty subjects who made up the study group were submitted to ear, nose and throat (ENT) exams and to polysomnography (PSG), and were divided in two groups: GROUP I (RO) comprised of 10 children who presented oral breathing and displayed normal PSG, and GROUP II (SAS) comprised of 10 children who presented oral breathing and displayed abnormal PSG. Their performance was compared to the performance of the third group--GROUP III (REN) comprised of 10 children who did not refer ENT difficulties. All the subjects completed a basic audiometric assessment as well as an auditory processing diagnosis. RESULTS: The analyses of the results revealed a statistically significant difference in ENT exams related to the turbinate and the palatine tonsils. Group II presented a higher incidence of turbinate hypertrophy levels II and III (p<0.001) and palatine tonsils hypertrophy grades III and IV (p 0.007). Regarding the auditory processing assessment, a statistically significant difference (p<0.001) was obtained in the dichotic digits test. Group II performed worse than group III. Also, for the non-verbal sequence memory test, Group II obtained a worse result (p<0.022) than Group I. CONCLUSION: Subjects with OSAS obtained worse results in auditory processing tests.

Audiometry↗

Oral and written language abilities of XXY boys: implications for anticipatory guidance.

Previous studies of XXY boys suggest that they are at risk for certain communication disorders involving oral and written language. In this study, the language, reading, and spelling skills of a group of 14 XXY boys identified during neonatal cytogenetic screening were compared with those of a group of 15 control children. The two groups were matched for age, grade, race, parity, birth weight, parental age and education, and socioeconomic status. The mean age of the XXY group was 9 years 7 months and that of the control group was 9 years 3 months. The mean academic grade level for both groups was at the transition between third and fourth grade. There was selective reduction in verbal IQ scores for the XXY group and no significant differences apparent between groups for performance IQ scores. The decrease in verbal IQ was associated with a reduced full-scale IQ and also with significant problems in expressive language, auditory processing abilities, and auditory memory. Word-finding difficulties and problems in the production of syntax were major components of the specific expressive language deficit. Except for difficulties in the understanding of complex sentence structures, the receptive language skills of XXY boys did not differ significantly from those of the control group. These reductions in speech and language abilities correlated with decreased achievement by the XXY group on a variety of reading and spelling tasks. These results suggest that difficulty learning how to read and spell may be due to a preexistent language disability. Early attention to such expressive language problems may be essential to ameliorate secondary maladaptive behaviors due to chronic language-related learning disabilities.

Auditory Perceptual Disorders↗

[Münchner screening of auditory perception disorders (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.

Auditory Perceptual Disorders↗