hearing problems in school – causes and solutions harvey dillon with thanks to: helen glyde sharon...

Hearing problems in school – causes and solutionsHarvey Dillon

With thanks to:

Helen Glyde

Sharon Cameron

Robyn Massie

National Acoustic Laboratories, Sydney, Australia

Presentation Overview

Causes of not hearing clearly in class

Solutions

Sound field amplification

Auditory training for Spatial Processing Disorder (SPD)

2

Why don’t some children seem to hear and understand easily in class?


Children may not understand speech easily in the classroom because of:

Hearing loss Sensorineural hearing loss – permanent Conductive hearing loss

Language impairment (including ESL)

Cognitive deficit Attention Verbal working memory IQ

Auditory processing disorder Spatial processing disorder Other types

4

Poor classroom acoustics

Child fails to understand

an instruction

Event

Acts (inappropriately) based on what

was heard

Asks for repetition of instruction

Does nothing

Misbehaves

Response by child

Interpretation by observer

Daydreams

Badly behaved

Can’t follow instructions

Is not very smart

Poor concentration

5

Differentiating these problems based on symptoms

Cognition

Language

Auditory processing

Hearing loss

What solutions exist?


Solutions to help hear more clearly:

Language intervention

Hearing aids

Wireless remote microphones

Sound field amplification

Auditory training

Memory training

7

Matching treatment to condition

Language

intervention

Hearing

aids

Wireless

remote microphone

Sound-field amplificatio

n

Auditory

training

Memory

training

Attention disorder

Language impairment √Sensorineural hearing loss √ √Conductive hearing loss (√ ) (√ ) √CAPD - general √CAPD – spatial processing disorder √Working memory deficit √

8

THE IMPACT OF SOUND-FIELD AMPLIFICATION IN

MAINSTREAM CLASSROOMs

Robyn Massie

Harvey Dillon

FACTORS AFFECTING CLASSROOM COMMUNICATION

Direct and reverberant fields in a room

50

60

70

80

90

0 1 2 3 4 5

Distance from source (m)

So

un

d le

ve

l (d

B S

PL

)

DirectReverberant

TotalNoise

SOUND-FIELD AMPLIFICATION

PREVIOUS STUDY FINDINGS

INCREASED:verbal communication children’s response to teacher verbal instructionchild proactiveness in classroom discussionchildren’s confidence

DECREASED:disruptive behaviours teacher voice fatigue


Aim of our study

To investigate the effects of sound field

amplification intervention on specific

educational goals


METHOD

Eight Grade 2 classes, in Queensland242 children43% Vietnamese, Samoan, Spanish, Aboriginal

Dual-channel sound-field amplification

Four classes started with amplification, four without. Change-over at mid year.

Educational attainment rated by teacher at year start, mid-year, and start of next year (Diagnostic Net)


PROCEDURE

Teacher in-service training

Audiological assessment

Classroom acoustic measurements


Hearing and acoustic results

Mean Hearing level

Overall effect

Mean noise Mean Reverberation Mean Signal-to-

noise

15 dB

+ 7 dB

Actual Recommended

50 dB 35 dB

1.5 secs 0.6 secs

- 3 dB + 15 dB

Overall “ON” / “OFF”

Results by skill area and language at home

On

Off


SUMMARY

Positive effect on literacy and numeracy Urgent need to improve classroom and

acoustic environment

Spatial Processing Disorder:

Overview

Diagnosis, cause, remediation


22

CatalystThe Australian Broadcasting Commission


Link between SPD andChronic Otitis Media (middle ear infections)

23

24

SPD and chronic otitis media (COM)

• 50% of children (24/49) diagnosed with SPD at NAL reported a history of COM. (Dillon et al., 2012).

• 30% of children (15/50) previously diagnosed with COM at University of Melbourne were diagnosed with SPD. (Graydon & Rance, ongoing).

• Spatial processing deficit worse for early onset age and longer duration of COM (n=35; Tomlin & Rance, under review).

• 6 yo children with history of COM have below average spatial advantage (n=17; z= -1.0) (Kapadia et al, 2012).

• 13-17 yo adolescents with history of COM have below average spatial advantage (n=20; z= -0.75) (Kapadia et al, 2014).

• 10% of a population sample (9/90) of Aboriginal children from remote Australia diagnosed with SPD. (Unpublished data).

• 7% of a population sample (10/144) of Aboriginal children from regional Australia diagnosed with SPD. (Cameron et al., in review).


25

Interpretation Based on These and Other Studies

Chronic otitis media

Fluctuating access to binaural cues

reduced effectiveness in better-ear glimpsing


Remediation of SPD:

The LiSN & Learn Auditory Training Software

26

Target: The horse kicked six wet shoes


LC SRT p = 0.158

Talker Advantage p = 0.981

HC SRT p = 0.0002

Spatial Advantage p = 0.0002

Total Advantage p = 0.001

L C S RT HC S RT T a l ke r S p a ti a l T o ta l

L iS N-S Co n d i ti o n

-4

-3

-2

-1

0

1

2

LiS

N-S

Sco

re(P

op

ula

tion

Sta

nd

ard

De

via

tion

Un

its)

P re -T ra i n i n g P o st-T ra i n i n g 3 M P o st-T ra i n i n g

LiSN-S Results - Pre- vs. Post-Training

Cameron & Dillon (2011) 28


LiSN & Learn – Preliminary Study

• 9 children with SPD (6 to 11 years)

• LiSN & Learn – 2 games/day, 5 days/week, 12 weeksLi

SN

& L

earn

SR

T (

dB)

Bet

ter

Game NumberCameron & Dillon (2011)

Average SRTFirst vs Last 30 Days

p = 0.000052

29

10 dB


Self-Report Questionnaire - Pre- vs. Post-TrainingCA P D S S Q

P re -T ra in i n g P o st-T ra in i n g 3 M P o st-T ra in i n g0 .0

0 .5

1 .0

1 .5

2 .0

2 .5

3 .0

3 .5

4 .0R

atin

g

S S Q - No i se

S S Q - Q u ie t

Very Hard

Hard

OK

Easy

Very Easy

SSQ –Listening in Noise:Pre vs Post - p = 0.0002 *Post vs 3MP - p = 0.397

SSQ –Listening in Quiet:Pre vs Post - p = 0.103Post vs 3MP - p = 0.529

Cameron & Dillon (2011) 30


31

Blinded Randomized Control Study

1. 10 children (aged 6 yrs 0 mths to 9 yrs, 9 mths) diagnosed with LiSN-S as having SPD:

a) 5 x LiSN & Learn (experimental group)b) 5 x Earobics (control group)

2. Questionnaires

a) Participant (LIFE)b) Parent (Fishers)c) Teacher (LIFE)

3. LiSN & Learn or Earobics training – 15 minutes daily x 60 sessions

4. Re-evaluate LiSN-S and questionnaires post-training


LiSN-S Results – Pre vs. Post Training

Earobics (n = 5) Lisn & Learn (n = 5)

32Cameron, Glyde & Dillon (2012)

p = 0.5 to 0.7 p = 0.03 to 0.0008


L iSN & Lea rn Ea rob ics-1 0

-5

0

5

1 0

1 5

2 0

2 5

3 0

3 5

L.I.

F.E

Te

ach

er

- P

ost

-In

terv

en

tion

Ra

ting

Pre -Tra in ing Pos t-Tra in ing4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

L.I.

F.E

. Stu

de

nt -

Sco

re

L iSN & Lea rn Ea rob ics

Pre -Tra in in g Po s t-Tra in in g0 .2

0 .3

0 .4

0 .5

0 .6

0 .7

0 .8

0 .9

1 .0

Fis

he

r's C

he

cklis

t - S

core

L iSN & L e a rn Ea ro b ics

Questionnaires – Post Training Improvements

Teachers

Children

33

Parents

L&L = 22%; Earobics = 9%L&L = 31%; Earobics = 9%

L&L = 16 pts; Earobics = 7 pts;where 0 pts = “no improvement”

p = 0.028

Spatial Processing Disorder:

Prevalence in a clinical population


Australian Hearing’s CAPD Service

• Operating in 42 Australian Hearing centers around Australia since May 2012.

• Diagnosis, assessment and management of specific aspects of CAPD.

• Recruitment targets children experiencing difficulty hearing in background noise.

• Tests are chosen which:

1. Have been shown to be associated with difficulties in real life.

2. Are reliable, repeatable and relatively quick to administer.

3. Lead to remediation that is backed by research evidence.

35


Test structure

LiSN-S

Auditory memory(digits forward and

reverse)

Dichotic digits

Remediate(Memory booster)

Remediate(wireless remote

microphone)

Remediate(L&L)


Age DistributionN=618

37

Passes and Fails

Hearing screening

LiSN - HC

Minimal Sensorineural

Mild Conductive

UnknownLiSN

Memory

Age

DDT

23

666

4

3 636Pass

Z < -1 329

Z ≥ -1 307

SPDFail120

Pass (not SPD) 209

Pass 349

Auditory memory

Fail167

< 7 years76

≥ 7 yrs 273

Pass 173

Dichotic deficit

Fail100

Testing discontinued

19%

26%

20%27%

National CAPD service results: LiSN & Learn effects

LiSN & Learn training: COSI results

N = 34

Effect of Memory Booster training

41

COSI scores for Memory Booster training

Take-home messages

• Children need to hear their teacher easily

• Many deficits in children prevent this

• Many classroom prevent this

• Acoustics can be improved

• Classroom amplification helps everyone

• Spatial Processing Disorder (SPD) is common but can be diagnosed and cured

43


Disclosure

The National Acoustic Laboratories, is an Australian government laboratory

NAL licences the LiSN-S test to Phonak, and is paid a royalty on sales.

• NAL directly sells the LiSN & Learn training package through its web site.

44

Thanks for listening

CAPD.NAL.gov.au - TV news story - science TV show

The support of the Commonwealth Department of Health is greatly appreciated

hearing problems in school – causes and solutions harvey dillon with thanks to: helen glyde sharon...

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