multidisciplinary diagnosis of (c)apd: panel discussion teri james bellis, ph.d. the university of...
TRANSCRIPT
Case #1:
• Age 4 years, 1 month • History of chronic otitis media
beginning in first year of life; PE tubes precluded further OAE testing
• Play skills appropriate• Fine and gross motor skills
appropriate
• No apparent developing phonological system in place
• Could combine 2-3 ASL signs with verbalizations
• Verbalizations seemed to preserve prosodic qualities of speech
• Had had SLP intervention for 2 ½ years
• Imitation and/or approximation of speech sounds when looking at the clinician
• Significantly better imitation/ use of motor actions, including sign
• Behavior very similar to a child with a significant hearing impairment
• Normal peripheral hearing sensitivity confirmed through conditioned play audiometry/OAEs
Recommendation:
• Electrophysiologic evaluation to rule out auditory neuropathy or similar disorder
• ABR normal bilaterally
C4; R & L Ears
C3; R & L Ears
Pre-training MLRAge: 4 years, 2 months
Na
Pa
Normal Cortical Potentials in Children
From: Sharma, Kraus, McGee, & Nicol (1997). Electroenceph. Clin. Neurophys., 104, 540-545.
Pre-training Corticals
(C3)
(C4)
P1
N1b
Conclusions and Recommendations:
• Results suggested abnormal neurophysiologic representation of acoustic stimuli, consistent with (C)APD
• Recommended intensive computer-based auditory training, 45 minutes per day, 5 days per week throughout 8-week summer session
• Auditory training to focus on both perception and production of auditory stimuli
• Earobics training daily; Target = verbal imitation of stimuli, mouse controlled by clinician
• Goals:– Improve phonological
awareness (discrimination, synthesis, etc.) and phoneme production/ imitation skills simultaneously
Immediate Post-Training (4 years, 4 ½ months)
• Spontaneous eye contact during conversation 100% of the time
• Turned to voice 100% of the time
• Imitation of vowels, CV syllables with 100% accuracy
• Approximation of CVC words with some final phoneme deletions or appropriate inflection, but incorrect phonemes
At 4 years, 6 months
• Significant improvement in auditory comprehension
• 100% imitation of sounds, words, gestures
• Dozens of new words, including verbs, nouns, adjectives
• Semantic relations with 90% accuracy
• Plural /s/ and progressive /ing/ with 80% accuracy
• Use of “in” and “on” with 100% accuracy
• Imitation of multi-word sentences
Post-training MLR4 years, 9 months
Ipsilateral (C4/A2)
Contralateral (C3/A2)
Pa
Pa
Na
Na
C4; R & L Ears
C3; R & L EarsNa
Pa
Na
Pa
Post-training Corticals
(C4)
(C3)
P1
N1b
N1b
P1N1a
N1a
By 4 years, 10 months
• Spontaneous use of multi-word sentences with appropriate syntax
• Kahn Phonological Analysis:
– Phonological development at approximately 3.5 years of age
– Errors developmental in nature
Conclusions
• Intensive auditory training combining perception with production resulted in significant, rapid improvement in auditory comprehension and expressive skills.
• Behavioral observations were accompanied by a concomitant improvement in the neurophysiologic representation of acoustic stimuli.
Case #2
• P300 reduced, other electrophysiology normal
• Auditory fusion, speech and nonspeech discrimination probably normal, though some inconsistency in performance
• Continuous performance (auditory and visual) – high error rate
• Impression: Higher-order, likely attention-based disorder