professional education and assessment practices in central … · 2019. 12. 19. · j am acad...

J Am Acad Audiol 9 : 452-465 (1998)

Professional Education and Assessment Practices in Central Auditory Processing Gail D . Chermak* Wendy A. Traynham* J. Anthony Seikel* Frank E. Musiekt

Abstract

A 17-item questionnaire probing professional preparation and current practices in central auditory assessment was mailed to 500 audiologists selected randomly from the member-ship directory of the American Academy of Audiology. Data from 183 respondents, representing a 37 percent response rate, were analyzed . The majority of respondents reported minimal academic and clinical preparation in assessment of the central auditory nervous system . Eighty percent of respondents had not taken any graduate course explicitly dedicated to cen-tral auditory processing . However, 80 percent had taken at least one basic science course in central audition and 83 percent reported having taken at least one graduate course that included some coverage of central auditory processing and/or the central auditory nervous system . A mean of 3 clinical clock hours accrued in this area was reported . Not surprisingly, 78 percent reported a satisfaction rating of <_50 percent relative to the graduate education they received in this area and only 41 percent reported providing central auditory assess-ment . Comparisons with prior surveys show substantial change in the preferred test battery. Most notable is the pivotal role of physiologic measures, with the acoustic reflex and audi-tory brainstem response listed along with the SCAN as the three most frequently used assessment tests/procedures . Overall, the results suggest a need for improvement in pro-fessional preparation in evaluation of central auditory function .

Key Words: Assessment, central auditory processing disorder, professional practices

Abbreviations: ABR = auditory brainstem response, CANS = central auditory nervous system, CAP = central auditory processing, CAPD = central auditory processing disorder, CFY = Clinical Fellowship Year, MMN = mismatch negativity response, SCAN =A Screening Test for Auditory Processing Disorders, SCAN-A = A Test for Auditory Processing Disorders in Adolescents and Adults, SSI = Synthetic Sentence Identification test, SSW = Staggered Spondaic Word test

A

number of reports have identified cur-rent audiologic practices in the United States during the last 20 years (Martin

and Pennington, 1971 ; Burney, 1972 ; Penning-ton and Martin, 1972 ; Martin and Forbis, 1978; Martin and Bides, 1985 ; Oliver, 1987 ; Martin and Gravel, 1989 ; Martin and Morris, 1989; Martin

*Department of Speech and Hearing Science, Wash-ington State University, Pullman, Washington ; tAudiology Department, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire

Reprint requests : Gail D . Chermak, Department of Speech and Hearing Science, Washington State University, Pullman, WA 99164-2420

452

et al, 1994 ; Wiley et al, 1995). Several surveys included items on central auditory testing; how-ever, only one focused on audiometric tests and procedures used by audiologists in assessing central auditory processing (CAP) and the central auditory nervous system (CANS) (Oliver, 1987). Recent advances in our understanding of CANS, as well as technological developments, have substantially changed best practices in central auditory assessment (ASHA, 1996). Therefore, the primary purpose of the present survey was to update and examine in greater detail current central auditory assessment prac-tices in the United States . A second purpose was to ascertain the professional preparation audiologists receive in central auditory assess-

Assessment Practices in CAPD/Chermak et al

ment, following a recent report suggesting that graduate audiology students do not receive ade-quate preparation in this area (Henri, 1994).

Oliver (1987) found that just over half (i .e ., 52%) of the audiologists she surveyed provided central auditory assessment . The Staggered Spondaic Word (SSW) test (Katz, 1962), Wille-ford test battery (i .e ., competing speech, filtered speech, binaural fusion, and rapidly alternating speech) (Willeford, 1977), and speech in noise were the most commonly used central auditory tests with children ; the SSW, auditory brainstem response (ABR), and speech in noise were the most frequently used central auditory tests with adult patients (Oliver, 1987). As part of their larger study of audiologic practices, Martin et al (1994) found an average decrease of 12 percent in the use of CAP tests relative to the Martin and Morris (1989) study, with the performance inten-sity function for PB words (PI-PB) the most commonly used procedure for assessing central auditory processing . Other common tests were the SSW, speech in noise, and the Synthetic Sentence Identification (SSI) test (Jerger et al, 1968).

The American Speech-Language-Hearing Association (ASHA) consensus report (1996) defined central auditory processing disorder (CAPD) and identified a range of behavioral and electrophysiologic tests and procedures available to assess the CANS and its processes. According to the ASHA consensus report, CAPD involves deficits in sound localization and lat-eralization, auditory discrimination, auditory pattern recognition, temporal aspects of audition, and auditory performance with competing or degraded acoustic signals. Following the publi-cation of this report, we might anticipate some changes in audiologists' current practices in this area . Indeed, the test battery has changed sig-nificantly since the early reports of central audi-tory testing with adult subjects began appearing in the literature in the 1950s (Bocca et al, 1954; Calearo and Lazzaroni, 1957 ; Bocca, 1958; Jerger, 1960a, b; Kimura, 1961 ; Katz et al, 1963 ; Calearo and Antonelli, 1968). For example, audiologists now have a battery of tests appropriate for use with pediatric patients (Musiek and Chermak, 1994 ; Chermak, 1996 ; Chermak and Musiek, 1997), and recent data suggest that event-related potentials such as the mismatch negativity response (MMN) and the P300 may provide elec-trophysiologic correlates of the psychoacoustic abilities of auditory discrimination and selective auditory attention (Jirsa and Clontz,1990; Jirsa, 1992; Musiek et al, 1992; Kraus et al, 1993).

METHOD

k A 17-item questionnaire and cover letter explaining the purpose of the study were

mailed to 500 audiologists selected randomly from the membership directory of the American Academy of Audiology. A postage-paid envelope was included . The questionnaire was divided as follows: six items probed assessment practices, including one item soliciting impressions regard-ing limitations of available testp and proce-dures; five items probed graduate course work and clinical training ; one question examined clinical experiences during the Clinical Fel-lowship Year (CFY) ; two items asked to whom referrals were directed for management/treat-ment ; and three items requested demographic information. Consistent with Dillman's Total Design Method for mail surveys (Dillman, 1978), a follow-up postcard was mailed 3 weeks after the initial mailing.

RESULTS

0 f the 500 surveys mailed, 183 were returned, representing a 37 percent

response rate . Data from four surveys were not analyzed : two were incomplete, one respondent was retired, and one respondent was still a stu-dent . Therefore, data from 179 respondents, or 36 percent of the sample, were analyzed . A sum-mary of the most pertinent findings is presented here . A more detailed analysis is found in the Appendix .

Demographic Information

Respondents were queried about their edu-cational background, years in practice, work setting, geographic location, and ASHA mem-bership. According to information in the Amer-ican Academy of Audiology (AAA) membership directory, 90 percent of respondents (N = 161) were educated at the master's level and 10 per-cent (N = 18) at the doctoral level. Respondents reported a mean of 13.3 years in practice, with a minimum of 1 year and a maximum of 38 years. The largest number of respondents, 22 percent (N = 40), practice in the Great Lakes region, followed by 15 percent (N = 27) in the South Atlantic region, 13 percent (N = 23) in the Mid Atlantic region, 11 percent (N = 20) in the Pacific Northwest and Mountain regions, 11 percent (N = 19) in the North Central region, 11 percent (N = 19) in the Southwest states, 9 per-

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Journal of the American Academy of Audiology/Volume 9, Number 6, December 1998

cent (N = 16) in the South Central states, 4 per-cent (N = 8) in the East Central region, and 4 percent (N = 7) in the New England states . The largest percentage of respondents (39%) were employed in private practice, with 29 percent employed in an ENT office and 21 percent employed in hospitals. Ninety-four percent (N = 168) were members of ASHA.

Professional Preparation

Seventy-eight percent of respondents (N = 130) reported a satisfaction rating of <_50 percent relative to the amount of information on evaluation of CAP/CANS presented during their graduate program. Eighty-three percent of respondents (N = 149) reported taking at least one course in graduate school in which CAP was examined . Over half of these respondents (N = 77) reported having taken one such course . In contrast, 80 percent of respondents (N = 144) had not taken any graduate course explicitly dedicated to CAP Eighty percent of respondents (N = 144) reported taking at least one graduate basic science course focused on the CANS, with 51 percent of respondents (N = 91) having taken one such course .

Respondents reported little clinical experi-ence during their graduate program in assess-ing CAP. The mean number of clock hours reported in assessing children, adults, and older adults was 5.5, 2 .4, and 1.0, respectively (over-all mean = 3.0 hours) . Experience during the CFY also was limited, with 6.0, 2.1, and 4.2 mean clock hours accrued in central auditory assessment of children, adults, and older adults, respectively (overall mean = 4.1 hours) .

Assessment Practices

Forty-one percent (N = 74) of respondents assess CAP/CANS, a figure close to the ASHA (1995) omnibus survey finding that 48 percent of audiologists regularly serve individuals with CAPD. Sixty-nine percent (N = 51) of 74 respon-dents reporting that they assess CAP/CANS indicated that they use a test battery approach (questions 10 and 13). Of the 61 respondents rat-ing their satisfaction with their current test battery (question 14), 48 percent (N = 29) rated their satisfaction as <_50 percent.

Chi-square analysis was used to examine whether graduate preparation may have affected current professional decisions to engage in CAP/CANS assessment and satisfaction with the test battery. Categories were collapsed to

permit statistical analysis in cases where cells were small or empty. No significant difference in current involvement in CAP/CANS assess-ment was seen relative to the number of assess-ment courses taken in graduate school generally or specifically dedicated to CAP/CANS assess-ment (X2 = .82, df = 1, p = .45 and X2 = .57, df = 2, p = .66, respectively) . Involvement in CAP/CANS assessment did differ as a function of the number of basic science courses taken in graduate school (X2 = 6.13, df = 2, p < .05) . Sim-ilarly, involvement in CAP/CANS assessment did not differ as a function of the number of clock hours accrued in central auditory assessment during graduate training; however, involvement did differ as a function of the number of hours accrued in central auditory assessment during the CFY with both children (X2 = 10.34, df = 1, p < .05) and adults (X2 = 7.27, df = 1, p < .05) . No significant difference was found in current involvement in CAP/CANS assessment as a function of the distribution of satisfaction rat-ings for information presented at the graduate level (X2 = .98, df = 3, p = .81), nor was number of years in practice a significant factor in one's involvement in central auditory assessment (X2 = 3.44, df = 5, p = .63) .

Notably, respondents' satisfaction with their test batteries differed significantly as a function of the number of graduate courses taken that examined CAP/CANS assessment (X2 = 4.26, df = 1, p < .05) . No significant difference in sat-isfaction with the test battery was seen as a function of the number of courses explicitly ded-icated to CAP/CANS assessment (X2 = 2.8, df = 1, p = .09) or the number of basic science courses taken (X2 = 1 .78, df = 1, p = .18) . Respondents' satisfaction with their test batteries differed as a function of the number of clock hours accrued in central auditory assessment with adults and older adults during graduate training (X2 = 6.88, df=1,p< .05andX2=12.41,df=1.p< .05, respectively) . Satisfaction with the test battery also differed significantly as a function of the number of clock hours accrued in central audi-tory assessment with children, adults, and older adults during the CFY (X2 =10.94, df =1, p < .05; X2 = 14 .12, df = 1, p < .05; and X2 = 16.47, df = 1, p < .05, respectively) .

Assessment of CAP/CANS did not vary sig-nificantly across settings (X2 = 7 .02, df = 9, p = .64) . Respondents reported that they assessed CAP/CANS more frequently in children (35%), less frequently in adults (14%), and least fre-quently in older adults (9%) . Collapsing across small or empty cells, chi-square analysis revealed

454

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Test/scales/procedures

Figure 1 Number and percentage of respondents using the 11 most frequently reported CAP/CANS tests and procedures. Key: AR = acoustic reflex, ABR = auditory brainstem response, SCAN = screening test for auditory processing disorders, SCAN-A = test for auditory pro-cessing disorders in adults and adolescents, FSLP = fil-tered speech (low pass), CS = competing sentences, SSW = Staggered Spondiac Word test, DSI = Dichotic Sentence Identification, SSI-ICM = Synthetic Sentence Identifi-cation with Ipsilateral Competing Message, SSI-CCM = Synthetic Sentence Identification with Contralateral Competing Message, BF = Binaural Fusion.

no significant difference in satisfaction with the test battery as a function of the number of years in practice (X2 = 11.41, df = 8, p = .18) . However, there was a tendency for those in practice for 6 years or longer to assign higher satisfaction rat-ings to their test battery.

The 11 most frequently used CAP/CANS tests and procedures are shown in Figure 1. No significant difference was seen in the most fre-quently used test or procedure as a function of work setting (X2 = 30.95, df = 60, p > .05) ; how-ever, several interesting trends emerged. Phys-iologic measures (acoustic reflex and the ABR) were the two most frequently used procedures across work settings (80% and 60% of respon-dents, respectively) . The SCAN and SCAN-A (Keith, 1986, 1994) were the two most used behavioral tests across settings (37% and 30%, respectively) . Some differences in test use were seen, however, across work settings . The acoustic reflex was the most frequently used procedure in all settings except in schools, where audiolo-gists reported using the SCAN most frequently. The acoustic reflex was nonetheless ranked fourth in frequency of use by audiologists work-ing in schools. The SSW test displaced the SCAN in frequency of use by audiologists employed in ENT clinics and the Veterans Administration, and was ranked as the third most used test by audiologists in the schools.

Similar to the analysis of tests used as a function of work setting, the most frequently used tests and procedures did not differ statis-tically as a function of years in practice


(X2 = 35.31, df = 50, p > .05), although some interesting trends emerged. Respondents in practice up to 5 years reported using the ABR most frequently. Those in practice for 6 years or longer most often used the acoustic reflex, but those in practice for 21+ years used the SCAN as frequently as the acoustic reflex .

All respondents, whether or not they reported CAP/CANS testing in their practices, were asked their impressions regarding possi-ble difficulties with CAP/CANS tests and pro-cedures. Problems with remediation, follow-up, and implementing recommendations were the major concerns, followed by a sense that more research is needed. Respondents also noted a lack of training in central auditory testing.

Referrals for Management

Respondents most frequently (44%, N = 78) referred to the speech-language pathologist fol-lowing diagnosis of CAPD. Diagnosis specifi-cally involving the CANS most frequently resulted in referral to an ENT physician (45%, N = 81), followed by the neurologist (36%, N = 64) ana the neuro-otologist (30%, N = 54).

DISCUSSION

R esults of this survey suggest that university training programs do not provide sufficient

academic and clinical graduate preparation in assessment of the CANS. This finding is espe-cially interesting in the context of a recent report by Sykes et al (1997), who reported that audi-ology faculty identified CAP evaluation as the most frequently offered service provided by on-campus audiology clinics. Perhaps reflecting the basis for the shortcoming in academic and clinical preparation programs identified in this survey is a second finding reported by Sykes et al that audiology faculty ranked evaluation and management of CAPD as the least important of five areas, including hearing aids, tinnitus, cochlear implant, and dizziness. If these rank-ings reflect the priorities of audiology faculty, this attitude likely adversely impacts students' clin-ical experiences in CAP evaluation .

Although the majority of respondents had taken at least one basic science course in CAP and one course that included some discussion of central auditory function, 80 percent of respon-dents had not taken any graduate course explic-itly dedicated to CAP. The latter finding should cause serious concern, given the complexity of the CANS and heterogeneity and impact of


CAPDs for listening, language acquisition and use, and learning (ASHA, 1996 ; Chermak and Musiek, 1997). Perhaps more alarming is the near absence of graduate clinical experience reported by respondents. Audiology students are receiving the least preparation in an area that is among the most complex. These results also document practitioners' dissatisfaction with the graduate education they received in this area and their reticence to engage in central auditory assessment.

Respondents' decision to engage in central auditory assessment seemed influenced more by graduate preparation in the basic science of central auditory function and involvement in central auditory testing during the CFY Sur-prisingly, the decision to engage in central audi-tory testing did not differ as a function of respondents having completed clinically focused central auditory course work or having accrued clinical hours in central auditory testing while in graduate school . In contrast, satisfaction with their test battery depended more on the num-ber of graduate courses taken that examined clin-ical aspects of CAP/CANS rather than the number of basic science graduate courses taken. These findings suggest that respondents thought their basic science course work prepared them for the clinical responsibilities in this area but left them dissatisfied with their clinical tools, unless they had taken specific clinical course work and gained sufficient clinical experience .

Similar to the respondents in the Oliver (1987) and Martin et al (1994) studies, the most frequently reported practice settings were pri-vate practice, ENT office, and hospitals. The number of audiologists in the present survey pro-viding central auditory assessment (41%) is con-sistent with the ASHA (1995) omnibus survey finding that 48 percent of audiologists regularly serve individuals with CAPD. Both percentages fall somewhat below the 52 percent reported earlier by Oliver (1987) . Similarly, Martin et al (1994) report a decrease in the use of CAP tests relative to the Martin and Morris (1989) study.

Importantly, those audiologists providing central auditory assessment are using a test battery that differs substantially from that reported in'prior surveys. Most notable is the emerging pivotal role of physiologic measures, with the acoustic reflex and ABR listed along with the SCAN as the three most frequently used assessment tests/procedures in the pre-sent survey. Reflecting advances in the test bat-tery, the ABR is the only commonly used test reported in previous studies (Oliver, 1987 ; Mar-

tin et al, 1994) that maintained a high frequency of use by audiologists surveyed here . The SCAN has replaced other behavioral tests reported as frequently used in these prior studies (e .g ., SSW, Willeford tests, speech in noise tests, PI-PB function, and SSI).

Although efficiency data are limited, the acoustic reflex and ABR appear to be among the more sensitive and specific measures of cen-tral auditory function of the low brain stem (Hall, 1985 ; Musiek et al, 1996). The SCAN may not be an efficient measure of CAPD as it is sensitive to a wide range of deficits (e .g ., atten-tion deficits, language deficits, learning dis-abilities) associated with but not necessarily true disorders of CAP (Stack, 1992). Similarly, low-pass filtered speech, identified in this sur-vey as the fifth most frequently used CAP test, has been shown to have poor efficiency (Cher-mak and Musiek, 1997). Absent from the most frequently used central auditory tests and pro-cedures are measures of temporal processing and specific binaural integration measures with documented efficiency (e .g ., duration patterns, frequency patterns, dichotic digits) (Musiek, 1983 ; Musiek et al, 1990; Chermak and Musiek, 1997 ; Hurley and Musiek, 1997). Although the ABR and acoustic reflex provide efficient mea-sures of brainstem function, they do not assess the high brainstem, cortical, and subcortical auditory areas. Given the low incidence of brain-stem lesions and the limited scope of ABR and acoustic reflex procedures, these results sug-gest that the ABR and acoustic reflex are being used inappropriately.

The increased use of electrophysiologic pro-cedures by those who entered professional prac-tice more recently suggests that graduate preparation is focusing on site-of-lesion testing. This finding may suggest also that the faculty responsible for educating master's level audiol-ogists are not adequately preparing them in the area of CAP Heartening, however, is the tendency for those in practice for longer periods of time to ascribe higher satisfaction ratings to their test battery, perhaps suggesting that despite short-comings in graduate education in this area, pro-fessionals are developing their skills and competencies through continuing education.

CONCLUSIONS

R esults of this survey suggest a need for uni-versity training programs to examine the quality of graduate academic and clinical prepa-ration in the assessment of the CANS and CAP

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jwa~o it .

Notwithstanding some significant changes and some positive developments in the composition of the central auditory test battery since the Martin et al (1994) survey, practitioners are not employing measures that have documented effi-ciency. The significant increases in course work and clinical practicum proposed in the new ASHA certification standards for audiology (ASHA, 1997) should provide opportunities for university programs to address the educational and postgraduate clinical fellowship shortcom-ings identified in this study.

Acknowledgment. Portions of this paper were pre-sented at the Annual Convention of the American Speech-Language-Hearing Association, Boston, MA, November

21, 1997 .

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American Speech-Language-Hearing Association: Task Force on Central Auditory Processing Consensus Development. (1996) . Central auditory processing : cur-rent status of research and implications for clinical practice . Am JAudiol 5(2):41-54 .

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Calearo C, Lazzaroni A. (1957). Speech intelligibility in relation to the speech of the message . Laryngoscope 67 :410-419 .

Chermak GD. (1996) . Central testing. In : Gerber SE, ed. The Handbook of Pediatric Audiology Washington, DC : Gallaudet University Press, 206-253.

Chermak GD, Musiek FE . (1997) . Central Auditory Processing Disorders: New Perspectives . San Diego, CA: Singular Publishing Group.

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Hall III JW (1985) . The acoustic reflex in central audi-tory dysfunction. In : Pinheiro ML, Musiek FE, eds.


Assessment of Central Auditory Dysfunction: Foundations and Clinical Correlates Baltimore: Williams and Wilkins, 103-130.

Henri BP. (1994) . Graduate student preparation: tomor-row's challenge. ASHA 36:43-46 .

Hurley RM, Musiek FE . (1997) . Effectiveness of three central auditory processing (CAP) tests in identifying cerebral lesions. J Am Acad Audiol 8:257-262 .

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Jerger J. (1960b). Observations on auditory behavior in lesions of the central auditory pathways . Arch Otolaryngol 71:797-806 .

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Jirsa RE, Clontz KB . (1990). Long latency auditory event-related potentials from children with auditory processing disorders. Ear Hear 11:222-232.

Katz J. (1962). The use of staggered spondaic words for assessing the integrity of the central auditory nervous system . J Auditory Res 2:327-337 .

Katz 3, Basil RA, Smith JM . (1963) . A staggered spondaic word test for detecting central auditory lesions. Ann Otol Rhinol Laryngol 72:906-917 .

Keith RW (1986) . SCAN. A Screening Test for Auditory Processing Disorders. San Antonio, TX : Psychological Corporation.

Keith RW (1994). SCAN-A: A Test for Auditory Processing Disorders in Adolescents and Adults . San Antonio, TX : Psychological Coporation .

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Q2 . In which type of setting(s) are you employed?*

University 30 17 School 22 12 Private practice 69 39 Ear, nose, and throat 52 29 Hospital 37 21 Government 8 5 Veterans administration 10 6 Manufacturer 2 1 Clinic 28 16 Other 13 7

Oliver SK . (1987) . Current Trends in Central Auditory Processing Testing. Paper presented at the annual meet-ing of the California Speech-Language-Hearing Association, Los Angeles, CA .

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APPENDIX

Survey questions, number, and percentage (in parenthesis) of responses. Note that rounding errors result in percentage totals less than or greater than 100 percent.

Q1 . How many years have you been practicing as a professional audiologist?

Years N

1-5 38 21 6-10 37 21 11-15 36 20 16-20 33 18 21-25 23 13 26-30 6 3 31-35 4 2 36-40 2 1 Mean : 13 .32 years Range : 0-38 years

*Respondents selected all settings that applied . Percentages are based on the sample of 179 respondents.

Q3. Are you a member of the American Speech-Language-Hearing Association (ASHA)?

N

Yes 168 94 No 11 6

Q4. How much course work did you have in graduate school in which central auditory pro-cessing (CAP) and/or central auditory nervous system (CANS) function was examined?

Number of Courses N

0 30 17 1 77 43 2 48 27 3 15 8 4 7 4 6 2 1

Q5 . How many courses did you have that were explicitly dedicated to CAP/CANS?

Number of Courses N

0 44 80 1 21 12 2 13 8 3 0 0 4 1 0

Q6 . How much basic science course work in structure and function of the CANS did you have in graduate school?

Number of Courses N

0 35 20 1 91 51 2 43 24 3 7 4 4 1 1 5 2 1

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Q7. How would you rate the amount of infor-mation regarding evaluation of CAP/CANS pre-sented to you during your graduate education? (100% very satisfied to 0% dissatisfied)?

Satisfaction (%) N

0-10 59 35 11-20 22 13 21-30 16 10 31-40 12 7 41-50 21 13 51-60 0 0 61-70 4 2 71-80 13 8 81-90 10 6 91-100 11 7 Mean 35.22 Range 0-100 No response 11 6

Q8. How many clinical clock hours did you accrue in CAP/CANS evaluation during gradu-ate work?

Children

Hours N

0-5 102 72 6-10 19 13 11-15 1 1 16-20 9 6 21-25 2 1 26-30 2 1 31-40 1 1 41-50 3 2 51-60 1 1 61-70 0 0 71-80 1 1 81-90 0 0 91-100 1 1 Mean 5.46 Range 0-100 No response 37 21

Adults

Hours N

0-5 121 85 6-10 11 8 11-15 4 3 16-20 2 1 21-25 1 1 26-30 1 1 31-40 0 0 41-50 1 1 51-60 1 1 61-70 0 0 71-80 0 0 81-90 0 0 91-100 0 0 Mean 2.39 Range 0-60 No response 37 21

OlderAdults

Hours N

0-5 129 91 6-10 8 6 11-15 2 1 16-20 1 1 41-50 1 1 Mean 1 .01 Range 0-50 No response 38 21

Q9. How many clinical hours did you accrue in CAP/CANS evaluation during your clinical fel-lowship year?

Children

Hours N %

0-5 106 77 6-10 11 8 11-15 1 1 16-20 5 4 21-25 3 2 26-30 0 0 31-40 3 2 41-50 4 3 51-6Q 1 1 61-70 1 1 91-100 2 1 >100 1 1 Mean 6.01 Range 0-100 No response 41 23

Adults

Hours N

0-5 125 91 6-10 4 3 11-15 2 1 16-20 4 3 41-50 1 1 51-60 1 1 91-100 1 1 Mean 2.12 Range 0-100 No response 41 23

OlderAdults

Hours N %

0-5 132 74 6-10 2 1 11-15 1 1 31-40 1 1 51-60 1 1 >100 1 1 Mean 4.19 Range 0-600 No response 41 23

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Q10. Do you currently use tests that assess CAP/CANS function? If yes, go to Q.11; if no, go to Q.15.

Q12 . Please identify the tests/scales/procedures that you use in your professional setting. (0 = never, 1 = least, 6 = most used)

Yes No

N

74 105

41 59

Rating

Acoustic Reflex

N

0 1

4 5

Q11. In which proportion of your caseload do you 2 1 1

1 1

evaluate CAP/CANS? 3 9 12 4 5 7

Children 5 11 15 Proportion N 6 43 58

0-10 30 46 Auditory Brainstem Response 11-20 6 9 Rating N 21-30 2 3 31-40 2 3 41-50 2 3 0 16 22

51-60 1 2 1 2 3 71-80 5 8 2 5 7

81-90 8 12 3 7 9

91-100 9 14 4 14 19

Mean 35.04 5 9 12 Range 0-100 6 21 28 No response 114 64

Auditory Continuous Performance Test (ACPT) Adults Rating N

Proportion N 0 60 81

0-10 44 68 1 4 5 11-20 8 12 2 2 3 21-30 2 3 3 3 4 31-40 1 2 4 1 1 41-50 3 5 5 3 4 51-60 1 2 6 1 1 61-70 2 3 71-80 2 3 Binaural Fusion 81-90 2 3 91-100 0 0 Rating N Mean 14.43 Range 0-90 0 47 64 No response 114 64 1 4 5

2 3 4

OlderAdult 3 2 3 4 7 9

Proportion N 5 4 5 6 7 9

0-10 54 83 11-20 0 0 21-30 4 6 Children's Auditory Processing

31 40 Performance Scale (CHAPPS) - 0 0 41-50 1 2 Rating N 51-60 3 5 61-70 0 0 0 60 81 71-80 1 2 1 3 4 81-90 0 0 2 2 3 91-100 2 3 3 3 4 Mean 9.32 4 2 3 Range 0-90 5 1 1 No response 114 64 6 3 4

460

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Competing Environmental Sounds Dichotic Sentence Identification Rating N % Rating N

0 55 74 0 45 61 1 3 4 1 1 1 2 1 1 2 3 4 3 4 5 3 4 5 4 4 5 4 5 7 5 3 4 5 8 11 6 4 5 6 8 11

Competing Sentences Duration (Tone) Patterns

Rating N Rating N

0 39 53 0 62 84 1 1 1

1 2 3 2 0 0 2 1 1 3 7 9 3 2 3 4 10 14 4 2 3

5 8 11 5 1 1 6 9 12 6 4 5

Compressed Speech with Reverberation Filtered Speech (Low Pass)

Rating N % Rating N %

0 65 88 0 1

40 54

1 2

2 1

3 1 2

1 2

1 3

3 2 3 3 3 4

4 1 1 4 6 8

5 2 3 5 9 12

6 1 1 6 13 18

Filtered Speech (High Pass) Dichotic Digits

Rating N Rating N %

0 52 70 0 1

51 69

1 5 7 2 2 4

3 5

2 3 4 3 2 3 3 4

4 5 4 4 5

5 3 2

4 3

5 7 9

6 5 7 6 4 5

Fisher's Checklist Dichotic Chords

Rating N Rating N

0 70 95 0 56 76 1 2 3 1 2 3 2 0 0 2 0 0 3 2 3 3 5 7 4 0 0 4 2 3 5 0 0 5 2 3 6 0 0 6 7 9

Dichotic CVs Frequency (Pitch) Patterns Rating N % Rating N

0 58 78 0 53 72 1 2 3 1 3 4 2 2 3 2 2 3 3 2 3 3 2 3 4 5 7 4 3 4 5 3 4 5 4 5 6 2 3 6 7 9

461


G-F-W Test of Auditory Discrimination Phonemic Synthesis Rating N % Rating N

0 57 77 0 60 81 1 6 8 1 1 1 2 2 3 2 1 1 3 3 4 3 1 1 4 3 4 4 3 4 5 2 3 5 2 3 6 1 1 6 6 8

Interaural Timing Tasks Psychoacoustic Pattern Discrimination Test Rating N Rating N

0 69 93 0 69 93 1 1 1 1 3 4 2 1 1 2 1 1 3 2 3 3 1 1 4 1 1 4 0 0 5 0 0 5 0 0 6 0 0 6 0 0

Masking Level Differences (Tones) P300 Rating N % Rating N

0 65 88 0 59 80 1 1 1 1 5 7 2 4 5 2 1 1 3 2 3 3 4 5 4 2 3 4 3 4 5 0 0 5 1 1 6 0 0 6 1 1

Masking Level Differences (Spondees) Rapidly Alternating Speech Perception (RASP) Rating N % Rating N %

0 66 89 0 56 76 1 3 4 1 2 3 2 1 1 2 0 0 3 3 4 3 3 4 4 0 0 4 3 4 5 0 0 5 5 7 6 1 1 6 5 7

Middle Latency Response Rush Hughes Difference Score Rating N % Rating N %

0 55 74 0 69 93 1 7 9 1 3 4 2 1 1 2 2 3 3 8 11 3 0 0 4 2 3 4 0 0 5 1 1 5 0 0 6 0 0 6 0 0

Pediatric Speech Intelligibility Test (PSI) Screening Test of Auditory Processing Disorders (SCAN) Rating N % Rating N

0 54 73 0 27 36 1 3 4 1 2 3 2 2 3 2 1 1 3 4 5 3 7 9 4 7 9 4 3 4 5 3 4 5 4 5 6 1 1 6 30 41

462


Test for Auditory Processing Disorders Synthetic Sentence Identification with Ipsilateral in Adolescents and Adults (Scan-A) Competing Message (SSI-ICM)

Rating N % Rating N

0 37 50 0 46 62 1 2 3 1 3 4 2 0 0 2 3 4 3 5 7 3 3 4 4 1 1 4 8 11

5 8 11 5 3 4 6 21 28 6 8 11

Selective Auditory Attention Test Tallal's Test

Rating N Rating N

0 51 69 0 1

68 1

92 1

1 4 5 2 0 0 2 1 1 3 3 4 3 5 7 4 1 1 4 5 7 5 0 0 5 2 3 6 1 1 6 6 8

Test forAuditory Perceptual Skills Self-Assessment Scale

Rating N % Rating N

0 59 80 0 67 91 1 2 3 1 0 0 2 5 7 2 1 1 3 2 3 3 3 4 4 1 1 4 1 1 5 2 3 5 0 0 6 3 4 6 2 3 Time Compressed Speech

Speech Perception in Noise (SPIN) Test Rating N %

Rating N 0 65 88

0 48 65 1 3 4

1 5 7 2 2 3

2 3 4 3 2 3

3 4 5 4 0 0

4 7 9 5 1 1

5 2 3 6 1 1

6 5 7 Wichita Auditory Fusion Test

Staggered Spondaic Word (SSW) Test Rating N °l°

Rating N °l° 0 71 96 1 3 4

0 37 50 2 0 0 1 3 4 3 0 0 2 3 4 4 0 0 3 4 5 5 0 0 4 6 8 6 0 0 5 3 4 Other* 6 18 24

Rating N Synthetic Sentence Identification with Contralateral

Competing Message (SSI-CCM) 0 68 92 Rating N % 1 0 0

2 0 0 0 47 64 3 2 3

1 2 3 4 1 1 2 4 5 5 1 1 3 3 4 6 2 3 4 9 12 *Lindamood Auditory Conceptualization Test, ENG, 5 2 3 Auditory Fusion Test-Revised, speech-in-noise/competition, PI- 6 7 9 PB rollover, otoacoustic emissions .

463


Q13 . Do you use a test battery approach when evaluating CAP/CANS?

N

Yes 51 69 No 23 31

Q14. How satisfied are you with the test battery you are using to evaluate CAP/CANS? (100% very satisfied to 0% not satisfied at all)

Satisfaction (%) N %*

0-25 14 23 26-50 15 25 51-75 11 18 76-100 21 34 Mean 46.74 Range 0-95 No response 13 18

*Percentage of respondents who reported assessing CAP/CANS (Q .10) .

Q15 . Designate your impressions regarding possible difficulties with some CAP/CANS tests/procedures . (0 = not applicable, 1 = no problem, 6 = major concern)

Poor Test Construction

Rating N %

0 57 32 1 11 6 2 17 9 3 49 27 4 24 13 5 9 5 6 12 7

Difficulty Interpreting Tests

Rating N %

0 41 23 1 12 7 2 21 12 3 24 13 4 28 16 5 25 14 6 28 16

Problems with Remediation/Follow-up/Recommendations

Rating N %

0 35 20 1 2 1 2 10 6 3 13 7 4 23 13 5 39 22 6 57 32

464

Too Time Consuming

Rating N

0 44 25 1 9 5 2 11 6 3 38 21 4 25 14 5 30 17 6 22 12

More Research Is Necessary

Rating N %

0 45 25 1 2 1 2 8 4

3 23 13 4 29 16 5 30 17 6 42 23

Effects of Peripheral Hearing Loss

Rating N

0 47 26 1 7 4

2 14 8

3 33 18 4

27 15

5 23 13

6 28 16

Lack of Equipment

Rating N %

0 57 32 1 25 14 2 15 8 3 22 12 4 11 6 5 20 11 6 29 16

Lack of Training

Rating N %

0 42 23 1 11 6 2 10 6 3 22 12

4 17 9

5 27 15 6 50 28


Rating

Difficulty Gaining Reimb ursement

N % Q16. To whom do you refer for treatment/rehabilitation if you diagnose CAP disorders?*

0 74 41 N

1 10 6 2 9 5 ENT 32 9

3 15 8 Family physician 12 3

4 15 8 Other audiologist 61 17

5 30 17 Pediatrician 15 4

6 26 15 School psychologist 30 8 Self 21 6 Special education teacher 40 11

Other* Speech-language pathologist 78 22 Teacher 38 11

Rating N % Othert 33 9

0 171 96 *Respondents selected all professionals to whom they refer.

1 0 0 tLearning disabilities teacher, reading specialist,

2 0 0 occupational therapist, developmental specialist,

3 0 0 neuropsychologist, vision specialist .

4 0 0 5 1 1 Q17. To whom do you refer for treatment/ 6 7 4 rehabilitation if you diagnose CANS problems?*

*Confounding variables of language, speech, psychological state ; failure to address basic science issues, lack of published norms; lack of developmentally appropriate tests for children, lack of physicians interest in this type of testing ; does not change treatment .

N

ENT 81 29 Family physician 28 10 Neurologist 64 23 Neuro-otologist 54 19 Pediatrician 31 11 Surgeon 1 0 Othert 18 6

*Respondents selected all professionals to whom they refer. tPsychologist, other audiologist, speech-language

pathologist, special educator .

professional education and assessment practices in central … · 2019. 12. 19. · j am acad...

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