Koifman, Shiran; (2022) Improving the understanding and diagnosis of Auditory Processing Disorder (APD) in Children. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Developmental APD remains poorly characterised with no ‘gold-standard’ diagnostic tools or clear intervention plans. The thesis’ objectives were to study specific higher-level cognitive auditory processing aspects recently associated with developmental APD, and to develop new clinically applicable diagnostic tests that may be used to assess APD. Objectives were addressed in a series of experiments using two paradigms measuring speech perception in a wide range of speech and nonspeech distractors: (1) Switching task (ST): which is the main focus of the thesis, is a novel paradigm that is based on the ability to switch attention and integrate short-term auditory information of interrupted target and distractor signals alternated between the ears in a dichotic configuration, with only one stimulus present in each ear at any given time, (2) LiSNS-UK: an independent UK version of the established Listening in Spatialised Noise-Sentences type task (LiSN-S; Cameron & Dillon, 2007a) which is based on spatial release from masking through symmetrically-placed interfering maskers. Testing included young normal hearing adults and two groups of children aged 7 to 13 years, one group diagnosed with APD, and the other typically developing controls (TD). To ensure high accuracy and reproducibility of the task’s measure, intelligibility of the speech material was first matched in a norming study across children. Two additional adult studies investigated potentially critical factors that influence ST performance, examining the effect of distractor types (speech vs. nonspeech), the extent to which listeners obtained information from both ears as opposed to attending one ear only (binaural advantage), and the influence of speech material structure and complexity on performance. Outcomes served as foundations for the final study comparing performance of APD and TD children. Additional measures of potentially relevant skills such as high-frequency audiometric thresholds, attention, and language skills were included and correlations with performance in the auditory tasks were examined. Group comparison of age-corrected scores revealed poorer performance in the APD group, especially for more challenging conditions with speech distractors (ST) or when localisation cues were missing (LiSNS-UK, collocated target-maskers configuration). The results correlated with several measures, e.g., language and communication skills. Nonetheless, as seen in other studies with a clinical population, heterogeneity in the APD group and the small sample-size made general conclusions difficult. The newly developed tasks seem to have real clinical potential, separating reasonably well between children with and without APD. Norm values for the LiSNS-UK were established and the task can be readily used, whereas further evaluation and validation studies are yet needed to determine the sensitivity of the switching task.

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