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The co-occurrence of CAPD and Learning Disability

The co-occurrence of CAPD and Learning Disability. Amani Shalaby Prof. of Audio-vestibular Medicine Ain Shams University. Agenda. LD Peripheral hearing. What is ( C ) APD? Difference between hearing and percetion . Practicum Management of APD. Definition Learning disability (LD)

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The co-occurrence of CAPD and Learning Disability

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  1. The co-occurrence of CAPD and Learning Disability AmaniShalaby Prof. of Audio-vestibular Medicine Ain Shams University 14th Educational coference, AUC, 2017

  2. Agenda • LD • Peripheral hearing. • What is ( C ) APD? • Difference between hearing and percetion. • Practicum • Management of APD. 14th Educational coference, AUC, 2017

  3. Definition Learning disability (LD) Is a term that refers to a heterogeneous group of neurobehavioral disorders manifested by significant unexpected specific and persistent difficulties in the acquisition and use of efficient reading (dyslexia), writing (dysgraphia) or mathematical (dyscalculia) abilities despite conventional instruction, intact sense, normal intelligence, proper motivation and adequate socio-cultural opportunity . (Kulkarni, 2006) 14th Educational coference, AUC, 2017

  4. Learning disorders are complex diseases that affect about 2-10 % of the school age population (Margari et al., 2013). All over the world over 10 out every 100 school children are said to suffer from LD (Sakhuja, 2004). 14th Educational coference, AUC, 2017

  5. In school-age children, (C)APD has attracted considerable interest because it may lead to learning difficulties, especially affecting language and literacy, and hence to poor school performance (Rosen et al., 2010). Prevalence of CAPD in children diagnosed with LD is estimated to be as high as 30–50% (King et al., 2002 ; Ramus, 2003; Kamal et al., 2005). 14th Educational coference, AUC, 2017

  6. Objectives • Is there a Link between LD & (C)APD? • What is (C )APD? • Whento suspect the presence of (C)APD? • Howto pick up candidates for (C )APD? • Whatis the implication of (C )APD on child’s life? • Why& When Multi-disciplinary approaches are needed 14th Educational coference, AUC, 2017

  7. Auditory System • Peripheral pathway : Transmission ( We Hear ) • Central pathway : Processing “What we do with what we hear”

  8. What is Central Auditory Processing? How well the ear talks to the brain How well the brain understands what the ear tells it (Musiek,2007) 14th Educational coference, AUC, 2017

  9. Central Auditory Processing “The efficiency and effectiveness by which the CNS utilizes auditory information.” (ASHA, 2005) 14th Educational coference, AUC, 2017

  10. Central Auditory Processing It involves a range of activities from the awareness of the presence of sound to…….. the analysis of linguistic information (Lasky & Katz, 1983) 14th Educational coference, AUC, 2017

  11. Central Auditory Abilities • Sound localization & lateralization • Auditory discrimination with pattern recognition • Auditory temporal processing • Auditory performance with competing acoustic signals • Auditory performance with degraded acoustic signals • Inter-hemispheric transfer of auditory information • Auditory attention & memory (Cognitive-Communicative) • Phonemic awareness (ASHA, 1996 & 2005, AAA, 2010) 14th Educational coference, AUC, 2017

  12. Normal CAP 1-Normal development of speech and language. 2- Good scholastic achievement. 3- Normal achievement within quiet and difficult situations. (Noisy, multi-talkers, rapid rate of speech) 14th Educational coference, AUC, 2017

  13. Nature of the disease CAPD is a deficit in neural processing of auditory stimuli. It is not due to higher order language, cognitive, or related factors. However, it may lead to or be associated with difficulties in higher order language, learning and communication functions. It presents either in isolation or associated with other disorders. 14th Educational coference, AUC, 2017

  14. CAPD can be present due to/ with • Sensory deprivation • Speech & language disorders • Learning disability • Co-morbid with other disorders (ADHD, Dyslexia) 14th Educational coference, AUC, 2017

  15. Impact of (C)APD on Children • Academic problems. • Communication problems. • Social problems. • Emotional problems. • Behavioral problems. 14th Educational coference, AUC, 2017

  16. When to suspect the presence of CAPD in a child • Difficulty in following instructions. • Difficulties in understanding speech in background noise. • Localization problems. • Difficulty hearing over the phone • Difficulty following rapid speech 14th Educational coference, AUC, 2017

  17. When to suspect the presence of CAPD in a child • Difficulty in learning novel speech material • Easily distracted • Poor singing, musical abilities • Inability to detect subtle changes in prosody • Attention and memory problems. • Scholastic underachievement. (AAA, 2010) 14th Educational coference, AUC, 2017

  18. How to pick up candidate for CAPD • Listening • Learning • Language • behavioral 14th Educational coference, AUC, 2017

  19. Listening Symptoms Parents/Teachers • Inconsistent response to soft sounds • Says ”huh” or whatfrequently • Often misunderstands what issaid • Difficulty in listening in presence of noise, multi‐talkers, rapidspeech 14th Educational coference, AUC, 2017

  20. Language Symptoms Parents • Delayed languagedevelopment • Phonologicalerrors • Difficulty with phonics and speech sounddiscrimination • Poor receptive & expressive skills 14th Educational coference, AUC, 2017

  21. Learning Symptoms Parents/Teachers • Poor scholasticachievement • Readingproblems • Writingproblem • Mathematicalproblems • Learns poorly through auditory channels. 14th Educational coference, AUC, 2017

  22. Behavioral • Symptoms • Withdrawal • Aggression • Hyperactivity Parents/Teachers 14th Educational coference, AUC, 2017

  23. Diagnosis is challenging • Heterogeneous group. • One or more ability affected. 14th Educational coference, AUC, 2017

  24. Diagnostic Protocol for ChildrenFlow Chart History taking Basic audiological evaluation Arabic questionnaire Psycho-social evaluation Speech & language evaluation Screening tests 14th Educational coference, AUC, 2017

  25. Regular Requirements for CAPD testing • Adequate age • Average intelligence • Normal peripheral hearing • Adequate language abilities • No neuropsychiatric disorders (AAA, 2010) 14th Educational coference, AUC, 2017

  26. Behavioral Tests • Tests designed to examine how efficiently the CANS operates by “overloading” it • Tests maximize function of CANS & minimizeinfluence of language & cognition • Sensitized tests that use various means of distortion in order to reduce acoustic redundancy(Teatini, 1970) 14th Educational coference, AUC, 2017

  27. Behavioral TestsWhy???? • To detect the presence of CAPD • To identify:- - The affected abilities -To assess the areas of child weakness & strength • Design an appropriate intervention plan 14th Educational coference, AUC, 2017

  28. Behavoiral TestsTest battery approach • More than one test • Tests for different abilities & various levels • Must use both verbal & non verbal stimuli • Evaluate neuromaturation of CANS • Correlated with patient functional difficulties 14th Educational coference, AUC, 2017

  29. Test Selection Criteria • Tests should be: • Valid • Reliable • Sensitive • Specific • Age & culture appropriate 14th Educational coference, AUC, 2017

  30. Test selection Criteria • GoodValidity & Reliability • Validity How well a test measures what it is supposed to measure • Reliability Stability /repeatability of a measure Consistency over time 14th Educational coference, AUC, 2017

  31. Test Selection Criteria • Sensitivity & specificity • Sensitivity Probability of a positive test among patients • Specificity Probability of a negative test among patients • Efficiency sensitivity & specificity 14th Educational coference, AUC, 2017

  32. Test Selection Criteria • Age & culture appropriate Chronological age Language age Native language Social standard 14th Educational coference, AUC, 2017

  33. Behavioral Test Categories • Verbal Nonsense syllable/ Words/digits/ sentences • Non verbal Tones/clicks/ complex waveforms Why???? • Different aspects of auditory processing • Different levels of auditory nervous system 14th Educational coference, AUC, 2017

  34. Psychophysical Test Categories • According to abilities Bottom Up Top Down 14th Educational coference, AUC, 2017

  35. Multi-disciplinary approach • Experienced Audiologist • Speech & language Pathologist • Neuro-psychiatrist • Pediatrician • Teachers & social workers • Parents 14th Educational coference, AUC, 2017

  36. 10 years old boy with learning disability wrote a poem called confusion: When you areconfused You try to hide it Because all the other kids get it & you don’t It is alwaysfrustrating To feel like you arestupid Sometimes u feel like you are in another country Anddon’t speak their language. (ELDA, 2002) 14th Educational coference, AUC, 2017

  37. Management of CAPD 14th Educational coference, AUC, 2017

  38. CANS Complex Redundant 14th Educational coference, AUC, 2017

  39. Challenge (C)APD children are heterogenous Remediation should be tailored according to: Defective Ability(ies) Language Age 14th Educational coference, AUC, 2017

  40. Auditory Neuro-plasticity • It is the modification and reorganization of central auditory system by • Experience • Learning • Rehabilitation Increase stimulation Structural changes functional improvement 14th Educational coference, AUC, 2017

  41. MANAGEMENT OF (C)APD 14th Educational coference, AUC, 2017

  42. Direct Skill Remediation • Multidisciplinary approach is essential • Intervention of CAPD should be: • Early • Comprehensive • Specialized training programs • Different approaches 14th Educational coference, AUC, 2017

  43. Concluding Remark: Management of children with LDs is optimally defined on the basis of the deficits identified; thus, CAPD related deficits ought to be addressed, as the presence of this disorder may compromise a child’s ability to successfully process auditory information in less than ideal situations and may interfere with the learning process. 14th Educational coference, AUC, 2017

  44. Thank You for your Attention AmaniShalaby amani_shalaby@yahoo.com

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