Trials in children with chronic kidney disease do not consistently report outcomes that are critically important to patients and caregivers. This can diminish the relevance and reliability of evidence for decision making, limiting the implementation of results into practice and policy. As part of the Standardized Outcomes in Nephrology-Children and Adolescents (SONG-Kids) initiative, we convened 2 consensus workshops in San Diego, California (7 patients, 24 caregivers, 43 health professionals) and Melbourne, Australia (7 patients, 23 caregivers, 49 health professionals). This report summarizes the discussions on the identification and implementation of the SONG-Kids core outcomes set. Four themes were identified; survival and life participation are common high priority goals, capturing the whole child and family, ensuring broad relevance across the patient journey, and requiring feasible and valid measures. Stakeholders supported the inclusion of mortality, infection, life participation, and kidney function as the core outcomes domains for children with chronic kidney disease.
WAI measurements for some middle-ear conditions were consistent with patterns and profiles previously reported in the literature. WAI profiles for other middle-ear conditions, which had not been previously reported in the literature, were presented. Relationships between WAI data and results of standard audiometric tests were generally consistent with expectations. However, in some cases, WAI measurements were suggestive of middle-ear dysfunction despite normal 226-Hz admittance tympanometric findings.
Purpose
A normative study using the Multiple Auditory Processing Assessment–2 (MAPA-2; Schow et al., 2018) was recently completed. With access to these data, the authors extend that work and support a definite construct for auditory processing disorder (APD). The goal here is to examine MAPA-2 reliability and validity (construct, content, and concurrent). Evidence for the APD construct is further buttressed by measures of sensitivity and specificity. Results of MAPA-2 testing on children diagnosed with learning disability (LD), attention-deficit/hyperactivity disorder (ADHD), and specific language impairment (SLI) are included.
Method
Normative data (previously published as the MAPA-2) allowing derivation of these findings included a representative sample of 748 children (53% girls) ages 7–14 years tested by 54 speech-language pathologists and audiologists in 27 U.S. states. The authors examined diagnostic accuracy based on the American Speech-Language-Hearing Association (2005) criteria (index test) for confirmed cases of APD. The index was also used to identify listening problems for three other diagnostic categories (LD, ADHD, and SLI). Validated questionnaire responses from parents and school personnel allowed incorporation of functional measures widely supported in APD diagnosis but unavailable with other normative and sensitivity/specificity studies.
Results
Reliability and validity were both satisfactory, and diagnostic accuracy for an APD group of 18 (28% female) compared to the remaining typical group of 625 yielded 89% sensitivity and 82% specificity. The remaining three groups (LD, ADHD, and SLI), where comorbidity was expected to be about 50%, had APD-type listening problems with a prevalence ranging from 52% to 65%.
Conclusions
Current results provide important evidence for the construct of APD. The MAPA-2 can be administered by an audiologist or speech-language pathologist. A similar diagnostic protocol in Australia yielded positive therapeutic gains. Further study is encouraged to determine if the present positive findings will be found in future research.
Self-assessment of hearing is being used for screening, diagnostic, and rehabilitative audiology. Hearing handicap/disability measures were derived on a large number of patients who were classified based on pure tone findings into Pure Tone Groups (PTGs). A systematic relationship was found between handicap/disability as measured with Self-Assessment of Communication (SAC) and PTG. Handicap/disability ratings were also found to be systematically related to use of hearing aids.
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