The Relationship between Types of Attention and Auditory Processing Skills: Reconsidering Auditory Processing Disorder Diagnosis

Abstract

Measures of attention have been found to correlate with specific auditory processing tests in samples of children suspected of Auditory Processing Disorder (APD), but these relationships have not been adequately investigated. Despite evidence linking auditory attention and deficits/symptoms of APD, measures of attention are not routinely used in APD diagnostic protocols. The aim of the study was to examine the relationship between auditory and visual attention tests and auditory processing tests in children with APD and to assess whether a proposed diagnostic protocol for APD, including measures of attention, could provide useful information for APD management. A pilot study including 27 children, aged 7–11 years, referred for APD assessment was conducted. The validated test of everyday attention for children, with visual and auditory attention tasks, the listening in spatialized noise sentences test, the children's communication checklist questionnaire and tests from a standard APD diagnostic test battery were administered. Pearson's partial correlation analysis examining the relationship between these tests and Cochrane's Q test analysis comparing proportions of diagnosis under each proposed battery were conducted. Divided auditory and divided auditory-visual attention strongly correlated with the dichotic digits test, r = 0.68, p < 0.05, and r = 0.76, p = 0.01, respectively, in a sample of 20 children with APD diagnosis. The standard APD battery identified a larger proportion of participants as having APD, than an attention battery identified as having Attention Deficits (ADs). The proposed APD battery excluding AD cases did not have a significantly different diagnosis proportion than the standard APD battery. Finally, the newly proposed diagnostic battery, identifying an inattentive subtype of APD, identified five children who would have otherwise been considered not having ADs. The findings show that a subgroup of children with APD demonstrates underlying sustained and divided attention deficits. Attention deficits in children with APD appear to be centred around the auditory modality but further examination of types of attention in both modalities is required. Revising diagnostic criteria to incorporate attention tests and the inattentive type of APD in the test battery, provides additional useful data to clinicians to ensure careful interpretation of APD assessments.

Are “Dichotic” Deficits Uniquely Dichotic? Investigating Dichotic Performance with the Dichotic Digits Difference Test (DDdT) in a Large Clinical Population of Children Referred for an Auditory Processing Assessment

“…After accounting for the influence of short-term memory, simultaneous segregation (diotic performance), and RME, only 16% of the variation in DDdT FR total z-scores can be attributed to the ability to separate different signals at each ear (dichotic processing). Although the clinical data analyzed for this study did not include a test of attention, this factor was found to be associated with variation in dichotic scores in Cameron et al (2016b) and in Stavrinos et al (2018), and cannot be ruled out as an additional variable contributing to dichotic test performance.…”

“…As detailed in the introduction to Cameron et al (2016a), a number of recent studies have not only reported significant correlations between dichotic performance and cognitive ability but also cast doubt on the interpretation of uncharacteristic right-ear advantage (REA) scores as impaired conduction properties of specific auditory pathways. Instead, it is suggested results can be explained in terms of dynamic processes, including those in which individuals deliberately direct their attention in different ways (Westerhausen and Hugdahl, 2008;Hiscock and Kinsbourne, 2011;Cameron et al, 2016a,b;Stavrinos et al, 2018). Because of the wide use of dichotic tests around the world and the ongoing questions raised in respect to efficacy, the Dichotic Digits difference Test (DDdT; Cameron et al, 2013) was developed to investigate the relationship between dichotic processing and cognitive abilities via the use of differential test scores.…”

Absence of Rhythm Benefit on Speech in Noise Recognition in Children Diagnosed With Auditory Processing Disorder

“…In both PPS and DPS, working memory is loaded with sensory information, i.e., pitch and duration respectively, rather than verbal as in the case of Digit Span, and this kind of information is not processed in the same way in working memory (Wilsch and Obleser, 2016). Furtherly, sensory, rather than verbal processing correlating with impairments in APD children (here deficit in rhythm effects), fits better with the view that APD concerns mainly impairments in lower levels of auditory perception and less with cognition (American Speech-Language-Hearing Association [ASHA], 2005; American Academy of Audiology [AAA], 2010;Stavrinos et al, 2018;Sidiras et al, 2019).…”

“…Particularly, the core interest of this study is how these effects differ in APD children compared to typically developing ones, and whether they correlate with auditory processing as measured in everyday clinic practice and cognition. In particular, we tested auditory working memory and auditory attention, as these processes have been linked to auditory processing (Weihing et al, 2014;Iliadou et al, 2018;Stavrinos et al, 2018). As the purpose of this study is not to investigate the relation of cognition in general and APD, we limited assessment of cognition to these specific measures.…”

Behavioral assessment of auditory processing deficits in schizophrenia: Literature review and suggestions for future research

“…Cameron, Glyde, Dillon and Whitfield () reported significant correlations between dichotic listening performance and cognitive measures of attention and memory in children with dichotic or memory deficits. Furthermore, new research showed that APD diagnosed individuals may demonstrate attention deficits focused on the auditory modality and limited to a subgroup (Stavrinos, Iliadou, Edwards, Sirimanna & Bamiou, ). From a management point of view, it is well founded that untreated auditory processing deficits have a great negative impact on everyday lives of children (Bamiou, Musiek & Luxon, ) and adults (Atcherson, Nagaraj, Kennett & Levisee, ).…”