Moore David R, Sieswerda Stephanie L, Grainger Maureen M, Bowling Alexandra, Smith Nicholette, Perdew Audrey, Eichert Susan, Alston Sandra, Hilbert Lisa W, Summers Lynn, Lin Li, Hunter Lisa L
Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Otolaryngology, University of Cincinnati College of Medicine, Cincinnati, OH.
J Am Acad Audiol. 2018 May;29(5):364-377. doi: 10.3766/jaaa.16130.
Children referred to audiology services with otherwise unexplained academic, listening, attention, language, or other difficulties are often found to be audiometrically normal. Some of these children receive further evaluation for auditory processing disorder (APD), a controversial construct that assumes neural processing problems within the central auditory nervous system. This study focuses on the evaluation of APD and how it relates to diagnosis in one large pediatric audiology facility.
To analyze electronic records of children receiving a central auditory processing evaluation (CAPE) at Cincinnati Children's Hospital, with a broad goal of understanding current practice in APD diagnosis and the test information which impacts that practice.
A descriptive, cross-sectional analysis of APD test outcomes in relation to final audiologist diagnosis for 1,113 children aged 5-19 yr receiving a CAPE between 2009 and 2014.
Children had a generally high level of performance on the tests used, resulting in marked ceiling effects on about half the tests. Audiologists developed the diagnostic category "Weakness" because of the large number of referred children who clearly had problems, but who did not fulfill the AAA/ASHA criteria for diagnosis of a "Disorder." A "right-ear advantage" was found in all tests for which each ear was tested, irrespective of whether the tests were delivered monaurally or dichotically. However, neither the side nor size of the ear advantage predicted the ultimate diagnosis well. Cooccurrence of CAPE with other learning problems was nearly universal, but neither the number nor the pattern of cooccurring problems was a predictor of APD diagnosis. The diagnostic patterns of individual audiologists were quite consistent. The number of annual assessments decreased dramatically during the study period.
A simple diagnosis of APD based on current guidelines is neither realistic, given the current tests used, nor appropriate, as judged by the audiologists providing the service. Methods used to test for APD must recognize that any form of hearing assessment probes both sensory and cognitive processing. Testing must embrace modern methods, including digital test delivery, adaptive testing, referral to normative data, appropriate testing for young children, validated screening questionnaires, and relevant objective (physiological) methods, as appropriate. Audiologists need to collaborate with other specialists to understand more fully the behaviors displayed by children presenting with listening difficulties. To achieve progress, it is essential for clinicians and researchers to work together. As new understanding and methods become available, it will be necessary to sort out together what works and what doesn't work in the clinic, both from a theoretical and a practical perspective.
被转介至听力服务机构、存在无法解释的学业、听力、注意力、语言或其他困难的儿童，听力测试结果往往显示正常。其中一些儿童会接受进一步的听觉处理障碍（APD）评估，这是一个存在争议的概念，它假定中枢听觉神经系统存在神经处理问题。本研究聚焦于一家大型儿科听力机构对APD的评估及其与诊断的关系。
分析在辛辛那提儿童医院接受中枢听觉处理评估（CAPE）的儿童的电子记录，总体目标是了解APD诊断的当前实践以及影响该实践的测试信息。
对2009年至2014年间接受CAPE的1113名5至19岁儿童的APD测试结果与听力学家最终诊断进行描述性横断面分析。
儿童在所用测试中的表现总体较高，约一半的测试出现明显的天花板效应。由于大量被转介儿童虽明显存在问题但未达到美国听力学学会（AAA）/美国言语语言听力协会（ASHA）的障碍诊断标准，听力学家制定了“弱点”诊断类别。在所有测试双耳的测试中均发现“右耳优势”，无论测试是单耳呈现还是双耳呈现。然而，耳朵优势的方向和大小均不能很好地预测最终诊断。CAPE与其他学习问题同时出现几乎很普遍，但同时出现问题的数量和模式均不是APD诊断的预测指标。个体听力学家的诊断模式相当一致。研究期间年度评估数量大幅下降。
鉴于当前使用的测试，基于现行指南对APD进行简单诊断既不现实，也不恰当，这是由提供服务的听力学家判断得出的。用于测试APD的方法必须认识到，任何形式的听力评估都同时探测感觉和认知处理。测试必须采用现代方法，包括数字测试呈现、自适应测试、参考标准化数据、对幼儿进行适当测试、经过验证的筛查问卷以及相关的客观（生理）方法（如适用）。听力学家需要与其他专家合作，更全面地了解有听力困难儿童所表现出的行为。为取得进展，临床医生和研究人员共同努力至关重要。随着新的认识和方法的出现，有必要从理论和实践角度共同梳理出在临床中哪些有效、哪些无效。
