1. lecture outline الخطوط العريضة للمحاضرة 2 3 introduction المقدمة 4

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Language Affection in Children Having CAPD

Dr. Dalia Mostafa Osman, M.D. Phoniatrics, ASHA CCC-SLP

Assist. Prof. of Phoniatrics, Cairo University

When the brain can’t hear

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Lecture Outlineالعريضة الخطوط

للمحاضرة

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Introductionالمقدمة

الدرسة Aim of the studyالهدفمن

البحث في Participantsالمشاركون

اللغوية Linguistic tasksالمهامالجداول و البيانية Graphsالرسوم& tables

االستنتاجات Conclusions

Recommendationsالتوصيات

Agenda &

Outline

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Introduction المقدمة

5الحسالسمعي هو اللغوية المهارات لنمو طريقة أكفأ

Before birth Birth 6 months 1 year 2 years 3 years 4 years 5 years

First wordsالكلمات األولى

Vocalization أصوات

Phrasesعبارات

Sentencesجمل

Story tellingقصة رواية

Almost adult like

مماثلة لغةالراشدين للغة

5 سنة 3سنوات 4سنوات سنتين عند 6سنوات أشهرالوالدة بعد الوالدة

Language skills are developed most efficiently through the auditory sensory modality

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When hearing abilities are mentioned, it is

mostly thought of as the sound perception that occurs in the ear

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However, sound perception is just the first part of hearing

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What is Central Auditory Processing (CAP)

Operations

Peripheral Auditory Input

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WHAT WE DOWITH

WHAT WE HEAR

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CAP Skills

Auditory attention

Auditory discrimination

Auditory localization

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CAP Skills

Auditory figure ground

Auditory association

Auditory blending

Auditory segmentation

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Auditory memory

Auditory sequential memory Auditory closure

Auditory integration Together

CAP Skills

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Difficult to Delineate / Separate

Discrimination

Blending

Segmentation

Auditory figure-ground

Auditory closure

Auditory Memory

Auditory Sequential Memory

Auditory Integration

Auditory Attention

Auditory Association

Attention

Comprehension

CAP

SKIL

LS

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-Understanding conversation in noise-Following complex directions

-Learning new vocabulary words-Language & Academic Difficulties

Auditory-based language learning problems

Central Auditory Processing Disorders

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CAPD & Language

• Children with CAPD usually experience language difficulties

• Some difficulties may be more prominent than others Classification

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-Difficulty in blocking noise out -Distractibility + Hyperactivity-Poor reading comprehension-Poor oral + written narratives

Tolerance Fading Memory

-Difficulty in sequencing-Easy fatigability when listening

-Spelling difficulties-Sound reversals

Organization deficit (temporal processing)

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Phonology Reading Spelling

Left Hemisphere Decoding deficit

Prosody Conversation

Right Hemisphere Prosodic Deficit

Difficulty linking prosody & linguistic contents

Difficulty Integrating different modalities

Corpus Callosum Integration Deficit

Left Right

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• Children with CAPD usually share common features

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What are the language difficulties that children with CAPD commonly share?

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Aim of the studyالدراسة الهدفمن

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• Compare the performance of a group of children having CAPD to a group of age-and gender- matched children on some linguistic tasks

• To reach a better understanding

• Thereby, enabling early detection and referral

Aim

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Participants في المشاركون

البحث

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Group I (Study)

• N = 20• Audiology Unit, Ain Shams University• 7;07-10;06 years old• 8; 08 ± 1; 02 years old

Group II (Control)

• N = 20• Age + Gender- matched • 7; 06 – 10;07 years old• 8; 07± 1; 01 years old

Subjects

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Linguistic Tasks اللغوية المهارات

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Linguistic Tasks

• Earlier researches

• Parents’ report

• Standardized Formal Tests

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Linguistic Tasks

1:1Quiet Room

Demos &

Trials

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Linguistic Tasks

1. Semantic Categorization 2. Understanding Oral Instructions 3. Auditory Comprehension

4. Expressive vocabulary 5. Word Retrieval 6. Sentence Formation 7. Sentence Repetition 8. Narrative Skills

9. Forward Number Repetition 10. Backward Number Repetition 11. Repetition of Familiar Sequences

Memory Expressive Receptive Relatede

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1- Semantic Categorization

No picture Stimuli20 itemsRepetitions (once)A score of 1 for each correct response

Sets of 4 words were introduced to each child and he/she was asked to choose the odd word

اشارة - – – بنزين قلم عربية

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• More difficulties with abstract items

طموح – - – ناجح قرن متحمس

• Difficulties with category names & being specific

Semantic Categorization

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2- Understanding Oral Instructions

Picture Stimuli50 itemsRepetitions not allowedA score of 1 for each correct response

Each child was asked to follow 50 instructions presented orally. The commands were graded in difficulty

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Simple instructionsSimple instructions with modifiers 2-3 order (multi-sequential instructions)Instructions involving embedded phrasesExceptional indicatorsConditional indicators Temporal indicatorsSpatial indicatorsOrdinal / serial numbers

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Understanding Oral Instructions

• Most common complaint • Temporal indicators

• An important distinguishing feature

• Auditorization (verbally repeating the introduced instruction before responding)

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3-Auditory Comprehension

Three age-relevant stories15 questions (5 for each story)Repetitions for questions but not paragraphA score of 1 for each correct response

Main topicFine details Sequence of eventsInfer indirect informationPredict logical events

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Auditory Comprehension

• Poor performance

• More challenging to auditory attention and memory than mere sentence comprehension.

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4-Expressive Vocabulary

Picture Stimuli20 items (10 nouns + 10 verbs)Repetitions (once)A score of 1 for each correct response

Pictures were shown to each child and he /she was asked to mention the name of the object or action demonstrated in each picture.

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4- Expressive Vocabulary (EV)• 20 picture stimuli were used

• It included 20 pictures; 10 of which were designed to test the child's ability to name nouns and 10 were designed to test the child's ability to name verb actions. Both sets were graded in difficulty proceeding from nouns and verbs commonly encountered in daily life activities to less common ones.

• Pictures were shown to each child and he /she was asked to mention the name of the object or action demonstrated in each picture.

• A score of 1 was given for each correct response.

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Expressive Vocabulary• Relatively good performance in Expressive

Vocabulary in the study group

• Related to the nature of the test being simple and aided by pictures

• More difficulties for uncommon objects

• Word finding difficulties have been previously found to be greatly dependent on the frequency of word utilization in daily life activities.

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5-Word Retrieval

No picture StimuliThree groupsA score of 1 for each correct response

Each child was asked to name as much as he/she can of certain classes (animals, foods, and occupations).

Examples for each class were given and the child was asked to name more

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Word Retrieval• Disruption in the mental activity responsible for

storing retrieving and selecting stored words

• Inefficient temporal-to-frontal

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Word Retrieval

• Clustering and Grouping

• Repetition

• Interjections

• Circumlocutions

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6- Sentence FormationPicture Stimuli 10 itemsRepetitions (of the word to be used once)A score of 1 for relevant useA score of 1 for correct syntax

Pictures demonstrating various actions were sequentially introduced & the child was asked to use a certain word to describe the picture

Words were graded in difficulty

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6- Sentence Formation (SF)• Picture stimuli were used to elicit verbal responses from the children

under study.

• This test, like Expressive Vocabulary test, was aided with visual stimuli. Each child was given sets of 10 pictures demonstrating various actions and was asked to use a certain word to describe what he/she could see in the picture.

• For each, picture 2 scores were given; 1 for the appropriate use of the introduced word in a meaningful relevant description of the picture and 1 for the correct syntactical arrangement of the words within the sentence.

• The introduced words were graded in difficulty and level of abstractness

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Difficulties with sticking to the instructions

Sentences produced by the

study group

Syntactically correct Incoherent

Bearing little

meaning Simple

Sentence Formation

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7- Sentence RepetitionNo picture stimuli30 items Repetitions not allowed A score of 3 --no errorsA score of 2 ---1-2 errorA score of 1 ---3-4 errorsA score of 0 more than 4 errors.

Repeat each sentence after hearing it Sentences were graded in difficulty

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Sentence Repetition

• Inefficient auditory memory

• It seemed as if they misheard some sounds e.g. /l/ heard as /j/

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8-Narrative Skills

No picture Stimuli15 items (5 for each narrative)A score of 1 for each correct response

Describe three events1 for ability to maintain the topic discussed1 for ability to sequence ideas logically 1 for providing necessary details1 for being specific1 for using appropriate close endings

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9-Forward Number RepetitionNo picture Stimuli10 itemsRepetitions not allowedA score of 1 for each correct response

10 sets of numbers (progressively graded in length) Precisely repeat each

1-2-52-5-6-9-10

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10- Backward Number Repetition

No picture stimuli10 itemsRepetitions not allowed A score of 1 for each correct response

10 sets of numbers (progressively graded in length)

Precisely repeat each but in the reverse order2-3-7

2-1-6-8-4

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Forward & Backward Number Repetition

• Non significant in Forward Number Repetition but significant in Backward Number Repetition

• Backward Number Repetition is more difficult for a child with CAPD as it requires multi-stage processing.

• Forward Number Repetition is more related to echoic memory and requires less processing.

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11- Repetition of Familiar Sequences No picture Stimuli6 itemsRepetitions not allowedA score of 1 for each correct response

Each child was asked to list familiar sequences after listening to them

- - - - - - - - سبتمبر- أغسطس يوليو يونيه مايو أبريل مارس فبراير يناير- ديسمبر- نوفمبر أكتوبر

10-9-8-7-6-5-4-3-2ا-- - - - - الجمعة- الخميس األربعاء الثالثاء األثنين األحد السبت

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Repetition of Familiar Sequences

• Difficulties mostly related limited auditory sequential abilities

• It is not unusual to see such children with CAPD, though were able to make to prep and secondary stages, still have difficulties with sequentially listing the months of the year or the alphabetic letters

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Tables & Graphs

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Significance P value

“t ”Test

Group IIMean + SD

Group IMean + SD

Receptive Tasks

Significant <0.05 2.306 10.90 +3.13 9.10 + 1.55 Semantic Categorization

Significant <0.05 1.696 44.55+2.84 23.55+5.73 Understanding Oral Instructions

Significant <0.05 10.948 10.90 +1.74 5.55+1.32 Auditory Comprehension

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Significance P value

“t” Test Group IIMean + SD

Group IMean + SD

Expressive Tasks

Non-significant

>0.05 0.753 12.20 4.29± 11.35 2.6±6

Expressive Vocabulary

Significant <0.05 5.046 45.05±19.36 23.15±1.31 Word Retrieval

Significant <0.05 9.309 13.75 3.45± 5.15 2.28± Sentence Formation

Significant <0.05 17.518 57.50 7.86± 21.40 4.8±1

Sentence Repetition

Significant <0.05 11.215 12.85 1.60± 5.75 2.34± Narrative Skills

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Significance P value

“t ”Test

Group IIMean + SD

Group IMean + SD

Memory-Related Tasks

Non significant

>0.05 1.491 7.65±1.60 7.05±0.83 Forward NumberRepetition

Significant <0.05 9.940 3.90±0.72 1.30±0.92 Backward NumberRepetition

Significant <0.05 15.057 4.50±0.50 1.05±0.89 Repetition of Familiar Sequences

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CAPD Group Control Group 0

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Semantic CategoizationUnderstanding Oral InstructionsAuditory Comprehension

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CAPD Group Control Group0

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20

30

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50

60

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Expressive VocabularyWord RetrievalSentence FormationSentence RepetitionNarrative Skills

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CAPD Group Control Group0

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Forward Number Repeti-tionBackward Number Repe-titionRepetition of Familiar Sequences

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Conclusion & Recommendations

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CAPD

Word Finding Difficulties

Temporal

Indicators

Multi-step Directions

Auditory Comprehension

Narrativeskills

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• The applied linguistic tasks in this study were introduced in 1:1 situations in a quiet room.

• The performance of such children is expected to be worse in noise

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CAPD may have negative consequences

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Co-operation of all professionals

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SPEECH

State the topic to be discussed

Pace conversation

Enumerate clearly

Enthusiastically communicate

Check comprehension

Teac

hing

CAPD

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