J Am Acad Audiol 25:697-705 (2014)
Letters to the Editor DOI: 10.3766/jaaa.25.7.9
It Is N either N ecessary nor D esirable to Test for A bnorm alities in Other M odalities When D iagnosing A uditory P rocessing D isorder (APD) The recent paper by Cacace and McFarland (2013) presents an interesting and timely critique of several aspects of auditory processing th at are summarized in the accompanying letter by Dillon et al (2014). In that letter, a counter-argument is made against Cacace and McFarland’s conclusion th at a diagnosis of auditory processing disorder (APD) requires demonstrating spe cificity of processing problems to the auditory modality. Dillon et al (2014) provide the following arguments: • Auditory processing disorders, ju st like hearing loss, may or may not occur in conjunction with other sen sory problems (e.g., visual impairment) whether of peripheral or central origin. • In either case, it is beneficial to the individual for the auditory processing disorder to be identified and managed. • A differential test format enables the confounding effects of cognitive, language, and motor abilities to be controlled for without testing in modalities other than auditory. We agree with these arguments and would like to add some observations based on our attem pts in several studies to examine the perceptual performance of chil dren on visual analogs of auditory tests. Like Cacace and M cFarland (2013), we thought it would be possible to dissociate the sensory and cognitive elem ents of auditory processing by developing carefully matched auditory and visual stimuli. The rationale was th at if individuals performed equally poorly on both auditory and visual versions of a test, they could have either a bimodal sensory deficit or a “supramodal” cognitive def icit th a t prevented them from performing well on any comparable test. An example could be a working mem ory deficit th at prevented them from accurately indicat ing which of three stimuli was the “odd one out.” On the other hand, if individuals performed poorly on either the visual or the auditory test, they would likely have a specific sensory deficit. Thus, a child with a listening problem might be diagnosed with APD if he or she per formed poorly only on the auditory test. In one set of studies, we used analogous auditory and visual frequency discrim ination tests, and a threestim ulus, “odd-one-out” procedure. Each auditory trial presented three successive tones (e.g., 1000-1100-1000
Hz) and the 6-11 yr old listeners had to indicate which one differed from the others. Similarly, in the visual test, one of three black-white vertical striped “gratings” presented on a high-definition PC monitor had a higher “spatial frequency”; the lines were thinner and spaced more closely together. Thresholds were determined adap tively, using computer control, as suggested by Cacace and McFarland (2013). We found no significant correlation between thresh old performance or response variability on the auditory and visual tests, either in typically developing children (Moore et al, 2008a) or in children clinically diagnosed with APD or specific language impairment (SLI; Moore et al, 2008b; Ferguson, 2013). However, studied within a modality (i.e., vision or hearing), the pattern of data resem bled each other. Younger children had poorer thresholds and higher variability on both auditory and visual tests, and children with SLI or APD did more poorly (and somewhat more variably) on both tests. In another study (Halliday et al, 2012), we examined audi tory and visual learning in typically developing children who practiced on each test. Children showed good learn ing on the auditory test, but the learning did not transfer to the visual test. Finally, in a large-scale study of 6-11 yr old children that included differential tests of auditory and visual cued reaction time (“phasic alertness,” a type of attention; Moore et al, 2010), we found correlated per formance between the modalities, but no association between auditory alertness and other auditory percep tual skills. Curiously, we did find an association between visual alertness and auditory perception. Overall, we were able to devise what we thought were analogous tests of vision and hearing and to measure performance by children on those tests. Therefore, we might conclude that it is possible to dissociate sensory and cognitive contributions to hearing by comparing performance on auditory and visual tests, as Cacace and McFarland (2013) have proposed. However, the results summarized here suggest otherwise. Lack of correlation between auditory and visual perception, poor thresholds and high response variability in both modalities, and complex interactions among groups of children and their performance indicate th at our ration ale developed above was too simple. It turns out to be well recognized in cognitive science (e.g., Posner and Petersen, 1990; Driver and Spence, 2000) th at attention has both modality-specific and modality-independent components. It appears that younger children and some children with language-based learn ing difficulties have problems with both sorts of a t tention. The question of whether some children have
697
Journal of the American Academy of Audiology/Volume 25, Number 7, 2014
additional, age-inappropriate, and specifically auditory sensory impairments of central origin is, in our opinion, an open one. Dillon et al (2014) have argued persua sively th a t “spatial processing disorder,” as detected with the Listening in Spatialized Noise—Sentences Test (LiSN-S), may be one such instance. Whatever the underlying sensory and cognitive ele ments of APD, our experiments clearly demonstrate that it is by no means a simple process to dissociate the ele ments of auditory and visual perception. In addition, as commented by Dillon et al (2014), the practicalities of measuring both auditory and visual performance of chil dren in the clinic are daunting. For example, in our research we “discovered” something that is no doubt well known to visual scientists. Sound delivery to the ears can be largely controlled by the use of headphones, but direct ing visual stimulation to the fovea absolutely requires vis ual attention. Above all else, however, we do not believe the require m ent th at a diagnosis of APD should be restricted to those with only specifically auditory problems is very helpful clinically. It is likely to be arbitrary (depending on what test(s) are used); it would exclude those who have genuine auditory problems if they also have visual problems; and it may be difficult, or impossible, to estab lish who is in and who is out. David R. Moore Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology, University o f Cincinnati College o f Medicine Melanie A. Ferguson NIHR Nottingham Hearing Biomedical Research Unit, Nottingham University Hospitals N H S Trust, Nottingham, United Kingdom
REFERENCES Cacace AT, McFarland DJ. (2013) Factors influencing tests of auditory processing: a perspective on current issues and rele vant concerns. J A m Acad Audiol. 24(7):572-589. doi:10.3766/ jaaa.24.7.6. Dillon H, Cameron S, Tomlin D, Glyde H. (2014) Comments on “Factors influencing tests of auditory processing: A perspective on current issues and relevant concerns” by Tony Cacace and Den nis McFarland. J Am Acad Audiol 25(7):697-700. Driver J, Spence C. (2000) Multisensory perception: beyond mod ularity and convergence. Curr Biol 10(20):R731-R735. Halliday LF, Taylor JL, Millward KE, Moore DR. (2012) Lack of generalization of auditory learning in typically developing children. J Speech Lang Hear Res 55(1):168—181. Moore DR, Ferguson MA, Halliday LF, Riley A. (2008a) Frequency discrimination in children: perception, learning and attention. Hear Res 238(1-2):147—154.
698
Moore DR, Ferguson MA, Riley A, Halliday LF. (2008b). Auditory processing disorder (APD) in children. In: Dau T, Buchholz JM, Harte JM, Christiansen, TU, eds. 1st International Symposium on Auditory and Audiological Research (ISAAR 2007). Copenha gen, Denmark: Centertryk A/S 281-290. Moore DR, Ferguson MA, Edmondson-Jones AM, Ratib S, Riley A. (2010) Nature of auditory processing disorder in children. Pedia trics 126(2):e382-e390. Posner MI, Petersen SE. (1990) The attention system of the human brain. Annu Rev Neurosci 13:25-42.
M odality Specificity Is the Preferred M ethod for D iagnosing the Auditory P rocessing D isorder (APD): R esponse to Moore and Ferguson In their letter, Moore and Ferguson essentially agree with Dillon et al (their letter) and add their experience with attempting to develop multimodal tests for assess ing auditory processing disorders (APDs). According to Moore and Ferguson, they found no significant correla tion between threshold or variability between auditory and visual tests and state th at younger children had poorer thresholds and higher variability on both tests. They also indicate th at children with APD and specific language impairment (SLI) performed more poorly and showed greater variability on both auditory and visual tests (Moore et al, 2008; 2013). They concluded that APD is primarily an “attentional” problem, as indicated by the substantial variability th at they observed in par ticipants’ responses to stimuli. However, there are sev eral relevant issues here. First, the Ferguson (2013) report referenced in their letter is not publicly available at this time, is not in their list of references, and there fore, we cannot comment on it. Moreover, like Beilis et al (2008), Moore and Ferguson (2013) describe chil dren diagnosed with APD as having poor performance on both auditory and visual tasks; secondly, like Beilis et al (2008), Moore and Ferguson also chose to question the logic of multimodal testing rather than addressing the legitimacy of their original APD diagnosis. This rai ses the issue of whether the tests they used were reli able. In other words, would their tests produce similar results in the same individuals on two separate occasions (i.e., would they have good test-retest reliability)? If not, such tests would be subject to a high degree of error and would not be useful clinically (McFarland and Cacace, 2006. This could also give the appearance of an atten tional problem when, in fact, it could be one of poor reli ability. Attention problems might produce variability, but so might other factors, such as too few test items, etc. In summary, the letter to the editor and the pub lished works of Dillon et al (2012; 2014) and Moore and colleagues (Moore et al, 2010; Moore and Hunter, 2013; Moore and Ferguson, 2014) have a common fun damental linkage: both groups lack a clear theoretic
Letters to the Editor
framework for understanding the underlying APD. Although there is disagreement on whether multimodal testing is the course to follow in order to provide specif icity of the APD diagnosis, the arguments by Dillon et al (2014) and Moore and Ferguson (2013) are not compel ling enough to alter the use of modality specificity as the favored theoretic framework to apply in APD assess ments. From a neurodevelopmental perspective, Moore and H unter (2013) favor a supramodal attentional def icit, th a t they call “neurodevelopmental syndrome,” with auditory processing being part of a global set of symptoms or patterns of dysfunction. This is a common position th at has been advocated by others (e.g., Musiek et al, 2005). This approach treats poor performance on auditory tests as a symptom, rather than as an indica tion of a modality-specific disorder of the auditory nerv ous system. Of course, there is nothing wrong with providing a global (supramodal or polysensory) descrip tor, if the specificity of the deficit cannot be ascertained. It may well be the case, as Moore and Ferguson (2013) have suggested, th at a large portion of children sus pected of having an APD may actually have a global attention deficit. However, the possibility th at there might be a subset of individuals with modality-specific impairments should be investigated, because lack of diagnostic specificity can result in grouping individuals with heterogeneous deficits into a single/unitary cate gory. Furthermore, diagnostic specificity is important because different deficits may require dissimilar treat ments and have diverse prognoses. As we reviewed in our original discussion of modality specificity (McFarland and Cacace, 1995), cases of modality-specific impairment have been identified in the neurology literature through multimodal testing. However, we agree with Moore and Ferguson (2013) that “it is by no means a simple process to disassociate the elements of auditory and visual percep tion.” This is precisely why we advocate that researchers develop tests of perceptual abilities that minimize con founding factors.
Dillon H, Cameron S, Glyde H, Wilson W, Tomlin D. (2012) An opinion on the assessment of people who may have an auditory processing disorder. J A m Acad Audiol 23(2):97-105. Dillon H, Cameron S, Tomlin D, Glyde H. (2014) Comments on “Factors influencing tests of auditory processing: A perspective on current issues and relevant concerns” by Anthony T. Cacace and Dennis J McFarland. J A m Acad Audiol 25(7):697-700. McFarland DJ, Cacace AT. (1995) Modality specificity as a crite rion for diagnosing central auditory processing disorders. A m J Audiol 4(3):36-48. McFarland DJ, Cacace AT. (2006) Current controversies in CAPD: From Procrustes’ Bed to Pandora’s Box. In: Parthasarathy TK, ed. An Introduction to Auditory Processing Disorders in Children. NJ: Lawrence Erlbaum, 247-263. Moore D, H unter L. (2013) Auditory processing disorder (APD) in children: A marker of neurodevelopmental syndrome. Hear Bal ance Comm 11:160-167. Moore DR, Ferguson MA. (2014) It is neither necessary nor desir able to te st for abnormalities in other modalities when diagnos ing auditory processing disorder (APD). J A m Acad Audiol 25 (7):695-696. Moore DR, Ferguson MA, Halliday LF, Riley A. (2008) Frequency discrimination in children: perception, learning and attention. Hear Res 238(1-2):147-154. Moore DR, Ferguson MA, Edmondson-Jones AM, Ratib S, Riley A. (2010) N ature of auditory processing disorder in children. Pedia trics 126(2):e382-e390. Moore DR, Rosen S, Bamiou DE, Campbell NG, Sirimanna T. (2013) Evolving concepts of developmental auditory processing disorder (APD): a British Society of Audiology APD special interest group ‘w hite paper’ In t J A udiol 52(1):3—13. Musiek FE, Beilis TJ, Chermak GD. (2005) Nonmodularity of the central auditory nervous system: implications for (central) audi tory processing disorder. A m J Audiol 14(2): 128-138, discussion 143-150.
C om m ents on “F a cto rs In flu en cin g T ests o f A u d itory P ro cessin g : A P e r sp e c tiv e on C urren t Issu es an d R elev a n t C on cern s” by T ony C acace an d D en n is M cF arland
Dennis J. McFarland The Wadsworth Center, N Y S Department o f Health, Albany, N Y
Cacace and McFarland (2013) have written an inter esting and provoking article on auditory processing. Our summary of their main concerns is as follows:
Anthony T. Cacace Department of Communication Sciences & Disorders, Wayne State University, Detroit, M I
• Auditory processing is defined as a modality-specific activity, and hence an auditory processing disorder cannot be diagnosed unless it can be shown that any deficit in performance is limited to, or at least pre dominantly affects, just the auditory input modality. • Auditory processing is a “theoretical construct,” “underlying trait,” or “disposition” (like personality or intelligence) th at cannot directly be observed, rather than a behavior, or a set of test results. • The characteristics of such an underlying trait can be inferred only by analyzing the results of a set of tests th at tap abilities dependent on the underlying trait.
REFERENCES Beilis TJ, Billiet C, Ross J. (2008) Hemispheric lateralization of bilat erally presented homologous visual and auditory stimuli in normal adults, normal children, and children with central auditory dysfunc tion. Brain Cogn 66(3):280-289 doi:10.1016/j.bandc.2007.09.006. Cacace AT, McFarland DJ. (2005) The importance of modality spe cificity in diagnosing central auditory processing disorder. A m J Audiol 14(2):112-123.
699
Copyright of Journal of the American Academy of Audiology is the property of American Academy of Audiology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letters to the Editor DOI: 10.3766/jaaa.25.7.9
It Is N either N ecessary nor D esirable to Test for A bnorm alities in Other M odalities When D iagnosing A uditory P rocessing D isorder (APD) The recent paper by Cacace and McFarland (2013) presents an interesting and timely critique of several aspects of auditory processing th at are summarized in the accompanying letter by Dillon et al (2014). In that letter, a counter-argument is made against Cacace and McFarland’s conclusion th at a diagnosis of auditory processing disorder (APD) requires demonstrating spe cificity of processing problems to the auditory modality. Dillon et al (2014) provide the following arguments: • Auditory processing disorders, ju st like hearing loss, may or may not occur in conjunction with other sen sory problems (e.g., visual impairment) whether of peripheral or central origin. • In either case, it is beneficial to the individual for the auditory processing disorder to be identified and managed. • A differential test format enables the confounding effects of cognitive, language, and motor abilities to be controlled for without testing in modalities other than auditory. We agree with these arguments and would like to add some observations based on our attem pts in several studies to examine the perceptual performance of chil dren on visual analogs of auditory tests. Like Cacace and M cFarland (2013), we thought it would be possible to dissociate the sensory and cognitive elem ents of auditory processing by developing carefully matched auditory and visual stimuli. The rationale was th at if individuals performed equally poorly on both auditory and visual versions of a test, they could have either a bimodal sensory deficit or a “supramodal” cognitive def icit th a t prevented them from performing well on any comparable test. An example could be a working mem ory deficit th at prevented them from accurately indicat ing which of three stimuli was the “odd one out.” On the other hand, if individuals performed poorly on either the visual or the auditory test, they would likely have a specific sensory deficit. Thus, a child with a listening problem might be diagnosed with APD if he or she per formed poorly only on the auditory test. In one set of studies, we used analogous auditory and visual frequency discrim ination tests, and a threestim ulus, “odd-one-out” procedure. Each auditory trial presented three successive tones (e.g., 1000-1100-1000
Hz) and the 6-11 yr old listeners had to indicate which one differed from the others. Similarly, in the visual test, one of three black-white vertical striped “gratings” presented on a high-definition PC monitor had a higher “spatial frequency”; the lines were thinner and spaced more closely together. Thresholds were determined adap tively, using computer control, as suggested by Cacace and McFarland (2013). We found no significant correlation between thresh old performance or response variability on the auditory and visual tests, either in typically developing children (Moore et al, 2008a) or in children clinically diagnosed with APD or specific language impairment (SLI; Moore et al, 2008b; Ferguson, 2013). However, studied within a modality (i.e., vision or hearing), the pattern of data resem bled each other. Younger children had poorer thresholds and higher variability on both auditory and visual tests, and children with SLI or APD did more poorly (and somewhat more variably) on both tests. In another study (Halliday et al, 2012), we examined audi tory and visual learning in typically developing children who practiced on each test. Children showed good learn ing on the auditory test, but the learning did not transfer to the visual test. Finally, in a large-scale study of 6-11 yr old children that included differential tests of auditory and visual cued reaction time (“phasic alertness,” a type of attention; Moore et al, 2010), we found correlated per formance between the modalities, but no association between auditory alertness and other auditory percep tual skills. Curiously, we did find an association between visual alertness and auditory perception. Overall, we were able to devise what we thought were analogous tests of vision and hearing and to measure performance by children on those tests. Therefore, we might conclude that it is possible to dissociate sensory and cognitive contributions to hearing by comparing performance on auditory and visual tests, as Cacace and McFarland (2013) have proposed. However, the results summarized here suggest otherwise. Lack of correlation between auditory and visual perception, poor thresholds and high response variability in both modalities, and complex interactions among groups of children and their performance indicate th at our ration ale developed above was too simple. It turns out to be well recognized in cognitive science (e.g., Posner and Petersen, 1990; Driver and Spence, 2000) th at attention has both modality-specific and modality-independent components. It appears that younger children and some children with language-based learn ing difficulties have problems with both sorts of a t tention. The question of whether some children have
697
Journal of the American Academy of Audiology/Volume 25, Number 7, 2014
additional, age-inappropriate, and specifically auditory sensory impairments of central origin is, in our opinion, an open one. Dillon et al (2014) have argued persua sively th a t “spatial processing disorder,” as detected with the Listening in Spatialized Noise—Sentences Test (LiSN-S), may be one such instance. Whatever the underlying sensory and cognitive ele ments of APD, our experiments clearly demonstrate that it is by no means a simple process to dissociate the ele ments of auditory and visual perception. In addition, as commented by Dillon et al (2014), the practicalities of measuring both auditory and visual performance of chil dren in the clinic are daunting. For example, in our research we “discovered” something that is no doubt well known to visual scientists. Sound delivery to the ears can be largely controlled by the use of headphones, but direct ing visual stimulation to the fovea absolutely requires vis ual attention. Above all else, however, we do not believe the require m ent th at a diagnosis of APD should be restricted to those with only specifically auditory problems is very helpful clinically. It is likely to be arbitrary (depending on what test(s) are used); it would exclude those who have genuine auditory problems if they also have visual problems; and it may be difficult, or impossible, to estab lish who is in and who is out. David R. Moore Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Department of Otolaryngology, University o f Cincinnati College o f Medicine Melanie A. Ferguson NIHR Nottingham Hearing Biomedical Research Unit, Nottingham University Hospitals N H S Trust, Nottingham, United Kingdom
REFERENCES Cacace AT, McFarland DJ. (2013) Factors influencing tests of auditory processing: a perspective on current issues and rele vant concerns. J A m Acad Audiol. 24(7):572-589. doi:10.3766/ jaaa.24.7.6. Dillon H, Cameron S, Tomlin D, Glyde H. (2014) Comments on “Factors influencing tests of auditory processing: A perspective on current issues and relevant concerns” by Tony Cacace and Den nis McFarland. J Am Acad Audiol 25(7):697-700. Driver J, Spence C. (2000) Multisensory perception: beyond mod ularity and convergence. Curr Biol 10(20):R731-R735. Halliday LF, Taylor JL, Millward KE, Moore DR. (2012) Lack of generalization of auditory learning in typically developing children. J Speech Lang Hear Res 55(1):168—181. Moore DR, Ferguson MA, Halliday LF, Riley A. (2008a) Frequency discrimination in children: perception, learning and attention. Hear Res 238(1-2):147—154.
698
Moore DR, Ferguson MA, Riley A, Halliday LF. (2008b). Auditory processing disorder (APD) in children. In: Dau T, Buchholz JM, Harte JM, Christiansen, TU, eds. 1st International Symposium on Auditory and Audiological Research (ISAAR 2007). Copenha gen, Denmark: Centertryk A/S 281-290. Moore DR, Ferguson MA, Edmondson-Jones AM, Ratib S, Riley A. (2010) Nature of auditory processing disorder in children. Pedia trics 126(2):e382-e390. Posner MI, Petersen SE. (1990) The attention system of the human brain. Annu Rev Neurosci 13:25-42.
M odality Specificity Is the Preferred M ethod for D iagnosing the Auditory P rocessing D isorder (APD): R esponse to Moore and Ferguson In their letter, Moore and Ferguson essentially agree with Dillon et al (their letter) and add their experience with attempting to develop multimodal tests for assess ing auditory processing disorders (APDs). According to Moore and Ferguson, they found no significant correla tion between threshold or variability between auditory and visual tests and state th at younger children had poorer thresholds and higher variability on both tests. They also indicate th at children with APD and specific language impairment (SLI) performed more poorly and showed greater variability on both auditory and visual tests (Moore et al, 2008; 2013). They concluded that APD is primarily an “attentional” problem, as indicated by the substantial variability th at they observed in par ticipants’ responses to stimuli. However, there are sev eral relevant issues here. First, the Ferguson (2013) report referenced in their letter is not publicly available at this time, is not in their list of references, and there fore, we cannot comment on it. Moreover, like Beilis et al (2008), Moore and Ferguson (2013) describe chil dren diagnosed with APD as having poor performance on both auditory and visual tasks; secondly, like Beilis et al (2008), Moore and Ferguson also chose to question the logic of multimodal testing rather than addressing the legitimacy of their original APD diagnosis. This rai ses the issue of whether the tests they used were reli able. In other words, would their tests produce similar results in the same individuals on two separate occasions (i.e., would they have good test-retest reliability)? If not, such tests would be subject to a high degree of error and would not be useful clinically (McFarland and Cacace, 2006. This could also give the appearance of an atten tional problem when, in fact, it could be one of poor reli ability. Attention problems might produce variability, but so might other factors, such as too few test items, etc. In summary, the letter to the editor and the pub lished works of Dillon et al (2012; 2014) and Moore and colleagues (Moore et al, 2010; Moore and Hunter, 2013; Moore and Ferguson, 2014) have a common fun damental linkage: both groups lack a clear theoretic
Letters to the Editor
framework for understanding the underlying APD. Although there is disagreement on whether multimodal testing is the course to follow in order to provide specif icity of the APD diagnosis, the arguments by Dillon et al (2014) and Moore and Ferguson (2013) are not compel ling enough to alter the use of modality specificity as the favored theoretic framework to apply in APD assess ments. From a neurodevelopmental perspective, Moore and H unter (2013) favor a supramodal attentional def icit, th a t they call “neurodevelopmental syndrome,” with auditory processing being part of a global set of symptoms or patterns of dysfunction. This is a common position th at has been advocated by others (e.g., Musiek et al, 2005). This approach treats poor performance on auditory tests as a symptom, rather than as an indica tion of a modality-specific disorder of the auditory nerv ous system. Of course, there is nothing wrong with providing a global (supramodal or polysensory) descrip tor, if the specificity of the deficit cannot be ascertained. It may well be the case, as Moore and Ferguson (2013) have suggested, th at a large portion of children sus pected of having an APD may actually have a global attention deficit. However, the possibility th at there might be a subset of individuals with modality-specific impairments should be investigated, because lack of diagnostic specificity can result in grouping individuals with heterogeneous deficits into a single/unitary cate gory. Furthermore, diagnostic specificity is important because different deficits may require dissimilar treat ments and have diverse prognoses. As we reviewed in our original discussion of modality specificity (McFarland and Cacace, 1995), cases of modality-specific impairment have been identified in the neurology literature through multimodal testing. However, we agree with Moore and Ferguson (2013) that “it is by no means a simple process to disassociate the elements of auditory and visual percep tion.” This is precisely why we advocate that researchers develop tests of perceptual abilities that minimize con founding factors.
Dillon H, Cameron S, Glyde H, Wilson W, Tomlin D. (2012) An opinion on the assessment of people who may have an auditory processing disorder. J A m Acad Audiol 23(2):97-105. Dillon H, Cameron S, Tomlin D, Glyde H. (2014) Comments on “Factors influencing tests of auditory processing: A perspective on current issues and relevant concerns” by Anthony T. Cacace and Dennis J McFarland. J A m Acad Audiol 25(7):697-700. McFarland DJ, Cacace AT. (1995) Modality specificity as a crite rion for diagnosing central auditory processing disorders. A m J Audiol 4(3):36-48. McFarland DJ, Cacace AT. (2006) Current controversies in CAPD: From Procrustes’ Bed to Pandora’s Box. In: Parthasarathy TK, ed. An Introduction to Auditory Processing Disorders in Children. NJ: Lawrence Erlbaum, 247-263. Moore D, H unter L. (2013) Auditory processing disorder (APD) in children: A marker of neurodevelopmental syndrome. Hear Bal ance Comm 11:160-167. Moore DR, Ferguson MA. (2014) It is neither necessary nor desir able to te st for abnormalities in other modalities when diagnos ing auditory processing disorder (APD). J A m Acad Audiol 25 (7):695-696. Moore DR, Ferguson MA, Halliday LF, Riley A. (2008) Frequency discrimination in children: perception, learning and attention. Hear Res 238(1-2):147-154. Moore DR, Ferguson MA, Edmondson-Jones AM, Ratib S, Riley A. (2010) N ature of auditory processing disorder in children. Pedia trics 126(2):e382-e390. Moore DR, Rosen S, Bamiou DE, Campbell NG, Sirimanna T. (2013) Evolving concepts of developmental auditory processing disorder (APD): a British Society of Audiology APD special interest group ‘w hite paper’ In t J A udiol 52(1):3—13. Musiek FE, Beilis TJ, Chermak GD. (2005) Nonmodularity of the central auditory nervous system: implications for (central) audi tory processing disorder. A m J Audiol 14(2): 128-138, discussion 143-150.
C om m ents on “F a cto rs In flu en cin g T ests o f A u d itory P ro cessin g : A P e r sp e c tiv e on C urren t Issu es an d R elev a n t C on cern s” by T ony C acace an d D en n is M cF arland
Dennis J. McFarland The Wadsworth Center, N Y S Department o f Health, Albany, N Y
Cacace and McFarland (2013) have written an inter esting and provoking article on auditory processing. Our summary of their main concerns is as follows:
Anthony T. Cacace Department of Communication Sciences & Disorders, Wayne State University, Detroit, M I
• Auditory processing is defined as a modality-specific activity, and hence an auditory processing disorder cannot be diagnosed unless it can be shown that any deficit in performance is limited to, or at least pre dominantly affects, just the auditory input modality. • Auditory processing is a “theoretical construct,” “underlying trait,” or “disposition” (like personality or intelligence) th at cannot directly be observed, rather than a behavior, or a set of test results. • The characteristics of such an underlying trait can be inferred only by analyzing the results of a set of tests th at tap abilities dependent on the underlying trait.
REFERENCES Beilis TJ, Billiet C, Ross J. (2008) Hemispheric lateralization of bilat erally presented homologous visual and auditory stimuli in normal adults, normal children, and children with central auditory dysfunc tion. Brain Cogn 66(3):280-289 doi:10.1016/j.bandc.2007.09.006. Cacace AT, McFarland DJ. (2005) The importance of modality spe cificity in diagnosing central auditory processing disorder. A m J Audiol 14(2):112-123.
699
Copyright of Journal of the American Academy of Audiology is the property of American Academy of Audiology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
