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Master Title

Constructing and Norming Arabic Screening Tool of Auditory Processing Disorders: Evaluation in a Group of Children at Risk For Learning Disability

Master Abstract

Constructing and Norming Arabic Screening Tool of Auditory Processing Disorders: Evaluation in a Group of Children at Risk For Learning Disability In Special Education and Rehabilitation Mohamed Mostafa Taha Cologne University Germany 2010 1.1. Introduction to the Literature At the present time, the interest of many scientists and researchers in the field of education and psychology is focused on those individuals with special needs which their level deviated from the level of their normal peers in spite of the availability of the necessary intellectual/mental abilities, especially the lower levels of these abilities in order to find out the problems that hinder their development and obstruct their way towards learning which are known as learning disabilities. Actually, some school-aged children appear to have hearing problems. They are described by their parents and teachers as children who are uncertain about what they hear, have difficulty listening in the presence of background noise, have difficulty following oral instructions, and have difficulty understanding rapid or degraded speech. Some of these children will have a significant loss in peripheral hearing sensitivity. In others, however, auditory thresholds will be within normal limits. It is assumed that, in a significant proportion of the latter group of children, the listening problems result from an auditory processing deficit, the defective processing of auditory information in spite of normal auditory thresholds (Jerger & Musiek, 2000). In the past, children with such problems have been labeled as having "central auditory processing disorder" (CAPD). And it was broadly stated, that (Central) Auditory Processing [(C)AP] refers to the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information. Narrowly defined, (C)AP refers to the perceptual processing of auditory information in the CNS and the neurobiological activity that underlies that processing and gives rise to electrophysiological auditory potentials. (C)AP includes the auditory mechanisms that underlie the following abilities or skills: sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals (ASHA, 1996; Bellis, 2003; Chermak & Musiek, 2002). (Central) Auditory Processing Disorder [(C)APD] referred to difficulties in the perceptual processing of auditory information in the CNS as demonstrated by poor performance in one or more of the above skills. In keeping with the goals of maintaining operational definitions, avoiding the imputation of anatomic loci, and emphasizing the interactions of disorders at both peripheral and central sites, however, it seems more appropriate to label such problems as "auditory processing disorder" (APD) ( Jerger & Musiek, 2000). Therefore, An APD may be broadly defined as a deficit in the processing of information that is specific to the auditory modality. The problem may be exacerbated in unfavorable acoustic environments. It may be associated with difficulties in listening, speech understanding, language development, and learning. In its pure form, however, it is conceptualized as a deficit in the processing of auditory input. Often children diagnosed with APD may have received another diagnosis before being seen by an audiologist. The disorder can be confusing for parents, educators, and other professionals working with these children. Children with APD are first diagnosed with attention deficit hyperactivity disorder (ADHD) or learning disabilities in general Later (Young, 1999). The Study Questions: Indeed, it is proved from the literature and previous studies why listening speech in binaural noise and phonemes identification ability were chosen to be screened by the current study, hence, the aims of the study are constructing and norming: - An Arabic version of adaptive auditory speech test (AAST) in quiet to rule out the peripheral auditory involvement by screening the children for any hearing loss in dB SPL units. - An Arabic version of adaptive auditory speech test (AAST) in binaural noise for screening the first selected APD aspect: listening speech in binaural noise. - Teetaatoo tests for the Arabic phonemes identifications. Participants included children between the ages of 5 to 7 years old from the nursery school children. The main question of the study is: How the two selected APD (listening speech in binaural noise and the phonemes identification ability disorders could be screened in the Egyptian children at risk for learning disability aged from 5 to 7 years old? And to answer this question, the following sub-questions should be answered: 1. What are the norms of AAST in Quiet (peripheral hearing threshold) for the Egyptian children aged from 5 to 7 years old? 2. What are the norms of AAST in binaural noise for the Egyptian children aged from 5 to 7 years old? 3. What are the norms of the ‘’teetaatoo’’test for Egyptian children aged from 5 to 7 years old? And this question could be divided to five sub questions according the phonemes sub categories: 3.1. What are the norms of the Cons-A sub test (easy set for all the consonants)? 3.2. What are the norms of the Cons-B1 sub test (for: plosives identification)? 3.3. What are the norms of the Cons-B2 (for: nasals, trill, approximant and lateral identification)? 3.4. What are the norms of the Cons-B3 (for: fricatives identification)? 3.5. What are the Norms of the Vow-A (easy set for vowels identification)? 4. Do the scores of the abnormal cases on the Arabic AAST in binaural-noise and the five subtests in teetaatoo test matches their SIFTER data analysis? Results Discussion: The aims of this study were to develop and to provide the normative data of Arabic screening tool for screening the children with auditory processing disorders: an Arabic version of Adaptive auditory speech test (AAST) in quiet for screening the peripheral hearing in dB SPL units, as a first step, an Arabic AAST in binaural noise for screening the temporal interaction deficit: listening speech in binaural noise, then teetaatoo test with a five subtests for screening the Modern Standard Arabic language phonemes identification ability. For the AAST in quiet, 21 to 33 dB SPL is the normal range of the hearing peripheral loss. There are three different norms, especially, for the AAST in binaural noise; -9 to -13 dB SNR is the normal range of children aged 5 years old, -10 to -13 dB SNR is the normal range of children aged 6 years old, and -10 to -14 dB SNR is the normal range of children aged 7 years old. Finally, for the five subtests (teetaatoo) : > 85% (correct answers) is the normal percentage of the Cons-A, >62& (correct answers) is the normal percentage of the Cons-B1, >76% is the normal percentage of the Cons-B2, >63% (correct answers) is the normal percentage of the Cons-B3, and 84% (correct answers) is the normal percentage of the Vow-A. As mention in table 20, there were no significant differences in the phonemes identification abilities because of the varying in age from 5 to 7 years old, thus, only one norm of normal performance was developed for whole the study sample aged from 5 to 7 years, which may be because the early maturation of this cognitive ability (phonological awareness) in line with Lonigan et al., (2000) & Bertoncini et al., (2009) who found a high level of stability in a longitudinal measure of phonological awareness in which the performance of 5-year-old preschoolers on a series of tasks perfectly predicted the same children’s performance on similar tasks in kindergarten and first grade. While the current study had to provide three different norms for listening speech in binaural noise because of the varying in age from 5 to 7 years old, which may be because listening speech in noise or degraded speech strain the auditory pathways of the central nervous system more than the recognition of unaltered speech or speech in quiet, hence, it is necessary to obtain normative data for each age especially for this kind of tasks (Ollendick & Schroeder, 2003, 87). According, the calculated normative data and the mentioned above, 129 children were screened for any APD risk, using the developed minimal APD battery, and after excluding the successful cases on the SIFTER, 23 children were detected as cases with poor scores, with 17,8% ratio. The 17,8 % ratio of those children at risk for APD equals more than the double of the international ratio of the children with APD, whereas 7% of children are estimated Roughly to have (C)APD (Bamio et al., 2001), which might be because unsuitable living conditions in Egypt compared to the European countries or in USA, especially, the noise levels, whereas the noise issue in Egypt, as environmental pollution, ranks second among environmental pollution issues according to the complaint survey (received by Egyptian Environmental Affairs Agency/EEAA) for 2006, It is considered a serious issue because of its harmful impacts on citizens and public health, In the last years, it has been noticed that noise levels in Egyptian streets are disturbingly increasing. These levels have reached unacceptable limits locally and internationally. Measurements indicate that noise levels in major squares and streets may reach approx. 75–85 dB SPL (Ali & Tamura, 2002). Also, many previous studies on the etiology of auditory processing disorders have proved that low level carbon monoxide, lead exposure in children may affect sites in the CANS producing auditory processing disorders (Edmon, 1998; Musiek & Lee, 1999; Dietrich et al., 1992). Hence, The air pollution in Egypt might be an important second reason for the high ratio of children at APD risk, Actually, it is a serious problem in thickly populated and industrialized areas, especially in greater Cairo area, whereas the conducting of the current study tests was in Beni-suef; the closest town to the greater Cairo. The Carbon monoxide, for the year 2000 presented the most critical air quality problem in Egypt, primarily due to high background values resulting from dust blown from the desert. The highest recorded PM10 values were found in industrial and heavy traffic areas, also a high concentration of Lead which reaches 0.5-10 annual mean 1.5 quarterly mean (Ramadan, 2009; Elraey et al., 2006). Unfortunately, there were not available data by other researches about the estimated ratio of the APD children until this moment and according to the researcher abilities to compare it with the current study out comes.

PHD Title

Constructing and Norming Arabic Screening Tool of Auditory Processing Disorders: Evaluation in a Group of Children at Risk For Learning Disability

PHD Abstract

Constructing and Norming Arabic Screening Tool of Auditory Processing Disorders: Evaluation in a Group of Children at Risk For Learning Disability In Special Education and Rehabilitation Mohamed Mostafa Taha Cologne University Germany 2010 1.1. Introduction to the Literature At the present time, the interest of many scientists and researchers in the field of education and psychology is focused on those individuals with special needs which their level deviated from the level of their normal peers in spite of the availability of the necessary intellectual/mental abilities, especially the lower levels of these abilities in order to find out the problems that hinder their development and obstruct their way towards learning which are known as learning disabilities. Actually, some school-aged children appear to have hearing problems. They are described by their parents and teachers as children who are uncertain about what they hear, have difficulty listening in the presence of background noise, have difficulty following oral instructions, and have difficulty understanding rapid or degraded speech. Some of these children will have a significant loss in peripheral hearing sensitivity. In others, however, auditory thresholds will be within normal limits. It is assumed that, in a significant proportion of the latter group of children, the listening problems result from an auditory processing deficit, the defective processing of auditory information in spite of normal auditory thresholds (Jerger & Musiek, 2000). In the past, children with such problems have been labeled as having "central auditory processing disorder" (CAPD). And it was broadly stated, that (Central) Auditory Processing [(C)AP] refers to the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory information. Narrowly defined, (C)AP refers to the perceptual processing of auditory information in the CNS and the neurobiological activity that underlies that processing and gives rise to electrophysiological auditory potentials. (C)AP includes the auditory mechanisms that underlie the following abilities or skills: sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals (ASHA, 1996; Bellis, 2003; Chermak & Musiek, 2002). (Central) Auditory Processing Disorder [(C)APD] referred to difficulties in the perceptual processing of auditory information in the CNS as demonstrated by poor performance in one or more of the above skills. In keeping with the goals of maintaining operational definitions, avoiding the imputation of anatomic loci, and emphasizing the interactions of disorders at both peripheral and central sites, however, it seems more appropriate to label such problems as "auditory processing disorder" (APD) ( Jerger & Musiek, 2000). Therefore, An APD may be broadly defined as a deficit in the processing of information that is specific to the auditory modality. The problem may be exacerbated in unfavorable acoustic environments. It may be associated with difficulties in listening, speech understanding, language development, and learning. In its pure form, however, it is conceptualized as a deficit in the processing of auditory input. Often children diagnosed with APD may have received another diagnosis before being seen by an audiologist. The disorder can be confusing for parents, educators, and other professionals working with these children. Children with APD are first diagnosed with attention deficit hyperactivity disorder (ADHD) or learning disabilities in general Later (Young, 1999). The Study Questions: Indeed, it is proved from the literature and previous studies why listening speech in binaural noise and phonemes identification ability were chosen to be screened by the current study, hence, the aims of the study are constructing and norming: - An Arabic version of adaptive auditory speech test (AAST) in quiet to rule out the peripheral auditory involvement by screening the children for any hearing loss in dB SPL units. - An Arabic version of adaptive auditory speech test (AAST) in binaural noise for screening the first selected APD aspect: listening speech in binaural noise. - Teetaatoo tests for the Arabic phonemes identifications. Participants included children between the ages of 5 to 7 years old from the nursery school children. The main question of the study is: How the two selected APD (listening speech in binaural noise and the phonemes identification ability disorders could be screened in the Egyptian children at risk for learning disability aged from 5 to 7 years old? And to answer this question, the following sub-questions should be answered: 1. What are the norms of AAST in Quiet (peripheral hearing threshold) for the Egyptian children aged from 5 to 7 years old? 2. What are the norms of AAST in binaural noise for the Egyptian children aged from 5 to 7 years old? 3. What are the norms of the ‘’teetaatoo’’test for Egyptian children aged from 5 to 7 years old? And this question could be divided to five sub questions according the phonemes sub categories: 3.1. What are the norms of the Cons-A sub test (easy set for all the consonants)? 3.2. What are the norms of the Cons-B1 sub test (for: plosives identification)? 3.3. What are the norms of the Cons-B2 (for: nasals, trill, approximant and lateral identification)? 3.4. What are the norms of the Cons-B3 (for: fricatives identification)? 3.5. What are the Norms of the Vow-A (easy set for vowels identification)? 4. Do the scores of the abnormal cases on the Arabic AAST in binaural-noise and the five subtests in teetaatoo test matches their SIFTER data analysis? Results Discussion: The aims of this study were to develop and to provide the normative data of Arabic screening tool for screening the children with auditory processing disorders: an Arabic version of Adaptive auditory speech test (AAST) in quiet for screening the peripheral hearing in dB SPL units, as a first step, an Arabic AAST in binaural noise for screening the temporal interaction deficit: listening speech in binaural noise, then teetaatoo test with a five subtests for screening the Modern Standard Arabic language phonemes identification ability. For the AAST in quiet, 21 to 33 dB SPL is the normal range of the hearing peripheral loss. There are three different norms, especially, for the AAST in binaural noise; -9 to -13 dB SNR is the normal range of children aged 5 years old, -10 to -13 dB SNR is the normal range of children aged 6 years old, and -10 to -14 dB SNR is the normal range of children aged 7 years old. Finally, for the five subtests (teetaatoo) : > 85% (correct answers) is the normal percentage of the Cons-A, >62& (correct answers) is the normal percentage of the Cons-B1, >76% is the normal percentage of the Cons-B2, >63% (correct answers) is the normal percentage of the Cons-B3, and 84% (correct answers) is the normal percentage of the Vow-A. As mention in table 20, there were no significant differences in the phonemes identification abilities because of the varying in age from 5 to 7 years old, thus, only one norm of normal performance was developed for whole the study sample aged from 5 to 7 years, which may be because the early maturation of this cognitive ability (phonological awareness) in line with Lonigan et al., (2000) & Bertoncini et al., (2009) who found a high level of stability in a longitudinal measure of phonological awareness in which the performance of 5-year-old preschoolers on a series of tasks perfectly predicted the same children’s performance on similar tasks in kindergarten and first grade. While the current study had to provide three different norms for listening speech in binaural noise because of the varying in age from 5 to 7 years old, which may be because listening speech in noise or degraded speech strain the auditory pathways of the central nervous system more than the recognition of unaltered speech or speech in quiet, hence, it is necessary to obtain normative data for each age especially for this kind of tasks (Ollendick & Schroeder, 2003, 87). According, the calculated normative data and the mentioned above, 129 children were screened for any APD risk, using the developed minimal APD battery, and after excluding the successful cases on the SIFTER, 23 children were detected as cases with poor scores, with 17,8% ratio. The 17,8 % ratio of those children at risk for APD equals more than the double of the international ratio of the children with APD, whereas 7% of children are estimated Roughly to have (C)APD (Bamio et al., 2001), which might be because unsuitable living conditions in Egypt compared to the European countries or in USA, especially, the noise levels, whereas the noise issue in Egypt, as environmental pollution, ranks second among environmental pollution issues according to the complaint survey (received by Egyptian Environmental Affairs Agency/EEAA) for 2006, It is considered a serious issue because of its harmful impacts on citizens and public health, In the last years, it has been noticed that noise levels in Egyptian streets are disturbingly increasing. These levels have reached unacceptable limits locally and internationally. Measurements indicate that noise levels in major squares and streets may reach approx. 75–85 dB SPL (Ali & Tamura, 2002). Also, many previous studies on the etiology of auditory processing disorders have proved that low level carbon monoxide, lead exposure in children may affect sites in the CANS producing auditory processing disorders (Edmon, 1998; Musiek & Lee, 1999; Dietrich et al., 1992). Hence, The air pollution in Egypt might be an important second reason for the high ratio of children at APD risk, Actually, it is a serious problem in thickly populated and industrialized areas, especially in greater Cairo area, whereas the conducting of the current study tests was in Beni-suef; the closest town to the greater Cairo. The Carbon monoxide, for the year 2000 presented the most critical air quality problem in Egypt, primarily due to high background values resulting from dust blown from the desert. The highest recorded PM10 values were found in industrial and heavy traffic areas, also a high concentration of Lead which reaches 0.5-10 annual mean 1.5 quarterly mean (Ramadan, 2009; Elraey et al., 2006). Unfortunately, there were not available data by other researches about the estimated ratio of the APD children until this moment and according to the researcher abilities to compare it with the current study out comes.