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Language Affection in Children Having CAPD

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Dr. Dalia Mostafa Osman, M.D. Phoniatrics,

ASHA CCC-SLP

Assist. Prof. of Phoniatrics, Cairo University

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When

the brain

can’t hear

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Lecture Outline

الخطوط العريضة للمحاضرة

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Introduction

المقدمة

��أكفأ طريقة لنمو المهارات اللغوية هو الحس السمعي �

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First words

الكلمات الأولى

Vocalization

أصوات

Phrases

عبارات

Sentences

جمل

Story telling

رواية قصة

Almost adult like

لغة مماثلة للغة الراشدين

5سنوات 4 سنوات 3 سنوات سنتين سنة 6 أشهر عند الولادة بعد الولادة

Language skills are developed most efficiently through the auditory sensory modality

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)

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Operations

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Peripheral Auditory Input

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WHAT WE DO

WITH

WHAT WE HEAR

CAP Skills

• Auditory attention

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• Auditory discrimination

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• Auditory localization

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CAP Skills

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• Auditory figure ground

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• Auditory association

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• Auditory blending

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• Auditory segmentation

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CAP Skills

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• Auditory memory

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• Auditory sequential memory
• Auditory closure

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• Auditory integration

Together

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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 SKILLS

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CAPD & Language

• Children with CAPD usually experience language difficulties

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• Some difficulties may be more prominent than others Classification

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Left

Right

• 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 study

الهدف من الدراسة

Aim

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

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• To reach a better understanding

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• Thereby, enabling early detection and referral

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Participants

المشاركون في البحث

Subjects

Group I (Study)

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• N = 20
• Audiology Unit,

Ain Shams University

• 7;07-10;06 years old
• 8; 08 ± 1; 02 years old

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Group II (Control)

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

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Linguistic Tasks

المهارات اللغوية

Linguistic Tasks

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• Earlier researches

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• Parents’ report

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• Standardized Formal Tests

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Linguistic Tasks

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1:1

Quiet Room

Demos &

Trials

Linguistic Tasks

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

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• Expressive vocabulary
• Word Retrieval
• Sentence Formation
• Sentence Repetition
• Narrative Skills

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• Forward Number Repetition
• Backward Number Repetition
• Repetition of Familiar Sequences

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1- Semantic Categorization

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• No picture Stimuli
• 20 items
• Repetitions (once)
• A score of 1 for each correct response

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

عربية - قلم – بنزين – اشارة

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Semantic Categorization

• More difficulties with abstract items

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متحمس – قرن - ناجح – طموح

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• Difficulties with category names & being specific

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2- Understanding Oral Instructions

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• Picture Stimuli
• 50 items
• Repetitions not allowed
• A score of 1 for each correct response

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

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• Simple instructions
• Simple instructions with modifiers
• 2-3 order (multi-sequential instructions)
• Instructions involving embedded phrases
• Exceptional indicators
• Conditional indicators
• Temporal indicators
• Spatial indicators
• Ordinal / serial numbers

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Understanding Oral Instructions

• Most common complaint

• Temporal indicators

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• An important distinguishing feature

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• Auditorization (verbally repeating the introduced instruction before responding)

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3-Auditory Comprehension

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• Three age-relevant stories
• 15 questions (5 for each story)
• Repetitions for questions but not paragraph
• A score of 1 for each correct response

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• Main topic
• Fine details
• Sequence of events
• Infer indirect information
• Predict logical events

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Auditory Comprehension

• Poor performance

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

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4-Expressive Vocabulary

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• Picture Stimuli
• 20 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.

4- Expressive Vocabulary (EV)

• 20 picture stimuli were used

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• 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.

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• 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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• 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

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

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• More difficulties for uncommon objects

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• 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

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• No picture Stimuli
• Three groups
• A 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

Word Retrieval

• Disruption in the mental activity responsible for storing retrieving and selecting stored words

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• Inefficient temporal-to-frontal

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Word Retrieval

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• Clustering and Grouping

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• Repetition

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• Interjections

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• Circumlocutions

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6- Sentence Formation

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• Picture Stimuli
• 10 items
• Repetitions (of the word to be used once)
• A score of 1 for relevant use
• A 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

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• Words were graded in difficulty

6- Sentence Formation (SF)

• Picture stimuli were used to elicit verbal responses from the children under study.

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• 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.

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• 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.

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

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Difficulties with sticking to the instructions

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Sentence Formation

7- Sentence Repetition

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• No picture stimuli
• 30 items
• Repetitions not allowed
• A score of 3 --no errors
• A score of 2 ---1-2 error
• A score of 1 ---3-4 errors
• A score of 0 more than 4 errors.

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• Repeat each sentence after hearing it
• Sentences were graded in difficulty

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Sentence Repetition

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• Inefficient auditory memory

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

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8-Narrative Skills

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• No picture Stimuli
• 15 items (5 for each narrative)
• A score of 1 for each correct response

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• Describe three events
• 1 for ability to maintain the topic discussed
• 1 for ability to sequence ideas logically
• 1 for providing necessary details
• 1 for being specific
• 1 for using appropriate close endings

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9-Forward Number Repetition

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• No picture Stimuli
• 10 items
• Repetitions not allowed
• A score of 1 for each correct response

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

1-2-5

2-5-6-9-10

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10- Backward Number Repetition

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• No picture stimuli
• 10 items
• Repetitions not allowed
• A score of 1 for each correct response

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• 10 sets of numbers (progressively graded in length)

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• Precisely repeat each but in the reverse order

2-3-7

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

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

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

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11- Repetition of Familiar Sequences

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• No picture Stimuli
• 6 items
• Repetitions not allowed
• A score of 1 for each correct response

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

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

ا-2-3-4-5-6-7-8-9-10

السبت-الأحد-الأثنين-الثلاثاء-الأربعاء-الخميس-الجمعة

Repetition of Familiar Sequences

• Difficulties mostly related limited auditory sequential abilities

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• 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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Conclusion & Recommendations

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

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• 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

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Teaching

CAPD

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