Performance of normal adults and children on central auditory diagnostic tests and their corresponding visual analogs

It has been suggested that, in order to validate a diagnosis of (C)APD (central auditory processing disorder), testing using direct cross-modal analogs should be performed to demonstrate that deficits exist solely or primarily in the auditory modality (McFarland and Cacace, 1995; Cacace and McFarland, 2005). This modality-specific viewpoint is controversial and not universally accepted (American Speech-Language-Hearing Association [ASHA], 2005; Musiek et al, 2005). Further, no such analogs have been developed to date, and neither the feasibility of such testing in normally functioning individuals nor the concurrent validity of cross-modal analogs has been established.

The purpose of this study was to investigate the feasibility of cross-modal testing by examining the performance of normal adults and children on four tests of central auditory function and their corresponding visual analogs. In addition, this study investigated the degree to which concurrent validity of auditory and visual versions of these tests could be demonstrated.

An experimental repeated measures design was employed.

Participants consisted of two groups (adults, n=10; children, n=10) with normal and symmetrical hearing sensitivity, normal or corrected-to-normal visual acuity, and no family or personal history of auditory/otologic, language, learning, neurologic, or related disorders.

Visual analogs of four tests in common clinical use for the diagnosis of (C)APD were developed (Dichotic Digits [Musiek, 1983]; Frequency Patterns [Pinheiro and Ptacek, 1971]; Duration Patterns [Pinheiro and Musiek, 1985]; and the Random Gap Detection Test [RGDT; Keith, 2000]). Participants underwent two 1 hr test sessions separated by at least 1 wk. Order of sessions (auditory, visual) and tests within each session were counterbalanced across participants. ANOVAs (analyses of variance) were used to examine effects of group, modality, and laterality (for the Dichotic/Dichoptic Digits tests) or response condition (for the auditory and visual Frequency Patterns and Duration Patterns tests). Pearson product-moment correlations were used to investigate relationships between auditory and visual performance.

Adults performed significantly better than children on the Dichotic/Dichoptic Digits tests. Results also revealed a significant effect of modality, with auditory better than visual, and a significant modality×laterality interaction, with a right-ear advantage seen for the auditory task and a left-visual-field advantage seen for the visual task. For the Frequency Patterns test and its visual analog, results revealed a significant modality×response condition interaction, with humming better than labeling for the auditory version but the reversed effect for the visual version. For Duration Patterns testing, visual performance was significantly poorer than auditory performance. Due to poor test-retest reliability and ceiling effects for the auditory and visual gap-detection tasks, analyses could not be performed. No cross-modal correlations were observed for any test.

Results demonstrated that cross-modal testing is at least feasible using easily accessible computer hardware and software. The lack of any cross-modal correlations suggests independent processing mechanisms for auditory and visual versions of each task. Examination of performance in individuals with central auditory and pan-sensory disorders is needed to determine the utility of cross-modal analogs in the differential diagnosis of (C)APD.