Origin of the 7 year old threshold for CAPD Testing

Frank E. Musiek

A popular discussion for some time has been why can’t children under 7 years of age be tested for CAPD? Many audiologists and speech pathologists argue that much could be done for these children if only a diagnosis of CAPD could be rendered at an earlier age. This is certainly a worthy concept with which I agree. However, let’s return to the first question. I was the individual back in the early 1980s who first stated/showed the test battery I used could not, and should not be applied to children under the age of 7 years. It could be used, however for typically developing 7 year old children and those older (Musiek, Geurkink, Keitel, 1982; Musiek, 1979). My rational for this cut off age was quite simple. When I normed my central auditory tests on children, after many many hours of work most of which I did myself, I found that the variability for children under 7 years of age, was in my opinion too great to make the tests reliable. Obviously, some tests revealed more variance than others but I decided that 7 years of age was a reasonable cut off. Therefore, I began to use these criteria, and also to present it at conferences and also wrote about it in some publications. This decision that was made pertained only to the tests that I normed back in the 1980s and was not intended to be universally applied. At this point in time I encouraged other researchers and clinicians to collect their own norms for the tests they used and for populations seen clinically.

In establishing our original pediatric norms almost 40 years ago I used 2 standard deviations below the mean on these tests to indicate a non-passing performance. If these norms for these tests are “loosened” then of course accuracy suffers and soon these tests essentially become very poor at separating typically performing children from those with CAPD. It also lends itself to a “bottoming” or “floor” effect –where scores are so low they have no differential capability. It should be noted that some tests from back in 1979 were recommended to only use on 8 year olds because for these tests (frequency/pitch patterns, competing sentences) variability was too great for even 7 year olds. Therefore, we suggested that frequency patterns and competing sentences should be used with children 8 years of age and older while the remaining test battery could be employed with 7 year olds). Our original norms were established on children from the mid, eastern Vermont, western New Hampshire region which was our primary but not only referral area. Though our pediatric norms were modified ever so slightly over the years they remained essentially the same. In fact, though I can’t be sure of this, I believe Teri Bellis who did a NeuroAudiology fellowship with me in the 1990’s later collected her own pediatric norms and they were very similar (Bellis, 2002).

There is another interpretive factor worth mentioning here. It is what I refer to as a one way interpretation. This simply means that if a child is under 7, and a test battery is conducted on them and they perform at a 7 year old age level or better then one could consider them as without CAPD (but they should be followed yearly). On the other hand, if a child under 7 takes the tests and performs below the norms then really nothing can be said regarding a CAPD diagnosis. It could be a number of things other than CAPD that could drive down the tests scores on these children into the abnormal range.

So even though variability in very young children for our test battery restricted it’s age range this doesn’t mean there are not other tests that cannot be used with children under 7 years of age. It is important however to look carefully at any test’s variability in very young children. This variability is usually greater the younger the child and much of this is related to immature central nervous systems as well as other things. I sincerely hope that other tests have and or will emerge that can be reliably employed with young children—but we all need to be careful.

Another point that I would like to make is that even if children must meet the 7 year old criteria it does not mean that some form of auditory training/habilitation can’t be performed on 6 year olds and even much younger children (see Chermak and Musiek, 2014a). Children that have a high index of suspicion for CAPD can partake in various auditory training (AT) exercises and games. This can be conducted on an individual basis or in groups. Auditory training games serve all children well. This idea is not new, many years ago and even now, AT games for elementary school age children have been utilized—-though probably not as much as they should be. Good listening skills are the foundation of learning and a derivative of AT.

There can be a definite advantage of employing listening exercises (games) for pre-school children whether they are suspected of CAPD or not. For example, (1) games involved in following auditory directives progressing from simple to complex can be conducted in practically any setting. This exercise can be done with a group or single child. (2) Simple localization tasks where children who are blind folded point to the source that can be moved with every trial. (3) The discrimination of two sounds/ phonemes/ words can be generated through a computer and presented in a sound field using adaptive techniques (see Chermak and Musiek, 2014a; Thibodeau, 2014)). These are only a few ideas on composing listening games that are also a form of AT —many more examples can be found in various references (Chermak and Musiek, 2014b).

 

References

  1. Bellis, T. (2002) When the Brain Can’t Hear, New York: Pocket Books, 2002.
  2. Chermak, G. and Musiek, F. (2014a). Emerging and future directions in intervention for central auditory processing disorder. In: Chermak, G and Musiek, F. (Eds.), Handbook of Central Auditory Disorder: Comprehensive Intervention (vol. 2, 2nd ed.). San Diego, CA: Plural Publishing.
  3. Chermak, G. & Musiek, F. (2014b) 2nd Editions Handbook of Central Auditory Processing Disroder, Vol. II: Comprehensive Intervention. San Diego, CA. Plural Publishing.
  4. Musiek, F. (1979) Auditory Perception in Children.  Council of Exceptional Children, Annual Meeting, Manchester, NH, April.
  5. Musiek, F.E., Geurkink, N.A. & Keitel, S.  (1982). Test Battery Assessment of Auditory Perceptual Dysfunction in Children.  Laryngoscope, 92, 251-257.
  6. Thibodeau, L. (2014) Computer-Based Auditory Training (CBAT) for Central Auditory Processing Disorder, In: Chermak, G and Musiek, F. (Eds.), Handbook of Central Auditory Disorder: Comprehensive Intervention (vol. 2, 2nd ed.). San Diego, CA: Plural Publishing.

About Pathways

Pathways is both a column that covers topics related to CAPD and Neuroaudiology and a society for people interested in central auditory disorders that regularly meets to discuss these issues.

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