Editors Note: The Auditory Processing Domains Questionnaire (APDQ) by Brian O’Hara has continued to receive more attention as a tool in CAPD evaluation. Pathways thought it was timely to do an interview with Dr. O’Hara and learn more about him and the APDQ. The following is the first in a two-part interview that delves into the background of this clinician who has a rather unique background and his now popular questionnaire.
Q1. Hi Brian thanks for this interview. Your background is different than most people in clinical or hearing research. Could you elaborate on this?
QA 1. Thanks for the opportunity to share my story about being a pediatric Marco Polo in Terra Audiology for the past 20 years. It is timely since by June 2023 we will have launched our online version of the Auditory Processing Domains Questionnaire (APDQ).
Yes, my medical professional background was atypical from the start, since I avoided undergraduate laboratory science (history major) but still found biomedical education the most humanistic and practical study of all. In 1970 I went into general pediatric practice in Honolulu after post-doc fellowship training in Development-Behavioral Pediatrics (DBP) at the University of. Washington. My passion, however, was “the learning brain” and consulting at school special-ed student conferences under IDEA ((Individuals with Disabilities Education Act).
By my retirement in 1998 DPB had been recognized as a board certified pediatric subspecialty and I was to develop a half-time clinic at our Kaiser Medical Center. Much of this was driven by the historical events of parents demanding community resources for their newly diagnosed autistic and other handicapped children with the concept of treatable alternatives to their previous unpopular and unkind Mental Retardation labelling
Q2. Given your background then, how did you become interested in CAPD?
QA 2. My part time DBP clinic continued for several years after my retirement. I encountered a patient who had been evaluated by a visiting audiologist, Dr. J Ferré, whose clinic conference presentation made me realize that APD-Listening skills were a critical and missing part of my
learning puzzle. Soon I met Dr. Musiek at an AAA conference and was able to sign up for his “mini” neuro-audiology fellowship at Dartmouth-Hitchcock. Terra Audiology soon became a winter wonderland with frozen lake skating, skiing, and solid, novel learning for 3 months.
Q3. Do you think pediatricians are or should be interested in CAPD ?
QA 3. Pediatricians, especially DBP subspecialists, should be very interested in APD and encounter audiologists in their training. Unfortunately, this rarely happens. Throughout my collaboration I was usually the only pediatrician at national audiology meetings. This can and will change with greater interdisciplinary outreach from both MD’s and AudD-PhDs. A common language must be found in approaching patients with listening/hearing difficulties, APD, ADHD, ASD, and Learning Disabilities. It is critical that technological advances step up with gold standard reference capabilities, such as promised in the electro-acoustical research of Dr. Nina Kraus et,al.
Q4. How did you get started on investigating a questionnaire for CAPD ?
QA 4. While studying in the library at Dartmouth-Hitchcock, I read that a recent American Academy of Audiology – APD Consensus Conference had recommended “the development and validation of screening questionnaires for school age children based on accepted psychometric principles with clearly defined pass/refer criteria” (Jerger and Musiek 2000). A bright torch appeared. A more up to date psychometric, multidisciplinary approach was needed, perhaps to be husbanded by a multidisciplinarian- pediatrician cross-trained in neuroaudiology I had access to statistician consultation and my SPSS for data analysis and felt my broad exposure to LD constructs as well as medical-center access to a group of kids with ADHD would offer advantages.
Q5. Initially what was the over-all goal in developing the APDQ?
QA 5. Our goal was to develop a screening instrument for parents or teachers to rate their kid’s risk factors for auditory processing, attention deficit and language disorders and be at least 70% accurate on follow-up clinical evaluations. Smart clinical referrals and valuable ecological student data could be expedited for the benefit of the child and family. This goal was later rewarded by a “personal communication” report from a California pediatric medical center audiologist in 2019 where their final clinical diagnoses were correctly predicted by the APDQ as follows: APD 68% accuracy, ADHD 79%, LD 85%and Language Disorder 85%. Simultaneously parents rated their kids with the Evaluation of Children’s Listening and Processing Skills (ECLiPS) questionnaire with double digit lower accuracy for all diagnoses noted, except for APD (62 %). An Iranian APDQ study with 396 Kurdish student in 2018 reported a 9 % prevalence for APD risk factors with 95% of that listening -difficulty group failing the Dichotic Digits and 65% failing the SIN test (Z.Moloudi 2018). We are encouraged that APDQ will pass our > 75 % accuracy goal. A secondary goal of increasing public awareness of APD and connecting parents with professionals will be addressed by our online screening project at auditoryprocessing.org. APDQ User Manuals I and II are available at this website for detailed Questionnaire information.
**Click here for Part 2
