An interview with Brian O’Hara Regarding the Auditory Processing Domains Questionnaire (APDQ), Part 2

August 9, 2023

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. This month is Part 2 of an interview with Brian O’Hara and the APDQ. (click here for Part 1)

Q6. For those not familiar with your questionnaire could you provide a brief overview?

QA 6.   The APDQ Online and Excel version questionnaires conclude with a Screening REPORT which displays Item and Scale scores. Based on Receiver Operator Curve data cutoffs) and inter-group regression data the most likely risk factor(s) are automatically selected from the following menu:

Primary  Risk Factors (only one selected)

1-2.  High or Mild to Moderate  APD Risks

3-4. High or Mild to Moderate ADHD Risks

5. Combined APD-ADHD Risks

6-7. Language-Learning Listening Challenges or Language Deficits

8. Normal Screening results

Lessor Risk Factors ( two selectable)

10-11-12. Possible Auditory Processing, Attention, and/or Language Deficit Concerns.

Depending on the scale cited, High Risk Factor cut off scores are < 5th to 10th rank percentile while Mild to Moderate Risk Factors cut-offs are at < 15th to 20th rank percentiles

To get this REPORT parents or teachers would have taken 10 to 15 minutes to rate 50 key items (skill performance indicators) from 3 Scales. The AP Scale has 29 items, Attention Scale 10 items,  and Language Scale 11 items.  Ratings follow a 4 point modified Richter Scale with 4 points for “Most Times,” 3 points for “Often,” 1 point for “Sometimes “ and  0 points for “Rarely” occurring.  Our Pearson R parent-repeat rating of .88 suggests psychometrically acceptable intra-rater reliability. Our between-group differences analyzed with a regression model offered one acceptable measure of  eternal validity.

It is beyond the score of this interview to discuss details of the many factors involved in  -scoring. Because “bonus” points are subtracted for extreme degradation between “listening in quiet” and “listening in noise” the AP scale can only be scored by Excel or online.  All other scales, including TAP can be scored manually. . Suffice it to say that the APDQ has no difficulty separating both normal listeners from clinical groups and clinical groups from each other to guide referral needs.   However, clinical group subjects often have “Lessor concerns” with 1 or 2 other scales: 80 percent of ADHD group with APD, and 65 % of the APD group with ADHD .  It was an exception to find a clinical group subject with only one risk factor.  We chose to remove any student with a < 3rd rank percentile Language Scale score (< 45% raw score)  from a Primary APD or ADHD risk designation since very low Language scores create different, non APD remediation priorities. than the opposite).  This data interpretation could  be questioned by an audiologist as too arbitrary and be re-interpreted. However, major cognitive-language limitations  contribute to misunderstanding APD as a top-down, less auditory, cognitive disorder.

Q7. Brian, you had a long course in refining this procedure – can you again briefly, take us down this road?

Q A7. Evolutionary timeline for APDQ:

1999 – 2002 Mini fellowship with Dr. Musiek (and follow ups) at Dartmouth-Hitchcock Medical Center from January to March – APDQ conceived.

2003 – 2005.  Completion of draft questionnaire after wide-ranging literature search to pair 52 key skill-performance items with 3 Listening and Learnings scale constructs.

An aspirational, instrumental  software consultant, Tim Holmes of Ontario Canada was recruited to spearhead Excel scoring and database operations. It was his vision to put the  APDQ online.

2005 – 2007.  Normative data was collected with generous assistance from the Kaiser Center for Health Research – an  invaluable resource since no grant money was ever available.  Two hundred fifty parents responded to 1700 mail-outs (14.7% return).  Final normative group           N(umbers) were 190 Normal Group, 40 ADHD clinical group, 20 APD clinical group and 20 Language/LD clinical group. Normative Scale value results were significantly affected only by age. The racial demographic was typical for Hawaii but not the entire US. The parent education level of 2/3rd college graduates and above was atypical but this demographic  slightly affected only the Language Scale.  The fact that Scale means, and SD results have been generally comparable between  Hawaiian, Iranian and Brazilian studies suggests that demographic factors may not be a major obstacle in interpreting APDQ results.

2008 – 2016  APDQ presentations occurred at several National Meetings (AAA,ASHA, EAA). Questionnaire requests answered by free email downloads. A Persian language translation request from Dr. Mohsen Ahadi (now Director of Audiology at Tehran Medical University)  resulted in the first published APDQ research article in 2017 (authored by Zohre Amadi, PhD  candidate),  with a robust 270 subject normative population. This was followed by 2 more  Iranian APDQ studies with impressive 400 subjects each.

2016 –2018 Extensive collaboration occurred with Drs. Harvey Dillon and  Kiri Mealings at Macquarie University-National Acoustics Lab, in  Sydney Australia. A 50 item online version of APDQ briefly appeared on their Website until removed by a change in NAL administration.  November 2018 “Developing the Auditory Processing Questionnaire: A Differential Screening Tool for  Auditory Processing Disorder) was published in the  International Journal of Audiology, co-authored by Drs. O’Hara and Kiri Mealings.

2019 – 2023  Excel database analysis determined that the 2018 APDQ revision from 52 to 50 items changed only 3 of 250 normative subjects’ risk-factor designations. This has made it possible to use our original 52 item database unchanged since raw scores are “percent of perfect” scale scores and not penalized by item removed. We are reporting this now to clarify the record.

Q8. There has recently been a considerable uptake in the attention the APDQ – tell us about this.

QA 8.  A steady increase in APDQ interest has occurred with mean monthly “hits” at our posting  site averaging  25  in 2021 – 2022, but 50  since 2023.   About 35% are from abroad.  The Taylor and Francis Publisher’s website indicates 1200 hits total since 2018 (300 by 2020).  Language translations have continued with Persian, Norwegian, Brazilian, Portuguese, Spanish, French, Kuwaiti- Arabic, and Turkish being followed by Mandarin (Taiwan), Russian (St. Petersburg), Tamil (India), Romanian, Hungarian, and Greek. This has been  very   rewarding world travel!  Only Norwegian, Brazilian, and Iranian translations have been published, while many are still in progress.

Q9. What about future Directions?

QA 9.  The future seems bright for APDQ as its use should increase with online exposure. New studies will need to be published documenting its accuracy on clinical and APD test follow-ups.     The hit rate for may be a new “periscope up” for world-wide interest in APDQ.  New hands will soon be sought to manage this project into the future. We are looking for an individual audiologist, or clinic/academic group to do so. “ Happy 87th Birthday, Dr. O’Hara!”

Please visit the new auditory screening website for free APDQ use with instant scoring.  Keep in touch at [email protected].

(FM), Thank you for a most interesting interview and keep up the good work!

(Brian) Thanks again Frank, for allowing us to share this news on Pathways.

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