Speech in Noise Deficits in Children with Attention Deficit Hyperactivity Disorder

Donna Geffner, Ph.D., CCC-Sp/A, Long Island AuD. Consortium
St. John’s University, New York

As audiologists it is not typical for us to encounter a population of children and adults with AD/HD unless they disclose their diagnosis. However, this is the very population that we should encounter for they exhibit many auditory processing deficits. It was of interest to investigate whether children with AD/HD have more problems listening in background noise than the typical child. Over the years, it has become apparent that children with AD/HD complain about not hearing when it is noisy, not being able to focus when there is noise in the classroom, or not being able to concentrate if other people are talking. Are those the symptoms of AD/HD or is it a manifestation of an auditory processing problem? Can they co-occur and not be mutually exclusive? The DSM-4 cites problems for AD/HD Inattentive Type as: having difficulty following directions, distractibility in noise and listening problems, not being able to listen when spoken to directly. It is known that 8.4% of school-age children are diagnosed with AD/HD according to the Centers for Disease Control (2011), and among this population of children, 50-80% have co-morbid conditions (Redmond, 2003). Many of the co-morbid conditions include reading disabilities, learning disabilities, OCD, Tourette’s syndrome, sensory integrative disorder, depression, anxiety, and auditory processing disorders. For instance, approximately 14% of children with the diagnosis of AD/HD have behavioral disorders, while 25% have autism, 50% have dyslexia and/or dyscalculia, with mild LD, and 50% have motoric disorders. Westby and Watson (2004) found a relationship between AD/HD and auditory abilities. Lucker, Geffner and Koch, (1996) found reduced tolerance and comfort levels of listening in AD/HD children, suggesting a possible hypersensitivity to loud sounds. Cohen, Davine, Horodezky, Lipsett and Isaason (1993) found that children with AD/HD had problems processing verbal and phonological information. Higher prevalence of difficulties in both following directions and auditory comprehension (CELF-4) were found in a population of children with AD/HD (DaParma, Geffner and Martin, 2011). Keith in 1983 found a relationship between APD and AD/HD in children. Keller (1992) found a correlation between AD/HD and poor listening skills, weak auditory association skills and distractibility. Riccio et al. (1994) found a high co-morbidity of APD and AD/HD, and 50% of their population diagnosed with APD also fit the criteria for AD/HD. Geffner, Lucker and Koch (1996) found speech in noise deficits using the Nu-6 word list (S/N+10) and the GFWT of Selective Attention (AGS). Sutcliffe, Bishop, Houghton and Taylor (2006) found deficits in discriminating pitch and slower processing speech of response in a population of AD/HD. The literature suggests that for the population of children with AD/HD there is a possibility of auditory processing problems present. Further, it is not unlikely to hear complaints from parents who bring their children for hearing tests that the teacher has informed them that their child doesn’t seem to hear, or listen in class.

We set out to investigate the question whether children with AD/HD have more problems discriminating speech in the presence of noise. Going through the archives of records of children with the diagnosis of AD/HD who were also seen for auditory processing evaluation, 100 were selected between the ages of 8-11 years. There were 64 males and 36 females, not unlike the typical distribution of males to females with AD/HD (usually 4:1). Of the 100 children, 70 had unspecified AD/HD, that is we did not know whether they were the inattentive or hyperactive or combined type. Of the population, 25% had at least one known co-morbid condition. The review of the files produced information pertaining their test scores on the W-22 Speech-in-noise test (Katz, 1997) administered at a S/N +5 @40dBHL, and the Auditory Figure Ground Listening Subtest of the Scan-3C (Keith, 2009) administered at S/N+8dBHL. Scores and standard deviations were compared to test normative data for ages 8-11 in order to obtain a Speech-in-Noise difference score. Scores for each ear were compared with the scores registered for age appropriate norms.

Results indicated that on the Figure-Ground listening test (SCAN-3C) 32% of this sample scored more than 2 Standard Deviations below the median (in comparison 2% of normally developing children scored in this range). On the W-22 Speech-in-noise Test, a slightly greater prevalence of disorder occurred with 23% showing a failure in the right ear and 30% showing a failure in the left ear, thus suggesting a right ear advantage. In comparison to Katz’ data for each age group (8,9,10,11), our data indicated a greater number of children failed to meet the criterion reference cut off score and produced greater inter-aural difference than the data appearing in the CD Word Recognition test in Noise Limits of Normal (Katz,1997).

Overall findings indicate that there is a higher prevalence of speech-in-noise deficits in a population of children with AD/HD, with a greater incidence of left ear disorder, or a right ear advantage.

The findings of this research suggest that children with AD/HD should be screened for Speech-in-noise deficits so accommodations may be afforded them, such as the use of an FM unit in class, or accommodations such as preferential seating, copy of class notes, seating away from distractions, and other accommodations. Such deficits may and do exacerbate their AD/HD symptoms. Thus children with Ad/HD should not just be glossed over and their symptoms of poor listening attributed to their AD/HD only. They should be evaluated for central auditory processing disorders. The best outcome of this measure is to provide those children with means to accommodate their auditory processing challenges and improve their auditory attention.

Dr. Donna Geffner, a dually certified and licensed speech-language pathologist and audiologist maintains a private practice in Long Island, NY.  She serves as the Director of the Speech and Hearing Center at St. John’s University, Queens, New York, where she created and founded both the undergraduate and graduate programs and Center.  She is the recent developer of a consortium doctoral program in audiology with her colleagues from Adelphi and Hofstra Universities, and serves as the director of the St. John’s University Doctoral Audiology program for the LI AuD Consortium. 

References

1. Centers for Disease Control and Prevention. (2011). Attention/hyperactivity disorder (ADHD). https://www.cdc.gov/ncbdd/adhd/data/html
2. Cohen, N. J., Davine, M., Horodezky, N., Lipsett, L., & Isaacson, L. (1993). Unsuspected language impairment in psychiatrically disturbed children: Prevalence and language and behavioral characteristics. Journal of American Academy and Adolescent Psychiatry, 32, 595-603.
3. DaParma, A., Geffner, D., & Martin, N. (2011). Prevalence and nature of language impairment in children with attention deficit/hyperactivity disorder. Contemporary Issues in Communication Sciences and Disorders, 28, 119-125. doi: 1092-5171/11/3802-0119.
4. DSM-4 Development. https://dsm.psychiatryonline.org/book.aspx?bookid=22
5. Geffner, D., Lucker, J. R., & Koch, W. (1996). Evaluation of auditory discrimination in children with ADD and without ADD. Child Psychiatry and Human Development, 26(3), 169-179.
6. Katz, J. (1997). CID Auditory Test W-22 (Speech-in-Noise Test). Vancouver, WA 98664.
7. Keith, R. W. (2009). SCAN-C test of auditory processing in children – revised. San Antonia, TX, Pearson Education Inc.
8. Keller, W. D. (1992). Auditory processing disorder or attention deficit disorder? In J. Katz, N. A. Stecker, & D. Henderson (Eds.), Central auditory processing: A transdisciplinary view.
9. Lucker, J. R., Geffner, D., & Koch, W. (1996). Perception of loudness in children with ADD and without ADD. Child Psychiatry and Human Development, 26(3), 181-190.
10. Redmond, S. (2003). Conversational profiles of children with ADHD, SLI and typical development. Clinical Linguistics & Phonetics, 18(2), 107-125. doi: 10.1080/026699200310001611612.
11. Riccio, C. A., Hynd, G. F., Cohen, M. J., Hall, J. & Molt, L. (1994). Comorbidity of central auditory processing disorder and attention –deficit hyperactivity disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 849-857.
12. Sutcliffe, P. A., Bishop, D. V., Houghton, S., & Taylor, M. (2006). Effect of attentional state on fluency discrimination: A comparison of children with ADHD on and off medication. Journal of Speech, Language and Hearing Research: JSLHR, 49(5), 1072-1084.
13. Wetsby, C., & Watson, S. (2004). Perspectives on attention deficit hyperactivity disorder: Executive functions, working memory, and language disabilities. Seminars in Speech and Language, 25(3), 241-253.