Criteria to Classify Children as Having Auditory Processing Disorders Purpose The study aimed to determine a criterion to diagnose the presence of auditory processing disorder (APD) in children. Method Using a standard comparison design, 280 children “not at risk” for APD and 100 children “at risk” for APD were evaluated on 4 different tests: Speech-in-Noise Test in ... Clinical Focus
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Clinical Focus  |   June 08, 2018
Criteria to Classify Children as Having Auditory Processing Disorders
 
Author Affiliations & Notes
  • Asha Yathiraj
    All India Institute of Speech and Hearing, Manasagangothri, Mysuru, India
  • Chitnahalli Shankaranarayan Vanaja
    School of Audiology & Speech Language Pathology, Bharati Vidyapeeth (Deemed to be University), Pune, India
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Asha Yathiraj: asha_yathiraj@rediffmail.com
  • Editor-in-Chief: Sumitrajit Dhar
    Editor-in-Chief: Sumitrajit Dhar×
  • Editor: Ann Eddins
    Editor: Ann Eddins×
Article Information
Hearing Disorders / Attention, Memory & Executive Functions / Clinical Focus
Clinical Focus   |   June 08, 2018
Criteria to Classify Children as Having Auditory Processing Disorders
American Journal of Audiology, June 2018, Vol. 27, 173-183. doi:10.1044/2018_AJA-17-0091
History: Received September 8, 2017 , Revised December 25, 2017 , Accepted January 27, 2018
 
American Journal of Audiology, June 2018, Vol. 27, 173-183. doi:10.1044/2018_AJA-17-0091
History: Received September 8, 2017; Revised December 25, 2017; Accepted January 27, 2018

Purpose The study aimed to determine a criterion to diagnose the presence of auditory processing disorder (APD) in children.

Method Using a standard comparison design, 280 children “not at risk” for APD and 100 children “at risk” for APD were evaluated on 4 different tests: Speech-in-Noise Test in Indian English (Yathiraj, Vanaja, & Muthuselvi, 2010), Dichotic Consonant–Vowel (Yathiraj, 1999), Duration Pattern Test (Musiek, Baran, & Pinheiro, 1990), and the Revised Auditory Memory and Sequencing Test in Indian English (Yathiraj, Vanaja, & Muthuselvi, 2010). The age of the children ranged from 6 to 10 years.

Results With a cutoff criterion of 1 SD below the mean of the test scores, 8% of the children “at risk” for APD passed all the tests, whereas 28% passed with a criterion of 2 SDs below the mean scores. The tests most frequently failed by these children were Speech-in-Noise Test in Indian English and Dichotic Consonant–Vowel.

Conclusions A cutoff criterion of 2 SDs below the mean scores of typically developing children is recommended to diagnose children as having APD if they performed poorly on only one test. For children who performed poorly on more than one test, a cutoff criterion of 1 SD below the mean scores of typically developing children is recommended.

Processing of auditory signals requires several auditory abilities or skills. These include sound localization and lateralization, auditory discrimination, auditory pattern recognition, temporal aspects of audition such as temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, temporal masking, as well as auditory performance with degraded acoustic signal (American Speech-Language-Hearing Association [ASHA], 2005). A deficit in any of these processes has been found to result in an auditory processing disorder (APD). It has been observed that children with APD have poor academic performance (Chermak & Musiek, 1992; Dawes & Bishop, 2007; Emerson, Crandall, Seikel, & Chermak, 1997). The prevalence of APD has been noted to vary considerably across studies. In the United States, the prevalence was estimated to be around 2%–5% by Chermak and Musiek (1997), whereas it was found to be just 0.19% in Delaware Valley by Nagao et al. (2016) . In the United Kingdom, Hind et al. (2011)  found the prevalence to be 0.5%–1% in the general population, whereas it was 5.1% in children who had difficulty in perceiving speech in the presence of noise. The prevalence of school-age children at risk for APD was found to be 3.2% in India (Muthuselvi & Yathiraj, 2009). Thus, the prevalence differs across locations. However, this variation could be due to the technique used to determine the prevalence.
The use of a test battery that detects different auditory processing difficulties has been recommended due to the heterogeneity seen in children with APD (Baran, 2007). In several studies, deficiency in one or more processes has been noted in children with APD (Katz, Kurpita, Smith, & Brandner, 1992; Musiek, Geurkink, & Kietel, 1982; Muthuselvi & Yathiraj, 2009; Welsh, Welsh, & Healy, 1980). Although it is an established fact that a test battery approach is superior to isolated tests, there are variations regarding the choice of tests to be incorporated in a test battery (Alles et al., 2011; ASHA, 1996, 2005; Bellis & Ferre, 1999; Dawes & Bishop, 2009; McArthur, 2009; Musiek et al., 2010). The sensitivity and specificity of a test battery have been found to differ depending upon the tests used in the assessment process. However, there is no gold standard presently available regarding the choice of tests to be utilized in a test battery for APD.
Despite there being no gold standard battery of tests, in literature, certain auditory processes have been noted to be commonly affected in children having APD. The processes reported to be frequently affected in children with APD include auditory separation/closure (Katz, 1992; Muthuselvi & Yathiraj, 2009; Welsh et al., 1980), binaural integration (Katz et al., 1992; Musiek et al., 1982; Muthuselvi & Yathiraj, 2009), and temporal processing (Musiek et al., 1982; Muthuselvi & Yathiraj, 2009). In addition, auditory memory has been found to be frequently deviant in children “at risk” for APD (Muthuselvi & Yathiraj, 2009; Yathiraj & Maggu, 2013, 2014). Furthermore, in the Buffalo model put forth by Katz (1992)  and the spoken language processing model given by Medwetsky (2011), a link between auditory memory and auditory processing was proposed.
The use of electrophysiological and electroacoustic measures was recommended to be included in a test battery for APD by Jerger and Musiek (2000) . However, the authors themselves mention that a disadvantage of using such measures is the time and cost involved. Furthermore, Katz et al. (2002)  also report that besides these tests not being cost and time efficient, there is little evidence to suggest that they should be included as a part of a minimal test battery for APD. Beck, Clarke, and Moore (2016)  have also expressed that there is not enough evidence to include electrophysiological tests in a clinical test battery for APD.
An important component of any diagnostic test battery for APD is the criterion used for diagnoses. The criteria used to identify individuals as having APD vary among studies (Bellis & Ferre, 1999; Chermak & Musiek, 1997; Jerger & Musiek, 2000; Keith, 2000) and reports of various monitoring organizations/associations (Alles et al., 2011; ASHA, 1996, 2005; Musiek et al., 2010). The ASHA task force on central auditory processing consensus development (ASHA, 1996) identified a child as having APD if deviant performance was measured on one or more of the processes mentioned in their definition. These processes included sound localization and lateralization, auditory discrimination, auditory pattern recognition, temporal aspects of audition, auditory performance decrements with competing acoustic signals, and auditory performance decrements with degraded acoustic signals. The ASHA working group on APDs in 2005 continued to maintain the criterion of the 1996 task force. However, based on the reports of Chermak and Musiek (1997), they recommended that the individual should be diagnosed as having APD if the performance was at least 2 SDs below the mean on two or more tests in the battery. In addition, they recommended that an individual could be diagnosed as having APD based on a single test when the individual's performance falls at least 3 SDs below the mean or when the finding is accompanied by significant functional difficulty in auditory behaviors reliant on the process assessed. Furthermore, it was recommended that the audiologist should readminister the sole test failed as well as another similar test that assesses the same process to confirm the initial findings.
Similarly, based on the findings of earlier published research (Musiek, Bellis, & Chermak, 2005; Shinn & Musiek, 2007; Spaulding, Plante, & Farinella, 2006; Turner & Hurley, 2009), the American Association of Audiology task force stated that “the use of cutoff scores that are based on appropriate normative data can be used. Cutoff scores (e.g., in percent correct, percentiles, or standard scores) are set at performance levels (e.g., ~−2 standard deviations below the mean) to achieve the best balance between hit rate (sensitivity) and correct rejection rate (specificity)” (Musiek et al., 2010, p. 15). Thus, only examples of cutoff values that may be utilized are provided, with no specific recommendation to differentiate those with from those without APD. Furthermore, unlike most of the sections addressed in the statement, where levels of evidence (1 being strong and 5 being weak) are provided, no level of evidence is mentioned for information on cutoff criteria.
The British Society of Audiology, in their position statement on APD, did not give any direct criterion to be used to diagnose an individual as having APD (Alles et al., 2011). The standard reiterates what is mentioned earlier in literature that there exist no gold standard tests to diagnose APD. However, it recommends “to focus on a core symptom or symptoms; aspects of auditory perception that reflect and can be shown to contribute to the clinical presentation, and that help to add information to the overall evaluation of a child with listening difficulties” (p. 5).
Wilson and Arnott (2013)  found that children were identified as having or not having APD depending on the criterion used. Using nine different criteria that were reported in the literature, they found that a stringent criterion (failure on any tests as per the primary APD subprofiles offered by Bellis, 2003) resulted in 7.3% being diagnosed as having APD. In contrast, a lenient criterion (≥ 1 test at least monaurally within ≥ 1 auditory processing domain, recommended by ASHA, 2005) resulted in 96.0% of the 150 children, who had been earlier assessed for APD, being diagnosed as having the condition. The study sheds light on the need for a consensus regarding the criteria to be used while diagnosing APD. Wilson and Arnott also recommend that diagnosis of the condition should be qualified by mentioning the criteria used and refrain from using the term “central auditory processing disorder” as a global label. However, it needs to be noted that several of the criteria utilized by Wilson and Arnott (2013)  to diagnose children as having APD did not have empirical evidence to support their recommendations.
More recently, Shaikh, Fox-Thomas, and Tucker (2016)  attempted to provide empirical evidence of two different criteria to diagnose APD in children. Retrospectively, they evaluated the impact of utilizing a 1 SD below mean and 2 SDs below mean criterion on 98 children who had been administered a battery of three APD tests recommended by Katz (1992) . The test battery included the Staggered Spondaic Word Test, the Phonemic Synthesis Test, and a speech-in-noise test. They observed that 20% more children failed the tests with a −1 SD criterion compared to a −2 SD criterion, when the data of the 68 children who failed two or more tests were analyzed. They recommended the use of a −1 SD criterion as it was observed that the performance of the children who fell between −1 SD and −2 SD “was similar to a normal distribution” (p. 43).
Earlier, Dillon, Cameron, Glyde, Wilson, and Tomlin (2012)  suggested three different ways to diagnose APD without having to administer too many tests. They also presented the adversities likely to be faced for each of their recommendations. Their first recommendation of making the pass–fail criterion on each test more stringent was not considered viable, as it required an individual to have very poor performance to be failed on a test. In their second suggestion, for an individual to be classified as having APD, he or she should fail more than a single test within the battery. This was considered to require evaluating the person with a large number of tests, thereby increasing statistical and fatigue problems. The third recommendation was to repeat tests that an individual failed, and the person was considered to have truly failed only if he or she obtained poor scores on both evaluations. However, the authors noted that the major adversity of their third recommendation was the additional time taken in evaluating the individual. Furthermore, it was noted that there is a lack of information regarding the extent of deficit that will result in an individual actually facing a problem in real life. Thus, the authors stressed the need for an objective measure of the degree of listening difficulty experienced.
From the literature, it can be seen that there is no consensus regarding the criterion that should be used to diagnose whether an individual has APD or not. The published reports that do provide specific criteria do not back their recommendations with empirical evidence. Hence, the study is aimed at determining cutoff criteria to diagnose the presence of APD in children.
Method
The current study is a continuation of an earlier published article (Yathiraj & Vanaja, 2015) wherein the findings of typically developing children aged 6–10 were provided. A standard group comparison design was used for this study. The typically developing children served as the standard group and the data obtained from the children with APD were compared with those of the standard group.
Participants
Two groups of school-age children in the age range of 6–10 years were evaluated. The first group included typically developing children who were “not at risk” for APD and the second group consisted of children “at risk” for APD. The children were assigned to the groups based on their scores obtained on the Screening Checklist for Auditory Processing (SCAP) developed by Yathiraj and Mascarenhas (2003, 2004) . The checklist has 12 questions related to the condition to be answered by a teacher who had taught children curricular subjects for at least 1 year. In order to be considered “not at risk,” the participants were required to have a cutoff score of less than 6, as recommended by Yathiraj and Mascarenhas (2003, 2004)  and Muthuselvi and Yathiraj (2009) . This cutoff value of SCAP had been found to result in an optimum sensitivity as well as specificity with the former being 71% and the latter being 68% (Muthuselvi & Yathiraj, 2009).
The data collection was obtained in two different centers in India, having similar test facilities, one located in Mysore and the other in Pune. The number of boys and girls tested in the two participant groups as well as within each age group was the same in both the centers. A purposive sampling technique was used to select the participants, wherein only those participants who met the inclusion criteria of the study were selected.
The children “not at risk” for APD consisted of 280 school-age children in the age range of 6–10 years. Among them, there were 40 children aged ≥ 6 to < 7 years and 60 children each in the other four age groups (≥ 7 to < 8 years, ≥ 8 to < 9 years, ≥ 9 to < 10 years, and ≥ 10 to 11 years). Each age group had an equal number of male and female children.
Furthermore, the children in both groups had average or above average IQ on the Raven's Progressive Coloured/Standard Matrices (Raven, 1952). All the children included in both groups attended schools where the instruction was in English. The children were proficient in English, as reported by their teachers. Only those children with air conduction and bone conduction thresholds less than 15 dB HL in the octave frequencies 250 Hz to 8 kHz and 250 Hz to 4 kHz, respectively, were included in the study. To confirm the presence of normal middle ear functioning, the participants were required to obtain “A” type tympanograms with ipsilateral and contralateral acoustic reflexes present for the frequencies 500 Hz, 1 kHz, and 2 kHz. In addition, speech identification scores in quiet, determined using the Common Speech Discrimination Test for Indians (Maya Devi, 1974), were greater than 85% for all the participants. This test with 25 consonant–vowel nonwords, common across several Indian languages, had norms established on children. The test, presented through headphones at 40 dB SL, was utilized to confirm that the participants had normal speech identification scores in quiet. In addition, the participants were required to have age-appropriate language on the Northwestern Syntax Screening Test developed by Lee (1969) . The Indian norms of the test, developed by Varma (2001), were used to determine the language age of the children.
The children “at risk” for APD included 100 children in the age range of 6–10 years. These children had similar inclusion criteria as that of the children “not at risk” for APD, except that they had a score of 6 and more on SCAP. Figure 1 depicts the age and gender distribution of all the children included in the study.
Figure 1.

Age and gender distribution of the children at risk and not at risk for auditory processing disorder (APD).

 Age and gender distribution of the children at risk and not at risk for auditory processing disorder (APD).
Figure 1.

Age and gender distribution of the children at risk and not at risk for auditory processing disorder (APD).

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Equipment
A calibrated dual-channel diagnostic audiometer (Madsen OB 922, Version 2) with air conduction (TDH-39) and bone conduction (B-71) transducers was used to carry out pure-tone audiometry, speech audiometry, and the APD tests. A calibrated immittance meter (Grason and Stadler, GSI Tympstar, Version 2) was utilized to ensure normal middle ear function. The APD tests were played through a CD using a laptop with an Intel Pentium dual-core processor.
Test Environment
All the audiological tests were carried out in an acoustically treated two-room suite with permissible noise limits as specified by the American National Standards Institute (1999) . The screening checklist, the IQ test, and the language screening tests were administered in quiet, distraction-free rooms.
Procedure
The study conformed with the Ethical Guidelines for Bio-Behavioral Research Involving Human Subjects of the All India Institute of Speech and Hearing, Mysore (2009) . Prior to evaluation of the participants, informed consent was obtained from the caregivers of the children. All the children enrolled in the study were evaluated using the CD version of four different APD tests at 40 dB SL (Ref. pure-tone average). The tests included Speech-in-Noise Test in Indian English (SPIN-IE) developed by Yathiraj, Vanaja, and Muthuselvi (2010), Dichotic Consonant–Vowel (DCV) constructed by Yathiraj (1999), Duration Pattern Test (DPT; Musiek, Baran, & Pinheiro, 1990) recorded by Gauri (2003), and Revised Auditory Memory and Sequencing Test in Indian English (RAMST-IE) developed by Yathiraj, Vanaja, and Muthuselvi (2010) . The four tests were used to measure monaural auditory separation/closure, auditory integration, temporal patterning, and higher-order cognitive ability associated with auditory processing, respectively. These processes/higher-order cognitive skills were selected as they have been reported to be frequently affected in children with APD. Furthermore, the DPT was preferred over the pitch pattern test as clinical experience has indicated that children were able to carry out the former more easily when compared to the latter. This was majorly due to them being able to understand the meaning of the word “duration” rather than the word “pitch.”
SPIN-IE contained phonemically balanced words in Indian English developed by Yathiraj and Muthuselvi (2009), embedded in an eight-talker Indian English babble. The testing was done using a 0 dB signal-to-noise ratio. The DCV test had 30 stimuli having six stop consonants (/pa/, /ta/, /ka/, /ba/, /da/, and /g/), presented with a 0-ms lag time. The DPT contained 30 triads of 1-kHz tones varying in duration, two being similar and one being different. The RAMST-IE had words highly familiar to children aged 6 years that were grouped to form tokens containing three-word to eight-word sequences. The three-word and four-word sequences had two tokens each, and the five-word to eight-word sequences had four tokens each. The total number of words per list was 118.
All the tests were played using a computer, the output of which was routed to TDH-39 earphones housed in MX-41/AR supra-aural ear cushions through a diagnostic audiometer. The order in which these tests were administered was randomized to prevent any test order effect. In addition, half the participants were evaluated in the right ear first, and half were tested in the left ear first, for the monaural tests (SPIN-IE and DPT), to avoid an ear-order effect.
SPIN-IE was administered to each ear independently using headphones. The participants were required to repeat the words heard by them. The tester marked the responses as correct or wrong on a response sheet. Each correct response was awarded a score of 1, and each incorrect response was scored as 0. Both raw and percentage scores were tabulated. The maximum attainable score was 25.
The DCV test was also administered via headphones, and closed-set responses were obtained. The participants were asked to mark the syllables heard on a response sheet that had multiple choices. Single-correct and double-correct responses were calculated. In the former, the responses of each ear were scored separately, and a correct response was given a score of 1 and an incorrect response was given 0. While calculating the double-correct responses, a score of 1 was awarded only if the responses in both ears were correct and a score of 0 was given if the response was incorrect in either of the ears. The maximum score that a child could obtain was 30 for the single-correct as well as the double-correct responses.
DPT was evaluated for each ear independently after instructing the participants to verbally report the pattern of the sounds heard in terms of their length. For example, the participant was required to respond “long, long, short” if the stimulus was “long, long, short.” The responses of the participants were noted, and the number of correctly identified patterns were calculated. Similar to the other tests that were administered, a correct response was given a score of 1 and an incorrect response was given a score of 0. The maximum possible score was 30.
The RAMST-IE was presented to the participants binaurally, either via headphones or through sound-field speakers. It had been established earlier that both presentation modes yielded similar results (Yathiraj & Vanaja, 2015). They were asked to listen to each word sequence and repeat the words heard in the order they were presented. The responses were noted by the evaluator on a scoring sheet. Both auditory memory and auditory sequencing were scored separately. While calculating auditory memory, a score of 1 was given for each correctly repeated word. Auditory sequencing score was established by giving a score of 1 only for words repeated in the correct order. Both auditory memory and sequencing scores were tabulated on a response sheet. The maximum possible score for auditory memory as well as auditory sequencing was 118.
Test–retest reliability
Test–retest reliability was assessed for the scores obtained on 5% of the participants. These participants were randomly selected after an interval of 3 months. It was ensured that none of the children on whom the retest was done attended any rehabilitation program during this interval.
Analyses
The data obtained from the participants were tabulated and subjected to statistical analyses. Besides descriptive statistics, inferential statistics was carried out. Multivariate analysis of variance (MANOVA) was carried out to check the difference between those “at risk” and those “not at risk” for APD. This was done separately for each of the four tests and for each of the five age groups. The number of participants “at risk” for APD having scores below 1 SD and 2 SDs of the mean of typically developing children was also calculated.
Results
The data of the 100 children suspected to have APD based on the results of SCAP were compared with those “not at risk” for APD. The comparison was done with each age group, as significant differences in scores were seen across age groups in the typically developing children (Yathiraj & Vanaja, 2015). Figures 2a, 2b, 2c, and 2d show the mean and standard deviation for the four different tests administered (SPIN-IE, DPT, DCV, and RAMST-IE) for each of the age groups. The figure also provides information about the significance of difference between the performances of the two participant groups based on the results of MANOVA carried out separately for each age group. The details of the MANOVA results, carried out separately for each age group, are also given in Table 1. It can be observed from the figure that the mean scores for children with suspected APD were less than the scores obtained by age-matched typically developing children for all the tests. For the 6-year-old children, a significant difference between the two groups was observed for the SPIN-IE, double-correct scores of the DCV test, and both auditory memory and sequencing scores of the RAMST-IE. For the remaining age groups, a significant difference was found between the two participant groups for all the tests except for auditory memory in the 7-year-olds, SPIN-IE in the left ear in the 8-year-olds, and DCV in the left ear in the 10-year-old children (Figure 2 and Table 1).
Figure 2.

Comparison of the scores of children at risk and not at risk for auditory processing disorder on SPIN-IE, DPT, DCV, and RAMST (*p < .05, **p < .01). SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; RAMST = Revised Auditory Memory and Sequencing Test in Indian English; Rt = right; Lt = left; Mem = RAMST auditory memory score; Seq = RAMST auditory sequencing score.

 Comparison of the scores of children at risk and not at risk for auditory processing disorder on SPIN-IE, DPT, DCV, and RAMST (*p < .05, **p < .01). SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; RAMST = Revised Auditory Memory and Sequencing Test in Indian English; Rt = right; Lt = left; Mem = RAMST auditory memory score; Seq = RAMST auditory sequencing score.
Figure 2.

Comparison of the scores of children at risk and not at risk for auditory processing disorder on SPIN-IE, DPT, DCV, and RAMST (*p < .05, **p < .01). SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; RAMST = Revised Auditory Memory and Sequencing Test in Indian English; Rt = right; Lt = left; Mem = RAMST auditory memory score; Seq = RAMST auditory sequencing score.

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Table 1. Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.
Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.×
 Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.
Table 1. Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.
Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.×
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To determine the cutoff criteria (−2 SD and −1 SD) to classify children as having APD, the number of children who failed each of the tests was determined. Table 2 shows the cutoff scores that are 1 and 2 SDs below the mean scores in the respective age groups and the number as well as the percentage of children at risk, who failed the different tests.
Table 2. Agewise cutoff scores to identify auditory processing disorder (APD) with −1 SD and −2 SD criteria.
Agewise cutoff scores to identify auditory processing disorder (APD) with −1 SD and −2 SD criteria.×
Tests SD Age groups
6 years
7 years
8 years
9 years
10 years
6–10 years
Cutoff n (%) Cutoff n (%) Cutoff n (%) Cutoff n (%) Cutoff n (%) n (%)
SPIN-IE right −1 11.4 7 (87.5) 14.8 8 (80) 14.2 21 (60) 18.7 16 (66.7) 16.5 6 (26.1) 58 (58)
−2 7.4 7 (87.5) 11.1 6 (60) 10.7 15 (42.9) 16.4 12 (50) 12.2 12 (50) 44 (44)
SPIN-IE left −1 11.4 6 (75) 14.8 7 (70) 14.2 12 (34.3) 18.7 20 (83.3) 16.2 7 (30.4) 52 (52)
−2 7.4 5 (62.4) 11.1 5 (50) 10.7 10 (28.6) 16.4 12 (50) 12.2 12 (50) 37 (37)
DPT right −1 0.2 0 (0) 4.9 8 (80) 8.3 20 (57.1) 11.9 11 (45.8) 12.7 13 (56.5) 52 (52)
−2 0.0 0 (0) 0.0 0 (0) 1.6 8 (22.1) 5.2 6 (25) 5.9 6 (25) 19 (19)
DPT left −1 0.2 0 (0) 5.4 7 (70) 8.7 17 (48.6) 11.7 12 (50) 12.9 13 (56.5) 49 (49)
−2 0.0 0 (0) 0.0 0 (0) 2.0 8 (22.1) 6.1 6 (25) 6.0 6 (25) 18 (18)
DCV right −1 12.3 2 (25) 13.6 4 (40) 15.6 17 (48.6) 16.3 9 (37.5) 18.0 10 (43.5) 42 (42)
−2 6.8 1 (12.5) 8.8 0 (0) 10.6 8 (22.9) 11.8 6 (25) 14.9 6 (25) 19 (19)
DCV left −1 6.4 1 (12.5) 12.2 4 (40) 13.8 12 (34.3) 14.0 9 (37.5) 14.6 6 (26.1) 32 (32)
−2 0.0 0 (0) 0.0 0 (0) 2.0 8 (22.1) 6.1 6(25) 6.0 6 (25) 18 (18)
DCV double correct −1 0.0 5 (62.5) 5.2 6 (60) 5.7 20 (57.1) 8.4 10 (41.7) 8.8 11 (47.8) 52 (52)
−2 0.0 5 (62.5) 0.3 0 (0) 0.0 0 (0) 2.8 9 (37.5) 4.5 9 (37.5) 23 (23)
RAMST-IE memory −1 42.5 4 (50) 44.2 1 (10) 44.3 13 (37) 50.9 10 (42) 50.4 8 (35) 36 (36)
−2 34.0 3 (37.5) 35.6 0 (0) 32.3 5 (15) 40.0 2 (8) 39.1 2 (8) 12 (12)
RAMST-IE sequencing −1 26.0 7 (87.5 26.6 3 (30) 26.5 16 (46) 29.8 11 (46) 31.1 8 (35) 45 (45)
−2 16.6 7 (87.5) 16.3 2 (20) 14.4 2 (6) 16.7 2 (8) 16.5 2 (8) 15 (15)
Note. Cutoff score is based on the normative data obtained on the typically developing children (1 SD and 2 SDs below the mean of the scores obtained on the typically developing children). n = number of children at risk for APD who failed (percentage in parenthesis) each test at each cutoff criterion; SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel. RAMST-IE = Revised Auditory Memory and Sequencing Test in Indian English.
Note. Cutoff score is based on the normative data obtained on the typically developing children (1 SD and 2 SDs below the mean of the scores obtained on the typically developing children). n = number of children at risk for APD who failed (percentage in parenthesis) each test at each cutoff criterion; SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel. RAMST-IE = Revised Auditory Memory and Sequencing Test in Indian English.×
Table 2. Agewise cutoff scores to identify auditory processing disorder (APD) with −1 SD and −2 SD criteria.
Agewise cutoff scores to identify auditory processing disorder (APD) with −1 SD and −2 SD criteria.×
Tests SD Age groups
6 years
7 years
8 years
9 years
10 years
6–10 years
Cutoff n (%) Cutoff n (%) Cutoff n (%) Cutoff n (%) Cutoff n (%) n (%)
SPIN-IE right −1 11.4 7 (87.5) 14.8 8 (80) 14.2 21 (60) 18.7 16 (66.7) 16.5 6 (26.1) 58 (58)
−2 7.4 7 (87.5) 11.1 6 (60) 10.7 15 (42.9) 16.4 12 (50) 12.2 12 (50) 44 (44)
SPIN-IE left −1 11.4 6 (75) 14.8 7 (70) 14.2 12 (34.3) 18.7 20 (83.3) 16.2 7 (30.4) 52 (52)
−2 7.4 5 (62.4) 11.1 5 (50) 10.7 10 (28.6) 16.4 12 (50) 12.2 12 (50) 37 (37)
DPT right −1 0.2 0 (0) 4.9 8 (80) 8.3 20 (57.1) 11.9 11 (45.8) 12.7 13 (56.5) 52 (52)
−2 0.0 0 (0) 0.0 0 (0) 1.6 8 (22.1) 5.2 6 (25) 5.9 6 (25) 19 (19)
DPT left −1 0.2 0 (0) 5.4 7 (70) 8.7 17 (48.6) 11.7 12 (50) 12.9 13 (56.5) 49 (49)
−2 0.0 0 (0) 0.0 0 (0) 2.0 8 (22.1) 6.1 6 (25) 6.0 6 (25) 18 (18)
DCV right −1 12.3 2 (25) 13.6 4 (40) 15.6 17 (48.6) 16.3 9 (37.5) 18.0 10 (43.5) 42 (42)
−2 6.8 1 (12.5) 8.8 0 (0) 10.6 8 (22.9) 11.8 6 (25) 14.9 6 (25) 19 (19)
DCV left −1 6.4 1 (12.5) 12.2 4 (40) 13.8 12 (34.3) 14.0 9 (37.5) 14.6 6 (26.1) 32 (32)
−2 0.0 0 (0) 0.0 0 (0) 2.0 8 (22.1) 6.1 6(25) 6.0 6 (25) 18 (18)
DCV double correct −1 0.0 5 (62.5) 5.2 6 (60) 5.7 20 (57.1) 8.4 10 (41.7) 8.8 11 (47.8) 52 (52)
−2 0.0 5 (62.5) 0.3 0 (0) 0.0 0 (0) 2.8 9 (37.5) 4.5 9 (37.5) 23 (23)
RAMST-IE memory −1 42.5 4 (50) 44.2 1 (10) 44.3 13 (37) 50.9 10 (42) 50.4 8 (35) 36 (36)
−2 34.0 3 (37.5) 35.6 0 (0) 32.3 5 (15) 40.0 2 (8) 39.1 2 (8) 12 (12)
RAMST-IE sequencing −1 26.0 7 (87.5 26.6 3 (30) 26.5 16 (46) 29.8 11 (46) 31.1 8 (35) 45 (45)
−2 16.6 7 (87.5) 16.3 2 (20) 14.4 2 (6) 16.7 2 (8) 16.5 2 (8) 15 (15)
Note. Cutoff score is based on the normative data obtained on the typically developing children (1 SD and 2 SDs below the mean of the scores obtained on the typically developing children). n = number of children at risk for APD who failed (percentage in parenthesis) each test at each cutoff criterion; SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel. RAMST-IE = Revised Auditory Memory and Sequencing Test in Indian English.
Note. Cutoff score is based on the normative data obtained on the typically developing children (1 SD and 2 SDs below the mean of the scores obtained on the typically developing children). n = number of children at risk for APD who failed (percentage in parenthesis) each test at each cutoff criterion; SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel. RAMST-IE = Revised Auditory Memory and Sequencing Test in Indian English.×
×
Figure 3 depicts the number of children at risk for APD who passed all the diagnostic tests, failed any one diagnostic test, and failed more than one diagnostic test, with the two different cutoff criteria (−1 SD of the mean and −2 SD of the mean). With the −1 SD criterion, the majority of the children with suspected APD (76) failed more than one test. Only 16 children failed one test, and eight children passed all the tests. However, with the −2 SD criterion, the number of children who failed more than one test reduced to 34. With this criterion, the number of children who failed one test increased to 38, and the number of children who passed all the tests increased to 28. While counting the number of tests failed by children who were at risk for APD, auditory “memory” scores and auditory “sequencing” scores were calculated separately on the RAMST-IE. This was done as there was a marked difference in these two scores in the typically developing children across all the age groups.
Figure 3.

Number of children at risk for auditory processing disorder (N = 100) who passed or failed tests with a (a) −1 SD of the mean cutoff criterion and (b) −2 SD of the mean cutoff criterion.

 Number of children at risk for auditory processing disorder (N = 100) who passed or failed tests with a (a) −1 SD of the mean cutoff criterion and (b) −2 SD of the mean cutoff criterion.
Figure 3.

Number of children at risk for auditory processing disorder (N = 100) who passed or failed tests with a (a) −1 SD of the mean cutoff criterion and (b) −2 SD of the mean cutoff criterion.

×
From Figures 4 and 5, it can be seen that the diagnostic test failed most frequently by children at risk for APD was SPIN-IE followed by DCV for both cutoff criteria. Furthermore, for the −1 SD criterion, the combination of tests that the participants failed the most was SPIN-IE + auditory sequencing followed by SPIN-IE + DCV and DPT + DCV. With the −2 SD criterion, the combination of tests failed most often was SPIN-IE + DPT, followed by SPIN-IE + auditory sequencing and SPIN-IE + DCV. Children failing a combination of three or four tests were seen majorly with the −1 SD criterion and rarely with a −2 SD criterion. The combination of three tests that was failed most often was SPIN-IE + DPT + DCV followed by DPT + DCV + auditory memory. All the children who failed on four tests, failed on DPT and auditory sequencing, and the three different combinations of tests included SPIN-IE + DPT + DCV + auditory sequencing or SPIN-IE + DPT + auditory memory + auditory sequencing or DPT + DCV + auditory memory + auditory sequencing.
Figure 4.

Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four/five diagnostic tests using 1 SD and 2 SD cutoff criteria (each child who failed a test or a combination of tests is represented only once). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.

 Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four/five diagnostic tests using 1 SD and 2 SD cutoff criteria (each child who failed a test or a combination of tests is represented only once). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.
Figure 4.

Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four/five diagnostic tests using 1 SD and 2 SD cutoff criteria (each child who failed a test or a combination of tests is represented only once). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.

×
Figure 5.

Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four or five diagnostic tests using 1 SD and 2 SD cutoff criteria (children who fail more than one test are represented multiple times, once under each test or combination of tests). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.

 Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four or five diagnostic tests using 1 SD and 2 SD cutoff criteria (children who fail more than one test are represented multiple times, once under each test or combination of tests). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.
Figure 5.

Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four or five diagnostic tests using 1 SD and 2 SD cutoff criteria (children who fail more than one test are represented multiple times, once under each test or combination of tests). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.

×
Test–retest reliability was checked on 5% of the total population that included the typically developing children and children with symptoms of APD. Pearson's correlation coefficient was found to vary from .65 to .8 across the test. These values were found to be significant at the .001 level of significance.
Discussion
The test battery used in the current study assesses the major processes/higher cognitive skills that are reported in literature to be affected in children (auditory separation, temporal processing, auditory integration, and auditory memory). As different processes were assessed, the battery was able to diagnose the presence of auditory processing difficulties/auditory memory problems in a high percentage of children who had symptoms of APD. The recommended battery was found to be time efficient as the entire diagnostic test could be run within an hour on children who were cooperative. This time included the time spent on routine audiological evaluation such as pure-tone audiometry, immittance audiometry, and otoacoustic emission evaluation. Although the current study used duration pattern to assess temporal processing, a test of temporal resolution could be used instead as this temporal aspect has also been noted to be affected in children with APD (Dias, Jutras, Acrani, & Pereira, 2012; Muthuselvi & Yathiraj, 2009; Phillips, Comeau, & Andrus, 2010; Yathiraj & Maggu, 2014).
From the results of the number of children at risk for APD who passed and failed the various tests (Figure 2), with a more stringent criteria (−1 SD below the mean for each test), the percentage of children who passed all the tests was just 8% and the percentage who failed one or two tests was as high as 92%. However, with the less stringent criterion (−2 SD below the mean for each test), the percentage of children at risk for APD who passed all the tests increased to 28% and the number who failed dropped to 72%. As a larger number of children at risk for APD could be identified with the stricter cutoff criteria, it is recommended that this be used while diagnosing a child as having APD. However, the number of children who failed only one test was lesser with the −1 SD criterion compared to the −2 SD criterion.
Hence, the −2 SD criterion is recommended when children fail only one test, and the −1 SD criterion is recommended when children fail more than one test. These findings are in consensus with that of Chermak and Musiek (1997), though the actual value of the cutoff criteria differed. They too recommended the use of the criteria of 3 SDs below the mean if the individual failed only one test and at least 2 SDs below the mean if the individual failed two or more tests in the APD battery.
Among the 100 children who were suspected to have APD, the tests that they failed most frequently were the SPIN-IE, DPT, and double-correct scores of the DCV. This was seen when the data of all five age groups were combined. However, on observation of the results of each age group, the tests that were failed most frequently were SPIN-IE and double-correct scores of the DCV. This occurred because none of the children failed the DPT test in the youngest age group. This probably was on account of the typically developing children in this age group having highly variable results, thus making the DPT norms of this age group unreliable (Yathiraj & Vanaja, 2015). In this age group, it was noted that the mean scores of the 6-year-olds were lower than their SD. As DPT is not a reliable test for typically developing children aged 6 years of age, the temporal problems in those with suspected APD in this age group were probably not detected.
The findings of the current study indicate that the children failed certain combinations of tests more often than others. It can be observed from Figure 4b that, among those who failed a combination, of two tests, failure on SPIN-IE continued to be the highest, followed by DCV and DPT. Very few children failed auditory memory and sequencing. A similar trend was seen also on those who failed a combination of three tests (Figure 4c). However, children who had difficulty in auditory and memory tended to fail most of the auditory processing tests on which they were evaluated (Figure 4d). It is possible that difficulty in auditory memory and sequencing affects the performance of these children on other tests. This finding is in accordance with the view of earlier studies (Katz, 1992; Medwetsky, 2011).
The results of this study suggest that SPIN-IE and DCV tests can identify children with APD in all the age groups. These results are in consensus with those reported earlier in literature (Keith, 1995; Schow & Chermak, 1999). Furthermore, among the behavioral indicators of APD, understanding speech in the presence of noise is one of the most frequently reported problems of children with APD (Lagace, Jutras, & Gagne, 2010). The findings of the current study confirm that listening in the presence of speech babble is more difficult when compared to difficulties in other processes.
From the findings of this study, administering DPT is not recommended as a test of choice while assessing 6-year-old children. It has been reported in literature that results of a gap detection test are reliable in children as young as 5 years of age (Keith, 2000). This probably occurs as DPT is more taxing due to it requiring linguistic labeling of the temporally processed signals. The cutoff for the older children was also very low for DPT (refer to Table 2), indicating that it was probably a difficult task for older typically developing children also. The floor effect may make it difficult to identify temporal processing problems in children with APD. In contrast, a gap detection test exclusively assesses only temporal processing as no linguistic labeling is required. Hence, temporal resolution may be the choice of test rather than temporal patterning.
The results of the current study suggest that SPIN-IE and DCV, as well as RAMST-IE, help identify APD even in 6-year-old children. However, Bellis (2003), ASHA (2005), and the American Association of Audiology recommended that the tests of APD be administered only after children are 7 years of age (Musiek et al., 2010). Similarly, the guidelines for screening, identification, and management of APD by the Colorado Department of Education (2008)  states that screening is generally not appropriate until a child is 5 or 6 years of age and assessment is generally not appropriate for children younger than 7 years of age. In this study, when the cutoff score was set at 2 SDs below the mean value of a particular test, six children failed the SPIN-IE and auditory sequencing score on the RAMST-IE, four children failed the SPIN-IE and DCV and three children failed the SPIN-IE, DCV, and auditory sequencing score. Thus, the findings of this study indicate that it is possible to identify APD in younger children. This, in turn, can lead to earlier rehabilitation on specific auditory processes/higher cognitive functions at an earlier age.
From the findings of the study, it can be seen that, using the battery consisting of SPIN-IE, DPT, DCV, and RAMST-IE, the majority of children with symptoms of APD can be identified. This battery of tests would provide information regarding the particular auditory process or higher cognitive function that is deviant in those with symptoms of APD. Such information would be highly beneficial in making further recommendations for management for individuals detected to have APD.
Conclusions
It is recommended that the test battery for APD should consist of SPIN-IE, DCV, DPT, and RAMST-IE for children aged 7 years and above. It is further recommended that criterion of 2 SDs below the mean of typically developing children should be used for diagnosing APD in children who performed poorly on only one APD diagnostic test. However, for children performing poorly on more than one test on the APD test battery, it is recommended that a cutoff criterion of 1 SD below the mean of typically developing children should be used. The recommended cutoff criteria were found to be effective in diagnosing the majority of children with symptoms of APD on SCAP, a screening checklist for APD.
With either of the cutoff criteria, it was found that the test that was failed most often was SPIN-IE, followed by DCV, DPT, and RAMST-IE. With the elimination of any one of the tests from the battery, the number of children identified to have the condition is reduced. Hence, it is recommended that all four tests be used to identify APD in children as they tap different auditory processes/higher cognitive function. Furthermore, it was observed that SPIN-IE and double-correct scores on the DCV help in identifying APD in all the age groups. Although children aged 7 years and above could perform the DPT, those aged 6 years found the task too difficult; hence, it is recommended that this test should be replaced by some other test of temporal processing in the test battery for children below 7 years of age.
Acknowledgment
We wish to thank the All India Institute of Speech and Hearing, Mysore, for funding this project and Bharati Vidyapeeth Deemed University for providing permission to carry out the project at Pune. The contribution of T. Muthuselvi, the research officer who worked for the project, is highly appreciated.
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Figure 1.

Age and gender distribution of the children at risk and not at risk for auditory processing disorder (APD).

 Age and gender distribution of the children at risk and not at risk for auditory processing disorder (APD).
Figure 1.

Age and gender distribution of the children at risk and not at risk for auditory processing disorder (APD).

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Figure 2.

Comparison of the scores of children at risk and not at risk for auditory processing disorder on SPIN-IE, DPT, DCV, and RAMST (*p < .05, **p < .01). SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; RAMST = Revised Auditory Memory and Sequencing Test in Indian English; Rt = right; Lt = left; Mem = RAMST auditory memory score; Seq = RAMST auditory sequencing score.

 Comparison of the scores of children at risk and not at risk for auditory processing disorder on SPIN-IE, DPT, DCV, and RAMST (*p < .05, **p < .01). SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; RAMST = Revised Auditory Memory and Sequencing Test in Indian English; Rt = right; Lt = left; Mem = RAMST auditory memory score; Seq = RAMST auditory sequencing score.
Figure 2.

Comparison of the scores of children at risk and not at risk for auditory processing disorder on SPIN-IE, DPT, DCV, and RAMST (*p < .05, **p < .01). SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; RAMST = Revised Auditory Memory and Sequencing Test in Indian English; Rt = right; Lt = left; Mem = RAMST auditory memory score; Seq = RAMST auditory sequencing score.

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Figure 3.

Number of children at risk for auditory processing disorder (N = 100) who passed or failed tests with a (a) −1 SD of the mean cutoff criterion and (b) −2 SD of the mean cutoff criterion.

 Number of children at risk for auditory processing disorder (N = 100) who passed or failed tests with a (a) −1 SD of the mean cutoff criterion and (b) −2 SD of the mean cutoff criterion.
Figure 3.

Number of children at risk for auditory processing disorder (N = 100) who passed or failed tests with a (a) −1 SD of the mean cutoff criterion and (b) −2 SD of the mean cutoff criterion.

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Figure 4.

Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four/five diagnostic tests using 1 SD and 2 SD cutoff criteria (each child who failed a test or a combination of tests is represented only once). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.

 Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four/five diagnostic tests using 1 SD and 2 SD cutoff criteria (each child who failed a test or a combination of tests is represented only once). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.
Figure 4.

Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four/five diagnostic tests using 1 SD and 2 SD cutoff criteria (each child who failed a test or a combination of tests is represented only once). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.

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Figure 5.

Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four or five diagnostic tests using 1 SD and 2 SD cutoff criteria (children who fail more than one test are represented multiple times, once under each test or combination of tests). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.

 Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four or five diagnostic tests using 1 SD and 2 SD cutoff criteria (children who fail more than one test are represented multiple times, once under each test or combination of tests). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.
Figure 5.

Number of children at risk for auditory processing disorder who failed (a) one, (b) two, (c) three, and (d) four or five diagnostic tests using 1 SD and 2 SD cutoff criteria (children who fail more than one test are represented multiple times, once under each test or combination of tests). SPIN = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel; Mem = Revised Auditory Memory and Sequencing Test in Indian English (RAMST) auditory memory score; Seq = RAMST auditory sequencing score.

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Table 1. Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.
Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.×
 Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.
Table 1. Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.
Significance of difference between children “at risk” versus children “not at risk” for auditory processing disorder for different age groups.×
×
Table 2. Agewise cutoff scores to identify auditory processing disorder (APD) with −1 SD and −2 SD criteria.
Agewise cutoff scores to identify auditory processing disorder (APD) with −1 SD and −2 SD criteria.×
Tests SD Age groups
6 years
7 years
8 years
9 years
10 years
6–10 years
Cutoff n (%) Cutoff n (%) Cutoff n (%) Cutoff n (%) Cutoff n (%) n (%)
SPIN-IE right −1 11.4 7 (87.5) 14.8 8 (80) 14.2 21 (60) 18.7 16 (66.7) 16.5 6 (26.1) 58 (58)
−2 7.4 7 (87.5) 11.1 6 (60) 10.7 15 (42.9) 16.4 12 (50) 12.2 12 (50) 44 (44)
SPIN-IE left −1 11.4 6 (75) 14.8 7 (70) 14.2 12 (34.3) 18.7 20 (83.3) 16.2 7 (30.4) 52 (52)
−2 7.4 5 (62.4) 11.1 5 (50) 10.7 10 (28.6) 16.4 12 (50) 12.2 12 (50) 37 (37)
DPT right −1 0.2 0 (0) 4.9 8 (80) 8.3 20 (57.1) 11.9 11 (45.8) 12.7 13 (56.5) 52 (52)
−2 0.0 0 (0) 0.0 0 (0) 1.6 8 (22.1) 5.2 6 (25) 5.9 6 (25) 19 (19)
DPT left −1 0.2 0 (0) 5.4 7 (70) 8.7 17 (48.6) 11.7 12 (50) 12.9 13 (56.5) 49 (49)
−2 0.0 0 (0) 0.0 0 (0) 2.0 8 (22.1) 6.1 6 (25) 6.0 6 (25) 18 (18)
DCV right −1 12.3 2 (25) 13.6 4 (40) 15.6 17 (48.6) 16.3 9 (37.5) 18.0 10 (43.5) 42 (42)
−2 6.8 1 (12.5) 8.8 0 (0) 10.6 8 (22.9) 11.8 6 (25) 14.9 6 (25) 19 (19)
DCV left −1 6.4 1 (12.5) 12.2 4 (40) 13.8 12 (34.3) 14.0 9 (37.5) 14.6 6 (26.1) 32 (32)
−2 0.0 0 (0) 0.0 0 (0) 2.0 8 (22.1) 6.1 6(25) 6.0 6 (25) 18 (18)
DCV double correct −1 0.0 5 (62.5) 5.2 6 (60) 5.7 20 (57.1) 8.4 10 (41.7) 8.8 11 (47.8) 52 (52)
−2 0.0 5 (62.5) 0.3 0 (0) 0.0 0 (0) 2.8 9 (37.5) 4.5 9 (37.5) 23 (23)
RAMST-IE memory −1 42.5 4 (50) 44.2 1 (10) 44.3 13 (37) 50.9 10 (42) 50.4 8 (35) 36 (36)
−2 34.0 3 (37.5) 35.6 0 (0) 32.3 5 (15) 40.0 2 (8) 39.1 2 (8) 12 (12)
RAMST-IE sequencing −1 26.0 7 (87.5 26.6 3 (30) 26.5 16 (46) 29.8 11 (46) 31.1 8 (35) 45 (45)
−2 16.6 7 (87.5) 16.3 2 (20) 14.4 2 (6) 16.7 2 (8) 16.5 2 (8) 15 (15)
Note. Cutoff score is based on the normative data obtained on the typically developing children (1 SD and 2 SDs below the mean of the scores obtained on the typically developing children). n = number of children at risk for APD who failed (percentage in parenthesis) each test at each cutoff criterion; SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel. RAMST-IE = Revised Auditory Memory and Sequencing Test in Indian English.
Note. Cutoff score is based on the normative data obtained on the typically developing children (1 SD and 2 SDs below the mean of the scores obtained on the typically developing children). n = number of children at risk for APD who failed (percentage in parenthesis) each test at each cutoff criterion; SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel. RAMST-IE = Revised Auditory Memory and Sequencing Test in Indian English.×
Table 2. Agewise cutoff scores to identify auditory processing disorder (APD) with −1 SD and −2 SD criteria.
Agewise cutoff scores to identify auditory processing disorder (APD) with −1 SD and −2 SD criteria.×
Tests SD Age groups
6 years
7 years
8 years
9 years
10 years
6–10 years
Cutoff n (%) Cutoff n (%) Cutoff n (%) Cutoff n (%) Cutoff n (%) n (%)
SPIN-IE right −1 11.4 7 (87.5) 14.8 8 (80) 14.2 21 (60) 18.7 16 (66.7) 16.5 6 (26.1) 58 (58)
−2 7.4 7 (87.5) 11.1 6 (60) 10.7 15 (42.9) 16.4 12 (50) 12.2 12 (50) 44 (44)
SPIN-IE left −1 11.4 6 (75) 14.8 7 (70) 14.2 12 (34.3) 18.7 20 (83.3) 16.2 7 (30.4) 52 (52)
−2 7.4 5 (62.4) 11.1 5 (50) 10.7 10 (28.6) 16.4 12 (50) 12.2 12 (50) 37 (37)
DPT right −1 0.2 0 (0) 4.9 8 (80) 8.3 20 (57.1) 11.9 11 (45.8) 12.7 13 (56.5) 52 (52)
−2 0.0 0 (0) 0.0 0 (0) 1.6 8 (22.1) 5.2 6 (25) 5.9 6 (25) 19 (19)
DPT left −1 0.2 0 (0) 5.4 7 (70) 8.7 17 (48.6) 11.7 12 (50) 12.9 13 (56.5) 49 (49)
−2 0.0 0 (0) 0.0 0 (0) 2.0 8 (22.1) 6.1 6 (25) 6.0 6 (25) 18 (18)
DCV right −1 12.3 2 (25) 13.6 4 (40) 15.6 17 (48.6) 16.3 9 (37.5) 18.0 10 (43.5) 42 (42)
−2 6.8 1 (12.5) 8.8 0 (0) 10.6 8 (22.9) 11.8 6 (25) 14.9 6 (25) 19 (19)
DCV left −1 6.4 1 (12.5) 12.2 4 (40) 13.8 12 (34.3) 14.0 9 (37.5) 14.6 6 (26.1) 32 (32)
−2 0.0 0 (0) 0.0 0 (0) 2.0 8 (22.1) 6.1 6(25) 6.0 6 (25) 18 (18)
DCV double correct −1 0.0 5 (62.5) 5.2 6 (60) 5.7 20 (57.1) 8.4 10 (41.7) 8.8 11 (47.8) 52 (52)
−2 0.0 5 (62.5) 0.3 0 (0) 0.0 0 (0) 2.8 9 (37.5) 4.5 9 (37.5) 23 (23)
RAMST-IE memory −1 42.5 4 (50) 44.2 1 (10) 44.3 13 (37) 50.9 10 (42) 50.4 8 (35) 36 (36)
−2 34.0 3 (37.5) 35.6 0 (0) 32.3 5 (15) 40.0 2 (8) 39.1 2 (8) 12 (12)
RAMST-IE sequencing −1 26.0 7 (87.5 26.6 3 (30) 26.5 16 (46) 29.8 11 (46) 31.1 8 (35) 45 (45)
−2 16.6 7 (87.5) 16.3 2 (20) 14.4 2 (6) 16.7 2 (8) 16.5 2 (8) 15 (15)
Note. Cutoff score is based on the normative data obtained on the typically developing children (1 SD and 2 SDs below the mean of the scores obtained on the typically developing children). n = number of children at risk for APD who failed (percentage in parenthesis) each test at each cutoff criterion; SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel. RAMST-IE = Revised Auditory Memory and Sequencing Test in Indian English.
Note. Cutoff score is based on the normative data obtained on the typically developing children (1 SD and 2 SDs below the mean of the scores obtained on the typically developing children). n = number of children at risk for APD who failed (percentage in parenthesis) each test at each cutoff criterion; SPIN-IE = Speech-in-Noise Test in Indian English; DPT = Duration Pattern Test; DCV = Dichotic Consonant–Vowel. RAMST-IE = Revised Auditory Memory and Sequencing Test in Indian English.×
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