Project Description:
I. Need
Auditory processing disorders are far-reaching with regard to communicative, educational, and psychosocial implications. Accurate and timely diagnosis is essential to minimize the impact of an auditory processing disorder for the sake of educational management and intervention.35 There are no unique behavioral symptoms that clearly mark a child with auditory processing disorder. These children are sometimes classified as a poor listener, slow responder, a child who is easily distracted, a child who has short attention span, poor memory, unable to complete a task, or has difficulty with language tasks. Some children are enigmatic because they appear to do very well in a relatively quiet, face-to-face situation. However, if background noise is introduced into the environment, they suddenly appear as if they are hearing impaired. Some children have difficulty with phonics while others do not. There may be a coexisting language disorder but not necessarily. These children may be extremely outgoing to the point of being labeled hyperactive or they may be very withdrawn and reluctant to participate. It is not uncommon for a child with auditory processing disorder to be labeled ADHD. Of particular importance is the clinical knowledge that auditory processing disorders may exist in isolation, may coexist with language disorders or ADHD, or may not be present at all in children who do have language disorders or ADHD. The only way to determine with accuracy whether an auditory processing problem exists is to test specifically for it.11
Auditory processing abilities have not been thoroughly investigated in the pediatric HIV population. Less is known about the relationship, if any, between the auditory evoked potentials and auditory processing outcomes. Drawing from clinical experience for auditory processing disorders in general, frustration, academic problems, and false appearance of other symptoms are very common in children with this diagnosis. If discovered, several things can be done to relieve processing stress from the auditory system. These forms of intervention may include preferential seating, teacher alertness for follow-up with a child to ensure appropriate understanding, classroom accommodations regarding spelling lists or homework assignments, and use of personal FM systems to improve speech understanding. These are all viable options to relieve frustration and assist in reaching academic potential.
Of particular importance to this study is the preliminary determination of whether the ABR or AMLR may predict with reasonable accuracy the existence of an auditory processing disorder. This would allow clinicians to overcome major hurdles dealing with English mastery, cultural influences, language abilities, and attention issues. If detected early in the process of disease progression, whether symptomatic or asymptomatic, intervention may began in a more timely manner to assist in reaching the child's academic potential.
II. Primary Aim
a. The primary aim of this study is to investigate the clinical usefulness of auditory evoked potentials including the auditory middle latency response (AMLR) and auditory brainstem response (ABR) to predict the diagnosis of an auditory processing disorder in HIV positive (HIV+) children.
III. Specific Objectives
a. Determine the number of HIV+ children in this sample who demonstrate evidence of an auditory processing disorder as determined by behavioral speech and psychoacoustic testing.
b. Determine the number of HIV+ children in this sample who demonstrate abnormal integrity of the auditory central nervous system assessed through the use of auditory evoked potentials.
c. Examine the co-occurrence of abnormal auditory processing outcomes with abnormal evoked potential outcomes in an effort to determine whether auditory evoked potentials can predict auditory processing status.
d. Determine whether current and previous developmental testing outcomes, CD-4 counts, viral load measurements, and CDC classifications may be clinically useful as screening referral criteria or preliminary predictive indicators of auditory processing abilities.
III. Expected Benefits
The children who participate in this study will receive direct benefit through disclosure of the evaluation results to the child and family when testing is completed for that child. The behavioral tests of auditory processing are very well-established clinically and will be the same tests incorporated as part of this protocol. Consequently, if the child is performing below age level with regard to auditory processing abilities, that information will be known based on the scoring of the speech-based and psychoacoustic tests administered. One of the main research questions of the study will be whether the ABR and/or AMLR can be used as objective predictors of the presence of auditory processing problems. But the behavioral tests, because they are clearly established through clinical protocol, will offer the outcome results by which each participant may benefit.
In addition, the hearing sensitivity status of each child will be determined at the time of the study. Sensorineural hearing loss is not unusual for individuals with HIV although it is not always clear whether the hearing loss is due to opportunistic infections, medication effects, direct viral influences, or combinations of the above. But the presence of sensorineural hearing loss is extremely important from an education perspective in that learning can be adversely affected from the hearing loss alone. Knowledge of the presence of a sensorineural hearing loss may lead to effective interventions to minimize these adverse effects on the child?s learning experience.
Indirect benefit will be provided to all children with HIV with regard to diagnostic regimens or protocol adjustments that are derived from the outcomes of this study.
Unserved or Under-served Populations:
Racial or Ethnic Minorities, Disadvantaged Circumstances, Specific Groups
