Comorbidity of Central Auditory Processing Disorder and Attention-Deficit Hyperactivity Disorder

doi:10.1097/00004583-199407000-00011

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 33, Issue 6, July–August 1994, Pages 849-857

https://doi.org/10.1097/00004583-199407000-00011 Get rights and content

ABSTRACT

Research has indicated that children with attention-deficit hyperactivity disorder (ADHD) demonstrate significant difficulty on tasks used to assess central auditory processing skills. These findings have raised the question of whether ADHD and central auditory processing disorder (CAPD) represent a singular disorder. Objective: The current study explored the incidence of ADHD in a group of 30 children who met diagnostic criteria for CAPD.

Method

Consecutive referrals specifically for this project were assessed on a variety of measures. In addition, rating scales were completed by teachers and structured interviews were completed with parents.

Results

Results indicate that although the incidence rate of ADHD (50%) in this sample significantly exceeds that found in the normative population (p < .001), not all children with CAPD demonstrated behaviors consistent with diagnostic criteria for ADHD. Furthermore, there was a low incidence of any other behavioral disorder in this sample. In contrast, it was found that the sample as a whole demonstrated impaired language abilities. No significant differences emerged across cognitive, auditory, or language measures. Conclusion: This study further supports the need for increased collaboration of those professionals who work with these children given the extent of overlap of language and behavioral difficulties in this sample.

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Cited by (102)

Dichotic listening deficits in amblyaudia are characterized by aberrant neural oscillations in auditory cortex
2021, Clinical Neurophysiology
Citation Excerpt :
The neurophysiological underpinning of APD likely represents varying etiologies (e.g., corpus callosum lesions, low birth weight, prematurity, chronic ear infection) (Jerger et al., 2002; Milner et al., 2018; Moncrieff, 2006) and there is limited consensus in terms of prevalence, test battery, diagnostic criteria, or even precise definition of APD (Dillon et al., 2012; Moore and Hunter, 2013; Wilson and Arnott, 2013). Moreover, common manifestations of auditory symptoms in various disorders [e.g., attention-deficit/hyperactivity disorder (ADHD), dyslexia, or specific language impairment (SLI)] may arise from the same basic auditory deficits that make the differential diagnosis of these patients even more complicated (Gilley et al., 2016, Milner et al., 2018; Riccio et al., 1994; Sharma et al., 2009). APD may also produce functional and anatomical abnormalities that are not limited solely to the auditory pathways (Farah et al., 2014; Kim et al., 2009; Micallef, 2015; Owen et al., 2013; Pluta et al., 2014; Schmithorst et al., 2011).
Children diagnosed with auditory processing disorder (APD) show deficits in processing complex sounds that are associated with difficulties in higher-order language, learning, cognitive, and communicative functions. Amblyaudia (AMB) is a subcategory of APD characterized by abnormally large ear asymmetries in dichotic listening tasks.
Here, we examined frequency-specific neural oscillations and functional connectivity via high-density electroencephalography (EEG) in children with and without AMB during passive listening of nonspeech stimuli.
Time-frequency maps of these “brain rhythms” revealed stronger phase-locked beta-gamma (~35 Hz) oscillations in AMB participants within bilateral auditory cortex for sounds presented to the right ear, suggesting a hypersynchronization and imbalance of auditory neural activity. Brain-behavior correlations revealed neural asymmetries in cortical responses predicted the larger than normal right-ear advantage seen in participants with AMB. Additionally, we found weaker functional connectivity in the AMB group from right to left auditory cortex, despite their stronger neural responses overall.
Our results reveal abnormally large auditory sensory encoding and an imbalance in communication between cerebral hemispheres (ipsi- to -contralateral signaling) in AMB.
These neurophysiological changes might lead to the functionally poorer behavioral capacity to integrate information between the two ears in children with AMB.
Effect of speech in noise training in the auditory and cognitive skills in children with auditory processing disorders
2021, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
The results of the correlation analysis are in consensus with previous studies like Tillery et al. [48], Sharma et al. [5], Rosen et al. [30], Iliadou et al. [6], Sidiras et al. [25], who reported no or weak correlation between the cognitive measures and the auditory processing skills. While the results contradicts with studies like Riccio et al. [49], Wilson et al. [31], Glydenkaerne et al. [50], who reported moderate correlation and Tomlin et al. [7], Riccio et al. [27], Cook et al. [28], Moore et al. [29], who reported strong correlations between the measures. The variability in the findings reported in the literature can be attributed to the fact that the studies varied in terms of test battery compositions, tools used for assessments and more importantly the characteristics of the study participants ranging from those referred for APD diagnosis, suspected APD and those who received a confirmed APD diagnosis.
Speech perception in the presence of background noise is identified as one of the most affected auditory processes in children with auditory processing disorders (APD). Mechanism of speech-in-noise perception is extensively studied and is reported to involve different auditory and cognitive skills. However previous research has reported mixed results investigating the relationship between the cognitive skills and speech-in-noise perception in children with APD. The present study intended to study the correlation between the speech-in-noise perception and other auditory and cognitive skills, and also to find the efficacy of speech-in-noise training in other auditory and cognitive skills in children with APD.
The study imparted words in noise training utilizing monosyllable and trisyllable words in the presence of speech shaped noise and 4-talker babble. Participants included 20 children with APD, 10 of them in the experimental group who underwent the training and the remaining 10 served as controls. Auditory outcome measures included five behavioural APD tests and four digit span tests to assess cognition.
There was a significant improvement in the speech-in-noise perception measures, temporal processing measures (gap detection test and duration pattern test) and the backward, ascending and descending digit span measures after the training in participants in the experimental group. However, Spearman rank order correlation did not reveal a significant correlation between the speech-in-noise perception scores and any of the auditory or cognitive measures.
Even though there was no correlation within and between auditory and cognitive measures, speech-in-noise training improved the temporal processing skills as well as the working memory skills in children with APD supporting the relationship between the said processes. These relationships with evidence from further research could be utilized to design more effective treatment strategies for children with APD.
Left and right reaction time differences to the sound intensity in normal and AD/HD children
2017, International Journal of Pediatric Otorhinolaryngology
Citation Excerpt :
However, the correlation between the mentioned right hemisphere abnormality and the auditory processing performance has not been investigated in AD/HD subjects. The relation between the AD/HD and central auditory processing disorder (CAPD) has been studied in different researches [7–14]. Some of them demonstrated that using CAPD diagnosis criteria can help us to distinguish predominantly inattentive subtype of the AD/HD from other types [8,11] or from its comorbid [13,14].
Right hemisphere, which is attributed to the sound intensity discrimination, has abnormality in people with attention deficit/hyperactivity disorder (AD/HD). However, it is not studied whether the defect in the right hemisphere has influenced on the intensity sensation of AD/HD subjects or not. In this study, the sensitivity of normal and AD/HD children to the sound intensity was investigated.
Nineteen normal and fourteen AD/HD children participated in the study and performed a simple auditory reaction time task. Using the regression analysis, the sensitivity of right and left ears to various sound intensity levels was examined.
The statistical results showed that the sensitivity of AD/HD subjects to the intensity was lower than the normal group (p < 0.0001). Left and right pathways of the auditory system had the same pattern of response in AD/HD subjects (p > 0.05). However, in control group the left pathway was more sensitive to the sound intensity level than the right one (p = 0.0156).
It can be probable that the deficit of the right hemisphere has influenced on the auditory sensitivity of AD/HD children. The possible existent deficits of other auditory system components such as middle ear, inner ear, or involved brain stem nucleuses may also lead to the observed results. The development of new biomarkers based on the sensitivity of the brain hemispheres to the sound intensity has been suggested to estimate the risk of AD/HD. Designing new technique to correct the auditory feedback has been also proposed in behavioral treatment sessions.
Abnormalities in cortical auditory responses in children with central auditory processing disorder
2017, Neuroscience
The main objective of the present study was to identify markers of neural deficits in children with central auditory processing disorder (CAPD) by measuring latency and amplitude of the auditory cortical responses and mismatch negativity (MMN) responses. Passive oddball paradigms were used with nonverbal and verbal stimuli to record cortical auditory-evoked potentials and MMN. Twenty-three children aged 9–12 participated in the study: 10 with normal hearing acuity as well as CAPD and 13 with normal hearing without CAPD. No significant group differences were observed for P1 latency and amplitude. Children with CAPD were observed to have significant N2 latency prolongation and amplitude reduction with nonverbal and verbal stimuli compared to children without CAPD. No significant group differences were observed for the MMN conditions. Moreover, electrode position affected the results in the same manner for both groups of children. The findings of the present study suggest that the N2 response could be a marker of neural deficits in children with CAPD. N2 results suggest that maturational factors or a different mechanism could be involved in processing auditory information at the central level for these children.
Oscillatory decoupling differentiates auditory encoding deficits in children with listening problems
2016, Clinical Neurophysiology
Citation Excerpt :
It is often difficult to determine whether poor auditory performance reflects an auditory processing disorder (APD) or some other impairment that affects auditory encoding (Cacace and McFarland, 2005). For example, up to 65% of children with APD may have coincident language and reading impairments (Sharma et al., 2009) and up to 50% may have coincident attention deficit disorders (Riccio et al., 1994), which complicates the differentiation of auditory specific deficits. A key issue is whether auditory deficits are the result of an impoverished signal from impaired encoding mechanisms (e.g., low-level feature encoding), or whether poor performance on psychoacoustic tasks reflects deficits in higher-order modulatory mechanisms (e.g., allocation of attention resources).
We sought to examine whether oscillatory EEG responses to a speech stimulus in both quiet and noise were different in children with listening problems than in children with normal hearing.
We employed a high-resolution spectral–temporal analysis of the cortical auditory evoked potential in response to a 150 ms speech sound /da/ in quiet and 3 dB SNR in 21 typically developing children (mean age = 10.7 years, standard deviation = 1.7) and 44 children with reported listening problems (LP) with absence of hearing loss (mean age = 10.3 years, standard deviation = 1.6). Children with LP were assessed for auditory processing disorder (APD) by which 24 children had APD, and 20 children did not. Peak latencies, magnitudes, and frequencies were compared between these groups.
Children with LP had frequency shifts in the theta, and alpha bands (p < 0.05), and children with LP + APD had additional frequency (p < 0.01) and latency shifts (p < 0.05) in the upper beta and in the lower gamma bands.
These results provide evidence for differences in higher level modulatory processing in children with LP, and that APD is driven by differences in early auditory encoding.
These findings may better guide future research toward improving the differential diagnosis and treatment of listening problems in this population of children.
Functional auditory disorders
2016, Handbook of Clinical Neurology
Citation Excerpt :
It is also important to assess global cognitive function with a battery of standard neuropsychological tests. A particular diagnostic challenge is the disambiguation of APD from more general deficits of attentional processes such as attention deficit hyperactivity disorder and, indeed, these conditions frequently coexist (Riccio et al., 1994). The interplay of attention and auditory processing is complex and variable.
There are a number of auditory symptom syndromes that can develop without an organic basis. Some of these, such as nonorganic hearing loss, affect populations similar to those presenting with functional somatosensory and motor symptoms, while others, such as musical hallucination, affect populations with a significantly different demographic and require different treatment strategies. Many of these conditions owe their origin to measurably abnormal peripheral sensory pathology or brain network activity, but their pathological impact is often due, at least in part, to overamplification of the salience of these phenomena. For each syndrome, this chapter briefly outlines a definition, demographics, investigations, putative mechanisms, and treatment strategies. Consideration is given to what extent they can be considered to have a functional basis. Treatments are in many cases pragmatic and rudimentary, needing more work to be done in integrating insights from behavioral and cognitive psychology to auditory neuroscience. The audiology literature has historically equated the term functional with malingering, although this perception is, thankfully, slowly changing. These disorders transcend the disciplines of audiology, otorhinolaryngology, neurology and psychiatry, and a multidisciplinary approach is often rewarding.

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ARTICLESComorbidity of Central Auditory Processing Disorder and Attention-Deficit Hyperactivity Disorder

ABSTRACT

Method

Results

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Manual for the Teacher Report Form and Profile

Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III)

Diagnostic and Statistical Manual of Mental Disorders, 3rd edition-revised (DSM-III-R)

DSM-IV Draft Criteria

Guidelines for hearing impairments and middle ear disorders

ASHA

Report of the Ad Hoc Committee on Central Auditory Processing Disorders

Comorbidity of ADHD and reading disability among clinic-referred children

J Abnorm Child Psychol

The association between emotional/behavior disorders and learning disorders in children with speech/language disorders

Advances in Learning and Behavioral Disabilities

Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment

Central auditory processing disorder or attention deficit disorder?

J Dev Behav Pediatr

Association between attention deficit hyperactivity disorder and learning disorders

Journal of Learning Disabilities

Big genes, little genes, affective disorder, and anxiety

Arch Gen Psychiatry

Peabody Picture Vocabulary Test-Revised Manual for Forms L and M

The boundaries of attention deficit disorder

Journal of Learning Disabilities

Methodological issues in the classification of attention-related disorders

Journal of Learning Disabilities

Central auditory processing and attention deficit disorders

J Child Neurol

Attention-deficit disorder with (ADD/H) and without (ADD/WO) hyperactivity: behavioral and neuropsychological differentiation

Journal of Clinical Child Psychology

Attention deficit disorder without hyperactivity (ADD/WO): a distinct neuro-cognitive syndrome

J Child Neurol

ARTICLES
Comorbidity of Central Auditory Processing Disorder and Attention-Deficit Hyperactivity Disorder