A magnetoencephalographic study of low-level auditory processing in developmental dyslexia

The possibility that developmental dyslexia results from low-level sensory processing deficits has received renewed interest in recent years. Opponents of such sensory-based explanations argue that dyslexia arises primarily from phonological impairments. However, many behavioural correlates of dyslexia cannot be explained sufficiently by cognitive-level accounts and there is anatomical, psychometric and physiological evidence of sensory deficits in the dyslexic population. This thesis aims to determine whether the low-level (pre-attentive) processing of simple auditory stimuli is disrupted in compensated adult dyslexics. Using psychometric and neurophysiological measures, the nature of auditory processing abnormalities is investigated. Group comparisons are supported by analysis of individual data in order to address the issue of heterogeneity in dyslexia. The participant pool consisted of seven compensated dyslexic adults and seven age and IQ matched controls. The dyslexic group were impaired, relative to the control group, on measures of literacy, phonological awareness, working memory and processing speed. Magnetoencephalographic recordings were conducted during processing of simple, non-speech, auditory stimuli. Results confirm that low-level auditory processing deficits are present in compensated dyslexic adults. The amplitude of N1m responses to tone pair stimuli were reduced in the dyslexic group. However, there was no evidence that manipulating either the silent interval or the frequency separation between the tones had a greater detrimental effect on dyslexic participants specifically. Abnormal MMNm responses were recorded in response to frequency deviant stimuli in the dyslexic group. In addition, complete stimulus omissions, which evoked MMNm responses in all control participants, failed to elicit significant MMNm responses in all but one of the dyslexic individuals. The data indicate both a deficit of frequency resolution at a local level of auditory processing and a higher-level deficit relating to the grouping of auditory stimuli, relevant for auditory scene analysis. Implications and directions for future research are outlined.

Anatomical correlates of dynamic auditory processing:relationship to literacy during early adolescence

Adults show great variation in their auditory skills, such as being able to discriminate between foreign speech-sounds. Previous research has demonstrated that structural features of auditory cortex can predict auditory abilities; here we are interested in the maturation of 2-Hz frequency-modulation (FM) detection, a task thought to tap into mechanisms underlying language abilities. We hypothesized that an individual's FM threshold will correlate with gray-matter density in left Heschl's gyrus, and that this function-structure relationship will change through adolescence. To test this hypothesis, we collected anatomical magnetic resonance imaging data from participants who were tested and scanned at three time points: at 10, 11.5 and 13 years of age. Participants judged which of two tones contained FM; the modulation depth was adjusted using an adaptive staircase procedure and their threshold was calculated based on the geometric mean of the last eight reversals. Using voxel-based morphometry, we found that FM threshold was significantly correlated with gray-matter density in left Heschl's gyrus at the age of 10 years, but that this correlation weakened with age. While there were no differences between girls and boys at Times 1 and 2, at Time 3 there was a relationship between gray-matter density in left Heschl's gyrus in boys but not in girls. Taken together, our results confirm that the structure of the auditory cortex can predict temporal processing abilities, namely that gray-matter density in left Heschl's gyrus can predict 2-Hz FM detection threshold. This ability is dependent on the processing of sounds changing over time, a skill believed necessary for speech processing. We tested this assumption and found that FM threshold significantly correlated with spelling abilities at Time 1, but that this correlation was found only in boys. This correlation decreased at Time 2, and at Time 3 we found a significant correlation between reading and FM threshold, but again, only in boys. We examined the sex differences in both the imaging and behavioral data taking into account pubertal stages, and found that the correlation between FM threshold and spelling was strongest pre-pubertally, and the correlation between FM threshold and gray-matter density in left Heschl's gyrus was strongest mid-pubertally.

Childhood auditory processing disorder as a developmental disorder:the case for a multi-professional approach to diagnosis and management

Auditory processing disorder (APD) is diagnosed when a patient presents with listening difficulties which can not be explained by a peripheral hearing impairment or higher-order cognitive or language problems. This review explores the association between auditory processing disorder (APD) and other specific developmental disorders such as dyslexia and attention-deficit hyperactivity disorder. The diagnosis and aetiology of APD are similar to those of other developmental disorders and it is well established that APD often co-occurs with impairments of language, literacy, and attention. The genetic and neurological causes of APD are poorly understood, but developmental and behavioural genetic research with other disorders suggests that clinicians should expect APD to co-occur with other symptoms frequently. The clinical implications of co-occurring symptoms of other developmental disorders are considered and the review concludes that a multi-professional approach to the diagnosis and management of APD, involving speech and language therapy and psychology as well as audiology, is essential to ensure that children have access to the most appropriate range of support and interventions.

The influence of adaptation and inhibition on the effects of onset asynchrony on auditory grouping

Onset asynchrony is an important cue for auditory scene analysis. For example, a harmonic of a vowel that begins before the other components contributes less to the perceived phonetic quality. This effect was thought primarily to involve high-level grouping processes, because the contribution can be partly restored by accompanying the leading portion of the harmonic (precursor) with a synchronous captor tone an octave higher, and hence too remote to influence adaptation of the auditory-nerve response to that harmonic. However, recent work suggests that this restoration effect arises instead from inhibitory interactions relatively early in central auditory processing. The experiments reported here have reevaluated the role of adaptation in grouping by onset asynchrony and explored further the inhibitory account of the restoration effect. Varying the frequency of the precursor in the range ± 10% relative to the vowel harmonic (Experiment 1), or introducing a silent interval from 0 to 320 ms between the precursor and the vowel (Experiment 2), both produce effects on vowel quality consistent with those predicted from peripheral adaptation or recovery from it. However, there were some listeners for whom even the smallest gap largely eliminated the effect of the precursor. Consistent with the inhibitory account of the restoration effect, a contralateral pure tone whose frequency is close to that of the precursor is highly effective at restoring the contribution of the asynchronous harmonic (Experiment 3). When the frequencies match, lateralization cues arising from binaural fusion of the precursor and contralateral tone may also contribute to this restoration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Sensory processing, reading, IQ, and attention

Detection thresholds for two visual- and two auditory-processing tasks were obtained for 73 children and young adults who varied broadly in reading ability. A reading-disabled subgroup had significantly higher thresholds than a normal-reading subgroup for the auditory tasks only. When analyzed across the whole group, the auditory tasks and one of the visual tasks, coherent motion detection, were significantly related to word reading. These effects were largely independent of ADHD ratings; however, none of these measures accounted for significant variance in word reading after controlling for full-scale IQ. In contrast, phoneme awareness, rapid naming, and nonword repetition each explained substantial, significant word reading variance after controlling for IQ, suggesting more specific roles for these oral language skills in the development of word reading. © 2004 Elsevier Inc. All rights reserved.

Auditory training and adult rehabilitation:a critical review of the evidence

Auditory Training (AT) describes a regimen of varied listening exercises designed to improve an individual’s ability to perceive speech. The theory of AT is based on brain plasticity (the capacity of neurones in the central auditory system to alter their structure and function) in response to auditory stimulation. The practice of repeatedly listening to the speech sounds included in AT exercises is believed to drive the development of more efficient neuronal pathways, thereby improving auditory processing and speech discrimination. This critical review aims to assess whether auditory training can improve speech discrimination in adults with mild-moderate SNHL. The majority of patients attending Audiology services are adults with presbyacusis and it is therefore important to evaluate evidence of any treatment effect of AT in aural rehabilitation. Ideally this review would seek to appraise evidence of neurophysiological effects of AT so as to verify whether it does induce change in the CAS. However, due to the absence of such studies on this particular patient group, the outcome measure of speech discrimination, as a behavioural indicator of treatment effect is used instead. A review of available research was used to inform an argument for or against using AT in rehabilitative clinical practice. Six studies were identified and although the preliminary evidence indicates an improvement gained from a range of AT paradigms, the treatment effect size was modest and there remains a lack of large-sample RCTs. Future investigation into the efficacy of AT needs to employ neurophysiological studies using auditory evoked potentials in hearing-impaired adults in order to explore effects of AT on the CAS.

Case study: auditory brain responses in a minimally verbal child with autism and cerebral palsy

An estimated 30% of individuals with autism spectrum disorders (ASD) remain minimally verbal into late childhood, but research on cognition and brain function in ASD focuses almost exclusively on those with good or only moderately impaired language. Here we present a case study investigating auditory processing of GM, a nonverbal child with ASD and cerebral palsy. At the age of 8 years, GM was tested using magnetoencephalography (MEG) whilst passively listening to speech sounds and complex tones. Where typically developing children and verbal autistic children all demonstrated similar brain responses to speech and nonspeech sounds, GM produced much stronger responses to nonspeech than speech, particularly in the 65–165 ms (M50/M100) time window post-stimulus onset. GM was retested aged 10 years using electroencephalography (EEG) whilst passively listening to pure tone stimuli. Consistent with her MEG response to complex tones, GM showed an unusually early and strong response to pure tones in her EEG responses. The consistency of the MEG and EEG data in this single case study demonstrate both the potential and the feasibility of these methods in the study of minimally verbal children with ASD. Further research is required to determine whether GM's atypical auditory responses are characteristic of other minimally verbal children with ASD or of other individuals with cerebral palsy.

Common variance in amplitude envelope perception tasks and their impact on phoneme duration perception and reading and spelling in Finnish children with reading disabilities

Our goal was to investigate auditory and speech perception abilities of children with and without reading disability (RD) and associations between auditory, speech perception, reading, and spelling skills. Participants were 9-year-old, Finnish-speaking children with RD (N = 30) and typically reading children (N = 30). Results showed significant group differences between the groups in phoneme duration discrimination but not in perception of amplitude modulation and rise time. Correlations among rise time discrimination, phoneme duration, and spelling accuracy were found for children with RD. Those children with poor rise time discrimination were also poor in phoneme duration discrimination and in spelling. Results suggest that auditory processing abilities could, at least in some children, affect speech perception skills, which in turn would lead to phonological processing deficits and dyslexia.

Separate influences of acoustic AM and FM sensitivity on the phonological decoding skills of impaired and normal readers

Developmental dyslexia is associated with deficits in the processing of basic auditory stimuli. Yet it is unclear how these sensory impairments might contribute to poor reading skills. This study better characterizes the relationship between phonological decoding skills, the lack of which is generally accepted to comprise the core deficit in reading disabilities, and auditory sensitivity to amplitude modulation (AM) and frequency modulation (FM). Thirty-eight adult subjects, 17 of whom had a history of developmental dyslexia, completed a battery, of psychophysical measures of sensitivity to FM and AM at different modulation rates, along with a measure of pseudoword reading accuracy and standardized assessments of literacy and cognitive skills. The subjects with a history of dyslexia were significantly less sensitive than controls to 2-Hz FM and 20-Hz AM only. The absence of a significant group difference for 2-Hz AM shows that the dyslexics do not have a general deficit in detecting all slow modulations. Thresholds for detecting 2-Hz and 240-Hz FM and 20-Hz AM correlated significantly with pseudoword reading accuracy. After accounting for various cognitive skills, however, multiple regression analyses showed that detection thresholds for both 2-Hz FM and 20-Hz AM were significant and independent predictors of pseudoword reading ability in the entire sample. Thresholds for 2-Hz AM and 240-Hz FM did not explain significant additional variance in pseudoword reading skill, it is therefore possible that certain components of auditory processing of modulations are related to phonological decoding skills, whereas others are not.

Development of a passive MEG stimulus for measurement of the binaural masking level difference

The ability to hear a target signal over background noise is an important aspect of efficient hearing in everyday situations. This mechanism depends on binaural hearing whenever there are differences in the inter-aural timing of inputs from the noise and the signal. Impairments in binaural hearing may underlie some auditory processing disorders, for example temporal-lobe epilepsies. The binaural masking level difference (BMLD) measures the advantage in detecting a tone whose inter-aural phase differs from that of the masking noise. BMLD’s are typically estimated psychophysically, but this is challenging in children or those with cognitive impairments. The aim of this doctorate is to design a passive measure of BMLD using magnetoencephalography (MEG) and test this in adults, children and patients with different types of epilepsy. The stimulus consists of Gaussian background noise with 500-Hz tones presented binaurally either in-phase or 180° out-of-phase between the ears. Source modelling provides the N1m amplitude for the in-phase and out-of-phase tones, representing the extent of signal perception over background noise. The passive BMLD stimulus is successfully used as a measure of binaural hearing capabilities in participants who would otherwise be unable to undertake a psychophysical task.

Causal attributions in King-Kopetzky syndrome

At least 10% of people who present for help with hearing difficulties will be found to have normal hearing thresholds. These cases are clinically categorized as King-Kopetzky syndrome (KKS), obscure auditory dysfunction (OAD), or auditory processing disorder (APD). While recent research has focussed on the possible mechanistic basis for these difficulties, the perceptions of the hearing difficulties that lead people to seek help have not hitherto been identified. This study presents findings from an observational survey of causal attributions of hearing difficulties from 100 people with KKS. The findings suggest that participants regard immunity and risk related causes of hearing difficulties as pre-dominant. Psychological factors were not considered to be causal for hearing difficulties. These factors were not affected by diagnostic classification. These findings inform audiologists about their patient beliefs for the first time. The authors suggest that clinicians take care to ensure that their counselling is responsive to these beliefs. © 2010 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society.

Illness perceptions and hearing difficulties in King-Kopetzky syndrome:what determines help seeking?

The present study explored illness perceptions of hearing difficulties amongst one hundred participants who reported experiencing hearing difficulties despite normal audiometric thresholds. This experience is referred to as King-Kopetzky syndrome (KKS), obscure auditory dysfunction (OAD), or auditory processing disorder (APD). Logistic regression was used to consider the associations between help-seeking and a range of audiological and illness perception measures. Results indicate that help-seekers present with poorer speech in noise thresholds than non help-seekers, and that coherent illness perceptions and a negative belief in the consequences of hearing difficulties are associated with help-seeking status, regardless of hearing sensitivity.

Predicting dyslexia using prereading skills:the role of sensorimotor and cognitive abilities

Background: It is well established that phonological awareness, print knowledge and rapid naming predict later reading difficulties. However, additional auditory, visual and motor difficulties have also been observed in dyslexic children. It is examined to what extent these difficulties can be used to predict later literacy difficulties. Method: An unselected sample of 267 children at school entry completed a wide battery of tasks associated with dyslexia. Their reading was tested 2, 3 and 4 years later and poor readers were identified (n = 42). Logistic regression and multiple case study approaches were used to examine the predictive validity of different tasks. Results: As expected, print knowledge, verbal short-term memory, phonological awareness and rapid naming were good predictors of later poor reading. Deficits in visual search and in auditory processing were also present in a large minority of the poor readers. Almost all poor readers showed deficits in at least one area at school entry, but there was no single deficit that characterised the majority of poor readers. Conclusions: Results are in line with Pennington’s (2006) multiple deficits view of dyslexia. They indicate that the causes of poor reading outcome are multiple, interacting and probabilistic, rather than deterministic. Keywords: Dyslexia; educational attainment; longitudinal studies; prediction; phonological processing.

Pediatric CNS pathophysiology

Research in pediatric central nervous system pathophysiology is focused around three primary goals: identification of neurodevelopmental disorders, understanding the differences in brain development which underlie these disorders, and improving treatment for these young children. Autism spectrum disorders (ASDs) are a complex set of disorders which are characterized by difficulties in language and social interactions. These behavioral measures are highly variable and a number of underlying causes can generate similar behavioral effects. Therefore, it is important to identify neurophysiological markers to better identify and characterize these disorders. Recent ASD findings using MEG show atypical latency and amplitude responses and poor cortical connectivity in children with ASDs across the cognitive spectrum from basic auditory processing, multisensory integration, to face and semantic processing. These results further support the view that ASDs are a complex neurologically-based disorder. On the other hand, the cause of Down syndrome is well understood as originating from a partial or full replication of chromosome 21. However, the cognitive and neurological consequences of this chromosomal abnormality are not yet well understood. Using a simple observation and motor execution task, poor functional connectivity in sensory-motor areas, particularly in the gamma band range, has been identified in children with Down syndrome and is consistent with behavioral deficits in the sensory-motor realm. Additional studies are needed to better understand whether targeted identification of these abnormalities can facilitate treatment in this disorder. Finally, while epilepsy can be reliably diagnosed, seizure control is still limited in many cases where the seizure onset zone is not readily apparent. Advances in pre-surgical evaluation and intra-operative co-registration will be described. These studies describing pediatric CNS pathophysiology will be discussed. © Springer-Verlag 2010.