title: Screening for auditory processing performance in primary school children.
abstract: BACKGROUND
  A deficit in the processing of auditory information may underlie problems in understanding speech in the presence of background noise, degraded speech, and in following spoken instructions. Children with auditory processing disorders are challenged in the classroom because of ambient noise levels and maybe at risk for learning disabilities.
  
  
  OBJECTIVE
  1) Set up and execute screening protocol for auditory processing performance (APP) in primary school children. 2) Construct database for APP in the classroom. 3) Set critical limits for deviant performance. Our hypothesis is that screening for APP in the classroom identifies pupils at risk for auditory processing disorders.
  Study consisted of two phases. Phase 1: 2,015 pupils were selected from fourth-, fifth-, and sixth-graders using stratified random sampling with the proportional allocation method. Male and female students were equally represented. Otoscopic examination, screening audiometery, and screening tests for auditory processing (AP) abilities (Pitch Pattern Sequence Test [PPST], speech perception in noise [SPIN] right, SPIN left, and Dichotic Digit Test) were conducted. A questionnaire emphasizing auditory listening behaviors (ALB) was answered by classroom teacher. Phase 2 included 69 pupils who were randomly selected based on percentile scores of phase 1. Students were examined for the corresponding full version AP tests in addition to Auditory Fusion Test-Revised and masking level difference. Intelligence quotient and learning disabilities were evaluated.
  
  
  RESULTS
  Phase 1: Results are displayed in frequency polygons for10th, 25th, 50th, 75th, and 90th percentiles score for each AP test. Fourth-graders scored significantly lower than fifth- and sixth-graders on all tests. Males scored lower than females on PPST. A composite score was calculated to represent a summed score performance for PPST, SPIN right ear, SPIN left ear, and Dichotic Digit Test. Scores <10th percentile were chosen to describe the poorest performance on screening. Performance was graded from 0 to 4 according to composite score; a score of 4 refers to scores <10th percentile on all four tests, while a 0 score designates performance ≥ the 10th percentile on all tests. ALB questionnaire scores of the sample screened varied significantly with sex and grade. Statistical analysis of phase 2 showed no statistical difference between mean score for Group 0 and clinic norms on all AP tests. Group 1 showed consistent poor performance in both the screening and full version SPIN test. Group 2 scored significantly lower on all screening tests, but not significantly different in some of the full version tests. Groups 3 and 4 showed significantly worse performance than clinic norms on all screening and full version tests. Auditory Fusion Test-Revised mean thresholds were statistically higher for groups with composite scores from 1 to 4. Masking level difference mean score was only significantly different for Group 4. ALB questionnaire results correlated to composite score categories. Dyslexia was a comorbid condition with Groups 2-4.
  
  
  CONCLUSIONS
  AP skills in primary education maybe classified as robust abilities that endure challenging listening conditions, vulnerable abilities that manifest in challenging conditions, and poor abilities that manifest in even the best listening conditions. Composite score concept provides adequacy in grading AP skills.
authors: Audiology Unit, Otorhinolaryngology Department, Faculty of Medicine, Alexandria University, Egypt.
authors: Mona
authors: M
authors: Mourad
authors: Biostatistics Department, Higher Institute of Medicine, Alexandria University, Egypt.
authors: Mona
authors: M
authors: Hassan
authors: Phoniatrics Unit, Otorhinolaryngology Department, Faculty of Medicine, Alexandria University, Egypt.
authors: Manal
authors: M
authors: El-Banna
authors: Audiology Unit, Otorhinolaryngology Department, Faculty of Medicine, Alexandria University, Egypt.
authors: Samir
authors: S
authors: Asal
authors: Audiology Unit, Otorhinolaryngology Department, Faculty of Medicine, Alexandria University, Egypt.
authors: Yasmeen
authors: Y
authors: Hamza
mesh_terms: D001299:Audiometry; D001307:Auditory Perception; D001308:Auditory Perceptual Disorders / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D004534:Egypt; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening; D009622:Noise; D011594:Psychometrics; D015203:Reproducibility of Results