Objectives: To examine the links between auditory processing (AP) test results, functional deficits, and cognitive abilities. Design: One hundred and fifty-five children, ages 7–12 years, comprising 50 control children and 105 children referred for AP assessment, all with normal peripheral hearing, completed an AP and cognitive (sustained attention, auditory working memory, and nonverbal intelligence) test battery. Functional outcome measures of listening ability (developed using questionnaires from parent, teacher, and child respondents) and reading fluency were also collected. Results: AP scores for dichotic digits, frequency pattern, and listening in spatialized noise-sentences test baseline scores showed significant intertask correlations, and significant correlations with functional outcomes. The gaps in noise task showed correlation with reading fluency only. The AP tasks of masking level differences and spatial advantage showed no correlation with listening ability or reading fluency. Results showed significantly poorer cognitive abilities overall in the children referred for AP assessment compared with the control group. Within the referred group, children diagnosed with an auditory processing disorder had significantly poorer cognitive abilities than those passing the test battery. Correlation and regression studies showed significant associations between AP and cognitive scores. The results of multilinear regression analyses showed that the associations of AP scores with listening and academic results were no longer significant when cognitive scores were also included as predictors. Conclusions: A complex interaction of cognitive abilities and AP scores is evident. For many children with listening difficulties, who perform poorly on AP tasks, cognitive deficits are also in place. Although the direction of causality is unclear, it is likely that these cognitive deficits are causing the perceived difficulty and/or are having a significant effect on the test results. Interpretation of AP tests requires consideration of how cognitive abilities may have impacted on not only task results but also the functional difficulties experienced by the child.

We need to rethink how we assess auditory processing disorder (APD). The current use of test batteries, while necessary and well accepted, is at risk of failing as the size of these batteries increases. To counter the statistical, fatigue, and clinical efficiency problems of large test batteries, we propose a hierarchical approach to APD assessment. This begins with an overall test of listening difficulty in which performance is measurably affected for anyone with an impaired ability to understand speech in difficult listening conditions. It proceeds with a master test battery containing a small number of single tests, each of which assesses a different group of skills necessary for understanding speech in difficult listening conditions. It ends with a detailed test battery, where the individual tests administered from this battery are only those that differentiate the skills assessed by the failed test(s) from the master test battery, so that the specific form of APD can be diagnosed. An example of how hierarchical interpretation of test results could be performed is illustrated using the Listening in Spatialized Noise—Sentences test (LiSN-S). Although consideration of what abilities fall within the realm of auditory processing should remain an important issue for research, we argue that patients will be best served by focusing on whether they have difficulty understanding speech, identifying the specific characteristics of this difficulty, and specifically remediating and/or managing those characteristics.

To investigate the long-term impact of childhood otitis media on listening ability in school-aged children. Speech perception in background noise was measured in two groups of 35 children, aged 6 to 12 years, with normal middle ear function and sound detection at assessment. The first consisted of children who had previously suffered middle ear disease; the second those with no history of middle ear disease. Binaural speech perception ability was significantly poorer in the children with prior middle ear disease. Furthermore, spatial listening (the ability to selectively attend to a sound signal from one location) was also significantly impaired. Significant correlations were demonstrated between both the age of onset and the duration of childhood otitis media and speech perception ability (onset: r = -0.58, p < 0.001; duration: r = -0.63, p < 0.001). These results demonstrate the risk of long-term functional hearing deficit for children with middle ear disease history in childhood. They also indicate that this risk is increased with earlier onset and longer duration. The findings highlight the need for early intervention and an awareness of the potential for reduced functional listening ability even after sound detection has returned to normal.

Neurodevelopmental delay has been proposed as the underlying cause of the majority of cases of auditory processing disorder (APD). The current study employs the cortical auditory evoked potential (CAEP) to assess if maturational differences of the central auditory nervous system (CANS) can be identified between children who do and do not meet the diagnostic criterion for APD. The P1-N1 complex of the CAEP has previously been used for tracking development of the CANS in children with hearing impairment. Twenty-seven children (7 to 12 years old) who failed an APD behavioral test battery were age-matched (within 3 months) to children who had passed the same battery. CAEP responses to 500-Hz tone burst stimuli were recorded and analyzed for latency and amplitude measures. The P1-N1 complex of the CAEP, which has previously been used for tracking development of the CANS in children with hearing impairment, showed significant group differences. The children diagnosed with APD showed significantly increased latency (∼10 milliseconds) and significantly reduced amplitude (∼10 μV) of the early components of the CAEP compared with children with normal auditory processing. No significant differences were seen in the later P2 wave. The normal developmental course is for a decrease in latency and increase in amplitude as a function of age. The results of this study are, therefore, consistent with an immaturity of the CANS as an underlying cause of APD in children.

To track the development of the auditory steady-state response (ASSR) through the neonatal and early infant periods in a group of normal-hearing babies. This longitudinal study involved assessment at four data collection points. ASSR thresholds to modulated 500 Hz and 4 kHz tones were established in 20 full-term subjects at 0, 2, 4, and 6 wks of age. Significant developmental changes were observed for both test frequencies. Mean ASSR threshold levels decreased by approximately 10 dB between the week 0 and week 6 data collection points. The results of this study indicate that ASSR threshold levels in normal-hearing neonates and young infants are different from those observed in older subjects. Clinical application of the ASSR procedure in this population will need to take into account developmental changes occurring in the first weeks of life. Furthermore, the findings indicate that ASSR thresholds in normal-hearing babies at 6 wks of age are not yet mature.

This study presents a scoping review of research on artificial intelligence (AI)- driven virtual patients (VPs) for communication skills training of healthcare students. We aimed to establish what is known about these emergent learning tools, to characterise their design and implementation into training programmes. The preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews framework was consulted. Searches occurred in six online databases to capture relevant articles from 2014 to 2024. Eight articles from five disciplines met inclusion criteria. A variety of design approaches, creation tools and VP appearances exist. Educational considerations such as consultation of educational theory, curricular integration and provision of feedback was overall lacking. Neutral to positive evaluations of satisfaction and acceptance of the VPs were provided by most students. Emerging literature suggests AI-driven VPs are increasingly being utilised for communication skills training, although their effectiveness is not established. Careful consideration of technological design features, educational theory and evidence regarding communication skill development should occur by clinical educators wishing to include AI-driven VPs in their training programmes. Further empirical research involving key stakeholders is needed to learn more about this technology. Implications for practice or policy: Students may find benefit from having opportunities to use AI-driven VPs for communication skill development. Developers could avoid some criticisms of AI-driven VPs by carefully addressing technical issues Educators should consult evidence on educational and communication theories when utilising AI-driven VPs. Researchers should consider increasing the involvement of key stakeholders in the design and evaluation of communication skill focused AI-driven VPs.