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1/11. The use of the ADI-R as a diagnostic tool in the differential diagnosis of children with infantile autism and children with a receptive language disorder.

    Children with infantile autism and children with a specific receptive language disorder often show similar behavioural problems, making the differentiation between these two diagnostic categories difficult. The purpose of this study is to evaluate the usefulness of parental information in the differential diagnosis of the two types of disorders mentioned above. Sixteen children with a receptive language disorder and 11 children with infantile autism participated in the study. All children had normal non-verbal IQs. The ADI-R (Autism Diagnostic interview-Revised) was performed with all children. The results showed that the ADI-R items reflecting behavioural features at pre-school age (age range 4-5 years) were better suited to differentiate the groups than the items reflecting behavioural features at the time of the investigation (mean age: 9 years). The items on the dimension "Reciprocal social interaction" and "communication and language" discriminated the groups better than the items of the dimension "Restricted interests". According to the ICD-10 algorithm of the ADI-R one child with autism and one child with a receptive language disorder were falsely classified. These false classifications were mainly due to a distorted parental perception of the child's behaviour. The ADI-R is a useful tool in the differential diagnosis of developmental disorders.
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2/11. Behavioral and electrophysiologic evidence of auditory processing disorder: a twin study.

    We administered a battery of both behavioral and electrophysiologic measures to a pair of fraternal twin girls, one of whom exhibited symptoms consistent with an auditory processing disorder. Both twins were within normal limits on standardized tests of cognitive and language skills. Basic audiometric measures, as well as behavioral tests of simultaneous masking, backward masking, gap detection, and frequency-sweep discrimination, showed little difference between the twins. Significant differences, however, were evident on event-related potentials (ERPs) in response to both within-channel and across-channel gap detection tasks. Substantial differences were also noted for ERPs to both linguistic and nonlinguistic targets in dichotic listening paradigms. The pattern of electrophysiologic results was consistent with a deficit in the efficiency of interhemispheric transfer of auditory information. A possible reason for the greater effectiveness of electrophysiologic over behavioral measures is discussed.
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3/11. Impaired processing of prosodic and musical patterns after right hemisphere damage.

    The distinction between the processing of musical information and segmental speech information (i.e., consonants and vowels) has been much explored. In contrast, the relationship between the processing of music and prosodic speech information (e.g., intonation) has been largely ignored. We report an assessment of prosodic perception for an amateur musician, KB, who became amusic following a right-hemisphere stroke. Relative to matched controls, KB's segmental speech perception was preserved. However, KB was unable to discriminate pitch or rhythm patterns in linguistic or musical stimuli. He was also impaired on prosodic perception tasks (e.g., discriminating statements from questions). Results are discussed in terms of common neural mechanisms that may underlie the processing of some aspects of both music and speech prosody.
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4/11. Crossed Wernicke's aphasia: a case report.

    Crossed aphasia is a phenomenon in which an individual sustains a lesion in the right hemisphere (typically non-language dominant), but who exhibits an aphasic syndrome. The authors present a case study of an individual with crossed aphasia (CA) in an attempt to provide anecdotal information for four questions posed by : (a). Is CA a reversal of the normal cerebral hemisphere pattern of language function? (b). Does the presence of aphasia following a right cerebral hemisphere lesion indicate that typical right hemisphere functions (e.g., visual perception) are intact? (c). How may the aphasia's presentation differ from typical left hemisphere aphasias? And (d). is the pattern of improvement following CA similar to that of typical left hemisphere aphasias? We longitudinally examined the communicative-cognitive performance of an adult man with crossed aphasia of the Wernicke's type following a cerebrovascular accident. A 21-week follow-up evaluation indicated improvements in his language functioning from our initial evaluation, but he continued to exhibit a classic, moderately severe Wernicke's aphasia.
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5/11. Central auditory processing disorder: a case study.

    We carried out extensive audiologic, electrophysiologic, and neuropsychologic testing on a young woman who complained that she had difficulty hearing in her educational environment. Conventional audiometric results, including pure-tone, speech, and immittance audiometry, were all within normal limits. The subject performed normally on tests involving the processing of rapidly changing temporal information, interaural time and intensity difference detection, and both absolute and relative sound localization. Early, middle, late and task-related auditory evoked potentials were essentially normal, although some asymmetry was observed in the middle latency (MLR) and late (LVR) responses. There was, however, a consistent left-ear deficit on dichotic sentence identification, on threshold and suprathreshold speech measures in the left sound field when various types of competition were delivered in the right sound field, and on cued-target identification in the left sound field in the presence of multitalker babble. Results suggest a central auditory processing disorder characterized by an asymmetric problem in the processing of binaural, noncoherent signals in auditory space. When auditory space was structured such that the target was directed to the left ear, and the competition to the right ear, unwanted background was less successfully suppressed than when the physical arrangement was reversed.
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6/11. Auditory perceptual problems in non-organic hearing disorder.

    A series of 22 patients who presented with non-organic hearing disorder were examined for auditory perceptual problems. A test battery that examined eight areas of auditory perception revealed significant auditory perceptual problems in each of the 22 patients. The results indicate a view that differs from the traditional view of non-organic hearing disorder as either conscious feigning of a hearing disorder or an unconscious symptom of an unidentified emotional disorder. The information presented here indicates that specific auditory processing disorders could adversely affect patients' hearing and that auditory perceptual disorders could be diagnosed and treated.
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7/11. Distinguishing auditory and speech-specific perceptual deficits.

    The ability to discriminate speech and nonspeech auditory stimuli was tested in a learning disabled child. The perception of speech stimuli was normal when the stimuli were presented in quiet but below normal when the stimuli were presented in noise. Although the perception of pure tone stimuli and environmental sounds was normal both in quiet and noise, the perception of nonspeech stimuli with rapid changes in acoustic information was impaired in noise. These findings illustrate the importance of relating performance for speech and complex nonspeech stimuli in investigating the basis of speech perceptual deficits. Whereas abnormal performance for speech stimuli coupled with normal performance for complex nonspeech stimuli argues for the existence of specialized speech processing mechanisms, abnormal performance for both types of stimuli, as was found in the present subject, argues for the existence of more generalized auditory processing mechanisms.
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8/11. Clinical and audiological findings in a case of auditory agnosia.

    A case is reported of severe agnosia for verbal and non-verbal sounds without associated aphasic disorder. A CT scan revealed bilateral, temporal lobe lesions from two ischaemic accidents that had occurred 9 months apart. The search for subtle deficits in the patient showed normal sensitivity to changes in the intensity and frequency of simple sounds; in contrast, his ability to discriminate sound duration and musical note sequences was severely impaired. The simultaneous recording of the whole auditory-evoked response pattern revealed no abnormality in the early components, which reflect the activation of the auditory nuclei and pathways of the brain stem. However, the middle and late components were delayed and slowed. These results and others in the literature suggest that the neocortex in man, as in other mammals, plays an essential role in the temporal aspects of hearing. Also, the two main ingredients commonly recognized in auditory agnosia, i.e. word deafness and the inability to interpret non-verbal sounds, are caused by the disruption of elementary, bilaterally represented cortical functions which start the processing of every kind of auditory information.
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9/11. Auditory perceptual problems in children: considerations for the otolaryngologist and audiologist.

    Five cases of children with auditory processing problems are presented. These children had essentially normal peripheral hearing and ENT exam, but were referred with a question of hearing loss. An auditory perceptual test battery including rapidly alternating speech (RASP), binaural fusion, low pass filtered speech (LPFS), competing sentences, staggered spondiac words (SSW), dichotic digits and frequency patterns was employed. Though some of these tests did not show a perceptual deficit, the majority did depict specific types of auditory processing problems. Based on the information provided by this test battery, appropriate diagnosis and therapy can be provided for the patient.
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10/11. Mismatch negativity in the neurophysiologic/behavioral evaluation of auditory processing deficits: a case study.

    The subject of this case report is an 18-year-old woman with grossly abnormal auditory brain stem response (ABR), normal peripheral hearing, and specific behavioral auditory processing deficits. Auditory middle latency responses (MLRs) and cortical potentials N1, P2, and P300 were intact. The mismatch negativity (MMN) was normal in response to certain synthesized speech stimuli and impaired to others--consistent with her behavioral discrimination of these stimuli. Behavioral tests of auditory processing were consistent with auditory brain stem dysfunction. A neuropsychological evaluation revealed normal intellectual and academic performance. The subject was in her first year of college at the time of the evaluation. This case study is important because: (1) Although there have been several reports of absent/abnormal ABR with preserved peripheral hearing and deficits in auditory processing, little is known about the specific nature of the auditory deficits experienced by these individuals. Such information may be valuable to the clinical management of patients with this constellation of findings. (2) Of interest is the information that the mismatch negativity (MMN) cortical event-related potential can bring to the evaluation of patients with auditory processing deficits. The MMN reflects central auditory processing of small acoustic differences and may provide an objective measure of auditory discrimination. (3) From a theorectical standpoint, a patient with neural deficits affecting specific components of the auditory pathway provides insight into the relationship between evoked potentials and physiological mechanisms of auditory processing. How do various components of the auditory pathway contribute to speech discrimination? How might evoked potentials reflect the processes underlying the neural coding of specific features of speech stimuli such as timing and spectral cues?
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