www.bjorl.org
Brazilian
Journal
of
OTORHINOLARYNGOLOGY
REVIEW
ARTICLE
Questionnaires
and
checklists
for
central
auditory
processing
screening
used
in
Brazil:
a
systematic
review
夽
Francielli
Loss
Volpatto
a,
Inaê
Costa
Rechia
b,
Alexandre
Hundertmarck
Lessa
c,
Cristina
Loureiro
Chaves
Soldera
a,
Maria
Inês
Dornelles
da
Costa
Ferreira
d,
Márcia
Salgado
Machado
a,∗aUniversidadeFederaldeCiênciasdaSaúdedePortoAlegre(UFCSPA),CursodeFonoaudiologia,PortoAlegre,RS,Brazil bUniversidadeFederaldeSantaMaria(UFSM),CursodeFonoaudiologia,SantaMaria,RS,Brazil
cUniversidadeFederaldoRioGrandedoSul(UFRGS),CursodeFonoaudiologia,PortoAlegre,RS,Brazil dFaculdadeNossaSenhoradeFátima,CursodeFonoaudiologia,CaixasdoSul,RS,Brazil
Received7March2018;accepted1May2018 Availableonline21June2018
KEYWORDS
Surveysand questionnaires; Auditory; Hearingtests; Auditoryperception; Brazil
Abstract
Introduction:The actionoflisteninginvolvesacomplexinteractionbetween theperipheral andcentralauditory systems.Central auditoryprocessing disordercanbe describedasany probleminoneormoreauditoryabilities.Literaturereportsthatbehavioralquestionnairesand checklistscanbeappliedtoscreenindividualsatriskforcentralauditoryprocessingdisorder. Objective: Toidentifyandanalyzeinthenationalliteraturequestionnairesandchecklistsfor thescreeningofcentralauditoryprocessingavailableinBrazilforthePortugueselanguage. Methods:The researchwas carried outin electronicdatabases and‘‘grayliterature’’.The search strategywas: ‘‘questionnairesORsurveysandquestionnairesAND auditory OR hear-ing tests ORauditory perceptionAND Brazil’’. The researchwas carried out between June and August of2017. Study selection followed inclusion and exclusion criteria.The criteria adoptedincludedBrazilianstudies,withoutdateanddesignrestriction,thatwerecarriedout, translated,adaptedand/orvalidatedtoBrazilianPortugueseorEuropeanPortuguese,astools forcentralauditoryprocessingscreening.Internationalstudiesthatwerenotadaptedtothe Portugueselanguagewereexcluded,aswellastheonesthatwerenotavailableinfull. Results:A total of3664 publicationswere found andseven articles were selected for this systematicreview,accordingtotheestablishedcriteria.
夽 Pleasecitethisarticleas:VolpattoFL,RechiaIC,LessaAH,SolderaCL,FerreiraMI,MachadoMS.Questionnairesandchecklistsfor centralauditoryprocessingscreeningusedinBrazil:asystematicreview.BrazJOtorhinolaryngol.2019;85:99---110.
∗Correspondingauthor.
E-mail:marciasm@ufcspa.edu.br(M.S.Machado).
PeerReviewundertheresponsibilityofAssociac¸ãoBrasileiradeOtorrinolaringologiaeCirurgiaCérvico-Facial.
https://doi.org/10.1016/j.bjorl.2018.05.003
100 VolpattoFLetal.
Conclusions:Thereisscarcenationalliteratureforcentralauditoryprocessingscreeningand the onlytool validatedto Brazilian Portuguese, published asa monograph,is the auditory processingdomainsquestionnaire.Itissuggestedthatnewstudieswithgreatermethodological stringencyrelatedtotheprocessesoftooladaptationandvalidationbedevelopedandpublished intheusualscientificdatabases,aimingatgreaterdiffusionandclinicalapplicability. © 2018 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).
PALAVRAS-CHAVE
Inquéritose questionários; Audic¸ão; Testesauditivos; Percepc¸ãoauditiva; Brasil
Questionáriosechecklists paratriagemdoprocessamentoauditivocentralutilizados noBrasil:revisãosistemática
Resumo
Introduc¸ão:O ato de ouvir envolve uma complexa interac¸ão entre os sistemas auditivo periféricoecentral.Otranstornodoprocessamentoauditivocentralpodeserdescritocomo qualqueralterac¸ãoemumaoumaishabilidadesauditivas.Aliteraturareferequequestionários echecklistscomportamentaispodemseraplicadosparatriagemdeindivíduosemriscoparao transtornodoprocessamentoauditivocentral.
Objetivo:Identificarnaliteraturanacionaleanalisarquestionáriosechecklistsparatriagem doprocessamentoauditivocentraldisponíveisnoBrasilparaalínguaportuguesa.
Método: Pesquisarealizadaembasesdedadoseletrônicase‘‘literaturacinza’’.Aestratégia debuscafoiaseguinte:questionnairesORsurveysandquestionnairesANDauditoryORhearing testsORauditoryperceptionANDBrazil.Apesquisafoirealizadadejunhoaagostode2017. Aselec¸ãodosestudosseguiucritériosdeinclusãoeexclusão.Oscritériosadotados compreen-deramestudosbrasileiros,semrestric¸ãodedataedelineamento,quetenhamsidoelaborados, traduzidos,adaptadose/ouvalidadosparaoportuguêsbrasileirooueuropeu,questionáriose checklistscomoinstrumentosparatriagemdoprocessamentoauditivocentral.Foramexcluídos estudosinternacionaisnãoadaptadosàlínguaportuguesa,bemcomoaquelesnãodisponíveis naíntegra.
Resultados: Foramencontradas3.664 publicac¸ões esete trabalhosforamselecionados para estarevisãosistemática,conformeoscritériosestabelecidos.
Conclusões:Háescassaliteraturanacionalparatriagemdoprocessamentoauditivocentraleo únicoinstrumentovalidadoparaoportuguêsbrasileiro,publicadoemformatodemonografia, éoAuditoryProcessingDomainsQuestionnaire.Sugere-sequenovostrabalhoscommaiorrigor metodológiconosprocessosdeadaptac¸ãoevalidac¸ãodosinstrumentossejamdesenvolvidose publicadosnasbasescientíficasusuais,comvistasàmaiordifusãoeaplicabilidadeclínica. © 2018 Associac¸˜ao Brasileira de Otorrinolaringologia e Cirurgia C´ervico-Facial. Publicado por Elsevier Editora Ltda. Este ´e um artigo Open Access sob uma licenc¸a CC BY (http:// creativecommons.org/licenses/by/4.0/).
Introduction
The action of listening involves a complex interaction between the peripheral and central auditory systems. In Brazil,sincethe1990s,studieshavebeencarriedout focus-ingonCentralAuditoryProcessing(CAP)1---definedbythe
AmericanSpeech-Language Hearing Association (ASHA) as theefficiencyand effectivenessbywhichthecentral ner-voussystemsusesauditoryinformation. Todoso,asetof skillsisrequired,whichaimstomeet,discriminate, recog-nize,storeandunderstandsoundinformation.2
Central Auditory Processing Disorder (CAPD) can be describedasany alterationin oneor more auditory abili-ties,namely:soundlocalizationandlateralization,auditory discrimination,recognitionof auditorypatterns, temporal
aspectsofhearing(temporalresolution, masking, integra-tionandordering),figure-groundandauditoryclosure.3
Individuals with CAPD have difficulty hearing and/or understandingauditoryinformation,evenwhentheir audi-tory thresholds arequantitatively normal.They mayhave several difficulties,suchas understandingspeech innoisy environments,followinginstructions,discriminatingsimilar speech sounds, and often request the repetition of ver-balinformation.Overall,morbiditiescanalsobeobserved regardingspelling,reading,andwriting.4
There is a significant association between CAPD and language disorders and school learning difficulties.5---10
complexandthatthereisanassociationbetweenthemand the integrityof theperipheral and central auditory path-ways. Thus, it is understood that parents’ and teachers’ perceptionsregardingthe child’sauditorybehavior in dif-ferent situations of daily life are extremely important to detectthosechildrenatpotentialriskforCAPD.
The AmericanAcademyofAudiology (AAA)2 andASHA11
indicatethatscreeningscalescanbeusedtoidentify indi-vidualsat riskforCAPD,sincefamily-basedquestionnaires andchecklists aretools thatcan assistin providing infor-mation about individual’s communication deficits and the impactonthedailylife.Severalquestionnairesand behav-ioralcheckliststhatassesshearingskillshavebeencreated andmentionedintheinternationalliterature,suchas Chil-dren’s Auditory Performance Scale (CHAPS),12 Screening
InstrumentforTargetingEducationalRisk(SIFTER),13,14Test
of Auditory Processing Skills --- Revised (TAPS-R),15
Chil-dren’sHomeInventoryofListeningDifficulties(CHILD),16,17
Fisher’sAuditoryProblemsChecklist(FAPC),18Auditory
Pro-cessingDomainsQuestionnaire(APDQ),19ListeningInventory
for Education(LIFE),20 ListeningInventoryfor Education
---Revised(LIFE-R),21ScaleofAuditoryBehaviors(SAB),22The
ListeningInventory(TLI)23 andEvaluationofChildren’s
Lis-teningandProcessingSkills(ECLIPS).24
The use of such tools has been discussed in the international literature for many years, and there have been divergences regarding their relevance and clinical applicability.11,25---27 However, in the Brazilian literature,
there is no published evidence on which tools are avail-able for the Portuguese language and have been used in research,1,28---39 nor is there information regarding the
degreesofsensitivity,specificityandtheauditoryabilities focusedbyeachone.
Therefore,theobjectiveofthissystematicreviewwasto identifyandanalyzeinthenationalliteraturethe question-naires andchecklistsfor CAP screening available in Brazil forthePortugueselanguage.
Methods
The researchquestionthat guidedthe present studywas: ‘‘WhichquestionnairesandchecklistsforCAPscreeningare availableinBrazilforthePortugueselanguage?’’.
AimingtoidentifythestudiesinCAPscreeningthrougha questionnaireorchecklist,scientificarticlesweresearched in the following electronic databases: National Library of Medicine (PubMed), Scopus, Scientific Electronic Library Online(SciELO)andtheLatin-AmericanandCaribbean Sys-temonHealthSciencesInformation(LILACS).
Asanalternativesearchsource,wealsousedthe‘‘gray literature’’---definedasanynon-conventionalprintor elec-tronicpublicationproducedatallgovernmental,academic, andcorporatelevels.40 Thus,unpublishedstudiesin
scien-tificdatabaseswerealsoconsideredforthepresentstudy, suchasmonographs,thesesanddissertations.Thesearches were performed in the Brazilian Digital Library of Theses andDissertations(BDTD)andinformally,includingsearches ontheelectronicsearchportalsandthebibliographic ref-erencescitedinthearticlesandin the‘‘grayliterature’’, directlyorindirectlyrelatedtothethemeofthissystematic review.
The descriptors used were selected from the exact descriptorsandtermsobtainedthroughtheHealthSciences Descriptors(DeCs),organizedbytheVirtualHealthLibrary ---Bireme---andtheresearchstrategywasasfollows: Ques-tionnairesORSurveysandquestionnairesANDAuditoryOR HearingtestsORAuditoryPerceptionANDBrazil.
The studies wereindependently analyzed andselected bytwoexaminersand,incaseofdivergence,consensuswas sought.Thefollowinginclusioncriteriawereused:Brazilian studies,withnodateor designrestriction,thatwere cre-ated,translated,adaptedand/orvalidatedforBrazilianor EuropeanPortuguese,usingquestionnairesandchecklistsas toolsforCAPscreening.Internationalstudiesnotadaptedto thePortugueselanguagewereexcluded,aswellasthosenot availableasfull-text.
The collected data were analyzed and qualitatively comparedregarding thefollowingvariables: general char-acteristics, target audience, age range of application, translation, adaptation and/or validation to Portuguese, focused listening skills, number of questions, correlation withthe CAP tests,national studies publishedinfull that usedthetoolandthedegreesofsensitivityandspecificity --- incaseswherevalidationoccurred.
Results
The search strategy occurred from June to August 2017. First,thesearchwascarriedoutintheusualscientific elec-tronic databases, resulting in 3378 published articles. Of these,66articleswereexcludedastheywereduplicatesin andamongthedatabasesthemselves.Ofthe3312remaining studiesfor theinitialanalysis,3311studieswereexcluded becausetheydidnotaddresstheobjectofthisstudyand/or becausetheywereinternationalstudiesnotadaptedtothe Portugueselanguage.Only onearticle,1which adequately
metthe selection criteriafor this systematic review, was included.
Usingthesamesearchstrategy,asearchwascarriedout inthe‘‘grayliterature’’throughtheBrazilianDigitalLibrary ofThesesandDissertations(BDTD),resultingin279studies (169dissertationsand110theses),whichwereexcludedas theydidnotassessthestudytheme.
Finally, informal searches were carried out in Google Scholarandthebibliographicreferencesofthestudies col-lectedforthisreview.Therefore,fourarticles35---38andthree
abstracts34,41,42 were found, which had been published in
Congress Annals that assessed the present theme. It was necessarytocontacttheauthorstohaveaccesstothe stud-iesnot available as full-texts. With the exception of one abstract,34itwaspossibletoobtainallstudiesintheir
origi-nalfull-textversions.Thesesearchandselectionstrategies areshowndiagrammaticallyinFig.1.
Intotal,sevenarticleswereselectedforthissystematic review, as shown in Table 1. Of these, three question-naireswereinformallycreatedbythestudies’authors36---38;
two were translated and adapted from the international literature1,43 (SAB andCHAPS);one wastranslatedonly35;
(QFISHER);and,finally,theother wastranslated,adapted andvalidated44 (APDQ).No original Brazilian studies that
102 VolpattoFLetal.
Identification of
descriptors
científicos
AND AND
Auditory OR Hearing
tests OR Auditory
perception
Brazil Questionnaires OR
Surveys and
questionnaires
3378 studies found.
PubMed
n= 2276
Scopus
n= 1059
SciELO
n= 11
LILACS
n= 32
66 studies excludedue torepetition in and between databas
Initial selection
(title / abstract) 3312 studies selected f the initial analysis
3211 studies excluded because they did not meet one or more cr
established for this systematic review.
1 study eligible for ful-text reading
1 arti cle selected Eligibility of studies
selected for full-text
reading
Includedin thestudy
Searchin the“ gray literature”
Informal search in the
electronic search portal. BDDT:
n= 279
279 studies excluded because th
did not meet one or more of the
established criteria.
279 studies excludeasthey did not meet
one or more of the established criteria.
3 abstracts published in Annals of Congres Secondarysearchof
studies
Contact the authors to read the f-text
articles.
Search in bibliographica
reference
4 articles eligible
for full-text
reading.
4 articles
selected.
1 monograph as Course
Conclusion Pape
1 specialization
monograph 1 abstract excluded due to
unavailability of full-text article.
2 articlesselected. A total of 7 studies
included inthis
systematic review.
Figure1 Diagramofstudysearchandselectionstrategy.
Table2showsthepopulationgroupsthathavebeen pre-viouslystudiedandtherespectivequestionnairesthathave beenused.
Table3demonstratestheauditoryskillsassessedbyeach tool.
Table4comparesandsynthesizesthetoolsregardingthe analyzedvariables.
Discussion
Questionnairesareimportanttoolsin clinicalpracticeand in several fields of knowledge, and currently there are
fewtools availableinBrazilianPortuguesefor audiology.43
Regarding thetools for CAP screening,the interestin the creation,translation,adaptationand/orvalidationofthese toolsinBrazilisquiterecent,comparedtotheinternational scientificproductions,allemerginginthelastdecade.
Regardingthetranslation,adaptationand/orvalidation studies,itisimportanttohighlightthedifficultyoflocating them in the scientific databases. With the exception of theScaleofAuditoryBehaviors(SAB),1publishedinarticle
Table1 Studiesselectedfortheanalysis.
Title/author/year Typeofstudy Objectiveofthestudy Mainfindings
1.Otitismediaandsound localizationabilityinpreschool children.Lima-Gregioetal. (2010)36
Scientificarticle Tocomparethe performanceofchildren intheSLtest,withthe parents’answerstoa questionnaire.
Exceptforthequestionthat investigatedinattention,therewas nosignificantdifferencebetweenthe twotestedgroups---withthe questionnaireandtheSLtestbeing insufficienttoolstodifferentiate them.Theauthorsbelievethisfactis justifiedbythesocioeconomic factorsoftheassessedsample. 2.Identificationofriskfactors
forthe(central)auditory processingdisorderin preschoolchildrenLuzand Costa-Ferreira(2011)37
Scientificarticle Toidentifytherisk factorsforCAPDin preschoolchildren attendingthepublic schoolsystem.
Thetoolwaseffectiveinidentifying statisticallysignificantriskfactorsfor CAPDinthestudiedpopulation regardingthevariables:greater numberofsiblings,greaterrequest forrepetitionofinstructionsand comprehensiondifficultiesina competitiveenvironment.Another importantfindingwasthelarge numberofchildrenwhonever underwentanytypeofaudiological examination,andsomeofthem requestedrepetitionofinstructions frequently.
3.Perceptionofparentsabout theauditoryattentionskillsof hiskidwithcleftlipand palate:retrospectivestudy. Fenimanetal.(2012)38
Scientificarticle Toverifytheperception oftheparentsof childrenwithCLPon theirchildren’sauditory attention.
Thefindingsshowedthatmost interviewedparentspointedoutat leastoneoftheattention-related behaviorsincludedinthe
questionnaire,suggestingthatthe presenceofCLPmayberelatedto difficultiesinauditoryattention. 4.ScaleofAuditoryBehaviors
andauditorybehaviortestsfor auditoryprocessingassessment inPortuguesechildrenNunes etal.(2013)1,22
Scientificarticle Toinvestigatethe hearingabilitiesof Portuguesechildrenand toverifyifthereis correlationbetween themandtheScaleof AuditoryBehaviors(SAB) score.
Asignificantcorrelationwasobserved betweenthequestionnairescoreand thatofthebehavioraltests,the highestofwhichwasobservedinthe testsrelatedtotemporalprocessing. ThehighertheSABscore,thebetter theresponsesobtainedatthe behavioralevaluationoftheCAP.The studyalsoconfirmedthatmost childrenwithascore<46pointsin theSABhadanalterationinoneor moreoftheCAPtests.
5.Theauditoryprocessing domainsquestionnaire(APDQ): Portugueseversion.Yokoyama, etal.(2015)19,33,44
Monograph ToadapttheAPDQinto Portugueseandapply thePortugueseversion ofthequestionnairetoa groupofschool-aged childrenwithoutCAP alterations.
104 VolpattoFLetal.
Table1(Continued)
Title/author/year Typeofstudy Objectiveofthestudy Mainfindings
6.Questionnairechildren’s auditoryperformancescale: translationandadaptationinto BrazilianPortugueseDonadon etal.(2015)12,43
Monograph Totranslateand culturallyadaptthe CHAPSquestionnaire intoBrazilianPortuguese andapplyittoverifyits effectiveness.
Thetoolwentthroughallstagesof theculturaladaptationprocess, obtainingsubstantialsupportforits contentvalidityaccordingto semantic-idiomaticandcultural equivalencecriteria.Themembersof thecommitteeagreedon84%with theculturaladaptationofthe questionnaire.Therewasa
correlationbetweenthequestionsof the‘‘AuditoryMemory’’moduleand theperformanceintheDDtest ---binauralintegrationstep. 7.Useofquestionnairesinthe
monitoringofauditorytraining results.CibianandPereira (2015)18,35
Scientificarticle Monitorauditory behaviorthroughFisher’s AuditoryProblems Checklistin19 individualsdiagnosed withCAPDwho underwentauditory training.
Thesample,whoshowedalterations inselectiveattentionand/or temporalprocessingskills,were submittedtoauditorytrainingand demonstrated,midwayandatthe endofthetraining,animprovement inthescoreofthequestionnaire answeredbytheparents.
SL,soundlocation;ME,middleear;CAPD,centralauditoryprocessingdisorder;CLP,cleftlipandpalate;CAP,centralauditoryprocessing; DD,dichoticdigittest.
Table2 Descriptionofpopulationgroupsassessedbyquestionnaire.
PG Meanage
range
Questionnaire Lima-Gregio etal.36
Audiologicaland cognitiveaspects inpre-schoolers37
Auditory/Attention Questionnaire38
SAB1,22 APDQ19,33,44CHAPS12,43 QFISHER18,35
Individuals with morbidities and/or CAPD
6---17 years
X X X X X X
Individuals withCLP
6---11 years
X X
Individuals withOSAS
6---12 years
X
PG,populationgroups;CAPD,centralauditoryprocessingdisorder;CLP,cleftlipandpalate;OSAS,obstructivesleepapneasyndrome.
screening methods28---33,39 and, consequently, the possible
lack of knowledge by professionals regarding the use of suchtoolsinclinicalpractice.
Thepopulationassessedbythetoolsfoundinthepresent systematicreviewcompriseschildrenandadolescents,with apredominanceof preschoolersandschool-agedchildren. This was also observed in seven other studies28,39 that
usedthesediagnostictoolsintheirmethodologiesfor CAP assessment, and it was observed that CHAPS and SAB were the most often used questionnaires in the national literature.28,39
Thedifficultyinidentifyingand/ortheabsenceof screen-ingtoolsinquestionnaireorchecklistformataimedatadult andelderly individuals is emphasized. This is believed to
be due to the factthat the signs and symptoms of CAPD manifestmainlyduringtheschoolperiod,makingthestudy focusaimatthepediatricpopulationforearlydetectionand intervention.5---10 Apositiveassociation between CAPDand
reading/writinglearningdifficulties/disordershasbeenwell established in the literature. Therefore,it is emphasized that losses in such processescan jeopardize an adequate overallchilddevelopment.
Regarding the number of questions, this variable was veryheterogeneous. Forpurposesof classification,in this systematic review, a ‘‘short tool’’ was defined as that having15itemsanda‘‘longtool’’ashavingmorethan15 items. With the exception of two questionnaires,1,36 the
Table3 Auditoryskillscontemplatedbyeachquestionnaire.
Instrumentos Auditoryskills
Figure-ground andauditory closure
Auditory attention
Binaural interaction
Temporal resolution
Temporal ordering
Binaural integrationand separation
Questionnaireby Lima-Gregio etal.36
X X X X
Audiologicaland CognitiveAspects inPre-Schoolers37
X X X X
Auditory/Attention Questionnaire38
X X X X
SAB1,22 X X X X X
APDQ19,33,44 X X X X X X
CHAPS12,43 X X X X X X
QFISHER18,35 X X X X X
of 38 questions. Inclinical practice,the application time ofthe toolisalsoa variabletobeconsidered and,in the identifiedstudies,thisfactorwasnotexplained.
Not all studies sought to associate performance in the questionnaireandCAPtests.Therefore,theauditory abili-tiesfocusedoneachonewerestudiedalsoconsideringthe subjectiveanalysisoftheitemsofeachtool,accordingto
Table3.ItcanbeobservedthatthetoolsthatcoverallCAP auditoryabilitiesaretheAPDQandCHAPS.However,more studiesareneededforobjectiveverification.
QuestionnairessuchastheonebyLima-Gregioetal.,36
‘‘AudiologicalandCognitiveAspectsinPreschoolers’’37and
the‘‘Auditory/AttentionQuestionnaire’’,38werecreatedas
methodologicaltoolsoftheirrespectivestudies.
ThequestionnairecreatedbyLima-Gregioetal.36aimed
tocomparetheperformanceofchildrenwithandwithouta historyofrecurrentotitismedia,intheSoundLocalization test (SL), with parents’ answers to a questionnaire. With theexceptionofthequestionthatinvestigatedinattention, therewasnosignificantdifferencebetweenthetwotested groups---thequestionnaireandtheSLTestwereinsufficient toolstodifferentiatethetestedgroups.Theauthorsbelieve thisfactisjustifiedbysocioeconomicfactorsoftheassessed sample.36
On the other hand, the questionnaire called ‘‘Audiological and Cognitive Aspects in Preschoolers’’37
aimed to identify the risk factors for CAPD in preschool children attending the public school system. The tool was effective in identifying statistically significant risk factorsfor CAPD inthe assessedpopulation regarding the variables: higher number of siblings, more requests to repeat instructions and difficulty in understanding in a competitive environment. Another important finding was thehighnumberofchildrenwhohadneverbeensubmitted toanytypeofaudiologicalexamination,withsomeofthem oftenrequestingrepetitionofinstructions.37
Thetool‘‘Auditory/AttentionQuestionnaire’’38wasused
toassess children withcleft lip and palate (CLP) through theparents’perception.Thefindingsshowedthatmostof the interviewed parents pointed out at least one of the
behaviorsrelated toattention contained in the question-naire,suggestingthatthepresenceofCLPmayberelatedto difficultiesinhearingcare.38Althoughthatisthemainfocus
ofthetool,itcanbeobservedthatseveralquestionsinclude moreskills,whichsuggestsitcanbeusedforotherskillsin additiontheauditoryattentionandinotherpopulations,as wellasthefactthatitcanidentifyorscreenindividualswith Attention-DeficitandHyperactivityDisorder(ADHD).
TheSABtool,originallyproposedbySchow,Seikel, Brock-ettandWhitakerin2007,22wasadaptedandtranslatedinto
EuropeanPortuguese.1The importantcorrelationbetween
thetoolandalltheauditoryabilitiestestedinthestudyis highlighted,butmainlywiththeabilityoftemporal order-ing.InBrazil, somestudies havebeen usedtoinvestigate auditorybehaviorandtemporalresolutionofchildrenwith obstructivesleepapnea syndrome(OSAS)28 andCAP
func-tioninstudents in thefirstyears ofschooling.29 Itshould
be noted that there is a published version of SAB avail-ablefor Brazilian Portuguese,45 which, however, does not
show methodologicaldata for the translation, adaptation andvalidationstepsofthetoolforuseinthispopulation.
TheCHAPStool12 hasbeentranslatedandadaptedinto
BrazilianPortuguese.43Duringtheprocessoftranslationand
adaptation to Brazilian Portuguese, there was a correla-tionbetween the Auditory Memory module questionsand theperformance in theDichotic Digits Test (DD) --- binau-ralintegrationstep.Brazilian studiesusedCHAPSprior to itstranslationandformaladaptation,aimingtoassessthe auditorybehavior ofchildren submittedtosurgerydue to CLPthroughtheassessmentofteachers30,31andtheparents’
ownperception.39
CHAPSisthetoolmostoftenusedintheassessmentof childrenwithCLP.
TheFAPCtool(1976)18doesnothaveanadaptedversion,
buthasbeeninformallytranslatedinstudies32,35tobeused
106
V
olpatto
FL
et
al.
Table4 Comparisonofquestionnairesandchecklistsforscreeningofcentralauditoryprocessing.
Versionavailablein Brazil
Currentsituation Toolcharacteristics Targetaudienceand
applicationrange
Typeandnumberof
questions
CorrelationswithCAP tests
Otherstudiesthat usedthetool
Lima-Gregioetal. (2010)
Questionnaire36
National; non-validated.
Coversbasicaudiological complaintssuchashearing, otitisandMEalterations,as wellasriskfactorsand classicsignsandsymptoms ofCAPD;
Doesnotgenerateascore.
Targetaudience:Parents;
Rangeofapplication:
Preschoolers.
14mixedquestions(open andclosed)
Nocorrelationwas foundwiththeSL test.36
Notfound
Audiologicaland CognitiveAspectsin Pre-Schoolers(Luz andCosta-Ferreira, 2011)37
National; non-validated.
Coversseveralaspectsof childdevelopment: gestation,birth, development,family history,routine,language, schoollearningandauditory behaviorssuggestiveof CAPD.
Doesnotgenerateascore.
Targetaudience:Parents;
Rangeofapplication:
Preschoolersand1st-Grade students.
39mixedquestions(open andclosed)
Nosuchcorrelations werecarriedout.
Notfound
Auditory/Attention Questionnaire (Fenimanetal., 2012)38
National; non-validated.
Itisdividedintothree parts:PartI(Child Identification),PartII (HearingHealth)andPartIII (Child’sattention);
Itcoversthefollowing aspectsofhearinghealth: historyofhearinglossand MEinfections.
Containsachecklistwith aspectsrelatedtohearing health.
Doesnotgenerateascore.
Targetaudience:Parents;
Rangeofapplication:6---11 yearsofage.
PartI:8openquestions; PartII:2mixedquestions (openandclosed);PartIII: 32closedquestions. Total:42questions
Nosuchcorrelations werecarriedout.
and
checklists
for
central
auditory
processing
screening
107
Table4(Continued)
Versionavailablein Brazil
Currentsituation Toolcharacteristics Targetaudienceand
applicationrange
Typeandnumberof
questions
CorrelationswithCAP tests
Otherstudiesthat usedthetool
ScaleofAuditory Behaviors--- SAB (Nunesetal.,2013)1
Translatedand adaptedto European Portuguese.
Likertscalestyle; Itcoversitemsofauditory behaviormostfrequently relatedtoCAP;
Generatesscore:Thesum oftheitemsgeneratesa finalscoreand,accordingto theperformance,it indicates:typicalauditory behaviorfortheagegroup; needtoevaluateCAP;or probablealterationinCAP.
Targetaudience:Parents and/orteachers
Rangeofapplication:
10---13yearsofage
12closedquestions. Therewascorrelation withalleighttests applied;statistical significanceforthe followingtestes:MSV, MSNV;FRinLE;DDin RE;TDDHintheRE andLE;DP;GINin theREandLE. Thehighest
correlationoccurred inthePDtest.1
KempAAT,Cardoso ACV(2016)29;
LeiteFilhoCA, etal.(2017)28
Children’sAuditory PerformanceScale ---CHAPS(Donadon etal.,2015)43
Translatedand adaptedto Brazilian Portuguese.
Likertscalestyle;Divided intosixAuditoryTask modules:InNoise,In Silence,InidealCondition, MultipleInformation, Auditory
Memory/Sequencingand ExtendedAuditory Attention.
Generatesscore:Grossand average,beingpossibleto analyzethembymoduleor bythetotalsum.According totheperformance,it indicatesnormalindividuals orthoseatriskforthe CAPD.
Analysisofresultsand referencevaluesarenot describedinthetranslation andadaptationstudy.
Targetaudience:Parents and/orteachers
Rangeofapplication:7---14 yearsofage.
36closedquestions. Therewascorrelation withtheDDTest (binauralintegration step).43
ManoelandFreitas (2006)31
Barufietal. (2004)39
108
V
olpatto
FL
et
al.
Table4(Continued)
Versionavailablein Brazil
Currentsituation Toolcharacteristics Targetaudienceand
applicationrange
Typeandnumberof
questions
CorrelationswithCAP tests
Otherstudiesthat usedthetool
Fisher’sAuditory ProblemsChecklist forAuditory
ProcessingEvaluation ---QFISHER(Cibiane Pereira,2015)35
Informally translatedinto Brazilian Portuguese.
Likertscalestyle;The questionscoverhearing, attention,memory, languageandschool performanceaspects. Generatesascore:Thesum oftheitemsgeneratesa scorebycategory(Hearing, Attention,Memory, LanguageandSchool Performance)andatotal score.Theindividualis consideredtobeatriskfor theCAPDif7ormoreitems arescored.
Targetaudience:Parents and/orteachers
Rangeofapplication:
12---15yearsofage.
24closedquestions. Therewas
improvementofthe scoresafterauditory trainingofdichotic approachwiththe followingtests:DD, NVD,PSI,SSI,DCVT andLSPMC35
Geribolaand Lewis(2008)32
AuditoryProcessing Domains
Questionnaire---APDQ (Yokoyamaetal., 2015)44
Translatedand validatedto Brazilian Portuguesewith 100%sensitivity andspecificity.
Likertscalestyle;Ithasa directedanamnesis; Itcoverstheeverydaylife auditoryskillsofastudent: decoding,prosody,auditory separationandbinaural integration,takinginto considerationthequietand noisyenvironment.Italso includesattention, languageandschool aspects.
Generatesscore:Analysis performedaccordingto threesubscales:‘‘Auditory Processing’’,‘‘Attention Control’’and‘‘Linguistic andCognitiveSkills’’; Analysisoftheresultsand parametersofnormality werenotdescribedinthe translation,adaptationand validationstudy.
Targetaudience:Parents and/orteachers
Rangeofapplication:7---17 years.
52closedquestions. ThefollowingCAP testswerecarried out:LS,MSV,MSNV, DP,RGDT,SSI,IPRF, FR,DD,DNV(freeand targetedattention). Therewascorrelation withtheSLtest.33
MartinsKVCetal. (2015)33
The use of the FAPC, called by the study authors35 as
‘‘QFISHER’’, is highlighted as an effective tool for audi-tory trainingmonitoring in childrenwithCAPD.The study demonstratedanassociation betweentheimprovementin thescoreswiththefollowingtests:DD,Non-verbalDichotic (NVD),Synthetic SentenceIdentification withCompetitive Message(PSI/SSI),DichoticConsonant-Vowel(DCV)andList of Sentences in Portuguese with contralateral message (LSPMC).
It is noteworthy that the APDQ questionnaire19 was
translated and validated into Brazilian Portuguese with 100% sensitivity and specificity, being therefore the most robust tool for use in clinical practice andresearch. One study44usedthequestionnaireafteritwastranslated,
back-translatedandculturally adaptedinagroupof school-age childrenwithoutCAPD.Thetotalscoreoftheoriginal ques-tionnairewas208pointsandthetranslatedversionaveraged 199.2points--- closetothatof theoriginalscore.Another study33usedthetranslatedandvalidatedversionin
school-age individuals with CAPD, obtaining an average of 92.6 points.Theauthorsstatethatthereisastatistically signifi-cantdifferencebetweentheCAPDandthenon-CAPDgroups assessedinthetranslationstudy,suggestingthis question-nairecanbeapotentialtooltoidentifyindividualsatrisk. Nevertheless,therewasapositivecorrelationbetweenthe totalscoreofthequestionnaireandtheSLTest.
Theinformationobtainedthroughwell-structured ques-tionnaires about the child’s auditory behavior by third parties, such as parents, guardians and/or teachers, can be very useful for the early identification of changes in CAPfunction,whichwillleadtootherevaluation, diagnos-ticandtherapeuticprocessesthatwillensue,accordingto eachchild’sneeds.However,morenational studiesshould bedevelopedtodemonstratetheireffectiveness,mainlyby associatingthescreeningtoolstotheCAPbehavioral evalu-ationdata.
This systematic review shows the need to develop screening toolsfor CAP functionfor the adultand elderly populations,astheyarecurrentlyrestrictedtothepediatric population. Regarding the study translation, adaptation and/or validation processes, it is essential to clarify the analysisoftheresultsandparametersofnormalityofeach tool for the Brazilian population, since these limitations werefoundinmoststudiesfoundinthe‘‘grayliterature’’. New studies with greater methodological stringency should be carried out and published for the purpose of demonstratingreliability,supporting evidence-based prac-ticeanddisseminatingtheuseanotherauxiliarytoolinthe diagnosisofCAPD,whichwillallowtheuseofsuchtoolsin clinicalpractice.
Conclusion
Thereisa scarcityofnationalliteratureonCAPscreening and the only tool validated to Brazilian Portuguese, pub-lishedasamonograph,istheAuditoryProcessingDomains Questionnaire(APDQ).Itissuggestedthatnewstudieswith greatermethodologicalstringencyrelatedtotheprocesses of tool adaptation and validation be developed and pub-lished in the usualscientific databases, aimingat greater diffusionandclinicalapplicability.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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