Language and auditory processing disorders: literature review

ABSTRACT

The auditory and language processes are interdependent and the good performance of one of them contributes to the proper functioning of the other. The purpose of this article was to make a literature review based on national and international studies in a systematic way. Such review was made to verify the relationship between language and auditory processing disorders. The bibliographic search used the Pubmed and Web of Science database, from May to June 2014. The inclusion criteria were: articles that answered the guiding question and were found through the descriptors used. Studies with animals, laboratory studies, opinion/authority articles, case series and reports were excluded. The selection of articles was made through a protocol created for the elaboration of this study. For that, the following aspects were used: author, year, place, design, sample, age group, used tests and results. The search through free descriptors and terms revealed 254 articles in the pre-established database, 187 from Pubmed and 67 from Web of Science. Of the total, 156 were excluded by the title and abstract and 87 by the reading of the full text. This enabled the analysis of 10 articles. It was observed that, in the auditory tests, children with language development disorders showed lower performance than those with typical development.

Keywords:
Auditory Perception; Hearing Tests; Language Development Disorders; Language; Language Tests

RESUMO

Há interdependência entre os processos auditivos e de linguagem, e o bom desempenho de um deles contribui para o adequado funcionamento do outro. O objetivo do presente artigo foi realizar uma revisão de literatura baseada em estudos nacionais e internacionais de forma sistemática. Tal revisão buscou verificar a relação entre alterações do processamento auditivo e alterações de linguagem. A pesquisa bibliográfica utilizou como bases de dados Pubmed e Web of Science, no período de maio a junho de 2014. Os critérios de inclusão utilizados foram: artigos que respondiam à pergunta norteadora e atendiam à temática estabelecida pelos descritores. Excluíram-se os estudos com animais, laboratoriais, artigos de opinião/autoridade, série de caso e relato de caso. A escolha dos artigos se deu por meio de um protocolo criado para a elaboração do presente estudo. Para isto, utilizaram-se os seguintes aspectos: autor, ano, local, delineamento, amostra, faixa etária, testes utilizados e resultados. A busca realizada por meio de descritores e termos livres revelou 259 artigos nas bases de dados pré-estabelecidas. Na Pubmed a pesquisa resultou em 187 estudos e 67 na Web of Science. Do total, 161 foram excluídos pelo título e resumo e 36 pela leitura do texto completo. Isso possibilitou a análise de 11 artigos. Foi observado que crianças com prejuízos no desenvolvimento linguístico apresentaram desempenho inferior nos testes auditivos, quando comparadas àquelas com desenvolvimento típico.

Descritores:
Percepção Auditiva; Testes Auditivos; Transtornos do Desenvolvimento da Linguagem; Linguagem; Testes de Linguagem

Introduction

Auditory processing is the ability of the Central Nervous System to receive, process and interpret sounds¹. The proper development of this ability depends on factors such as the preservation of the peripheral hearing, the neurobiological maturation, environmental stimuli and cognitive skills, such as attention, memory and language^1)-(3. The impairment of some of these aspects (or several of them together) can impair the physiological processing of sounds and lead to disorders of the auditory skills such as attention, discrimination, recognition and comprehension of the information⁴.

On the other side, language constitutes the human ability to combine conventional symbols in order to transmit and understand information⁵. For that, the interaction of the environmental influence, biological processes and various cognitive and auditory skills is also decisive^4),(6),(7. Otherwise, the language development will occur in an atypical way.

According to these considerations, it can be concluded that there is a relationship between the auditory and the language processes, and that the good performance of one of them contributes to the proper functioning of the other^4),(8. Therefore, the study of these aspects is of utmost importance for the understanding of their relationship. In addition, as the present study intends to raise studies that verify the relationship between language and auditory processing disorders, support is provided for health promotion strategies, guidance of family members and treatment planning.

The purpose of this study was to make a literature review based on national and international studies in a systematic way. Such review was made to verify the relationship between language and auditory processing disorders.

Methods

This is a systematic literature review based on national^9),(10 and international¹¹ recommendations, which sought to answer the following question: "Which is the relationship between language and auditory processing disorders?".

The bibliographic search used as databases: Pubmed and Web of Science, from May to June 2014. DeCS (Descriptors in Health Sciences), and terms of the MeSH (Medical Subject Headings) of the National Library of Medicine were combined by the Boolean operators AND and OR. Thus, the following cross checks in English, Portuguese and Spanish were made: ("Auditory Perception" OR "Percepción Auditiva" OR "Percepção Auditiva" OR "Hearing Tests" OR "Pruebas Auditivas" OR "Testes Auditivos" OR "Processamento Auditivo" OR "Auditory Processing") AND ("Language Development Disorders" OR "Trastornos del Desarrollo del Lenguaje" OR "Transtornos do Desenvolvimento da Linguagem) and ("Auditory Processing" and "Phonological Awareness"); descriptors and free terms, respectively.

Regarding the selection criteria, two researchers independently searched for articles according to the inclusion and exclusion criteria. The texts with different answers of the researchers were grouped in a table presented later to a third appraiser in order to resolve the points of disagreement. Articles published in the last five years, i.e., from 2010 to 2014, were selected.

The inclusion criteria were: articles that answered the guiding question and were found through the descriptors used. Studies with animals, laboratory studies, opinion/authority articles, case series and reports, and cross-sectional studies were excluded¹¹.

In the Pubmed database, filters related to species (humans), language (English, Portuguese and Spanish) and year (2010-2014) were used. No filters were used in the Web of Science.

The data analysis was initially made through titles and abstracts of articles. Then, the full text of the selected articles was read. Only studies within the established criteria were used for the review.

The selection of articles was made through a protocol created for the elaboration of this study. For that, the following aspects were used: author, year, place, design, sample, age group, used tests and results. The data were summarized in a table in order to better visualize the results.

Literature Review

The search through free descriptors and terms revealed 254 articles in the pre-established database, 187 from Pubmed and 67 from Web of Science. Of the total, 156 were excluded by the title and abstract and 87 by the reading of the full text. This enabled the analysis of 10 articles.

Figure 1:
Flowchart with articles found and selected after analysis and application of inclusion and exclusion criteria

As a wide variety of designs and criteria used for the elaboration of the results was found in the selected studies, such as sample, age group and used tests, it was not possible to make a statistical analysis. However, valid reflections can be drawn from this review.

Table 1:
Results of the selected studies according to the variables analyzed

Most of the selected articles were published in 2010, 2012 and 2013. No publications were found in 2011 and 2014.

Brazil and the United States were the countries with the largest number of selected studies related to the question of the review. The researches carried out in these countries, along with those of Mexico, highlight the predominance of studies that address this theme in the American continent. The other countries are located in Europe.

Regarding the design, the authors of the articles used in this review showed the need to make a comparison between typical and atypical development. It was made through the distribution of the population in groups of individuals with typical development and those with language or auditory processing disorders, or language and auditory processing disorders. Therefore, the most commonly used design was control case. In addition, cohort, literature review and experimental type studies were found.

The samples of the selected studies had at least 20 and at most 88 individuals, and all selected studies were conducted with children and adolescents aged 3 to 13 years. The fact that these samples are composed of such age group suggests the importance of considering the maturation of the Central Nervous System in language and auditory processing studies. Most language and auditory processing disorders are identified in the childhood, as it is during this phase that the maturation of the Central Nervous System occurs^2),(22),(23 .

In addition, this age group comprises the inclusion of the children in school, when linguistic and auditory demands increase. Thus, the difficulties become more evident, both for the professionals involved in the educational institution as for the health professionals^24),(25.

The selected articles presented a wide range of tests that assess language and auditory processing, and their selection was done according to the purpose of the study. Regarding the auditory processing tests, it was observed that the Staggered Spondaic Word - SSW^20),(21 and Speech in Noise^15),(19) were the most used tests. The Pediatrics Speech Intelligibility - PSI¹⁹, Dichotic Digit^18),(19, Frequency Standard¹²⁾ and Simplified Evaluation of Auditory Processing - ASPA^18),(19 tests were also frequently used. Regarding the language tests, the Phonological Awareness Test²⁰ was the most used.

The predominant use of SSW and Speech in Noise tests demonstrates the interest of the authors in the further investigation of the binaural integration and auditory closure skills, respectively. Both are extremely important in the language development, especially with regard to reading and writing learning. It occurs in the school, frequently with a noisy environment that requires the proper functioning of these skills⁴.

The fact that the Phonological Awareness Test is the most widely used may be related to its importance to the development of language. The acquisition of phonological awareness enables the development of oral language, communication, reading and writing²⁶. A deficit in the mental organization and representation of speech sounds leads to alterations in the processes of perception, analysis and conscious manipulation of syllables²⁷.

The results varied according to the objectives and selected variables of the studies, but most of them showed the relationship between language and auditory processing disorders. Children with language disorders presented lower performance in the auditory tests compared to those with typical development. This finding may be explained by the fact that language and hearing development occurs simultaneously and they are interdependent^2),(28.

The study of Murphy-Ruiz, Penaloza-López et. al¹² showed that children with developmental dyslexia presented lower performance than children with typical development in all auditory processing tests. Such evidence corroborates the literature, as children with language disorders present alterations in the phonological processing related to an auditory processing disorder, in other words, children with dyslexia present changes in auditory skills²⁹.

In addition to original articles, a literature review with a sample of 16 articles, published in England in 2010 was found. The research reveals that the auditory training used in the studies had little effect on the language skills, therefore a strong relationship between language and auditory processing disorders could not be established. Although the language skills depend on the integrity and maturation of the Central Nervous System, the establishment of a relationship with auditory processing disorders requires studies with strong scientific designs, i.e., that enable higher level of scientific evidence, such as randomized clinical trials.

Through the analysis of the results of each article included in the review, in children with language disorders, the occurrence of changes in auditory tests involving temporal processing, dichotic hearing and speech perception can be verified. In addition, there was an association between auditory processing disorders with cognitive-linguistic factors and tasks involving phonological awareness.

Conclusion

This study showed that most of the research conducted in the last five years, published in the PubMed and Web of Science databases, revealed an association between language and auditory processing disorders. It was observed that children with language development disorders have lower performance in the auditory test compared to those with typical development.

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• Sources of Support: National Council for Scientific and Technological Development (CNPq) and Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG. Notice 01/2013 - universal demand. Universal Notice - 14/2012

• Erratum

  In this article, published in the journal Revista Cefac, volume 18(2):513-519, where it is:
  Sources of Support: National Council for Scientific and Technological Development (CNPq) and Fundação de Amparo à Pesquisa do Estado de Minas Gerais – FAPEMIG .
  Notice 01/2013 - universal demand
  Universal Notice - 14/2012
  Read:
  Sources of Support: National Council for Scientific and Technological Development (CNPq) Universal Notice - 14/2012 and Fundação de Amparo à Pesquisa do Estado de Minas Gerais – FAPEMIG.
  Notice 01/2013 - universal demand

Publication Dates

• Publication in this collection
  Mar-Apr 2016

History

• Received
  06 Oct 2015
• Accepted
  21 Dec 2015