Association between language development and auditory processing disorders1

Braz J Otorhinolaryngol. 2014;80(3):231-236

Brazilian Journal of

OTORHINOLARYNGOLOGY www.bjorl.org

ORIGINAL ARTICLE

Association between language development and auditory processing disorders Caroline Nunes Rocha-Muniza,*, Elaine Cristina Zachib, Rosani Aparecida Antunes Teixeirab, Dora Fix Venturab'HERUD0DULD%HÀ/RSHVa, Eliane Schochata a b

Medicine School, Universidade de São Paulo (USP), São Paulo, SP, Brazil Psychology Institute, Universidade de São Paulo (USP), São Paulo, SP, Brazil

Received 9 September 2013; accepted 24 January 2014

KEYWORDS Auditory perception; Speech perception; Language development disorders

Abstract Introduction: It is crucial to understand the complex processing of acoustic stimuli along the auditory pathway ;comprehension of this complex processing can facilitate our understanding of the processes that underlie normal and altered human communication. Aim: To investigate the performance and lateralization effects on auditory processing assessment LQ FKLOGUHQ ZLWK VSHFLÀF ODQJXDJH LPSDLUPHQW 6/,  UHODWLQJ WKHVH ÀQGLQJV WR WKRVH REWDLQHG LQ FKLOGUHQZLWKDXGLWRU\SURFHVVLQJGLVRUGHU$3' DQGW\SLFDOGHYHORSPHQW7'  Material and methods:3URVSHFWLYHVWXG\6HYHQW\ÀYHFKLOGUHQDJHG\HDUVZHUHVHSDUDWHGLQ WKUHHJURXSVFKLOGUHQZLWK6/,FKLOGUHQZLWK$3'DQGFKLOGUHQZLWK7'$OOZHQWWKURXJK WKHIROORZLQJWHVWVVSHHFKLQQRLVHWHVW'LFKRWLF'LJLWWHVWDQG3LWFK3DWWHUQ6HTXHQFLQJWHVW Results:7KH HIIHFWV RI ODWHUDOL]DWLRQ ZHUH REVHUYHG RQO\ LQ WKH 6/, JURXS ZLWK WKH OHIW HDU presenting much lower scores than those presented to the right ear. The inter-group analysis has VKRZQWKDWLQDOOWHVWVFKLOGUHQIURP$3'DQG6/,JURXSVKDGVLJQLÀFDQWO\SRRUHUSHUIRUPDQFH FRPSDUHGWR7'JURXS0RUHRYHU6/,JURXSSUHVHQWHGZRUVHUHVXOWVWKDQ$3'JURXS Conclusion:7KLVVWXG\KDVVKRZQLQFKLOGUHQZLWK6/,DQLQHIÀFLHQWSURFHVVLQJRIHVVHQWLDOVRXQG FRPSRQHQWVDQGDQHIIHFWRIODWHUDOL]DWLRQ7KHVHÀQGLQJVPD\LQGLFDWHWKDWQHXUDOSURFHVVHVUHTXLUHGIRUDXGLWRU\SURFHVVLQJ DUHGLIIHUHQWEHWZHHQDXGLWRU\SURFHVVLQJDQGVSHHFKGLVRUGHUV © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

3$/$95$6&+$9(

Percepção auditiva; Percepção da fala; Transtornos do desenvolvimento da linguagem

Associação entre transtornos no desenvolvimento de linguagem e processamento auditivo

Resumo Introdução: Entender como os estímulos acústicos são processados ao longo da via auditiva é funGDPHQWDOSDUDFRPSUHHQGHURVSURFHVVRVTXHVXEMD]HPjFRPXQLFDomRKXPDQDQRUPDOHDOWHUDGD Objetivo: Investigar o desempenho e efeitos de lateralidade na avaliação do processamento DXGLWLYRHPFULDQoDVFRPGLVW~UELRHVSHFtÀFRGHOLQJXDJHP'(/ FRPSDUDQGRRVUHVXOWDGRV

3OHDVHFLWHWKLVDUWLFOHDV5RFKD0XQL]&1=DFKL(&7HL[HLUD5$$9HQWXUD')%HÀ/RSHV'06FKRFKDW($VVRFLDWLRQEHWZHHQODQJXDge development and auditory processing disorders. Braz J Otorhinolaryngol. 2014;80:231-6. * Corresponding author. E-mail:FDUROURFKD#XVSEU&150XQL]  1808-8694/$ - see front matter © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved. http://dx.doi.org/10.1016/j.bjorl.2014.01.002

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REWLGRVDRVHQFRQWUDGRVHPFULDQoDVFRPWUDQVWRUQRGHSURFHVVDPHQWRDXGLWLYR73$ HGHVHQYROYLPHQWRWtSLFR'7  Material e método:(VWXGR3URVSHFWLYRFULDQoDVDQRV GLYLGLGDVHPWUrVJUXSRV FULDQoDVFRP'(/FULDQoDVFRP73$HFULDQoDVHP'7 IRUDPVXEPHWLGDVDRVVHJXLQWHV WHVWHV7HVWHGH)LJXUDFRP5XtGR7HVWH'LFyWLFRGH'tJLWRVH7HVWHGH3DGUmRGH)UHTXrQFLD Resultado2VHIHLWRVGHODWHUDOLGDGHIRUDPREVHUYDGRVDSHQDVQRJUXSR'(/VHQGRRGHVHPSHQKRQDRUHOKDHVTXHUGDLQIHULRUDRDSUHVHQWDGRQDRUHOKDGLUHLWD1DFRPSDUDomRLQWHUJUXSRV RGHVHPSHQKRGRVJUXSRV73$H'(/IRLVLJQLÀFDWLYDPHQWHLQIHULRUDRREVHUYDGRQRJUXSR'7 SDUDWRGRVRVWHVWHV$OpPGLVVRREVHUYDPRVQDVFULDQoDVGRJUXSR'(/XPGHVHPSHQKRLQIHULRU jVGRJUXSR73$ Conclusão:(VWHHVWXGRFRQVWDWRXRSURFHVVDPHQWRLQHÀFLHQWHGHFRPSRQHQWHVFUXFLDLVGHVRQV HRHIHLWRGHODWHUDOLGDGHHPFULDQoDVFRP'(/(VVHVDFKDGRVHYLGHQFLDPTXHRVSURFHVVRV QHXUDLVTXHVXEMD]HPDRSURFHVVDPHQWRDXGLWLYRVmRGLIHUHQWHVHQWUHDOWHUDo}HVGHSURFHVVDPHQWRDXGLWLYRHDOWHUDo}HVGHIDOD © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados.

Introduction $ERXW  RI FKLOGUHQ KDYH VLJQLÀFDQW GLIÀFXOW\ LQ IXQFWLRQDO ODQJXDJH UHFHSWLYH DQGRU H[SUHVVLYH ODQJXDJH GLVRUGHUV IRUQRDSSDUHQWUHDVRQ,QRWKHUZRUGVWKHVH children have language alteration in the absence of heaULQJORVVFKDQJHVLQFRJQLWLYHGHYHORSPHQWVSHHFKPRWRU GHYHORSPHQW LPSDLUPHQW SHUYDVLYH GHYHORSPHQWDO GLVRUGHUVDQGDFTXLUHGVHQVRULQHXUDOFKDQJHVDQGV\QGURmes and in neurological lesions. This type of language GLVRUGHUKDVEHHQGHÀQHGLQPRVWVWXGLHVDVVSHFLÀFODQJXDJHLPSDLUPHQW6/,  'HVSLWH QHDUO\ D FHQWXU\ RI UHVHDUFK LQYHVWLJDWRUV KDYH not reached a consensus on the physiological basis of causation of this disorder involving language development yet. One possible theory suggests that one of the reasons for WKHRFFXUUHQFHRIVSHFLÀFODQJXDJHLPSDLUPHQWLVUHODWHGWR changes in abilities to process sounds and to abnormalities LQWKHQHXUDOFRGLQJRIDXGLWRU\LQIRUPDWLRQ contributing to changes in the perception of critical acoustic cues contained in the speech signals. The basic idea is as follows: the perception of those VKRUWTXLFNDFRXVWLFVLJQDOVVXFKDVVSHHFKVRXQGVLVUHlated to the ability to perceive and process rapid changes of VSHFWUDOFKDUDFWHULVWLFVDORQJWKHDXGLWRU\SDWKZD\ZLWKLQ D WLPH LQWHUYDO LQ WKH RUGHU RI PLOOLVHFRQGV WKLV EHLQJ DQ HVVHQWLDOSURFHVVIRUWKHGHYHORSPHQWRIODQJXDJH7KXVLW can be said that the auditory perception is the result of the auditory signal processing. When a change occurs in this auGLWRU\SURFHVVLQJKHQFHDQLQVWDELOLW\LQWKHUHSUHVHQWDWLRQ RIVSHHFKVRXQGVSKRQHPHV WKLVDOVRRFFXUVLQWKHEUDLQ This instability of the representation of speech sounds can OHDG WR D GLIÀFXOW\ LQ XQGHUVWDQGLQJ WKH VSHHFK RI RWKHU SHRSOHDQGDOVROLPLWVWKHDELOLW\WRDFTXLUHWKHSKRQRORJLFDOV\QWDFWLFDQGVHPDQWLFHOHPHQWVRIODQJXDJH Although the presence of alterations in auditory proFHVVLQJLQLQGLYLGXDOVZLWK6/,LVVXSSRUWHGE\PDQ\VWXGLHV WKLVWKHRU\LVQRWXQLYHUVDOO\DFFHSWHGVLQFHWKHUHVXOWVRI RWKHUVWXGLHVKDYHIDLOHGWRÀQGHYLGHQFHRIFKDQJHVLQDXditory processing in children with SLI7-9DQGFRQVHTXHQWO\ the etiological causes of disorders in language development remains controversial.

From the previously established relationships between WKHFRGLQJRIVSHHFKDQGODQJXDJHVNLOOVZHLQWHQGWRVWXG\ the auditory processing and possible effects of laterality in FKLOGUHQZLWK6/,UHODWLQJWKHPWRWKHVHRXWFRPHVIRXQGLQ FKLOGUHQ ZLWK DXGLWRU\ SURFHVVLQJ GLVRUGHU $3'  DQG ZLWK W\SLFDO GHYHORSPHQW 7'  WKURXJK EHKDYLRUDO PHDVXUHV 7KHK\SRWKHVLVLVWKDWWKHGLIÀFXOWLHVLQVSHHFKSURFHVVLQJ DUHGLUHFWO\UHODWHGWRDGHÀFLWLQDXGLWRU\SURFHVVLQJ We hope this study will provide new information on the FHQWUDODXGLWRU\IXQFWLRQLQJLQFKLOGUHQZLWK6/,DOORZLQJD better understanding of this disorder and more appropriate and effective therapeutic interventions.

Material and method This study was approved by the Ethics Committee under Protocol 1049/07. The children’s parents or guardians were instructed about the procedures of the study and signed a term of free and informed consent.

Cases 6HYHQW\ÀYHFKLOGUHQUDQJLQJIURP\HDUVZHUHHYDOXDted. All subjects evaluated had auditory pure tone thresholGV ZLWKLQ WKH QRUPDO UDQJH ”  G% +/  IRU WKH VWXGLHG IUHTXHQFLHV+] VSHHFKUHFRJQLWLRQVFRUHV• QRUPDOW\PSDQRPHWULFPHDVXUHVDQGDEVHQFHRIQHXURORJLFDOFRJQLWLYHRUSV\FKLDWULFGLVRUGHUV,IFKDQJHVUHJDUGLQJ WKHKHDULQJQHXURORJLFDOFRJQLWLYHDQGSV\FKLDWULFDVSHFWV ZHUHIRXQGWKHLQGLYLGXDOVZHUHH[FOXGHGIURPWKHVWXG\ and referred to specialized service. The subjects were divided into three groups: D 7\SLFDO GHYHORSPHQW 7' *URXS   FKLOGUHQ ZLWK W\SLFDO GHYHORSPHQW DFFRUGLQJ WR LQIRUPDWLRQ REWDLQHG through interviews with these children’s parents or guardLDQVDQGWHDFKHUVDQGZLWKQRVFKRROSUREOHPVRUVSHHFK DQGODQJXDJHSUREOHPV,QDGGLWLRQWKHVHFKLOGUHQKDGQRUPDOSHUIRUPDQFHLQ$3'HYDOXDWLRQ E$XGLWRU\SURFHVVLQJGLVRUGHU$3'*URXS FKLOGUHQ GLDJQRVHGZLWK$3'XVLQJFULWHULDHVWDEOLVKHGE\WKH$PHUL-

Association between language development and auditory processing disorders

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FDQ6SHHFK/DQJXDJH+HDULQJ$VVRFLDWLRQ$6+$ LHSHUformance below normal for their age on at least two tests RIWKH+HDULQJ3URFHVVLQJ(YDOXDWLRQEDWWHU\7KHPLQLPXP assessment battery applied in this group was composed of temporal processing and monotic and dichotic hearing tests. F6SHFLÀFODQJXDJHLPSDLUPHQW6/,*URXS FKLOGUHQ GLDJQRVHG ZLWK 6/, XVLQJ LQWHUQDWLRQDO UHIHUHQFH FULWHULD1 providing at least an average intellectual level in an intellectual assessment using the Raven Coloured Progressive 0DWULFHVWHVW10

mum. To compare the means of the tests in the three JURXSV DQG LQ WKH WZR HDUV HYDOXDWHG WHFKQLTXHV RI DQDO\VLV RI YDULDQFH $129$  DQG RI DQDO\VLV RI YDULDQFH ZLWK UHSHDWHG PHDVXUHV $129$ UHSHDWHG PHDVXUH  UHVSHFWLYHO\ZHUHDSSOLHG7KHYDOXHVFRQVLGHUHGVWDWLVWLFDOO\VLJQLÀFDQWZHUHPDUNHGZLWKDQDVWHULVN ZKHQ ”  ZLWK WZR DVWHULVNV 

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$IWHUWKHVHOHFWLRQRIFKLOGUHQEHKDYLRUDOWHVWVWKDWDVVHVV central auditory processing were performed.11D 0RQRWLF test – Speech-in-noise test – used to assess the ability of auditory closure. This test consists of a list of 10 monosyllaELFZRUGVE\HDUWRWDOOLQJYHUEDOVWLPXOLSUHVHQWHGDW DOHYHORILQWHQVLW\RIG%+/DERYHWKH657REWDLQHGLQ the speech test. The signal/noise ratio used was + 20 dB +/LHWKHVLJQUHSUHVHQWHGE\PRQRV\OODELFZRUGVZDV G%+/DERYHWKHQRLVHDQGWKHFKLOGZDVLQVWUXFWHGQRW WRSD\DWWHQWLRQWRWKHQRLVHSRLQWLQJWKHÀJXUHVFRUUHVponding to the words that were heard. This procedure was SHUIRUPHG LQ ERWK HDUV E  'LFKRWLF WHVW ² GLFKRWLF GLJLW WHVW²XVHGWRDVVHVVWKHÀJXUHEDFNJURXQGKHDULQJDELOLW\ and binaural integration for linguistic sounds. Two numbers ZHUH SUHVHQWHG VLPXOWDQHRXVO\ LQ SDLUV LQ HDFK HDU DQG the child was instructed to repeat both pairs immediately DIWHUWKHLUSUHVHQWDWLRQ,QWRWDOSDLUVRIQXPEHUVSHU HDU WRWDOLQJ  YHUEDO VWLPXOL ZHUH SUHVHQWHG DW DQ LQWHQVLW\ OHYHO RI  G% +/ DERYH WKH 657 REWDLQHG LQ WKH speech test. The number of digits correctly repeated was FRQYHUWHGWRDSHUFHQWDJHRIFRUUHFWDQVZHUVLHKLWV F  $XGLWRU\ WHPSRUDO SURFHVVLQJ WHVW ² SDWWHUQ RI IUHTXHQF\ WHVW3)7 ²XVHGWRDVVHVVWKHDELOLW\RIWHPSRUDORUGHULQJ DQGLQWHUKHPLVSKHULFWUDQVIHU,QWKLVWHVWWKHFKLOGZDV instructed to listen carefully to three stimuli and to respond orally to the order in which the sounds came. If the VWLPXOXV ZDV DFXWH WKH FKLOG ZDV LQVWUXFWHG WR UHVSRQG ZLWK DQ DFXWH YRLFH DQG LI WKH VWLPXOXV ZDV GHHS WKH FKLOGZDVDVNHGWRUHVSRQGZLWKDGHHSYRLFH,QWKHHQG  VHTXHQFHV RI WKUHH VWLPXOL ZHUH SHUIRUPHG DQG WKH QXPEHURIFRUUHFWVHTXHQFHVZDVFRQYHUWHGWRDSHUFHQtage of hits. The Speech-in-noise test and “dichotic digit” tests were XVHG WR YHULI\ DVSHFWV RI ODWHUDOLW\ 7KHUHIRUH WKH ULJKW and left ears were evaluated separately. The “pattern of IUHTXHQF\µ WHVW ZDV XVHG WR HYDOXDWH WHPSRUDO DXGLWRU\ SURFHVVLQJDQGZDVSUHVHQWHGELQDXUDOO\ULJKWDQGOHIWHDUV VLPXOWDQHRXVO\ 

The subjects’ age had a similar distribution among the three JURXSVPHDQDQGVWDQGDUGGHYLDWLRQRI“IRU7' “$3'DQG“6/,ZHUHIRXQG%\$129$ WKHUHZDVQRVWDWLVWLFDOO\VLJQLÀFDQWGLIIHUHQFHDPRQJWKH PHDQDJHV>)  S @ Table 1 shows the descriptive statistics of data obtained E\ WKH WKUHH JURXSV LQ WKH ´ÀJXUH ZLWK QRLVHµ WHVW 7KH mean percentage of hits in the left ear was smaller than the PHDQSHUFHQWDJHLQWKHULJKWHDULQ$3'& DQG'(/JURXSV +RZHYHUWKLVHIIHFWRIODWHUDOLW\ZDVVWDWLVWLFDOO\VLJQLÀFDQW only for SLI group. ,Q FRPSDULQJ WKH KLWV DYHUDJHG LQ WKH ´ÀJXUH ZLWK QRLVHµWHVWZHREVHUYHGVWDWLVWLFDOO\VLJQLÀFDQWGLIIHUHQFHV EHWZHHQ JURXSV IRU ERWK WKH ULJKW HDU >)     S  

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JURXSV LQDGGLWLRQWKH73$JURXSSHUIRUPHGEHWWHUWKDQWKH'(/S  JURXS 7KHQZHFRPSDUHGWKHUHVXOWVREWDLQHGLQ3)7LQWKHVH three groups. It should be noted that the percentages presented are the result of the use of the test in binaural form. In Table 2 the descriptive statistics of data obtained by WKHWKUHHJURXSVLQWKHSDWWHUQRIIUHTXHQF\WHVWDUHOLVWHG Comparing the mean percentages of correct answers for WKH3)7REWDLQHGLQWKHWKUHHJURXSVVWDWLVWLFDOO\VLJQLÀFDQW GLIIHUHQFHVZHUHGHWHFWHGEHWZHHQWKHJURXSV>)    S  

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Statistical analysis 7R DFFRPSOLVK WKH VWDWHG REMHFWLYHV WKH VWDWLVWLcal method used attempted to compare groups in IDFH RI WKH SHUIRUPDQFH LQ WKH HYDOXDWLRQ RI FHQWUDO  DXGLWRU\ SURFHVVLQJ 7KLV ZD\ WKH GHVFULSWLve analyses of children’s age and of results of the tests were carried out through the construction of tables with observed values from descriptive statistics: PHDQ VWDQGDUG GHYLDWLRQ PLQLPXP PHGLDQ DQG PD[L-

234

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Table 1'HVFULSWLYHVWDWLVWLFVIRUWKHSHUFHQWDJHRIFRUUHFWDQVZHUVRQWKHÀJXUHZLWKQRLVHWHVWDQGRQGLFKRWLFGLJLWWHVWLQ WKHWKUHHJURXSVE\HDU $129$

7'

Figure with noise test

$3'

SLI 7'

$3' 'LFKRWLFGLJLWWHVW SLI

0HDQ

6'

0LQLP

0HGLDQ

0D[LPXP

F

P value

RE

98.40

3.74

90

100.00

100

1.00

0.36

LE

98.80

3.31

90

100.00

100

RE

92.00

9.12

70

90.00

100

1.50

0.23

LE

90.00

10.00

60

90.00

100

RE

87.20

11.00

70

90.00

100

6.33

0.01**

LE

81.40

15.78

50

90.00

100

RE

95.90

6.49

77.50

100.00

100.00

0.92

0.34

LE

95.20

6.76

70.00

95.00

100.00

RE

81.60

16.95

30.00

87.50

100.00

2.82

0.10

LE

77.21

15.86

42.50

80.00

97.50

RE

77.60

16.64

25.00

80.00

97.50

LE

66.31

20.90

10.00

70.00

92.50

15.79

0.001**

S 

Table 2'HVFULSWLYHVWDWLVWLFVRIWKHSHUFHQWDJHRIFRUUHFW DQVZHUVWRSDWWHUQRIIUHTXHQF\WHVWLQWKHWKUHHJURXSV

Table 3 P values for comparison among the three groups in WKHSDWWHUQRIIUHTXHQF\WHVW p value

PFT 0HDQ

6'

0LQLPXP

0HGLDQ

0D[LPXP

7'

89.60

9.28

65.00

90.00

100.00

$3'

63.00

26.65

0.00

65.00

100.00

SLI

50.20

20.38

15.00

50.00

80.00

Pattern of IUHTXHQF\ test

7'YV$3'

7'YV6/,

$3'YV6/,

< 0.001***

< 0.001***

0.06

*** p < 0.001.  Trend towards significance.

Discussion 7KHUHVXOWVRIWKHEHKDYLRUDOHYDOXDWLRQRIWKHFHQWUDO DXditory processing showed that the performance obtained by $3'& DQG6/,JURXSVZHUHZRUVHZKHQFRPSDUHGWRWKH7' JURXS,QRWKHUZRUGVFKLOGUHQZLWK6/,DVZHOODVFKLOGUHQ ZLWK$3'VKRZHGGLIÀFXOWLHVLQVSHHFKFRPSUHKHQVLRQVNLOOV LQ FRQGLWLRQV RI GHJUDGHG KHDULQJ QRLVH DQGRU FRPSHWLWLYH VSHHFK DQGGLIÀFXOW\LQSURFHVVLQJQRQYHUEDOVWLPXOLGLVFULPLQDWLRQRUGLQDWLRQELQDXUDOLQWHJUDWLRQDQGLQWHUKHPLVSKHULF WUDQVIHU RI DFRXVWLF VWLPXOL SUHVHQWHG  WKDW FRXOG UHVXOW LQGLIÀFXOWLHVLQWKHDFFXUDWHSHUFHSWLRQRIVSHHFKDQGWKXV compromise the integrity of speech processing and production. 7KHVHUHVXOWVVHHPWRFRQÀUPRXUK\SRWKHVLVZKLFKLV VXSSRUWHGE\PDQ\VWXGLHVLQGLFDWLQJWKDWFKDQJHVLQFHQWUDO DXGLWRU\SURFHVVLQJFRH[LVWZLWKODQJXDJHGLVRUGHUV12 +RZHYHULQDGGLWLRQWRLGHQWLI\LQJDZRUVHSHUIRUPDQFH RI6/,JURXSUHODWLYHWR7'JURXSZHDOVRIRXQGWKDWFKLOGUHQZLWK6/,SHUIRUPHGZRUVHWKDQFKLOGUHQZLWK$3'LQWKH WHVWVXVLQJYHUEDOVWLPXOL)LJXUHZLWK1RLVH'LFKRWLF'LJLW WHVWV  7KHVH UHVXOWV DUH UHOHYDQW ZKHQ ZH FRQVLGHU WKDW LWLVSUHFLVHO\WKH6/,JURXSQRWWKH$3'JURXSZKLFKKDV

D GHOD\ LQ ODQJXDJH GHYHORSPHQW DQG WKDW WKHVH FKLOGUHQ VWLOOKDYHFXUUHQWGLIÀFXOWLHVUHJDUGLQJWKHH[SUHVVLYHDQG or receptive language. In that the temporal processing is involved in each test XVHG LQ WKLV VWXG\ WR DVVHVV DXGLWRU\ SURFHVVLQJ ZH UDLVH WZR K\SRWKHVHV 7KH ÀUVW LV UHODWHG WR VWXGLHV RI 7DOODO who attributes abnorlmalities of temporal auditory processLQJIRUGHÀFLWVRUGHOD\VLQWKHDFTXLVLWLRQRIODQJXDJH$FFRUGLQJWRKLVVWXGLHVFKDQJHVLQWHPSRUDOSURFHVVLQJUHVXOW in compromises in the perception of phonemes and of other DVSHFWVRIODQJXDJHDQGUHDGLQJZKLFKGHSHQGRQDSUHFLVH phonemic representation. +RZHYHU WKH7DOODO K\SRWKHVLV KDV EHHQ TXHVWLRQHG EHFDXVHVRPHVWXGLHVKDYHQRWFRQÀUPHGWKRVHÀQGLQJVLQcreasing the controversy about the aetiology of SLI. Some VWXGLHV XVLQJ HYRNHG SRWHQWLDOV9 SV\FKRDFRXVWLF WHVWV13 and speech perception tests8 showed children with language GLIÀFXOWLHVKDGDGHTXDWHSHUIRUPDQFHRQWDVNVRIGLVFULPLnation and temporal processing of auditory stimuli. The second hypothesis suggests the presence of other disabilities in children with SLI in addition to those responsible for the auditory processing. According to

Association between language development and auditory processing disorders

%LVKRSHWDO7WKHODQJXDJHGLVRUGHUVDUHOLNHO\DUHVXOW RI PXOWLSOH IDFWRUV LQFOXGLQJ DXGLWRU\ SURFHVVLQJ ODQJXDJH SURFHVVLQJ DQG KLJKHU FRJQLWLYH IXQFWLRQV  WKDW act synergistically. This would explain the fact that some children show changes in auditory processing and normal language development. ,QWKHFXUUHQWVWXG\WKH VWDWLVWLFDOO\ VLJQLÀFDQW GLIIHUHQFHVEHWZHHQ$3'DQG6/,JURXSVZHUHQRWVXSSRUWHGE\ the results of Ferguson et al.14 DQG 0LOOHU DQG :DJVWDII15 7KHVH UHVHDUFKHUV IRXQG QR GLIIHUHQFHV EHWZHHQ$3' DQG 6/,JURXSVIRUPHDVXUHVRIODQJXDJHFRPPXQLFDWLRQFRJQLWLYHVNLOOVDQGDXGLWRU\SURFHVVLQJVNLOOVDPRQJRWKHUV 'HVSLWH WKLV DSSDUHQW FRQWURYHUV\ LW VHHPV DQ LQGLVSXWDEOH IDFW WKDW FKLOGUHQ ZLWK 6/, KDYH GLIÀFXOW\ LQ WKHLU SURFHVVLQJVWLPXOLWKDWDUHEULHIRUSUHVHQWHGUDSLGO\1 and LQIUHTXHQF\GLVFULPLQDWLRQ16 and have problems with both auditory processing and language.6 Another feature found only by the SLI group in our research was a poorer performance of the left ear compared WRWKHULJKWHDUERWKIRUPRQRWLFDQGIRUGLFKRWLFWHVWV +HPLVSKHULFGLIIHUHQFHVDUHHYLGHQWLQWKHQRUPDOSURFHVVLQJ RI VSHHFK VRXQGV17 and the model presented by Kimura18 shows a right ear advantage over the left ear for VSHHFKVRXQGVSUHVHQWHGLQDGLFKRWLFZD\7KLVDGYDQWDJH RFFXUV EHFDXVH WKH VSHHFK DXGLWRU\ VWLPXOL FDSWXUHG E\ WKHULJKWHDUDUHGLUHFWO\SURFHVVHGLQWKHOHIWKHPLVSKHUH WKH PDLQ KHPLVSKHUH UHVSRQVLEOH IRU VSHHFK SURFHVVLQJ  through the actions of the contralateral pathways. When WKHVSHHFKVRXQGVDUHFDSWXUHGE\WKHOHIWHDUDUHSULPDULO\GLUHFWHGWRWKHULJKWKHPLVSKHUH5+ ÀUVWDQGODWHUYLD WKHFRUSXVFDOORVXPDUHSURFHVVHGLQWKHOHIWKHPLVSKHUH This asymmetry between ears would be expected to deFUHDVHZLWKLQFUHDVLQJDJHWKLVLVDOLNHO\PDUNHURIPDWXULty and of hearing process improvement.19 7KXVZHFRXOGVXJJHVWWKDWWKHGLIIHUHQFHVEHWZHHQ WKH HDUV IRXQG LQ RXU VWXG\ FRQVLGHULQJ RQO\ FKLOGUHQ ZLWK 6/, ZRXOG EH FRQVLVWHQW ZLWK DEQRUPDOLWLHV LQ WKH transmission of auditory information from the non-dominant ear toward the dominant hemisphere for speech SURFHVVLQJYLDFRUSXVFDOORVXP20 possibly due to a matXUDWLRQDOGHOD\OHVVP\HOLQDWLRQLQWKHLPPDWXUHEUDLQ  or to impairments in the auditory system.21 According to 0RQFULHII19WKHÀQGLQJVRQWKHGLIIHUHQFHVEHWZHHQULJKW and left ears represent an important aspect related to the immaturity in dichotic hearing ability. $QRWKHUSRVVLEOHLQWHUSUHWDWLRQRIRXUÀQGLQJVZRXOGEH WKDW FKLOGUHQ ZLWK 6/,  DFWXDOO\ H[KLELW D GLVDGYDQWDJH RI the left ear compared to the right ear rather than exhibit a right ear advantage.22 7KH GHÀFLW IRXQG LQ WKLV VWXG\ IRU WKH OHIW HDU LQ WZR EHKDYLRXUDOWHVWVFRPELQHGZLWKWKHGHÀFLWLQWKHWDVNRI temporal auditory processing manifested in the pattern of IUHTXHQF\WHVWVHHPVFRQVLVWHQWZLWKWKHK\SRWKHVLVRIDQ impairment of the inter-hemispheric function of auditory LQIRUPDWLRQWKLVIXQFWLRQEHLQJH[HUFLVHGE\WKHFRUSXVFDOORVXP ZKLFK LV WKH PDLQ SDWKZD\ RI DVVRFLDWLRQ EHWZHHQ the cerebral hemispheres.23 :H NQRZ WKDW WKH DGYDQWDJHV SUHVHQWHG E\ ZKDWHYHU HDU PD\ UHÁHFW IXQFWLRQDO GLIIHUHQFHV EHWZHHQ WKH EUDLQ KHPLVSKHUHV+RZHYHUWKLVFRQFHSWKDVEHHQGHVFULEHGLQ WKH VSHFLDOL]HG OLWHUDWXUH E\ GLFKRWLF EXW QRW E\ PRQRWLFWDVNV7KHÀUVWDSSOLFDWLRQVRIWHVWVXVLQJ´VSHHFKZLWK

235

QRLVHµ SHUIRUPHG E\ 6LQKD24 UHSRUWHG GHÀFLWV LQ WKH HDU FRQWUDODWHUDO WR FRUWLFDO OHVLRQV 6XEVHTXHQW VWXGLHV KDYH VKRZQLQWKH´VSHHFKZLWKQRLVHµWHVWFRQWUDODWHUDOKHPLVSKHUHGHÀFLWVZLWKLPSOLFDWLRQVLQWKHDXGLWRU\FRUWH[ +RZHYHUWKHVHDUHQRWDIIHFWHGE\LQWHUKHPLVSKHULFWUDQVIHUFRUSXVFDOORVXP  &RQVLGHULQJWKHGDWDREWDLQHG²JUHDWHUGHÀFLWIRXQGLQ the left ear in the dichotic test – plus the abnormal perforPDQFH LQ WKH OHIW HDU LQ WKH PRQRWLF WHVW LW LV VXJJHVWHG WKDWWKHUHLVDQLQYROYHPHQWRIWKHULJKWKHPLVSKHUH5+  RUSRVVLEO\RI5+DQGRILQWHUKHPLVSKHULFWUDQVIHU27 :HPXVWWDNHLQWRDFFRXQW²RQWKHK\SRWKHVLVRIDSRVVLEOHFKDQJHLQ5+²LWVUROHLQODQJXDJHSURFHVVLQJ:KLWHhouse and Bishop28 found some evidence that children with 6/,PLJKWKDYHWKHIXQFWLRQRIODQJXDJHODWHUDOL]HGWR5+28 7KDW LV RXU ÀQGLQJV FRXOG FRUURERUDWH WKH LPSRUWDQW ODQJXDJHGHÀFLWGLVSOD\HGE\WKHVHFKLOGUHQ ,Q IDFH RI WKH K\SRWKHVHV SUHVHQWHG ZH FDQ FRQVLGHU WKDWWKHSRVVLEOHFDXVHVRIDV\PPHWU\EHWZHHQHDUVIRXQG RQO\LQFKLOGUHQZLWK6/,PD\EHUHODWHGHLWKHUWRDPDWXrational delay – especially in regard to the interhemispheric WUDQVPLVVLRQFRUSXVFDOORVXP ²EXWDOVRWRDQLPSDLUPHQW LQ5+ZKLFKZRXOGKDPSHUWKHHIÀFLHQWSURFHVVLQJRIVSHFtral information contained in the speech stimuli. 7KXVRXUUHVXOWVVXJJHVWWKDWWKHQHXUDOSURFHVVHVWKDW underlie auditory processing disorders may differ between auditory and language processing change.

Conclusion ,Q WKLV VWXG\ FKLOGUHQ ZLWK 6/, H[KLELWHG SRRUHU SHUIRUmance on the auditory processing abilities compared to FKLOGUHQZLWK$3'DQG7',QDGGLWLRQRQO\FKLOGUHQZLWK 6/, VKRZHG ODWHUDOLW\ HIIHFW VXJJHVWLQJ WKDW GLIÀFXOWLHV with language processing found in these children are reODWHGWRSRVVLEOHGHÀFLWVLQLQWHUKHPLVSKHULFWUDQVPLVVLRQ and/or in auditory processing in the right hemisphere. 7KXVWKHVHÀQGLQJVVXJJHVWWKDWQHXUDOSURFHVVHVUHTXLUHGIRUDXGLWRU\SURFHVVLQJ DUHGLIIHUHQWIRUDXGLWRU\DQG speech processing changes.

Funding 7KLVVWXG\ZDVVXSSRUWHGE\)XQGDomRGH$PSDURj3HVTXLVDGR Estado de São Paulo – FAPESP.

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 7DOODO 3 3LHUF\ 0 'HIHFWV RI QRQYHUEDO DXGLWRU\ SHUFHSWLRQ LQ children with development dysphasia. Nature. 1973; 241:468-9.  %DVX0.ULVKQDQ$:HEHU)R[&%UDLQVWHPFRUUHODWHVRIWHPSRUDO DXGLWRU\ SURFHVVLQJ LQ FKLOGUHQ ZLWK VSHFLÀF ODQJXDJH LPSDLUPHQW'HY6FL 5. Tallal P. The science of literancy: From the laboratory to the classroom. Proc Natl Acad Sci USA. 2000; 97:2402-4.  %HQDVLFK$$ 7DOODO 3 ,QIDQW GLVFULPLQDWLRQ RI UDSLG DXGLWRU\ cues predicts later language impairment. Behav Brain Res. 2002;136:31-49.  %LVKRS '9 &DUO\RQ 53 'HHNV -0 %LVKRS 6-$XGLWRU\ WHPSRUDOSURFHVVLQJLPSDLUPHQWQHLWKHUQHFHVVDU\QRUVXIÀFLHQWIRU FDXVLQJODQJXDJHLPSDLUPHQWLQFKLOGUHQ-6SHHFK/DQJ+HDU Res. 1999; 42:1295-310. 8. Sussman J. Perception of formant transition cues to place of articulation in children with language impairment. J Speech +HDU5HV  7RPEOLQ % $EEDV 3- 5HFRUGV 1/ %UHQQHPDQ /0 $XGLWRU\ HYRNHG UHVSRQVH WR IUHTXHQF\PRGXODWHG WRQHV LQ FKLOGUHQ ZLWK VSHFLÀF ODQJXDJH LPSDLUPHQW - 6SHHFK /DQJ +HDU 5HV 1995;38:387-92.  5DYHQ-H&RXUW-+0DWUL]HV3URJUHVVLYDV&RORULGDVGH5DYHQ 0DQXDO6mR3DXOR&DVDGR3VLFyORJR  3HUHLUD/'6FKRFKDW(3URFHVVDPHQWR$XGLWLYR&HQWUDO²PDQXal de avaliação. São Paulo. Pro-Fono; 2011.  %HOOLV7-:KHQWKH%UDLQ&DQ·W+HDU8QUDYHOLQJWKH0\VWHU\ RI$XGLWRU\3URFHVVLQJ'LVRUGHU1HZ
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