Original Article

International Journal of Audiology 2006; 45:645 659

Adrian Fuente Bradley McPherson

Centre for Communication Disorders, The University of Hong Kong, China

Auditory processing tests for Spanish-speaking adults: An initial study

Pruebas de percepcio n auditiva para adultos hablantes del espan ol: un estudio inicial
Abstract
There is no standardized material to assess auditory processing (AP) in Spanish-speaking adults. The purpose of this research was to develop and obtain initial normative data for AP tests for Spanish-speaking adults. The AP tests comprised the Hong Kong CAPA (Hong Kong central auditory processing assessment) including speech-in-noise, binaural fusion, filtered speech, and dichotic digit tests. In addition five tests already developed by other authors, but with no normative data reported for the target population, were included in the study. These tests were staggered spondaic words, random gap detection, pitch pattern sequence, duration pattern sequence, and masking level difference. Forty normal hearing Chilean adults were assessed to obtain the initial normative data. Several correlations were found between tests and between subtests within the same test category. 90th percentiles are suggested as initial normative data.

Key Words
Auditory processing Binaural fusion Dichotic stimulation Filtered speech Pattern tests Speech-in-noise Test battery

Sumario
No existe material estandarizado para evaluar el procesamiento auditivo (AP) en los adultos hablantes del espan sito de esta investigacio n fue ol. El propo desarrollar y obtener datos normativos iniciales para las pruebas de AP en adultos hablantes del espan ol. Las pruebas de AP comprendieron la evaluacio n del procesamiento auditivo central de Hong Kong (CAPA) que incluye lenguaje en ruido, fusio n binaural, lenguaje filtrado y la prueba de d gitos dico ticos. Adicionalmente se incluyeron otras cinco pruebas desarrolladas para esta poblacio n por otros autores que carecen de datos normativos. Estas pruebas incluyen palabras espondaicas imbricadas, deteccio n aleatoria de intervalos, secuencia de patrones de tono, secuencia de patrones de duracio n y diferencia en el nivel de enmascaramiento. Se evaluaron cuarenta adultos chilenos para obtener los datos normativos iniciales. Se encontraron varias correlaciones entre pruebas y entre sub-pruebas dentro de la misma categor a. Se sugieren los percentiles 90 como datos normativos iniciales.

Auditory processing (AP) is not a new area of research, having a history of more than fifty years. From the first studies of Bocca et al (1954) using filtered speech to assess subjects with temporal lobe tumour, and those of Kimura (1961) using dichotic stimulation to assess subjects with cerebral lesions, to recent studies using electrophysiological measurements to assess AP (Moncrieff et al, 2004), this area has been of interest to audiologists. AP has been explored in many groups of subjects, such as in persons with Alzheimers disease (Iliadou & Kaprinis, 2003; Strouse et al, 1995), presbycusis (Frisina & Frisina, 1997), dyslexia (Hugdahl et al, 1998; Sapir et al, 2002; Schulte-Korne et al, 1998), specific language impairment (Tallal et al, 1985), brainstem and cortical lesions (Baran et al, 2004; Musiek, 1983), organic solvent exposure (Varney et al, 1998), and epilepsy (Ortiz et al, 2002). Due to the increasing concern regarding AP and the debate surrounding both the definition and diagnostic procedures of auditory processing disorders (APD), different associations have made efforts to unify concepts and procedures associated with APD. In 1996 the American Speech-LanguageHearing Association (ASHA) formulated a definition of both AP and APD. Recently, a new technical report was developed by ASHA in order to update the 1996 document. According to ASHA (2005), AP refers to the efficiency and effectiveness by which the central nervous system (CNS) utilizes auditory

information. AP relates to the perceptual processing of auditory information in the CNS, and the neurobiologic activity that underlies that processing and gives rise to electrophysiologic auditory potentials. AP includes the auditory mechanisms that underlie the following abilities or skills: sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination, temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals. On the other hand, APD refers to difficulties in the perceptual processing of auditory information in the CNS, as demonstrated by poor performance in one or more of the above skills (ASHA, 2005). Also, Jerger & Musiek (2000) organized a consensus conference on the diagnosis of auditory processing disorders in school-aged children. At this conference it was suggested that an APD may be defined as a deficit in the processing of information that is specific to the auditory modality (Jerger & Musiek, 2000). In the UK, the Auditory Processing Disorder Working Group of the British Society of Audiology (2006) defines APD as a hearing disorder resulting from impaired brain function and characterized by poor recognition, discrimination, separation, grouping, localization, and ordering of non-speech sounds.

ISSN 1499-2027 print/ISSN 1708-8186 online DOI: 10.1080/14992020600937238 # 2006 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society

Accepted: June 15, 2006

Adrian Fuente Division of Speech and Hearing Sciences, The University of Hong Kong, 5F, Prince Philip Dental Hospital, 34 Hospital Road, Hong Kong, China. E-mail: afuente@hkusua.hku.hk

To assess AP either in research laboratories or in clinical settings, both researchers and clinicians require tests specifically designed to assess different aspects of AP. For this, electrophysiological measurements and/or behavioural tests may be carried out. The former is more useful to detect the site of dysfunction in the CANS, while the latter is more useful to assess the subjects auditory performance in different auditory skills. At the conference organized by Jerger & Musiek (2000) three possible approaches to the construction of a minimal test battery for AP in school children were proposed: behavioural tests, electrophysiologic and electroacoustic tests, and neuroimaging studies. ASHA (2005) proposes that an AP test battery should include measures that examine different central processes, and also that tests should include both non-verbal and verbal stimuli to examine different aspects of auditory processing and different levels of the auditory nervous system. According to ASHA (2005), the purpose of an AP diagnostic test battery is to examine the integrity of the CANS, and to determine the presence of an APD and describe its parameters. To do this, the audiologist should examine a variety of auditory performance areas. Taking into account the definition of APD by ASHA (2005), there are different test categories that reflect the variety of auditory processes and regions/levels within the CANS that underlie auditory behaviour and listening, and which rely on neural processing of auditory stimuli. The following test categories may be used as a reference. According to ASHA (2005), clinicians do not have to choose one test for each category; instead, the listing serves merely as a guide for clinicians to the types of measures that are available for AP assessment. The test battery should be selected according to the clients referring complaint and the relevant information available to the audiologist. Test categories are: auditory discrimination, auditory temporal processing and patterning, dichotic speech, monaural low-redundancy speech, binaural interaction, and electroacoustic and electrophysiologic measures (ASHA, 2005). Currently, for English-speaking populations, there are different AP test batteries that can be used to assess the CANS. Instruments such as the Test for Auditory Processing Disorders in Adolescents and Adults [SCAN-A] (Keith, 1995), Test for Auditory Processing Disorders in Children-Revised [SCAN-C] (Keith, 2000a), and Multiple Auditory Processing Assessment [MAPA] (Domitz & Schow, 2000) are some examples of recent AP tests developed in the United States. Other English-speaking countries have either developed their own AP test batteries or adapted existing American-accented English material. An example of the former approach is the Australian AP test battery Macquarie University Speech Tests (Golding & Birtles, 2001). Examples of test adaptation are the creation of the Staggered Spondaic Words test (SSW) for Australian use (Golding et al, 1996), the creation of the Paediatric Speech Intelligibility test for Auditory Processing Disorder (an Australian adaptation of the PSI test of Jerger & Jerger, 1984) to be used with Australian children (Cameron et al, 2003), and the normalization study of the Tonal and Speech Materials for Auditory Perceptual Assessment disc 2.0 (Wilson & Strouse, 1998) in South African English first language children (Campbell & Wilson, 2003). Researchers in non-English speaking countries have also developed AP test batteries. In Brazil, Desgualdo & Schochat (1997) developed a comprehensive AP test battery in Portuguese.
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Neijenhuis et al (2001) developed an AP test battery with verbal material in Dutch; and in Belgium, Demanez et al (2003), created an AP test battery to be used with French-speaking populations. However, audiologists working with Spanish-speaking populations still lack an AP test battery normalized to be used with these populations. This is an important issue if the prevalence of APD is considered. Chermak & Musiek (1997) estimated that the prevalence of APD was 2 3% in children; and in the UK, Saunders & Haggard (1992) estimated that 10% of adults consulting for hearing difficulties did not have middle and/or inner ear pathology. One of the main concerns when assessing AP is the validity of the tests being used. So far, there is no gold standard to which one can compare test results (Musiek, 1999). Due to this issue it has been suggested that the use of individuals with frank lesions of the CANS may be the best option to establish sensitivity and specificity data for tests of AP (ASHA, 2005; Musiek, 1999). Thus, different studies have been conducted exploring the validity of AP tests in group of persons with known pathology of the CANS. Some AP tests have not shown high sensitivity or specificity values, including the binaural fusion test (Bellis, 2003), filtered speech (Chermak & Musiek, 1997), interrupted speech (Chermak & Musiek, 1997), and speech in noise test (Chermak & Musiek, 1997). Others, however, such as the dichotic digit (Musiek, 1983), pitch pattern sequence (Musiek & Pinheiro, 1987), duration pattern sequence (Musiek et al, 1990), and the masking level difference (Lynn et al, 1981; Noffsinger et al, 1982) have appeared sensitive in differentiating subjects with and without CANS lesions. In spite of the low sensitivity characteristics of some of the AP tests, different AP test batteries developed in the last decade in non-English languages (Demanez et al, 2003; Desgualdo & Schochat, 1997; Neijenhuis et al, 2003), have still included some of these tests, such as the filtered speech, speech in noise, and binaural fusion test. The inclusion of these tests is necessary as they assess aspects proposed by ASHA (1996; 2005) such as auditory performance with degraded speech material and auditory performance with competing acoustic signals, for which no other more sensitive tests have yet been developed. Taking into consideration the lack of AP tests suitable to be used with Spanish-speaking adults, the aim of the present study was to develop and obtain preliminary normative data for a set of AP tests to be used with this population. It was not the scope of the study to develop new AP tests with better sensitivity characteristics. This is an initial study on the development and standardization of existing AP tests, for Spanish-speaking adults. Some of the assessment items included in the present study were existing tests, and others were created in order to have a range of assessment tools covering all aspects of AP proposed by ASHA (1996, 2005), and thus give to clinicians different options for assessing AP. The AP tests comprise the Hong Kong Central Auditory Processing Assessment (Hong Kong CAPA) which includes speech-in-noise, binaural fusion, filtered speech, and dichotic digit tests, together with five tests already developed by other authors, but for which no normative data has been reported for Spanish-speaking populations. Some of these former tests are verbal, such as the staggered spondaic words, and others are non-verbal tests, such as masking level difference, random gap detection, pitch pattern sequence, and duration pattern sequence. Normative data for the non-verbal tests has
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been reported for English-speaking adults. However, as linguistic or cultural differences may induce different responses and thus different test scores, the authors of the present article included non-verbal tests in the collection of normative data for AP tests to be used with Spanish-speaking adults. Taking into account that this study is a first attempt to develop an AP test battery to be used with Spanish-speaking adults, for some auditory skills more than one test was selected. Future studies will determine the sensitivity and specificity of the tests included in the present research.

Method Material
The tests included in this study were selected from tests already developed either for Spanish-speaking adults or for Englishspeaking adults (tests using non-verbal material as stimuli). Also, the AP tests include a set of tests developed in the present study (Hong Kong CAPA) which were not previously available for Spanish-speaking adults. These tests were developed as they assess aspects of auditory processing not covered by the already commercially available tests. Therefore, all the aspects of auditory processing suggested by ASHA (1996; 2005) can be assessed from the AP tests developed in the present study together with those created by other authors and already commercially available.

For the purposes of this test, the time duration of the numbers was controlled when spoken by the speaker to create similar test item durations. The number with the shortest length was nueve (445 ms) and the number with the longest length was siete (498 ms). Stimuli (words and numbers) were spoken by a native male Spanish speaker from Chile with standard Chileanaccented Spanish. Recordings were made in a double-walled sound-treated room using a microphone (AKG C525 S) and the Multi-Dimensional Voice Program (MDVP) from Kay Elemetrics. All the words and numbers were digitally recorded for further processing. Later, using Praat software (Boersma & Weenink, 2003), all recordings were produced at the same arbitrary average intensity, that is, 60 dB SPL.

Test creation (Hong Kong CAPA)

For the creation of SPN, FS and BF tests, considering that the verbal material was the same (25 monosyllabic words), it was necessary to randomize the selected words a total of eight different times in order to diminish possible learning effects. Four randomizations for SPN (subtest SNR of 0 dB, and subtest SNR of '/10 dB), two randomizations for FS, and two randomizations for BF were assigned. For the creation of the DD test, numbers were randomized in 20 sets of 4 different numbers. All the tests were digitally created at a 44100 Hz sample rate and then recorded on a compact disc.

Development of speech material for Hong Kong CAPA

For speech-in-noise (SPN), filtered speech (FS), and binaural fusion (BF) tests, a set of 25 monosyllabic words (see appendix) were selected from lists developed by Rosemblu t & De Cruz (1962) for speech discrimination in Spanish. These lists comprise a total of three lists of commonly used monosyllables in Spanish. Each list contains 50 monosyllabic words, 25 words per ear, with a combined list of 150 different words. For the development of the tests mentioned above, monosyllabic words were selected because they represent the linguistic unit with the least extrinsic redundancy (linguistic information), and therefore distorting the stimulus by filtering or introducing background noise can easily affect patient performance (Mueller & Bright, 1992). The words taken from Rosemblu ts lists were selected because they are common words used in Spanish (Rosemblu t & De Cruz, 1962). A total of 25 out of 150 words from Rosemblu ts lists were selected. The criteria for selection were the grammatical function (noun) and structure of the syllable (consonant-vowel-consonant). Among the words with the characteristics mentioned above, those selected were most understandable as real words by Spanish-speaking adults. This part of the selection was done with the assistance of a native Spanish-speaking linguist. These criteria were adopted in order to have a set of speech stimuli with the same linguistic characteristics. Phonetic balance was not attempted for these lists because Spanish has a limited number of monosyllabic words and to achieve phonetic balance, it would have been necessary to include uncommon words. For the dichotic digit test (DD) the numbers one to nine in Spanish were selected to comprise the stimuli. These numbers were selected because they represent single unit numbers. Words for these numbers contain either one or two syllables. All of them were included in order to have more possible item combinations.
Auditory processing tests for Spanish-speaking adults: An initial study

SPEECH-IN-NOISE

(SPN)

Four different randomizations of the list of 25 monosyllabic words were added on a compact disc. Using Cool Edit 2000 software (Syntrillium Software Corporation, 1999), each randomization was placed on channel one. White noise was added to channel two. The objective of these four randomizations was to evaluate each ear at two different signal-to-noise ratios (SNRs). Verbal instructions were provided on the CD at the beginning of the test.

BINAURAL

FUSION (BF)

Using Cool Edit 2000, two different randomizations of the list of 25 monosyllabic words were filtered using a low-pass filter. Then, the same two non-filtered words lists were filtered using a high-pass filter. The cut-off frequency for the low-pass filter was 500 Hz and the cut-off frequency for the high pass filter was 3000 Hz. For both filters the slope was 45 dB/octave. The filter cut-off frequencies were the same as used in a previous Dutch study (Neijenhuis et al, 2001). These cut-off frequencies were used because the words were found to be degraded but still recognizable by normal-hearing listeners. Low-pass filtered words were placed on channel one and high-pass filtered words were placed on channel two of the compact disc. This procedure was also used in the creation of the Brazilian CAP test battery developed by Desgualdo & Schochat (1997). Verbal instructions were provided on the CD at the beginning of the test.

FILTERED

SPEECH (FS)

Using Cool Edit 2000 software, two different randomizations of the lists of 25 words were low-pass filtered with a slope of 45 dB/ octave. The cut-off frequency was 500 Hz. This cut-off frequency was used because after filtering the words were still recognizable
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by normal listeners. Verbal instructions were provided on the CD at the beginning of the test.

DICHOTIC

DIGITS (DD)

Using Cool Edit 2000 software, a randomization of 20 sets of four different digits was used to create the test. For this test each set comprised four different digits. Two digits were presented to one ear, while two other digits were presented simultaneously to the other ear. Numbers were added to the compact disc by pairs, that is, one number per channel in such a manner that when playing the test both numbers were heard at the same time. Onsets of each pair of digits were within 70 ms, which is within the normal range of onset times critical for maintaining dichotic perception (Musiek, 1983). Also, the offset of the numbers did not have differences of more than 70 ms between them. This was possible due to the similar spoken duration of the numbers. The greatest difference in duration (between the shortest and the longest one) was 53 ms. The digits interpair time was approximately 0.5 s and the interstimulus interval (inter-set) was approximately 5 s. Verbal instructions were provided on the CD at the beginning of the test. The tests used in the present study that were created by other authors were Pitch Pattern Sequence (Pinheiro, 1977), Duration Pattern Sequence (Musiek et al, 1990), Masking Level Difference (Wilson et al, 2003), Random Gap Detection (Keith, 2000b), and Staggered Spondaic Words Spanish version (Soto & Windham, 1992). All of these were acquired from Auditec, St. Louis, in digital format.

learning disabilities, and difficulties to understand speech in the presence of background noise or any other hearing-related difficulty. Only individuals reporting absence of these antecedents were included in the sample. Five subjects were excluded due to the presence of one or more of the exclusion criteria mentioned above.

OTOSCOPY
Only subjects with no visible pathologic alterations to either the ear canal or the tympanic membrane were considered for inclusion in the sample. Three subjects had obstruction of the ear canal and they were sent to an ENT doctor for cerumen removal. The three subjects were included in the sample after the cerumen was removed.

BILATERAL

PURE TONE AUDIOMETRY

In a double-walled, sound-treated room, meeting the ISO 8253-1 standards for ambient sound pressure levels, hearing thresholds were obtained at 250, 500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz for air conduction. Only subjects with bilateral hearing thresholds equal to or better than 20 dB HL at all test frequencies were considered for inclusion in the sample. Subjects whose hearing test results indicated threshold differences between ears of 10 dB or more at two or more frequencies were not included in the sample (Keith, 1995). A total of four subjects were eliminated after carrying out puretone audiometry as they did not show the pattern of normality mentioned above.

Normalization of the CAP tests PARTICIPANTS

A total of 40 individuals (13 males and 27 females) between 18 and 50 years of age (mean: 29.6, S.D: 7.2) were evaluated using the newly developed central auditory processing tests. Subjects were recruited by convenience sampling from individuals known to the authors. Adults only were chosen because most of the tests used were specifically designed for the adult population. Subjects had normal hearing acuity, as indicated below, and were native speakers of Chilean-accented Spanish. Appropriate approval was obtained prior to commencement of the study from the Ethics Committee of the School of Speech and Hearing Sciences, University of Chile. All subjects provided signed consent forms.

IMMITTANCE

AUDIOMETRY

Tympanometry and reflex audiometry were carried out. To be included in the sample, bilateral type A results (Jerger, 1970) in tympanometry and contralateral reflexes at 500, 1000 and 2000 Hz were required at 70 100 dB HL. Two subjects were excluded due to absence of acoustic reflex in at least one of the frequencies tested, and another one due to bilateral type C results in tympanometry.

Obtaining normative scores

For the central auditory processing tests a compact disc player (LG 7311N) was used. This equipment was connected to the audiometer. A 1000 Hz pure tone recorded on each compact disc was used to calibrate both the compact disc player and the audiometer. The tests were Hong Kong CAPA, Staggered Spondaic Word Spanish Version (SSW), Masking Level Difference (MLD), Pitch Pattern Sequence (PPS), Duration Pattern Sequence (DPS) and Random Gap Detection (RGD). The assessment began in the right ear for 20 randomly chosen subjects. The remaining 20 subjects were assessed starting in the left ear. The assessment was carried out in three sessions (the first session also included subject sample selection procedures). The first session consisted of the questionnaire, otoscopy, puretone audiometry, tympanometry, contralateral reflexes assessment, SPN, PPS, and RGD tests. During the second session, the SSW-Spanish version, DPS, and FS tests were administered. In the third session, the MLD, DD, and BF tests were administered. The first session took about 50 minutes, the second one approximately 30 minutes, and the final session about 20 minutes.

Procedure
The subject sample selection and evaluation procedures were conducted in a double-walled, sound-treated room meeting ISO 8253-1 standards of ambient sound pressure levels. For pure-tone audiometry an Interacoustics AC33 clinical audiometer was used with TDH-39P headphones. For immittance audiometry an Interacoustics AZ7 middle-ear analyser was used. The procedures for participant selection were:

QUESTIONNAIRE
Subjects were asked about their history of ear disease, neurological disease, occupational exposure to noise and organic solvents, hypertension, diabetes, history of language/

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Hong Kong CAPA SPEECH-IN-NOISE

Miller (1947) was one of the first authors to investigate the phenomenon of speech perception in the presence of background noise. Since then, many researchers have used the SPN test to assess retrococlear lesions (Pinheiro & Musiek, 1985). This test involves the assessment of the behavioural phenomenon of auditory performance decrements with competing acoustic signals (ASHA, 1996). The SPN test involves the phonetic decoding process, also called auditory closure (Masquelier, 2003), and figure-ground (Bellis, 2003). In the present study, four randomizations of the list of 25 monosyllabic words in the presence of white noise were presented monaurally at 40 dB SL (relative to the average threshold of the frequencies 500, 1000, and 2000 Hz) at 0 dB SNR (SPN 1) and '/10 dB SNR (SPN 2). Baran & Musiek (1999) noted that these are the SNRs parameters most often used in such tests. Each ear was tested twice as the test uses two different SNRs. Subjects were asked to repeat each word. They were encouraged to guess if they were unsure of the presented word. Answers were marked in a protocol sheet as correct or incorrect. A percentage of correct answers was calculated for each ear at both SNRs.

Masquelier, 2003; Santos & Pereira, 1997) and has been proposed by ASHA (1996, 2005) to be used when assessing dichotic perception. In the present study, 20 sets of two pairs of digits were presented dichotically at 50 dB SL relative to the average threshold of the frequencies 500, 1000, and 2000 Hz (Musiek, 1983). Subjects were asked to repeat each set of four numbers. The repetition task involved free recall. Scores correct per ear were obtained. Then, a total score was obtained by counting the overall correct numbers repeated. The score was in per cent correct items, thus each number had a value of 1.25%.

Central auditory processing tests developed by other authors PITCH

PATTERN SEQUENCE

BINAURAL

FUSION

This test involves the auditory process of binaural interaction (Bellis, 2003; Demanez & Demanez, 2003). In the present study, two randomizations of the list of 25 monosyllabic words filtered through high and low-pass systems were presented binaurally at 30 dB SL relative to subject threshold at the frequencies 500, 1000, and 2000 Hz (Desgualdo & Schochat, 1997). The test was played twice in order to obtain results for each ear. Thus, two different randomizations were used. The ear receiving the low-pass filter stimuli was considered the reference ear. Subjects were asked to repeat each word. They were encouraged to guess if they were unsure of the word. The answers were marked in a protocol sheet as correct or incorrect, and a percentage of correct answers was calculated for each ear.

This test was developed by Pinheiro (1977) and it is commercially available from Auditec, St. Louis. This test assesses pitch discrimination, temporal ordering, and linguistic labelling (Bellis, 2003). In the present study, a set of 50 sequences of three tone bursts differing in their pitch (1430 Hz and 880 Hz) were presented monaurally to each ear at 50 dB SL relative to the 1000 Hz pure-tone threshold (Musiek, 1994). The rise/fall time of each tone burst was 10 ms, the interburst interval was 15 ms and the interpattern interval was 7 s. Subjects were asked to verbalize the pitch (low or high) of each stimulus in the sequence. The test began with a trial set of 10 stimuli pairs. This was carried out to ensure that the subject was able to discriminate between high and low tones. Then, the test items were presented. The initial 10 stimuli sets were not included in the total score. For the remaining 40 stimuli sets, the answers were recorded on a protocol sheet, and a percentage of correct answers was calculated for each ear.

DURATION

PATTERN SEQUENCE

FILTERED

SPEECH

This test involves the phonetic decoding process, also called auditory closure (Bellis, 2003; Masquelier, 2003). The FS test is related to the assessment of the behavioural phenomenon of auditory performance decrements with degraded acoustic signals (ASHA, 1996). In the present study, 25 low-pass filtered monosyllabic words were presented monaurally to each ear at 50 dB SL relative to the average threshold of the frequencies 500, 1000, and 2000 Hz (Desgualdo & Schochat, 1997). Subjects were asked to repeat each word. They were encouraged to guess if they were unsure of the word. The answers were marked in a protocol sheet as correct or incorrect, and a percentage of correct answers was calculated for each ear.

This test was developed by Musiek et al (1990), and is commercially available from Auditec, St. Louis. Bellis (2003) notes that this test assesses the processes of duration discrimination, temporal ordering, and linguistic labelling. In the present study, a set of 50 sequences of three tone bursts differing in their duration (250 ms and 500 ms) were presented monaurally to each ear at 50 dB SL relative to the 1000 Hz pure-tone threshold (Musiek, 1994). The tone burst frequency was 1000 Hz with a rise/fall time of 10 ms, and the inter tone burst interval was 300 ms. Subjects were required to verbalize the duration (long or short) of each stimulus that comprised the sequence. The first 10 stimulus pairs were used as an initial trial set to ensure that the subject understood the task. Therefore, the initial 10 stimuli were not included in the total score. For the remaining 40 stimuli sets, the answers were recorded on a protocol sheet, and a percentage of correct answers was calculated for each ear.

SSW-SPANISH

VERSION

DICHOTIC

DIGITS

This test was initially described by Kimura (1961) and adapted by Musiek (1983). This test assesses the auditory ability of binaural integration and binaural separation (Bellis, 2003;

This test was first described by Katz (1962) and adapted to the Spanish language by Soto & Windham (1992). The SSWSpanish version test is commercially available from Auditec, St. Louis. The English SSW is one of the most widely used dichotic speech tests (Bellis, 2003). This test has been proposed by ASHA (1996) to be used when assessing dichotic perception.

Auditory processing tests for Spanish-speaking adults: An initial study

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This test involves the auditory process of hemispheric transfer (Masquelier, 2003) and binaural integration (Bellis, 2003; Masquelier, 2003). In the present study, 40 items of four words were presented dichotically at 50 dB SL relative to the average threshold of the frequencies 500, 1000, and 2000 Hz (Medwetsky, 2002; Soto & Windham, 1992). The test is composed of 40 pairs of words each recorded and presented contralaterally in an overlapped fashion. The second syllable of the first word is overlapped with the first syllable of the second word, resulting in the following four conditions: right noncompeting (RNC), right competing (RC), left competing (LC), and left noncompeting (LNC). Subjects were required to repeat the words in the same order that they were heard. Before starting the test, four items were presented as practice. Subjects answers were recorded on a protocol sheet for final analysis. A total of correct words was calculated for each condition (RNC, RC, LC, LNC) and for each ear (RNC plus RC, and LNC plus LC). The analysis included the exploration of whether a particular condition had better scores than others. Finally, the total percentage correct score was calculated by averaging the score of both ears.

condition (tone bursts in-phase and out-of-phase at different SNRs) were calculated. SNR thresholds were calculated for both conditions. Finally, the masking level difference was obtained by calculating the difference in thresholds for both conditions.

RANDOM

GAP DETECTION

MASKING

LEVEL DIFFERENCE

The test used in the present study was that developed by Wilson et al (2003) and it is commercially available from Auditec, St. Louis. The MLD assesses the auditory process of binaural interaction (Bellis, 2003; Demanez et al, 2003; Masquelier, 2003). The test is based on the finding that when noise is added to a tone burst, the sound level of the tone burst has to be increased in order to be perceived. Therefore, the noise masks the tone burst. However, when the tone burst and noise characteristics differ (for example, are out-of-phase) the masking effect of the noise decreases. The test developed by Wilson et al (2003) modifies the phase only of the tone burst, keeping the phase of the noise identical in both ears. When the signal is p radians out-of-phase at the ears and the noise is in-phase between ears (SpNo), then the waveforms of the signal presented to the ears differ with respect to both temporal and amplitude characteristics. This is opposite to when both the tone burst and the noise are inphase (SoNo) between ears. At 500 Hz (which is the tone burst frequency used in the test developed by Wilson et al, 2003), the largest release from masking or masking level difference (MLD) is achieved with the SpNo condition, which typically produces a threshold 10-14 dB below the threshold for SoNo. The test used here comprises 33 presentations. From these 33 presentations, ten correspond to the SoNo paradigm, twelve to the SpNo paradigm, and eleven presentations are only noise with no tone burst. SNRs between the tone burst and the noise are decreased by two dB in each presentation. For the SoNo condition the starting SNR is 1 dB, and for the SpNo the starting SNR is (/7 dB. Thresholds for each condition are obtained and finally a MLD is calculated subtracting the threshold for the SoNo from the threshold for the SpNo condition. In the present study, 33 tone bursts of 500 Hz, in-phase and out-of-phase between ears, were presented at 70 dB HL (Wilson et al, 2003) in the presence of white noise binaurally. Subjects were asked to state whether or not they heard the tone burst in the presence of noise. Correct items for each
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This test was developed as a clinical measure by Keith (2000b) and it involves the assessment of temporal resolution (Bellis, 2003). It is commercially available from Auditec, St. Louis. The purpose of the test is to identify and quantify disorders of timing in the auditory system (called temporal processing disorders) in children and adults (Keith, 2000b). In the present study, stimuli comprising two tones and clicks with a silent interval between the two stimuli at different milliseconds were presented at 50 dB HL binaurally (Keith, 2000b). The duration of each tone is 17 ms with a rise/fall time of 1 ms. The duration of the click is 230 ms. The stimulus pairs are recorded with silent intervals of 4.5 s. The silent interval between the two tones and clicks ranged from 0 to 40 ms (0, 2, 5, 10, 15, 20, 25, 30, and 40 ms, randomly presented). The test comprises subtest 1 (screening/practices) which uses a 500 Hz tone; subtest 2 for the 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. tones; subtest 3 used a screening/practice for clicks; and finally subtest 4 for clicks. Subjects were asked to state whether they heard one or two tones in each presentation. The test started with subtest 1 as a practice item. Then, stimuli of subtest 2 were presented at the following frequencies: 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz. Subtest 3 was then administered as a practice item for click stimuli. Next, subtest 4 for click stimuli was presented. Subject responses were marked as 1 when the subject heard one tone and 2 when he or she heard two tones (Keith, 2000b). Thresholds for each frequency tested and for clicks were obtained by identifying from the score sheet the interval in milliseconds when the subject consistently commenced detection of two stimuli instead of one. Also, the overall average gap detection threshold of the four frequencies presented was calculated.

Results Descriptive statistics

Descriptive statistics were obtained for all of the test results and are shown in Table 1. Score distributions showed a ceiling effect for most of the tests. A Kolmogorow-Smirnov test was computed for all test score data in order to test for normal distribution (see Table 2). The selected alpha level was .05. With the exception of the scores for the FS test, the SPN 1 test and RGD frequency average (RGDA), the normal distribution hypothesis was rejected. Given these results, non-parametric tests were used to examine the entire data set. Figure 1 shows the score distribution for SPN 1, SPN 2, FS, BF, PPS, DPS, DD and SSW. Figures 2 and 3 show the score distribution for RGD and MLD, respectively.

Relationship between and within tests WITHIN

TESTS

A Wilcoxon signed rank test was conducted to explore score differences between conditions within the AP tests. In the SPN test, there was a statistically significant increase in scores from
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Table 1. Mean, standard deviation, median, and 90th percentiles for AP tests to be used with Spanish-speaking adults Mean Speech-in-noise (SNR 0 dB) Speech-in-noise (SNR '/10 dB) Binaural Fusion Filtered Speech Dichotic Digits PPS DPS SSW MLD RGD 500 Hz RGD 1000 Hz RGD 2000 Hz RGD 4000 Hz RGD Clicks RGD Frequency Average 92.1 96.75 92.95 79.75 98.38 93.33 93.63 99.29 11.93 7.88 7.05 8.23 8.03 6.65 7.79 S.D 5.06 3.06 3.82 10.2 3.77 10.91 7.04 0.93 3.98 5.27 4.63 4.52 4.42 4.34 3.26 Median (50th Percentile) 92 98 94 80 100 98.5 95.75 99.37 10 5 5 10 5 5 7.5 90th Percentile 86.2 92 90 70 96.38 80 85.15 98.12 6.2 15 15 15 15 10 13.5

PPS: pitch pattern sequence; DPS: duration pattern sequence; SSW: staggered spondaic words (Spanish version); MLD: masking level difference; RGD: random gap detection. For speech-in-noise, binaural fusion, filtered speech, dichotic digits, PPS, DPS and SSW, scores are in per cent correct items. For MLD scores are in dB, and for RDG scores are in milliseconds.

the SNR of 0 dB (SPN 1) to scores obtained at SNR of '/10 dB (SPN2) (Z 0/ (/4.73, p B/.001). For SPN 1, there was a statistically significant increase in scores from the first ear to the second ear tested (Z 0/ (/3.17, p B/.01). Also, a statistically significant increase in scores from the first to the second

ear tested was found in the BF test (Z 0/ (/3.36, p B/.001); FS (Z 0/ (/3.59, p B/.001) and for the PPS (Z 0/ (/3.36, p B/.001). A Friedman test was computed to evaluate score differences among the five subtests (500 Hz, 1000 Hz, 2000 Hz, 4000 Hz and Clicks) of the RGD test. There was no significant difference in

Table 2. Tests of Normality (Kolmogorow-Smirnov) Test SPN 1 SPN 2 BF FS DD PPS DPS SSW MLD RGD.5 RGD1 RGD2 RGD4 RGDC RGDA Kolmogorow-Smirnov 0.121* 0.208 0.152 0.111* 0.373 0.270 0.202 0.285 0.253 0.232 0.346 0.228 0.303 0.230 0.136*

Scores for the left and right ear were taken together for all the tests, with the exception of random gap detection and masking level difference, which are binaural tests. SPN 1 0/Speech-in-noise test SNR 0 dB; SPN 2 0/Speech-in-noise test SNR '/10 dB; BF 0/Binaural fusion test; FS 0/Filtered speech test; DD 0/Dichotic digits test; PPS 0/Pitch pattern sequence test; DPS 0/ Duration pattern sequence test; SSW 0/Staggered spondaic words Spanish version; MLD 0/Masking level difference; RGD.5 0/Random gap detection subtest 500 Hz; RGD1 0/Random gap detection subtest 1000 Hz; RGD2 0/Random gap detection subtest 2000 Hz; RGD4 0/ Random gap detection subtest 4000 Hz; RGDC 0/Random gap detection subtest clicks; RGDA 0/Random gap detection average for frequency. * Non-significant results (p /.05) which indicate normal distribution.

Figure 1. Boxplots of the scores of the subjects (n 0/40) in seven of the nine auditory processing tests. For all the tests, scores are in per cent correct items. SPN 1 0/Speech-in-noise test SNR of 0 dB; SPN 2 0/Speech-in-noise test SNR of '/10 dB; FS 0/Filtered speech test; BF 0/Binaural fusion test; PPS 0/Pitch pattern sequence test; DPS 0/Duration pattern sequence test; DD 0/Dichotic digit test; SSW 0/Staggered spondaic words Spanish Version. Boxes represent scores of 50 per cent of cases. The line across the inside of the box represents the median value. Outliers (circles) represent values between 1.5 box-lengths and 3 box-lengths from the edge of the box. Extremes (asterisks) represent values more than 3 box-lengths from the edge of the box.
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ear advantage; with scores in the right ear significantly better than those in the left ear (Z 0/ (/2.64, p B/.01).

Between tests
Considering that the verbal material (25 words) of the Hong Kong CAPA is the same for the tests of SPN, FS and BF, Wilcoxon signed rank tests were used to determine if differences existed across the tests scores. Six pairs of test scores were constructed in order to analyse differences between scores. Scores in the SPN 2 were significantly better than those in: BF, Z 0/ (/3.95, p B/.001; and FS, Z 0/ (/5.44, p B/.001. Scores in SPN 1 were significantly better than those in FS, Z 0/ (/4.9, p B/ .001. Scores in BF were significantly better than those in FS, Z 0/ (/5.36, p B/.001. No significant differences were found in scores between SPN 1 and BF, Z 0/ (/.873, p /.05. Table 3 displays the correlation rank coefficients (Spearmans Rho) between all of the tests and conditions. Significant correlations were found between conditions such as RGD at different frequencies, and SPN at the two different SNRs used. Other correlations were found between tests of the same category proposed by ASHA (1996; 2005) such as DPS and PPS, and DD and SSW Spanish version. Some correlations were also found between tests of different categories such as RGD at 2000 Hz which showed a moderate negative correlation with PPS, Rho 0/ (/.41, p B/.01; SPN 1 which was correlated with PPS, Rho 0/.35, p B/.05, and DD which was correlated with DPS, Rho 0/.39, p B/.05.

Figure 2. Boxplots of the scores of the control subjects (n 0/40) in the random gap detection subtests. Scores are in milliseconds. RGD500: Subtest 500 Hz; RGD1000: Subtest 1000 Hz; RGD2000: Subtest 2000 Hz; RGD4000: Subtest 4000 Hz; RGDCLICK: Subtest for clicks. The boxes represent scores of 50 per cent of cases. The line across the inside of the box represents the median value. Outliers (circles) represent values between 1.5 box-lengths and 3 box-lengths from the edge of the box. score across the five subtests (x2 0/5.21, p /.05). Figure 2 shows the distribution of RGD scores.

Between gender
Gender differences for both age and scores of all of the tests (including subtests, average score between ears, frequency average score for RGD and tests conditions such as first and second ear tested and right versus left ear) were examined using Mann-Whitney U-tests. There were no significant differences in age between genders (Z 0/ (/1.23, p /.05). For the frequency average in the RGD test, male thresholds for gap detection were significantly better (lower) than those in females (Z 0/ (/3.35, p B/.01). Also, for the RGD subtests at 500 Hz and 2000 Hz, male thresholds for gap detection were significantly better (lower) than those obtained by females (Z 0/ (/2.94, p B/.01; Z 0/ (/2.48, p B/.05 respectively). For the rest of the tests and subtests there were no significant differences in scores between male and female subjects (p /.05). Table 4 shows the statistical results for all tests.

Ear effects
A Wilcoxon signed rank test was computed to determine if differences existed between left and right ear scores. In SPN 1, BF, FS, PPS, DPS and SSW there were no significant differences between ears (p /.05). In contrast, in SPN 2 there was a right

Discussion
Initial normative data for auditory tests proposed for use with Spanish-speaking adults were obtained by testing 40 normalhearing adult subjects. It was found that most of the test scores did not follow a normal distribution, due to the ceiling effect observed with most of the tests. Ceiling effects are expected to be found in normal populations in this type of tests. Many authors have found the same effect in AP tests (Arnst, 1981; Golding et al, 1996; Neijenhuis et al, 2001). Percentiles were computed to be used as reference standard scores, and 90th percentiles are suggested as initial cut-off scores for individual subjects when assigning normal or abnormal categorizations. The 90th percentile does not include the 10% of the subject group which are, in most cases, the outliers and extremes. Other researchers
International Journal of Audiology, Volume 45 Number 11

Figure 3. Boxplot of the scores of the control subjects (n 0/40) in masking level difference test. Scores are in dB SPL. The box represents scores of 50 per cent of cases. The line across the inside of the box represents the median value. Outliers (circles) represent values between 1.5 box-lengths and 3 box-lengths from the edge of the box.
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Table 3. Correlation coefcients (Spearmans Rho) for all tests SPN1 SPN1 SPN2 BF FS DD PPS DPS SSW MLD RGD5 RGD1 RGD2 RGD4 RGDC
+

SPN2
+

BF

FS

DD

PPS

DPS

SSW

MLD

RGD5

RGD1

RGD2

RGD4

0.37* 0.21 0.06 0.20 0.35* 0.22 0.25 0.18 0.04 0.01 (/0.03 0.05 0.16

(/0.00 (/0.11 0.09 0.30 0.04 0.07 0.23 0.12 0.20 (/0.15 0.17 0.19

0.24 0.17 0.16 0.01 0.02 0.04 (/0.12 (/0.07 (/0.20 (/0.16 (/0.20

(/0.17 (/0.10 (/0.09 (/0.05 0.15 (/0.06 (/0.06 0.23 (/0.14 (/0.10

0.30 0.39* 0.36* 0.31 0.25 0.13 0.22 0.20 (/0.32

0.38* 0.30 0.33 (/0.26 (/0.07 0.42** (/0.07 (/0.17

0.22 0.14 0.12 0.15 0.20 0.23 0.15

(/0.09 0.30 0.24 0.14 0.12 0.11

(/0.14 0.00 0.15 0.29 0.07

0.41** 0.38* 0.03 0.23

0.35* 0.33* 0.15

0.35* 0.28

0.24

Scores for the left and right ear were taken together for all the tests with the exception of random gap detection and MLD which are binaural tests. SPN 1 0/ Speech-in-noise test SNR 0 dB; SPN 2 0/Speech-in-noise test SNR '/10 dB; BF 0/Binaural fusion test; FS 0/Filtered speech test; DD 0/ Dichotic digits; PPS 0/Pitch pattern sequence test; DPS 0/Duration pattern sequence test; SSW 0/Staggered spondaic words Spanish version; MLD 0/ Masking level difference; RGD.5 0/Random gap detection subtest 500 Hz; RGD1 0/Random gap detection subtest 1000 Hz; RGD2 0/Random gap detection subtest 2000 Hz; RGD4 0/Random gap detection subtest 4000 Hz; RGDC 0/Random gap detection subtest clicks. * Statistically significant correlations (p B/.05) ** Statistically significant correlations (p B/.01)

have utilized the same boundary criteria for auditory processing tests (Demanez et al, 2003; Musiek, 1994; Neijenhuis et al, 2001; Neijenhuis et al, 2002).

Table 4. Statistical differences between gender for age, tests and subtests (Mann-Whitney U test) Test Age SPN 1 SPN 2 BF FS DD PPS DPS SSW MLD RGD5 RGD1 RGD2 RGD4 RGDC RGDA Z (/1.23 (/.37 (/1.83 (/.98 (/.46 (/1.09 (/.49 (/1.95 (/.33 (/.60 (/2.94** (/1.79 (/2.48* (/1.58 (/1.48 (/3.35**

SPN 1 0/Speech-in-noise test SNR 0 dB; SPN 2 0/Speech-in-noise test SNR '/10 dB; BF 0/Binaural fusion test; FS 0/Filtered speech test; DD 0/Dichotic digits test; PPS 0/Pitch pattern sequence test; DPS 0/ Duration pattern sequence test; SSW 0/Staggered spondaic words Spanish version; MLD 0/Masking level difference; RGD.5 0/Random gap detection subtest 500 Hz; RGD1 0/Random gap detection subtest 1000 Hz; RGD2 0/Random gap detection subtest 2000 Hz; RGD4 0/ Random gap detection subtest 4000 Hz; RGDC 0/Random gap detection subtest clicks; RGDA 0/Random gap detection average for frequency. * Statistically significant differences (p B/.05) ** Statistically significant differences (p B/.01)

Differences between test conditions were found in SPN 2, FS, BF, and PPS. Scores in the second ear tested were significantly higher (better) than those obtained in the first ear. This improvement in scores may be explained by a learning effect. Statistically significant differences between right and left ear were only found in the scores for SPN 1. Scores obtained in the right ear were significantly better than those obtained in the left ear. There is no clear explanation of this right ear advantage. However, it may be due to the relatively small sample size used in this study. Differences among these test conditions do not have negative clinical implications, as all the differences were less than five per cent. For this reason the same cut-off scores are suggested for both ears. Other authors have found similar results for the SPN test. Pereira (1993; cited in Desgualdo & Schochat, 1997) found a mean score of 83.9% for the first ear and 86.3% for the second ear tested, and the difference was statistically significant. Scores in SPN 2 were significantly better than those obtained in SPN 1. It is clear that using a SNR of '/10 dB, the task becomes easier as the words can be more readily identified than when using a SNR of 0 dB, where the noise plays a more effective role as a masker. When using this test clinically, the first condition that should be carried out is the SPN 1. If the results appear to be abnormal, then the SPN 2 may be used. Using these two conditions and comparing the results may help clinicians to identify subjects with difficulties in phonemic restoration. Correlation analysis showed that most of the significant correlations were for within test conditions such as the different subtests of RGD and the two SNRs used for SPN; and between tests assessing the same auditory ability, which was the case for DPS and PPS, which are tests of temporal configuration; and for DD and SSW-Spanish version, which are tests of dichotic stimulation. This suggests that similar tests are evaluating similar aspects of auditory processing and tests of different categories assess different aspects of auditory processing.
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However, for PPS and DPS it has been observed that some subjects with cerebral lesions obtained normal results for the former and abnormal ones for the latter (Musiek et al, 1990), which may imply that DPS and PPS tests involve different processes of higher auditory function. Musiek (1994) claimed that the duration pattern test can detect certain cerebral lesions that the frequency pattern test cannot and vice versa. Thus, clinicians should be careful when selecting these tests to assess temporal configuration. The fact that both tests appear to be correlated in the present study does not necessarily imply that only one test should be carried out. Both tests share the auditory ability of discrimination and ordering in a general manner, but the underlying processes of duration pattern perception appear to be different than those of frequency pattern perception (Musiek, 1994). Some correlations were found between tests not assessing the same auditory ability, as was the case for PPS which was correlated with RGD subtest 2000 Hz, and for PPS which was correlated with SPN 1. However, it may be that for a single auditory task there is more than one auditory process involved. Thus, each test may assess mainly one auditory process; however, it also might assess indirectly other auditory processes associated with the main auditory task. Nevertheless, results should be interpreted with caution as the correlation values were only moderate (see Table 3 for details). For RGDA and for the RGD subtest at 500 Hz and 2000 Hz, males obtained significantly better (lower) gap thresholds than females. Despite this finding, scores obtained by females were still within normal limits, according to the standard scores proposed by Keith (2000b). In a study of normalization of the random gap detection test, Keith suggested that normal scores should be between 2 and 20 ms for all frequencies. He proposed the use of means and standard deviations as standard scores. There are no reports in the literature of gender differences for the scores in the random gap detection test, and the difference in the present study may have been produced because there were fewer males than females. Considering that scores obtained by females were within the normal limits reported by Keith (2000b), we do not consider it clinically important to establish normative scores by gender. In spite of using eight randomizations of the same 25 words for the creation of SPN 1, SPN 2, FS, and BF tests, the authors of the present study do not consider learning effects to be an important factor in test results. No significant differences were found between BF and SPN1. The former was carried out during the third session and the latter during the first session. If important learning effects had arisen, we would expect that scores for BF would be significantly better than those for SPN 1. Results for BF were significantly better than those for FS. However, it is to be expected that results for BF are better than FS. BF includes almost all the spectrum of the speech material, of which part is delivered to the right ear and the other part to the left ear. However, FS is a monaural task where only the low-frequency spectrum of the speech material is used by subjects to identify the words. Other researchers using similar filtering cut-off frequencies for both FS and BF tests have found that scores for BF are better than FS (Desgualdo & Schochat, 1997; Neijenhuis et al, 2001). Significantly better scores were obtained for SPN 1 and SPN 2 than for FS. Both conditions (SNR at 0 dB and '/10 dB) of SPN were carried out during the first session. If important learning effects of words had occurred, we would expect that results for FS,
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which was carried out during the second session, would be better than those for SPN. Therefore, we conclude that scores obtained for each of these tests depended on test characteristics (speech material presented with background noise, low-pass filtering, or low-and high-pass filtering) rather than on learning effects. Generally, results of the present Spanish-language study were in accordance with those from other, non-Spanish studies. Wilson & Mueller (1984) reported for filtered English speech, using a cut-off frequency of 750 Hz, a mean score of 78.4% correct. Our data showed for FS, using a cut-off frequency of 500 Hz, a mean score of 79.75%. For BF in Dutch, Neijenhuis et al (2001) reported a median of 90% and a 90th percentile of 84%. Our results indicated for BF a median of 94% and a 90th percentile of 90%. For the American English version of the SSW, Arnst (1981) reported a mean of the total normative score of 98.4%. Golding et al (1996) for the Australian version of SSW reported a mean of the total score of 99.1%. In the present study the mean of the total score for the SSW-Spanish version was 99.29%. For pattern sequence tests, Musiek (1994) used the cut-off scores (90th percentile) of 78% for PPS and 73% for DPS. In the data obtained in the present study, the 90th percentile corresponds to the value of 80% for PPS which is very similar to that proposed by Musiek. For DPS the 90th percentile is 85.5%, which is higher than that found by Musiek. However, Neijenhuis et al (2001), when assigning cut-off scores of 90th percentiles also found higher scores in comparison to those reported by Musiek. Their percentiles were 89% for PPS and 90% for DPS. Our results are distributed between those reported by Musiek (1994) and Neijenhuis (2001). This may be explained for some differences in the procedures used by different researchers. Instead of assessing just one ear randomly, the method used by both Musiek (1994) and Neijenhuis et al (2001), the present study assessed both ears and the scores were averaged. Also, the present study presented 50 stimuli per ear instead of the 60 stimuli which were used by Musiek (1994). This study represents just a first step in the development of an auditory processing test battery for Spanish-speaking adults. A set of nine tests were studied. This does not mean that all of these tests have to be carried out for all patients. Clinicians may choose only one of two potential tests for assessing an auditory skill (as categorized by ASHA, 1996, 2005) or auditory process (Bellis, 2003; Masquelier, 2003); or for clinical reasons one or more auditory skills may not be assessed. The selection of tests depends on the patient complaint, clinical history and other factors. Audiologists should consider the linguistic, cognitive, and other non-auditory demands of the auditory tasks when selecting an auditory processing diagnostic test battery (ASHA, 2005). Table 5 details the auditory processes (Bellis, 2003; Masquelier, 2003), and/or auditory skills (ASHA, 1996, 2005), together with the behavioural phenomenon (ASHA 1996, 2005) that each of the tests studied in the present research is related to. This may help clinicians to select the most suitable tests when assessing a particular patient. Also, clinical audiologists are advised to take into consideration the validity of the same tests for English-speaking adults when choosing the Spanish versions. The reader is referred to Bellis (2003) for an analysis of AP test validity. Future studies should assess a greater number of subjects, with the aim of performing a factor analytic study of the relationships
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Auditory processing tests for Spanish-speaking adults: An initial study Fuente/McPherson 655

Table 5. Description of the main task, the auditory process according to Bellis (2003) and/or Masquelier (2003), behavioural phenomenon or auditory skill (ASHA 1996, 2005) and test category (ASHA 1996, 2005) for each test studied in the present research Auditory process(es) involved (Bellis 2003; Masquelier, 2003) Auditory closure (Bellis, 2003) Auditory figure/ground (Bellis, 2003) Phonetic decoding (Masquelier, 2003) Recognition of monosyllables that have Auditory closure (Bellis, 2003) been low-pass filtered. Phonetic decoding (Masquelier, 2003) Recognition of monosyllables whose low Binaural interaction (Bellis, 2003) frequency spectrum is presented to one ear and high spectrum is presented simultaneously to the other ear. Lateralization of a 500 Hz tone burst in Binaural interaction (Bellis, 2003; the presence of noise. Masquelier, 2003) Detection of a 500 Hz tone burst (in noise) which is in- or out-of-phase between ears. Repetition of two pairs of digits which are presented simultaneously (dichotically) to both ears. Behavioural process or auditory skill involved (ASHA, 1996, 2005) Test category according to ASHA, 1996, 2005

Test Speech-in-noise

Task description Recognition of monosyllables in the presence of white noise.

Auditory performance decrements Low redundancy monaural with competing acoustic signals. speech

Filtered speech

Auditory performance decrements Low redundancy monaural with degraded acoustic signals. speech Binaural interaction Binaural interaction

Binaural fusion

Masking level difference

Binaural interaction

Binaural interaction

Dichotic digits

Hemispheric transfer (Masquelier, 2003) Binaural integration-divided attention (Bellis, 2003; Masquelier, 2003)

Dichotic speech

Dichotic speech

Staggered spondaic words

Repetition of the numbers heard in one Binaural separation-selective attention ear. (Masquelier, 2003) Repetition of four words which are Hemispheric transfer (Masquelier, 2003) presented to both ears in an overlapped manner. Binaural integration-divided attention (Bellis, 2003; Masquelier, 2003)

Dichotic speech

Dichotic speech

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Table 5 (Continued) Auditory process(es) involved (Bellis 2003; Masquelier, 2003) Behavioural process or auditory skill involved (ASHA, 1996, 2005) Auditory discrimination Test category according to ASHA, 1996, 2005 Auditory temporal processing and patterning

Test Pitch pattern sequence

Task description

Discrimination of pitch and ordering of Temporal configuration (Masquelier, acoustic stimuli according to their pitch. 2003)

Auditory pattern recognition Frequency discrimination, temporal ordering, linguistic labelling (Bellis, 2003) Temporal aspects of audition, including resolution, masking, integration, and ordering Temporal processes: ordering, resolution, integration, and discrimination Auditory discrimination Auditory pattern recognition Temporal aspects of audition, including resolution, masking, integration, and ordering Temporal processes: ordering, resolution, integration, and discrimination Auditory discrimination Auditory pattern recognition Temporal aspects of audition, including resolution, masking, integration, and ordering Temporal processes: ordering, resolution, integration, and discrimination

Duration pattern sequence

Discrimination of duration and ordering Temporal configuration of acoustic stimuli according to their (Masquelier, 2003) duration. Duration discrimination, temporal ordering, linguistic labelling (Bellis, 2003)

Auditory temporal processing and patterning.

Random gap detection

Gap detection between two acoustic stimuli

Temporal resolution (Bellis, 2003)

Auditory temporal processing and patterning.

between the tests investigated in the present study. Other studies using auditory processing test batteries have already looked for the components which are involved in AP test batteries. Domitz & Schow (2000) found four test clusters in their Multiple Auditory Processing Assessment (MAPA) AP test battery. Neijenhuis et al (2002) found five different behavioural auditory factors in their AP test battery for Dutch-speaking populations. If possible, test-retest reliability data should be obtained for the present test battery. Other researchers have obtained values of test-retest for each test of their AP test batteries (Keith, 1995; Keith, 2000a; Neijenhuis et al, 2001). The test-retest reliability of AP test batteries should be taken into account by clinicians when diagnosing APD. In addition, the validity of the present AP tests should be explored. Keith measured validity for SCAN-A (1995) and SCAN-C (2000). He evaluated validity for these AP test batteries, comparing the scores obtained in SCAN-A and SCAN-C with the scores obtained on the original version, SCAN. Certainly, for the present AP tests, this would not be possible, as there is no any valid AP test available to be used with Spanish-speaking adults. Validity may be evaluated by assessing normal hearing subjects and subjects with known pathology of the CANS, as suggested by ASHA (2005).

and at the International Conference on Recent Developments in Paediatric Audiology, 3-5 December, 2004, Hong Kong.

References
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Conclusion
This study addressed the need to develop AP tests that can be used with Spanish-speaking adults. An AP test battery comprising tests of competing message (speech-in-noise), degraded speech (filtered speech), binaural interaction (binaural fusion), and dichotic perception (dichotic digits) was developed the Hong Kong CAPA (Hong Kong Central Auditory Processing Assessment). Initial normative data for Hong Kong CAPA and other AP tests were obtained for Spanish-speaking adults. Ninetieth percentiles are suggested for initial use as the cut-off points for normal scores. Some score differences were found between test conditions. However, due to the slight differences obtained (less than 5%), these differences were not considered to be clinically relevant. Therefore, cut-off scores are suggested for each overall test and not for within test conditions. Future research should be focused on obtaining reliability and validity measurements with the present AP tests.

Acknowledgements
This study was partially funded by the Sik Sik Yuen Education Research Fund, the University of Hong Kong 2003-2004. The collection of normative references was carried out at the facilities of Escuela de Fonoaudiologia of the University of Chile, Santiago. Sincere thanks are extended to Prof. Zulema De Barbieri. Also, the authors would like to thank Dr. Luis Mart nez, linguist from the University of Talca, who contributed in the selection of the speech material for the Hong Kong CAPA; and to Dr. Kathleen PichoraFuller from the University of Toronto, and three anonymous reviewers for helpful comments and suggestions on an earlier version of the manuscript. Portions of the material included in this report were presented at the XXVII International Congress of Audiology, 26-30 September, 2004, Phoenix, USA; at the III Panamerican Congress of Audiology, 3-4 November, 2004, Guatemala City;
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Appendix
Monosyllabic words for speech-in-noise, binaural fusion and filtered speech tests Hong Kong Central Auditory Processing Assessment (Hong Kong CAPA)

BUS CAL DON FIN GAS CHAL LUZ MES PAN RON SAL TOS PAR BAR MAL SUR PEZ MIL GOL PUS

SOL MAR PAZ DOS ZAR

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