Keywords hearing - auditory tests - auditory perception - adolescents
Introduction
Central auditory processing (CAP) can be defined as “the way in which the brain recognizes
and understands the sound information people listen”.[1 ] This processing encompasses auditory abilities of detection, discrimination, sound
localization, speech recognition, figure-ground for verbal and nonverbal sounds, auditory
closure, synthesis, simple and complex temporal ordering and temporal pattern recognition.[2 ]
[3 ]
The maturation process of the central auditory nervous system begins in the early
years of life and ends in adolescence.[4 ] Thus, adolescents are expected to be able to process auditory information properly.
Adolescence is a stage of life marked by a complex process of biopsychosocial growth
and development.[5 ] It is the moment when an individual develops his/her autonomy, leaves the family
universe and decides for himself/herself, building his/her own identity. Moreover,
it is at this stage that the maturation process of the central auditory nervous system
is completed.[4 ]
In general, the CAP is clinically evaluated through a battery of behavioral tests
to investigate some auditory abilities, such as sound localization and lateralization,
auditory discrimination of verbal and nonverbal sounds, temporal auditory processing,
and auditory performance with competing or degraded acoustic information, among others.[6 ]
Individuals diagnosed with central auditory processing disorder (CAPD) have the following
behaviors: great difficulty hearing in noise, difficulty understanding speech, frequent
repetition requests, and lack of attention and/or memory for verbal instructions.
These individuals may also have reports of speech, language, literacy, attention,
and academic performance disorders. Inattention and memory are often present, either
as a secondary characteristic (such as fatigue associated with auditory demands) or
as a primary characteristic of the impaired auditory perception.[7 ]
Studies describe that in this disorder individuals may have the following manifestations:
poor school performance, reading and writing problems, social behavior disorder, difficulty
discriminating sounds, difficulty in sound localization, recognizing, recording and/or
understanding stimuli presented.[8 ]
[9 ]
[10 ]
Moreover, to identify populations at risk for CAPD, the literature has recommended
the use of screening instruments to identify auditory behavior and/or performance
in auditory tests.[6 ]
[11 ]
The British Society of Audiology (2018)[7 ] recommends that the initial screening of CAP should include a well-structured clinical
history and application of validated questionnaires to both parents and teachers to
identify individuals at risk for CAPD.
Questionnaires and checklists are instruments that can be used in this screening because
they produce relevant information about daily life situations related to the functioning
of the individual's auditory system provided by family members, teachers, and the
individual himself/herself. One of these instruments is the scale of auditory behaviors
(SAB) questionnaire, which was translated into European Portuguese.[12 ] It is brief, easy to apply, and contains questions often related to the CAP.
A systematic review study demonstrated that the SAB questionnaire was translated and
adapted into Portuguese to be used as a screening tool for CAPD. The authors reported
that among the questionnaires analyzed, the SAB and the children's auditory performance
scale (CHAPS) were the most used in the national literature; they also determined
that the population screened through these instruments was children and adolescents,
emphasizing a predominance of the child population both in preschool and school age.[13 ]
In this same study, the authors highlighted that the auditory processing domains questionnaire
(APDQ) was translated and validated into Brazilian Portuguese with 100% sensitivity
and specificity, being the most suitable instrument for application in clinical practice
and research setting.[13 ]
The auditory processing domains questionnaire (APDQ) was designed to screen auditory
processing disorder. This instrument has 52 questions designed to enable parents/teachers
to classify students' auditory abilities regarding auditory processing, attention,
and language factors. The authors concluded the APQD seems to be an effective screening
questionnaire for individuals with CAPD because its standards on the scoring scale
are useful for making appropriate clinical referrals.[14 ]
Studies developed by Kemp (2016),[15 ] Menezes (2017)[16 ] and Cerqueira (2018)[17 ] used the SAB questionnaire as a screening tool to support the diagnosis of CAPD.
The study by Kemp[15 ] investigated the auditory ability of 36 schoolchildren in initial grades subdivided
into 2 groups: group 1 consisted of 13 children aged from 6 years to 6 years and 9
months; group 2 (G2) consisted of 23 children aged from 6 years and 11months to 7
years and 10 months. In one of the evaluation stages, the SAB questionnaire was sent
to the parents, and the analysis of items that composed the questionnaire revealed
that the most frequent behaviors reported by the parents of students in G1 were: “asking
to repeat things” and “disorganization,” and among the parents of students in G2,
they were: “not understanding well when someone speaks fast or muffled,” “asking to
repeat things” and “easily distracted.” The author observed that the majority of the
students' parents reported some behaviors that indicated difficulty in processing
auditory information; however, this frequency was relatively low.
Another study[16 ] described scores of the SAB questionnaire and verified the degree of agreement between
the questionnaire and the CAP evaluation of 60 female and male children, aged 9 and
12 years old, divided into two groups: group I (GI): 30 children with learning disorder
and; group II (GII): 30 children with dyslexia. The analysis of SAB questionnaire
showed that the average scores were similar for both groups, and the investigation
of the degree of agreement between the SAB results and the CAP evaluation showed an
accuracy of 95%. It was possible to conclude that the SAB questionnaire was an important
predictor in the identification of CAPD.
In this study, Cerqueira[17 ] compared and related the auditory behavior of 31 female and male individuals with
stuttering, aged 7 to 26 years old, and their performance in the behavioral evaluation
of CAP. The comparison of the results showed a significant difference between the
final SAB score and their performance, and these findings suggest that the questionnaire
was a good instrument in cases in which individuals had scores ≤ 45 points, that is,
they were considered at risk for CAPD, since it was confirmed in the evaluation. However,
the correlation between these variables was weak.
Information provided by parents/guardians and/or teachers about an individual's auditory
perception difficulties in different environments is relevant for the early identification
of CAPD, especially data reported by teachers, since these individuals remain a long
period of their time at school.[18 ]
Despite the existence of studies that previously investigated the parents' perception
about their children's auditory behaviors during childhood,[16 ]
[19 ] the parents' perception of adolescent populations about auditory behavior is still
little investigated. In addition, considering that adolescents are able to provide
feedback on their own auditory performance, it would also be relevant to investigate
the self-perception of this population about the auditory behavior, thus enabling
a comparison with their parents' perception.
As a hypothesis of this study, it is believed that adolescents can perceive their
own difficulties related to auditory behavior and have a better perception than their
parents.
Therefore, regarding the scarcity of studies on CAP with the adolescent population
and the need for applicability of screening instruments, the present study aimed to:
(1) characterize and compare adolescents' self-perception regarding their auditory
behavior with their parents' perception; (2) verify their agreement with findings
of the behavioral evaluation of CAP.
Method
This was a cross-sectional, prospective, and descriptive study, approved by the Research
Ethics Committee under number 2.179.621. The data collection of this study was conducted
in a private hospital, located in the city of Cuiabá, Mato Grosso, in partnership
with the Faculty of Philosophy and Sciences of the São Paulo State University “Júlio
de Mesquita Filho”, UNESP, Marília.
Adolescents who were invited to participate in the basic audiological assessment at
this location had hearing thresholds within the normal range bilaterally, based on
the classification of the degree of hearing loss from the World Health Organization.[20 ] Thus, the convenience sample consisted of 40 adolescents, being 20 female and 20
male, all regularly enrolled in elementary or high school aged 12 to 18 years old
(mean age 14.82 years) and 40 parents and/or guardians.
The inclusion criteria for selection of the adolescents were: a) hearing thresholds
within normal range in both ears; b) bilateral type “A” tympanometric curve, c) presence
of contralateral acoustic reflex in the 500, 1,000 and 2,000 Hz frequencies in both
ears; d) signature of the informed consent form or assent form.
The exclusion criteria were: a) to have neurological disorders; b) psychiatric disorders;
c) communication and genetic syndromes reported by parents during anamnesis, which
could interfere with behavioral evaluation of CAP; d) not understanding instructions
needed for performing tests from the behavioral evaluation battery of CAP; e) to give
up during the application of the evaluations.
Initially, the adolescents and their parents answered the anamnesis; soon after, they
individually answered the scale of auditory behaviors (SAB) questionnaire, and, then,
only the adolescents performed the behavioral evaluation of the CAP, composed by the
following tests: speech-in-noise (SIN), synthetic sentence identification (SSI), dichotic
digits test (DDT), pitch pattern test (PPT), random gap detection test (RGDT). This
evaluation was performed in one session in most adolescents, but, in some cases, it
took two sessions to confirm the results, especially those that presented alteration
in a single test of the behavioral evaluation of CAP.
The SAB is an easy-to-apply questionnaire consisting of 12 items and scored using
a 5-point Likert scale to screen auditory behavior.[19 ] The SAB was applied to the adolescents to verify their self-perception regarding
their auditory behavior and, later, to the parents to evaluate the perception about
their children's auditory behavior. According to the authors of the questionnaire,
the final score classifies auditory behavior as typical with a final score ≥ 46 points,
low-risk behavior for auditory processing disorder values between 31 and 45 points,
and high-risk behavior for auditory processing disorder is defined by a score ≤ 30
points ([Fig. 1 ]).
Fig. 1 Scale of auditory behaviors (SAB). Fonte : Nunes; Pereira e Carvalho (2013).
The test battery of the CAP evaluation was performed in an acoustic booth, using a
2-channel audiometer AD229-e, which was coupled to a computer, and it was applied
by an audiologist.
The SIN test evaluates the auditory ability of closure, being a monotic task. A list
of 25 monosyllables with a competitive message of white noise was displayed, in which
the competitive message was in a signal-to-noise ratio at +10 dB, monaurally, and
the main message was at an intensity of 40 dBSL. The adolescents were instructed to
repeat the monosyllables orally. The reference criterion adopted as normality was
to reach several correct answers (≥ 70%) in both ears or a difference between the
percentage of SRI and SIN results ˃ 20%, considering the same ear.[21 ]
The SSI test with competitive message is used to evaluate the auditory ability of
figure-ground for verbal sounds and the association of auditory and visual stimuli.
This test consists of 10 sentences, displayed simultaneously to a competitive message
composed by a story. The stimuli were displayed monaurally in two signals to noise
ratios (SNR), 0 and -10 dB, and the main message (phrase) was displayed at an intensity
of 40 dBSL. The adolescent was positioned in front of a poster containing the sentences,
and for each sentence heard, he or she should point to the corresponding phrase on
the poster. The reference criterion adopted for normality was to reach several correct
answers (≥ 70%) for the signal-to-noise ratio -10 dB.[21 ]
Another test applied was the DDT, which evaluates the figure-ground ability for verbal
sounds. The test consists of displaying 4 lists of 20 items each, in which each item
containing 4 digits, selected from numbers 1 to 9. In this study, only the binaural
integration stage was applied at an intensity of 50 dBSL. The adolescent was instructed
to orally repeat the four digits displayed, regardless of their presentation order.
The reference criterion adopted for normality was to reach several correct answers
(≥ 95%) in both ears.[21 ]
The PPT evaluates the temporal ordering ability. In this study, the PPS (adult version)
proposed by Auditec, Inc. (St. Louis. MO, USA) (1997) was applied because this version
shows potential to identify normality in the temporal ordering ability.[22 ] This test consists of 30 sequences of 3 tones, which can be low frequency (880 Hz)
or high frequency (1,430 Hz). Each tone has duration of 200 milliseconds (ms), with
an interval of 150 ms between tones and 7 seconds between sequences. The test allows
six combinations between the low (L) and high (H) stimuli: HHL, HLH, HLL, LLH, LHL,
and LHH. Prior to the beginning of the test, the patient underwent a training to ensure
the perception of the difference between tones to be tested and the understanding
of the task to be performed. The test was binaurally displayed at an intensity of
50 dBSL. Participants were instructed to name the stimuli in the same presentation
order. The normality criterion adopted was to reach a percentage of correct answers
≥ 90%.[23 ] Finally, the RGDT was applied to evaluate temporal resolution ability. The test
consists of displaying pure tones paired with short silent intervals ranging from
0 to 40 ms randomly presented. The interval detection threshold is considered to be
the shortest interval from which the individual is able to consistently identify the
occurrence of two stimuli. This test was displayed binaurally at an intensity of 50
dBSL. The patient was instructed to lift the finger each time he or she heard one
or two stimuli. The normality criterion adopted was values ≤ 10 ms.[24 ]
The CAP evaluation was classified as normal or altered based on the criteria established
by the Diagnostic Forum of the 31st International Audiology Meeting,[25 ] according to which alteration in only one physiological mechanism, being observed
the conditions of the test application regarding the individual's attention and the
compatibility of the alteration with the patient's history and test/retest in the
case of very small alterations.
To compare adolescents' self-perception of their auditory behavior, parents' perception
of their children's auditory behavior, and to analyze the relationship between the
adolescents' performance in each test and the final outcome of the behavioral evaluation
of the CAP, the test for equality of two proportions was applied. To compare adolescents'
self-perception with parents' perception about the auditory behavior, the Chi-squared
test and the Kappa concordance index were applied to measure the degree of agreement
between these variables.
To verify the relationship between adolescents' self-perception and parents' perception
regarding the auditory behavior and the performance in the behavioral evaluation of
the CAP (normal or altered), the Chi-squared test was applied. The significance level
adopted was 5% (p ≤ 0.05) and, for the Kappa concordance index, the following values were considered: < 0.200
negligible; between 0.210 and 0.400 minimum; between 0.410 and 0.600 regular; between
0.610 and 0.800 good and; above 0.810 great.
Results
The analysis of the SAB questionnaire answered by the adolescents showed that the
auditory behavior of most participants was classified as “low risk,” but this difference
was significant in relation to “high risk” ([Table 1 ]).
Table 1
Characterization of the classification of auditory behavior based on adolescents'
self-perception
Auditory behavior
N
%
P -value
High risk
1
2.5%
< 0.001[* ]
Low risk
23
57.5%
Ref.
Typical
16
40.0%
0.117
Abbreviations: N, casuistry; Ref, reference.
Test for equality of two proportions
* Significance level p ≤ 0.05
Regarding the parents' perception, 65% of parents rated the adolescents' auditory
behavior as “typical.” Comparison between the other classifications, “low risk” and
“high risk,” showed a significant difference ([Table 2 ]).
Table 2
Characterization of the classification of auditory behavior based on parents' perception
Auditory behavior perception
N
%
P -value
High risk
3
7.5%
< 0.001[* ]
Low risk
11
27.5%
< 0.001[* ]
Typical
26
65.0%
Ref.
Test for equality of two proportions
Caption: N, casuistry; Ref, reference
* Significance level p ≤ 0.05
When analyzing the agreement index between adolescents' self-perception and parents'
perception in relation to the auditory behavior, a significant difference was found.
However, as the agreement value was minimal, it should be disregarded ([Table 3 ]).
Table 3
Concordance Index between adolescents' self-perception and parents' perception about
auditory behavior
Adolescents' self-perception versus parents' perception
Kappa
0.397
P -value
0.001[* ]
Kappa concordance index
* Significance level p ≤ 0.05
When comparing adolescents' self-perception with their parents' perception in relation
to the auditory behavior with performance of the behavioral evaluation of the CAP,
a significant difference was found only for adolescents' self-perception ([Table 4 ]).
Table 4
Comparison between adolescents' self-perception and parents' perception about the
auditory behavior and the adolescents' performance in the behavioral evaluation of
central auditory processing
Behavioral evaluation outcome of CAP
Altered
Normal
Total
P -value
N
%
N
%
N
%
Auditory behavior self-perception (adolescents)
High risk
1
5.9%
0
0.0%
1
2.5%
0.005[* ]
Low risk
14
82.4%
9
39.1%
23
57.5%
Normal
2
11.8%
14
60.9%
16
40.0%
Auditory behavior perception (parents)
High risk
1
5.9%
2
8.7%
3
7.5%
0.058
Low risk
8
47.1%
3
13.0%
11
27.5%
Normal
8
47.1%
18
78.3%
26
65.0%
Abbreviations: N, casuistry; CAP, central auditory processing.
Chi-square test
* Significance level p ≤ 0.05
[Table 5 ] shows the classification of adolescents' performance in the tests that comprised
the behavioral evaluation of CAP. It was observed that in the DD, SIN, SSI, and RGDT,
there was a higher percentage of normal results and this difference was statistically
significant. However, the PPS showed a higher percentage of altered results.
Table 5
Classification of the adolescents' performance, normal or altered, in the tests that
composed the behavioral evaluation of central auditory processing
Classification of the behavioral evaluation of CAP
Altered
Normal
P -value
N
%
N
%
DDT
2
5.0%
38
95.0%
< 0.001[* ]
SIN
2
5.1%
37
94.9%
< 0.001[* ]
SSI
5
12.5%
35
87.5%
< 0.001[* ]
PPS
16
40.0%
24
60.0%
0.074
RGDT
2
5.0%
38
95.0%
< 0.001[* ]
Abbreviations: CAP, central auditory processing; N, casuistry; DDT, dichotic digits test; SIN, speech
in noise; SSI-synthetic sentence identification; PPS, pitch pattern test; RGDT, random
gap detection test.
Test for equality of two proportions
* Significance level p ≤ 0.05
Discussion
The application of well-designed questionnaires that have questions specifically related
to auditory behaviors may assist in the referral of at-risk populations to specialized
evaluation and, consequently, assist the diagnostic process of CAPD.[7 ]
In this study, the SAB questionnaire was applied as a screening instrument, with the
purpose of evaluating adolescents' self-perception regarding their auditory behavior
and also their parents' perception. Assuming that self-perception refers to the manner
in which an individual understands his/her own attitudes based on his/her behavior
in certain situations.
Considering the classification of auditory behavior based on the SAB score[19 ] and the adolescents' self-perception findings in relation to their auditory behavior,
it was observed that adolescents had an average score of 43.9 points, which corresponds
to the classification “low risk” for CAPD.
It is also worth mentioning that 57.5% of the adolescents in this study classified
their behavior as “low risk.” These results suggest that most adolescents were able
to identify, in their daily routine, situations in which they had difficulty understanding
information aurally received, especially in background noise.
Regarding the parents' perception of the auditory behavior of their adolescents, it
was observed that the average score of the SAB questionnaire answered by the parents
was 46.4 points, which corresponds to “typical” auditory behavior.[19 ] It is also highlighted that 65% of parents rated their adolescents' auditory behavior
as “typical.”
Findings of adolescents' self-perception and their parents' perception are relevant,
since no previous studies that used a screening instrument to characterize adolescents'
auditory behavior were found in the literature.
The analysis of agreement between adolescents' self-perception and parents' perception
regarding auditory behavior was minimal, and thus was disregarded.
In the reviewed literature, there are few studies that investigated the agreement
between adolescents' self-perception and parents' perception regarding auditory behavior.
However, a study which aimed to compare the students' and parents' responses using
a questionnaire found similarity in the results between the parents' and students'
responses.
Thus, the authors suggested that, based on the findings, there was greater reliability,
so that the questionnaire could be applied only to the student.[26 ] The findings of this study differ from those of a previous study,[26 ] most likely due to the different population's age range and the parents' attention
level in relation to the school difficulties shown by their children.
A study investigated children's hearing complaints and parents' opinions about their
children's hearing and concluded that the children's hearing complaints were prevalent
and relevant, but most of them had never undergone an audiological assessment and
most parents were unaware of the hearing complaints reported by their children[27 ].
The results of the present study showed the importance of valuing the individual's
self-perception regarding his/her auditory behavior in the diagnosis process of CAPD,
especially in the adolescent population, since they were able to identify and report
their difficulties in daily life activities, both at home and at school. Possibly,
due to the maturation process of the central auditory nervous system is complete in
the adolescence stage.
In terms of behavioral evaluation of the CAP, the analysis of the adolescents' performance
showed that 42.5% had alterations in this evaluation. The analysis by test showed
that the adolescents had performance compatible with normality in most tests (DD,
SIN, SSI ipsilateral competing message, and RGDT), and this difference was significant.
The only test in which 40% of adolescents had altered performance was the PPT.
This high rate of alteration (42.5%) in the behavioral evaluation of the CAP is probably
due to the fact that the present study adopts the criterion established by the Diagnostic
Forum of the 31st International Audiology Meeting[25 ] as reference, which considers alteration in only one test. Thus, it is worth mentioning
that the adolescents who had alterations in a single test were retested and confirmed,
and there was confirmation of such findings in this research.
The PPT evaluates the temporal ordering auditory ability, which has currently been
extensively investigated due to its importance for speech perception. This auditory
ability refers to the processing of two or more acoustic stimuli according to the
order of occurrence, in a certain time interval.[28 ] Thus, any inability to sequence the order of occurrence of sound events can impair
the perception of verbal and nonverbal sounds, the understanding of information about
things, places and events around us, as well as the perception of prosodic aspects
of speech and reading.[29 ]
[30 ]
[31 ]
A study that verified the relationship between academic performance and auditory temporal
aspects of adolescents in the 6th grade of elementary school showed that the results
of temporal tests were not influenced by the variables: gender, age, musicalization,
and manual preference; However, a significant difference was observed between the
speech-language management variable and the findings obtained in the GIN test. Regarding
the academic performance test, it was observed that the subtests that had the greatest
influence on the duration pattern (DP) and pitch pattern tests were writing, followed
by reading and arithmetic. The researchers concluded that there is a correlation between
academic performance and auditory temporal aspects, specifically for temporal ordering
ability.[31 ]
A study by Machado32 investigated and analyzed the CAP and some neuropsychological aspects of a group
of adolescents with chronic non cholesteatomatous otitis media and a control group.
The results showed a significant difference for the averages obtained between the
two groups in all CAP tests applied, including the PPT. This study concluded that
non-cholesteatomatous chronic otitis media had an influence on both CAP evaluation
and attention, memory, and executive function subtests.
Another study compared the adolescents' performance exposed and not exposed to metallic
mercury in the behavioral tests of the CAP. The analysis of the results showed a significant
difference between groups, and the group of adolescents exposed to mercury underperformed
in the majority of the applied tests, especially in the PPT, DP and ADDT.[33 ]
The findings of the present study corroborate the literature regarding the higher
occurrence of alteration in temporal ordering auditory ability for the adolescent
population. In the current study, the adolescent's self-perception was compared with
his/her performance in the auditory processing evaluation and the results showed a
significant difference between adolescents' self-perception and their performance
in the PPT, DD, and SSI - ipsilateral competing message. However, there were no studies
in the international and national literature comparing the self-perception and performance
of adolescents in the CAP evaluation.
However, a national study analyzed the students' performance in the simplified auditory
processing test and compared it with a self-perception questionnaire based on the
SAB. These questions were modified to a more accessible and direct language to facilitate
the participants' understanding. The analysis of the results showed that worse performance
for both the SAP test and the self-perception questionnaire (SAB) occurred in the
group of children who had school difficulties. From the correlation analysis, the
authors concluded that the SAP test and the self-perception questionnaire should be
used as complementary diagnostic methods.[26 ]
The findings of the present study also suggest that the SAB questionnaire was a good
screening instrument when applied to adolescents and that self-perception of this
population should be valued in the diagnostic process.
To verify one of the hypotheses of this study, the authors compared adolescents' self-perception
and parents' perception regarding the auditory behavior and performance in the behavioral
evaluation of the CAP. A significant difference was observed between the adolescents'
self-perception and their performance in the CAP evaluation, since the 15 adolescents
who had alterations in the behavioral evaluation of the CAP classified their auditory
behavior as “high risk” (5.9%) and “low risk” (82.4%) for CAPD. It is also noteworthy
that the same did not occur in relation to the parents' perception.
The disagreement between findings of the adolescents' self-perception and their parents'
perception can be explained due to the fact that self-perception is an individualized
process, characterized by a unique perception, and that cannot be measured equally
by the individuals around them, for example parents and/or teachers.
However, a study whose objective was to investigate the auditory abilities of European
Portuguese children and verify their correlation with the scale of auditory behaviors
(SABs) score answered by parents, concluded that this correlation exists.[19 ]
A study conducted with 60 Brazilian children diagnosed with learning disabilities
and dyslexia had as one of its specific objectives to verify the degree of agreement
between the SAB questionnaire answered by parents and the CAP evaluation. In this
study, a 95% agreement between the questionnaire score and the result of the behavioral
evaluation of the CAP was found.[16 ]
In the aforementioned studies, there was an agreement between the parents' perception,
obtained through the SAB questionnaire and the performance in the behavioral evaluation
of the CAP. However, such finding did not occur in this study.
In this study, the lack of agreement between parents' perception and performance in
the behavioral assessment of CAP may be explained by the average age of adolescents,
which was 14.82 years. In the other studies, the participants' age was lower, which
probably made parents more attentive to their children's auditory difficulties.
Finally, we believe in the design of new studies with greater investment of researchers
in non-invasive evaluations that provide evidence of central auditory nervous system
involvement in specific language and learning disorders in the adolescent population;
in validating questionnaires that can be used as screening instruments for CAPD; in
the inclusion of screening instruments in clinical routine of the audiologist for
the diagnosis of CAPD; and in the inclusion of temporal processing tests in the behavioral
test battery of the CAP.
Absence of a correlation between adolescents' self-perception and parents' perception
with the adolescents' school performance is highlighted as a limitation of this study.
Thus, new study designs with the adolescent population are needed to correlate these
aspects.
Conclusion
Most adolescents were able to perceive difficulties regarding their auditory behavior
and characterized it as “low risk” for CAPD but the same did not occur with their
parents. There was agreement only between the adolescents' self-perception and their
performance in the behavioral evaluation of the CAP.
