Multiple Auditory Processing Assessment

MAPA-2

The newest version of this APD test is MAPA-2 which was published by Academic Therapy Publications in 2018 and is available commercially.  The MAPA-2 Manual contains norms for children ages 7-14 based on the testing of 748 children nationwide. The commercial website can be found at this address.  An article in LSHSS can be found at this address.  The article will provide the main details on this normative process and the manual itself will spell out all the background information and norms.  

An earlier version of MAPA was available from 2007 until 2018 and it is described below. While it is basically the same as MAPA-2 there are some differences.  The new manual for MAPA-2 can be purchased but is not available online.  The descriptions on MAPA below will provide a lot of insight to the new version but there are differences and improvements.

MAPA

Purpose & Status of MAPA

The MAPA  was developed to identify children and adults who have auditory processing disorders beginning at 8 years of age and continuing into adult years.

The MAPA  includes five different subtests and requires the use of auditory skills in three general ASHA defined domains.  The current MAPA version is called 1.0.  Earlier versions were Beta I-III.  This manual, prepared to go with the 1.0 CD, is also called version 1.0. 

Overview

An earlier version of the MAPA (Beta 1) was described by Domitz and Schow, 2000.  The current version contains all four of the subtests used earlier, plus one new subtest.  These five subtests allow measurement in three main auditory processing domains as reflected in recent conference and work group reports (ASHA, 2005; Jerger & Musiek, 2000) and all five tests have been examined in at least one factor analysis study that demonstrated its loading on one of these domains.

MAPA was designed to provide professionals with an auditory test that 1) is standardized and has two forms, 2) covers the three most important auditory processing domains as defined by ASHA (2005), and 3) uses convenient CD technology for application in the classroom or the sound booth.

MAPA incorporates a hybrid testing approach in three areas and we believe this holds promise for clinical use.  Because (C)APD assessment should be performed by a team of professionals (e.g., audiologist, speech-language pathologist, educator, psychologist, medical professional, parent, etc.), we assume that other professionals may have their own testing processes and that, at some point in the assessment, this group of professionals would meet to discuss a final diagnosis of (C)APD, any possible need for further evaluation, and the plan for intervention. We believe MAPA may be used as a screener to be followed by other behavioral or physiological tests or it may be used for a preliminary diagnosis in the auditory area.

As part of the assessment process, in addition to behavioral tests, we discuss questionnaires that draw information from other key professionals, and we assume that the audiologist and/or speech-language pathologist involved in the process might use these questionnaires to gather information from psychologists, medical professionals, parents, teachers, and the individual of concern about the symptoms and about potential co-morbidities, such as attention deficit hyperactivity disorder (ADHD), learning disability (LD), reading problems, autistic spectrum disorder, and speech/language deficit (S/LD) as these disorders relate to behaviors suggesting (C)APD.

Screening with MAPA for children (or adults) at risk for (C)APD should be completed by the audiologist or speech-language pathologist in a manner similar to pure-tone screening in the school setting (probably at the 3rd grade level), or, alternatively, may be completed following referral by teacher, parent, or other professional. Clearly, a screening protocol is important in helping to minimize the related problems for the individual with (C)APD, for parents, educators, and other involved professionals. Such screening is important to allow timely intervention.

MAPA Subtests

In an effort to refine and develop a reliable behavioral test battery through the use of factor analysis, Domitz and Schow (2000) working with the other current test co-authors, administered a battery of auditory processing tests to school-aged children.  This test battery is called the Multiple Auditory Processing Assessment (MAPA).  While they felt the MAPA was an appropriate test, tapping into several important areas from the 1996 ASHA guidelines, a ceiling effect was found with some of the tests, and especially with older children.

The current manual reports on a revised version of the MAPA (1.0) which has been developed and recorded on compact disc. The MAPA now includes test information for a Form A and Form B version of the test. The new MAPA has all of the same tests as the original MAPA plus one more. These behavioral tests are organized into three areas (monaural, temporal, and binaural) as recommended by Chermak (2001) and (monotic, diotic, and dichotic) as advised by the Bruton group (Jerger & Musiek, 2000). In addition, the tests that were prone to the ceiling effect were modified so the tasks would be more difficult. The specific modifications to the tests will be described later.

The five MAPA subtests grouped within the three domains are:

1. MONAURAL (Low Redundancy)—(Monaural Separation Closure-MSC)
1. Monaural-Selective Auditory Attention Test (MSAAT)
2. TEMPORAL (Auditory Pattern Temporal Ordering-APTO)
1. TAP Test
2. Pitch Pattern (PP) Test
3. BINAURAL (Dichotic Speech)—(Binaural Integration/Binaural Separation-BIBS)
1. Dichotic Digits (DD)
2. Competing Sentences (CS)

MAPA MSAAT

Subtest 1. MAPA MSAAT:  (MAPA Monaural Selective Auditory Attention Test)
Non-competing (Audio Clip Coming Soon)
Competing (Audio Clip Coming Soon)

(Note about audio clips: Since most of the tests require some sort of binaural task, the clips will give you the most realistic example if you use earphones)

Background
The original SAAT (Cherry 1980, 1992) is normed for children between the ages of 4 and 9 years, and takes 8 minutes to administer.  The test compares the ability of the patient to recognize monosyllabic words without competing background (speech recognition task) and embedded in a background of competing high-interest speech.  Both target and competition stimuli were recorded by the same speaker, thereby eliminating speaker recognition cues. 

The signal-to-competition ratio is 0 dB.  Normative data provided evidence that it accurately screens 90% of children who have been identified as having a learning disability, which Cherry claimed related to an underlying, but undiagnosed, (C)APD (Cherry, 1992).

Test Method and Rationale

This test follows the construction of SAAT (Cherry, 1980, 1992).  It requires the subject to listen for a word selected from the WIPI word list that is embedded in competing background noise of high-interest speech, recorded by the same speaker. This version utilizes only monaural stimulation, as a monaural low-redundancy test was needed more than a binaural test and dichotic stimulation did not improve the sensitivity of the test.  This test loaded strongly (0.74) on the MSC domain in factor analysis (Summers, 2003).

APTO Auditory Pattern Temporal Ordering

MAPA Tap Test

Background

The MAPA Tap Test was developed upon the suggestion of Charles Berlin who has used it clinically for years and found it extremely useful (personal communication).  It is purported to test temporal resolving dimensions of the auditory system.  In this test, a series of tapping sounds is presented with an interval of 120 ms between taps.  Although the inter-stimulus interval is large in the context of temporal resolution, the Tap Test factors strongly along with at least one other test in the APTO domain.

Test Method and Rationale

Three series of taps are presented to the listener.  After each series the listener must indicate the number of taps heard.  The total number of test taps is 30, so that a raw score is based on the sum of the subject's estimate of number of taps.  The test proved surprisingly sensitive to (C)APD, loading firmly (0.50) on the APTO domain (Summers, 2003). (Factor loadings on TAP were even larger, i.e., 0.75. when Duration Patterns and AFT-R were included in the tests factored)

MAPA TAP Test (Audio Clip Coming Soon)

(Note about audio clips: Since most of the tests require some sort of binaural task, the clips will give you the most realistic example if you use earphones)

MAPA Pitch Pattern Test

Background
This test was modeled after the Frequency Patterns (FP) Test  (Musiek & Pinheiro, 1987).  The FP Test reflects the ASHA (1996, 2005) temporal component of auditory pattern recognition, and has been a staple for screening in (C)APD.  The test consists of 120 test sequences, each made of three tones.  Two of the tones are the same and one varies, and the subject is required to declare the pattern to the tester (verbally, by humming, or by pointing to a visual analog). 

Test Method and Rationale
The MAPA Pitch Patterns Test is derived from Pinheiro (1977).  This test introduces high and low pitches binaurally in a four-tone series, and the subject identifies the pattern by verbalizing (e.g., high-high-low-high).  The four-tone sequence was used instead of Pinheiro’s original three-tone sequence because of a ceiling effect identified by Shiffman (1999) and 4 tones were also used by Neijenhuis, Snik, Priester, van Kordenoordt, and van den Broek (2000).  A four-tone pattern avoids the ceiling effect observed using the three-tone pattern and results in the same factor structure as the three-tone pattern test.  Nonetheless, the additional tone is likely to exert greater demands on memory and reversals are scored correctly to avoid a floor effect. Summers (2003) tested 119 children using the entire MAPA battery, and results were subjected to factor analysis.  This test loaded strongly (0.74) to the APTO domain).

MAPA Pitch Pattern Test (Audio Clip Coming Soon)

(Note about audio clips: Since most of the tests require some sort of binaural task, the clips will give you the most realistic example if you use earphones)

MAPA Dichotic Digits 

Background
This test presents a different series of digits to each ear simultaneously, with the task being to identify as many numbers as possible.  Instructions vary, including requiring correct order, identification of ear of presentation, or simply listing the numbers heard.  Results rely on binaural integration, attention, and auditory memory.
            
Test Method and Rationale

The MAPA Dichotic Digits test (DD) is derived from Musiek (1983).  The original formulation required that two number pairs be presented simultaneously to each ear of the listener, with the subject being required to repeat all four numbers.  The MAPA DD employed number triplets presented dichotically, similar to that of Neijenhuis et al. (2000).  The subject repeats items from the right ear first, then from the left, following Moncrieff and Musiek (2002). This test loaded strongly (0.67) on the BIBS auditory domain during factor analysis (Summers, 2003). Again, it is important to note that while loading on the same factor suggests that double-digit and triplet pairs both provide a measure of similar processes the triplet MAPA DD probably involves memory to a greater extent than the double-digit DD.

MAPA Dichotic Digits (Audio Clip Coming Soon)

(Note about audio clips: Since most of the tests require some sort of binaural task, the clips will give you the most realistic example if you use earphones)

MAPA Competing Sentences

Background
Willeford (1985) introduced the Competing Sentences Test (CS), and Keith (2000 integrated competing sentences into the SCAN-A.  In the MAPA Competing Sentences Test, two sentences are presented dichotically, and the subject repeats both sentences.  This more difficult task was used because of a ceiling effect identified by Shiffman (1999) when only one sentence was repeated. 

Test Method and Rationale
Subjects are required to repeat either the right or the left ear first, and stimuli must be repeated with 100% accuracy to be considered correct.  Subjects are not penalized for reversing the order of the sentences as repeated.  Due to the greater difficulty of the modified task, 8- to 9-year-old subjects’ mean performance was  41% (SD = 14%). This test loaded strongly (0.65) on the BIBS auditory domain during factor analysis.  Besides the strong factor loading of DD and CS, the work of Domitz and Schow (2000) and Schow, Seikel, Chermak, and Berent (2000) recorded a 0.70 correlation between DD and CS, which strongly supports combining those two tests to derive a measure of the binaural domain (BIBS).  DD is thought to involve binaural integration, and because subjects are asked to repeat competing sentences (CS) in a certain order, this appears to be a binaural separation task or some combination of binaural integration and separation.

MAPA Competing Sentences (Audio Clip Coming Soon)

(Note about audio clips: Since most of the tests require some sort of binaural task, the clips will give you the most realistic example if you use earphones)

MAPA Supplemental Tests

The following tests may be used to supplement the MAPA findings and some factor studies are available to support their use. 

MAPA Durations Pattern Test (MAPA DP)

Sample Audio Clip: (Audio Clip Coming Soon)

(Note about audio clips: Since most of the tests require some sort of binaural task, the clips will give you the most realistic example if you use earphones)

Background

This is based on the Musiek et al. (1990) three-tone Duration Patterns test, but in this case groups of four-tone series are presented binaurally to the subject. Duration of the tones is randomly varied between short and long.

Test Method and Rationale

The subjects task is to verbally report the series in the order that the tones were presented (e.g., long-short-long-long). Summers (2003) reported only a modest loading on DP for APTO (.36) based on 119 subjects. Accordingly, the Pitch Pattern and Tap Test were selected in the MAPA battery to measure the temporal domain because of their more favorable factor loading compared to Duration Patterns and Auditory Fusion Test-Revised (AFT-R).

MAPA Speech in Noise for Children and Adults (MAPA SINCA)

Background

Because the MSAAT and SINCA both load (i.e., the correlation between each variable and the various factors) strongly on the monaural factor (0.74 and 0.72, respectively) there is support for using SINCA along with MSAAT to screen for the monaural domain. However, SINCA is recommended only as a supplementary test because test-retest reliability was low. We expect to provide an improved version in some future version of the MAPA and any input based on supplemental use will be helpful. SCAN AFG and SCAN FW have been shown also to load strongly (0.68 and 0.55, respectively) with MSAAT (0.78 and 0.74 for left and right ear MSAAT: Domitz & Schow, 2000). It is presumed that QuickSIN/BKB-SIN, which are nearly identical to SINCA, would also load in the monaural domain. Thus, these four other tests should provide good backup for testing the MSC domain. This is helpful because form equivalency and test-retest reliability on SINCA needs improvement, and until it is better in this area it would seem prudent to supplement MSAAT with other tests. MSAAT has other data to support form equivalency and test-retest reliability and therefore it has support for continued inclusion. Also, QuickSIN/BBK-SIN, fortunately, have many equivalent forms and should have strong utility in the MSC domain.

Test Method and Rationale

Monosyllabic PBK words were recorded and subjects were required to listen for the primary stimulus embedded in competing four-speaker babble background. After each four stimuli the signal to noise ratio decreases, ultimately to 0 dB. This test loaded strongly (0.72) in the MSC domain in factor analysis (Summers, 2003).

MAPA Fusion Test (MAPA AFT-R)

Background

The Auditory Fusion Test-Revised (AFT-R) (McCroskey & Keith, 1996) purports to examine the resolving capacity of the auditory nervous system of listeners. It is actually a test of temporal resolution, as are gap detection tests. The AFT-R provides the listener with pairs of gated tonal stimuli that are separated by millisecond-level intervals of silence. Because the expected temporal resolution is 1 to 2 ms (Green, 1973), listeners who fail to recognize the gaps at smaller intervals are assumed to be at risk for (C)APD.

The RGDT is a revised version of the Auditory Fusion Test-Revised (AFT-R) (McCroskey & Keith, 1996). Keith (2001) notes that the purpose of the Random Gap Detection Test (RGDT) is to identify deficits related to temporal function of the auditory system as they relate to phonologic processing deficits, auditory discrimination, receptive language, and reading. Similar to the AFT-R, the RGDT measures temporal resolution through determination of the smallest time interval detected between two temporally proximate stimuli. The listener attends to a series of paired stimuli as the silent interval between the pairs changes in duration. The task of the listener is to report whether the percept was of one or two tones. See Chermak and Lee (2005) for a comparison of tests of temporal resolution.

Test Method and Rationale

The MAPA Fusion Test uses the final subtest of the RGDT, which utilizes click stimuli of 230 �sec duration followed by interstimulus intervals of 0 to 40 ms presented in random order. Each stimulus pair is separated by an interstimulus interval of 4.5 seconds. The clicks were derived from a 1-ms compression (positive) section of white noise (Keith, 2001). Temporal resolution was only weakly loaded on the MSC domain (-0.29) during exploratory analysis, and did not provide increased sensitivity in identification of children at risk for (C)APD (Summers, 2003). Although the Bruton Conference summary (Jerger & Musiek, 2000) recommended the use of either a gap detection test or dichotic digits for screening (C)APD, we have found only dichotic digits to be supported by factor findings in two school screening studies in tests on almost 200 children (Domitz & Schow, 2000; Summers, 2003). With reference to gap detection, the Bruton group did not specifically recommend RGDT or AFT-R about which questions were raised regarding validity and reliability. The Gaps in Noise (GIN) test (Musiek, et al, 2005) may prove to be useful as a test of temporal resolution and will be discussed in Chapter 3.

Printed Resources

Below is a small collection of printed resources for both MAPA and MAPA-2:

MAPA-2

Schow, R. L., Whitaker, M. M., Seikel, J. A., Brockett, J. E., & Domitz Vieira, D. M. (2020). Validity of the Multiple Auditory Processing Assessment–2: A Test of Auditory Processing Disorder. Language, Speech, and Hearing Services in Schools, 1-14. Article in LSHSS

MAPA