SpeechPathology.com Phone: 800-242-5183


Signature Healthcare

Clinical Assessment of Speech Perception for Infants and Toddlers

Clinical Assessment of Speech Perception for Infants and Toddlers
Laurie S. Eisenberg, PhD, Karen Johnson, PhD, Amy S. Martinez, MA
August 8, 2005
Share:

Introduction

Early onset of hearing loss can impose substantial delays in communication and psychosocial development unless immediate and appropriate intervention is undertaken. The most obvious consequence of prelingual hearing loss is a decrease in the access to sound. Without maximal audibility, higher centers of auditory processing may receive stimuli devoid of important phonemic cues that contribute to speech understanding and language development. Even with optimum audibility, distortion of input may further affect recognition and comprehension. Development of spoken language for children with hearing loss requires the fitting of a sensory device followed by a well-designed habilitation program. The goal of prosthetic intervention is to maximize auditory capacity, thereby providing the sensory evidence necessary to perceive the acoustic cues of speech. We now have the tools to identify hearing loss at birth and to fit sensory devices soon thereafter. However, we are limited in the standardized behavioral tests required to assess auditory perceptual performance, particularly in babies from birth to 3 years of age.

The information required to assess higher level auditory processing and to appraise intervention outcomes depends, to a large extent, on speech perception data. According to Boothroyd (1991), speech perception is "the process by which a perceiver internally generates linguistic structures believed to correspond with those generated by a talker. (p.78)." Assessment of speech perception in the pediatric population is important for several reasons. First, results on speech perception measures help determine whether a child is benefiting from a hearing aid or should be considered for a cochlear implant. Although cochlear implants are approved for children 12 months of age and older, there is a growing trend in the United States to implant children under the age of 12 months (Luxford, Eisenberg, Johnson, & Mahnke, 2004), underscoring the need for measures that can be used with infants. Second, speech perception measures are important for comparing differences between sensory devices and/or processing algorithms. Third, follow-up assessments help track performance over time. Lastly, speech perception data in combination with speech and language outcomes are essential for establishing guidelines for habilitation.

In this overview, we highlight some of the important issues involved in speech perception assessment of hearing-impaired children with an emphasis on tests designed for children 3 years of age and younger. Illustrative cases are presented using several of these measures, including data from new implementations of established assessment techniques being developed at the House Ear Institute.

Considerations in Speech Perception Assessment

A number of important factors must be taken into consideration when assessing speech perception in children. These include a combination of child, task, tester, and environmental influences on test outcomes (Boothroyd, 2004). Child factors include the state of the child during testing, such as their attentiveness to the task. Moreover, children must demonstrate the requisite motor skills to perform the response task being asked of them (e.g., head turn, manipulation of objects, picture pointing, pushing a button), as well as the phonological, receptive and expressive language skills needed to participate in speech perception testing. Tester and environmental factors include the audiologist's aptitude to work with the pediatric hearing-impaired population, the general feel of the facility, and caregiver attitudes and behaviors.

Of those listed above, the task factors probably require the greatest consideration due to influences of maturation and language on test outcomes. A battery approach is needed to accommodate children of different ages (both chronological and linguistic), communication modes (oral vs. sign language), and auditory processing skills. For that reason, assessment batteries should include measures that vary from closed-set to open-set response formats, from live voice to recorded presentation, and from auditory-visual to auditory-only administration. In closed-set tasks, a limited number of choices are available to the listener. Words and nonsense syllables typically comprise the stimuli for these speech discrimination (two-alternative) or identification (multiple-choice) tasks. Phoneme identification tests are particularly useful for obtaining information about speech features (voicing, manner, and place) and do not rely on higher-level cognitive/linguistic processing, such as lexical, syntactic, and semantic knowledge. In contrast, there are no pre-defined response alternatives in open-set tasks, resulting in an unlimited number of choices. Open-set word and sentence recognition tests require higher-level cognitive/linguistic abilities than closed-set tasks and are more representative of real-life listening situations.

Assessing speech understanding in the presence of competition or background noise also expands the options used in speech perception testingas does testing under multimodal conditions (auditory-only, visual-only, and auditory-visual). With regard to the type of administration, live-voice affords the clinician greater efficiency and flexibility than the use of recorded stimuli, particularly when working with very young children. However, inter-talker variability makes it difficult to compare results obtained with live voice across different clinicians, let alone pediatric centers. Use of recorded stimuli provides for greater consistency in signal delivery across test sessions and test centers.


Laurie S. Eisenberg, PhD

Laurie S. Eisenberg, Ph.D., Scientist II and Acting Co-Department Head of the CARE Center, House Ear Institute.
Laurie Eisenberg is a scientist at the House Ear Institute where she heads the section on Pediatric Hearing Loss and Auditory Perception. She received her Ph.D. in Speech and Hearing Sciences from the City University of New York Graduate School and her postdoctoral training in speech perception at UCLA.
 


Karen Johnson, PhD


Amy S. Martinez, MA



Related Courses

The Art of Debriefing: Key Elements in CSD Simulation Education
Presented by Carol Szymanski, PhD, CCC-SLP, CHSE
Video
Course: #8704Level: Intermediate1.5 Hour
This course defines and describes the types of simulations utilized for clinical education in communication sciences and disorders (CSD). The learning theory behind simulation education will be presented, with the process and examples of debriefing specifically highlighted.
Please note: This course uses a different recorded format from most of our courses; arrows on the playbar must be used to progress through the course. When playback stops after the course introduction, use the right arrow key to progress to the second slide, where you can read the full playback instructions. Due to the nature of the development of this content, this course is best viewed on a tablet-sized screen or larger. Please plan your viewing experience accordingly.

Treatment Approach Considerations for School-Aged Children with Speech Sound Disorders
Presented by Kathryn Cabbage, PhD, CCC-SLP
Video
Course: #9472Level: Intermediate1 Hour
This course will address the theoretical underpinnings and research base related to differential diagnosis and treatment of articulation and phonological deficits in children with speech sound disorders. Special considerations for how to tailor evaluation and intervention to meet the needs of school-age children will be discussed.

Sustaining the Well-Being of Healthcare Workers During Coronavirus
Presented by Kathleen Weissberg, OTD, OTR/L, CMDCP, CDP
Audio
Course: #1033728Level: Intermediate1 Hour
The challenges presented by novel coronavirus (COVID-19) make it important for healthcare workers to find new ways to work and interact while also caring for themselves. This course provides strategies, exercises, activities and considerations for addressing health and wellness, including stress management, sleep behaviors, and social connectedness. Additionally, trauma symptoms are reviewed along with techniques supervisors can utilize for effective, empathic management.

The Ripple Effect of Stuttering: A Community-Based Approach
Presented by Craig Coleman, MA, CCC-SLP, BCS-F, ASHA Fellow, Mary Weidner, PhD, CCC-SLP
Video
Course: #9217Level: Intermediate2 Hours
This is Part 2 of a four-part series. The stuttering experience has a ripple effect that extends far beyond the child who stutters. Parents, teachers, peers, and others must possess both knowledge and skills to best support children who stutter. This course will highlight new clinical tools and resources to provide a community-based treatment approach for stuttering. (Part 1 - Course 9278, Part 3 - Course 9301, Part 4 - Course 9304)

Behavioral Frameworks for Dementia Management
Presented by Mary Beth Mason, PhD, CCC-SLP, Robert W. Serianni, MS, CCC-SLP, FNAP
Video
Course: #9473Level: Intermediate1 Hour
This course will focus on cognitive-communication intervention strategies for various dementia presentations and will provide a review of evidence-based treatment. Behavioral frameworks along with their rationales will be introduced and applied across several dementia types and mild, moderate and severe levels of impairment.