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. Words and nonsense syllables typically comprise the stimuli for these speech discrimination (two-alternative) or identification (multiple-choice) tasks. In closed-set tasks, a limited number of choices are available to the listener. 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. sign language), and auditory processing skills. A battery approach is needed to accommodate children of different ages (both chronological and linguistic), communication modes (oral vs. Of those listed above, the task factors probably require the greatest consideration due to influences of maturation and language on test outcomes.
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. 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. Child factors include the state of the child during testing, such as their attentiveness to the task. These include a combination of child, task, tester, and environmental influences on test outcomes (Boothroyd, 2004). 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.Ĭonsiderations in Speech Perception AssessmentĪ number of important factors must be taken into consideration when assessing speech perception in children. 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. Lastly, speech perception data in combination with speech and language outcomes are essential for establishing guidelines for habilitation. Third, follow-up assessments help track performance over time. Second, speech perception measures are important for comparing differences between sensory devices and/or processing algorithms. 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. 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. (p.78)." Assessment of speech perception in the pediatric population is important for several reasons. 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. The information required to assess higher level auditory processing and to appraise intervention outcomes depends, to a large extent, on speech perception data. 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. We now have the tools to identify hearing loss at birth and to fit sensory devices soon thereafter. The goal of prosthetic intervention is to maximize auditory capacity, thereby providing the sensory evidence necessary to perceive the acoustic cues of speech. Development of spoken language for children with hearing loss requires the fitting of a sensory device followed by a well-designed habilitation program.
Even with optimum audibility, distortion of input may further affect recognition and comprehension. Without maximal audibility, higher centers of auditory processing may receive stimuli devoid of important phonemic cues that contribute to speech understanding and language development. The most obvious consequence of prelingual hearing loss is a decrease in the access to sound.
Early onset of hearing loss can impose substantial delays in communication and psychosocial development unless immediate and appropriate intervention is undertaken.
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