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Denys S, Barry J, Moore DR, Verhaert N, van Wieringen A. A Multi-Sample Comparison and Rasch Analysis of the Evaluation of Children's Listening and Processing Skills Questionnaire. Ear Hear 2024; 45:1202-1215. [PMID: 38825739 PMCID: PMC11326025 DOI: 10.1097/aud.0000000000001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 03/15/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVES Assessing listening difficulties and associated complaints can be challenging. Often, measures of peripheral auditory functions are within normal ranges, making clinicians feel unsure about proper management strategies. The range and nature of observed or experienced difficulties might be better captured using a qualitative measure. The Evaluation of Children's Listening and Processing Skills (ECLiPS) questionnaire was designed to broadly profile the auditory and cognitive problems often present in children with listening difficulties. This 38-item questionnaire was initially standardized in British children aged 6 to 11 years, was subsequently modified for use with North-American children, and was recently translated into Flemish-Dutch. This study aimed to compare typical scores of the Flemish version with the UK and US versions, and to evaluate and compare its psychometric quality based on Rasch analysis. DESIGN We selected 112 Flemish children aged 6 to 11 years with verified normal hearing and typical development, and asked two caregivers of every child to fill out the ECLiPS. Data from two comparator samples were analyzed, including responses for 71 North-American children and 650 British children. Typical values for ECLiPS factors and aggregates were determined as a function of age and gender, and meaningful differences across samples were analyzed. Rasch analyses were performed to evaluate whether ECLiPS response categories work as intended, and whether item scores fit a linear equal interval measurement scale that works the same way for everyone. Item and person metrics were derived, including separation and reliability indices. We investigated whether items function similarly across linguistically and culturally different samples. RESULTS ECLiPS scores were relatively invariant to age. Girls obtained higher scores compared with boys, mainly for items related to memory and attention, and pragmatic and social skills. Across ECLiPS versions, the most pronounced differences were found for items probing social skills. With respect to its psychometric quality, ECLiPS response categories work as intended, and ECLiPS items were found to fit the Rasch measurement scale. Cultural differences in responses were noted for some items, belonging to different factors. Item separation and reliability indices generally pointed toward sufficient variation in item difficulty. In general, person separation (and reliability) metrics, quantifying the instrument's ability to distinguish between poor and strong performers (in a reproducible manner), were low. This is expected from samples of typically developing children with homogeneous and high levels of listening ability. CONCLUSIONS Across the languages assessed here, the ECLiPS caregiver questionnaire was verified to be a psychometrically valid qualitative measure to assess listening and processing skills, which can be used to support the assessment and management of elementary school children referred with LiD.
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Affiliation(s)
- Sam Denys
- University of Leuven, Department of Neurosciences, Research Group Experimental Otorhinolaryngology (ExpORL), Leuven, Belgium
- University Hospitals of Leuven, Department of Otorhinolaryngology - Head and Neck Surgery, Multidisciplinary University Center for Speech-Language Pathology and Audiology, Leuven, Belgium
| | - Johanna Barry
- Otorhinolaryngology - Head and Neck Surgery, Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - David R. Moore
- Communication Sciences Research Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
| | - Nicolas Verhaert
- University of Leuven, Department of Neurosciences, Research Group Experimental Otorhinolaryngology (ExpORL), Leuven, Belgium
- University Hospitals of Leuven, Department of Otorhinolaryngology - Head and Neck Surgery, Multidisciplinary University Center for Speech-Language Pathology and Audiology, Leuven, Belgium
| | - Astrid van Wieringen
- University of Leuven, Department of Neurosciences, Research Group Experimental Otorhinolaryngology (ExpORL), Leuven, Belgium
- Department of Special Needs Education, University of Oslo, Oslo, Norway
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Kojima K, Lin L, Petley L, Clevenger N, Perdew A, Bodik M, Blankenship CM, Motlagh Zadeh L, Hunter LL, Moore DR. Childhood Listening and Associated Cognitive Difficulties Persist Into Adolescence. Ear Hear 2024; 45:1252-1263. [PMID: 38764146 PMCID: PMC11333188 DOI: 10.1097/aud.0000000000001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Listening difficulty (LiD) refers to the challenges individuals face when trying to hear and comprehend speech and other sounds. LiD can arise from various sources, such as hearing sensitivity, language comprehension, cognitive function, or auditory processing. Although some children with LiD have hearing loss, many have clinically normal audiometric thresholds. To determine the impact of hearing and cognitive factors on LiD in children with a clinically normal audiogram, we conducted a longitudinal study. The Evaluation of Children's Listening & Processing Skills (ECLiPS), a validated and standardized caregiver evaluation tool, was used to group participants as either LiD or typically developing (TD). Our previous study aimed to characterize LiD in 6- to 13-year-old children during the project's baseline, cross-sectional phase. We found that children with LiD needed a higher signal-to-noise ratio during speech-in-speech tests and scored lower on all assessed components of the NIH Cognition Toolbox than TD children. The primary goal of this study was to examine if the differences between LiD and TD groups are temporary or enduring throughout childhood. DESIGN This longitudinal study had three data collection waves for children with LiD and TD aged 6 to 13 years at Wave 1, followed by assessments at 2-year (Wave 2) and 4-year (Wave 3) intervals. Primary analysis focused on data from Waves 1 and 2. Secondary analysis encompassed all three waves despite high attrition at Wave 3. Caregivers completed the ECLiPS, while participants completed the Listening in Spatialized Noise-Sentences (LiSN-S) test and the NIH-Toolbox Cognition Battery during each wave. The analysis consisted of (1) examining longitudinal differences between TD and LiD groups in demographics, listening, auditory, and cognitive function; (2) identifying functional domains contributing to LiD; and (3) test-retest reliability of measures across waves. Mixed-effect models were employed to analyze longitudinal data. RESULTS The study enrolled 169 participants, with 147, 100, and 31 children completing the required testing during Waves 1, 2, and 3, respectively. The mean ages at these waves were 9.5, 12.0, and 14.0 years. On average, children with LiD consistently underperformed TD children in auditory and cognitive tasks across all waves. Maternal education, auditory, and cognitive abilities independently predicted caregiver-reported listening skills. Significant correlations between Waves 1 and 2 confirmed high, long-term reliability. Secondary analysis of Wave 3 was consistent with the primary analyses of Waves 1 and 2, reinforcing the enduring nature of listening difficulties. CONCLUSION Children with LiD and clinically normal audiograms experience persistent auditory, listening, and cognitive challenges through at least adolescence. The degree of LiD can be independently predicted by maternal education, cognitive processing, and spatial listening skills. This study underscores the importance of early detection and intervention for childhood LiD and highlights the role of socioeconomic factors as contributors to these challenges.
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Affiliation(s)
- Katsuaki Kojima
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Li Lin
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lauren Petley
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Psychology, Clarkson University, Potsdam, New York
| | - Nathan Clevenger
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Audrey Perdew
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Bodik
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Cornell University, Ithaca, New York
| | - Chelsea M Blankenship
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lina Motlagh Zadeh
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lisa L Hunter
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Research in Patient Services, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- College of Allied Health, Communication Sciences and Disorders, University of Cincinnati, Cincinnati, Ohio
- Departments of Otolaryngology and Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David R Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Departments of Otolaryngology and Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
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Moore DR, Lin L, Bhalerao R, Caldwell-Kurtzman J, Hunter LL. Multidisciplinary assessment and interventions for childhood auditory processing disorder (APD) and listening difficulties (LiD). MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.12.24308837. [PMID: 38946985 PMCID: PMC11213078 DOI: 10.1101/2024.06.12.24308837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Purpose Auditory processing disorder (APD) has been studied in both research and clinic settings, but the relation between the two has not been addressed. In a longitudinal research study (SICLiD), we found that children with clinically normal audiometry who had caregiver-reported listening difficulties (LiD), with or without clinically assessed APD, performed poorly on both listening and cognitive tests. Specific questions asked here were, for the children with LiD, what other neurodevelopmental clinical conditions were identified, what interventions were used by different clinical providers, and how clinical practice was predicted by research results. Methods Study setting was a large, research-led, tertiary pediatric hospital. Electronic medical records of 74 children aged 6-13 years, recruited into SICLiD and assigned to an LiD group based on a validated and reliable caregiver report (ECLiPS), were independently reviewed. Focus was on clinical assessments and interventions following appointments provided in the Hospital Divisions of Audiology, Occupational Therapy, Psychology (Developmental and Behavioral Pediatrics), and Speech-Language Pathology (SLP), prior to participation in SICLiD. Descriptive statistics on clinical encounters, identified conditions, and interventions were compared with quantitative, standardized performance on SICLiD assessments of listening and cognitive function. SICLiD z-scores were compared for participants with and without each clinical condition using univariate and logistic prediction analyses. Results Most (86%) of the children with LiD had been evaluated by at least one clinical service. Overall, 24 assessment categories related to LiD, including APD, were identified. Most common conditions were attention (32%), language (28%), hearing (18%), anxiety (16%), and autism spectrum (6%) disorders. Performance on SICLiD measures varied significantly between providers, conditions, and interventions. Significant relationships between SICLiD and clinical conditions were mostly caregiver-reported items from the ECLiPS or the Children's Communication Checklist (CCC-2). Other significant correlations were scarce, but included the SCAN composite score, which predicted clinical language and attention, but not other auditory abilities or APD. SICLiD data combined with caregiver reports provided reliable predictions of all clinical conditions except APD. Conclusions The variety of disciplines, assessments, conditions and interventions revealed here supports previous studies showing that LiD and APD are multifaceted problems of neurodevelopment. Comparisons between clinical- and research-based assessments suggest a diagnostic path that prioritizes caregiver reports and selected psychometric tests for screening and diagnostic purposes.
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Affiliation(s)
- David R Moore
- Communication Sciences Research Center, Division of Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, OH
- Manchester Centre for Audiology and Deafness, University of Manchester, United Kingdom
| | - Li Lin
- Communication Sciences Research Center, Division of Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
| | - Ritu Bhalerao
- Communication Sciences Research Center, Division of Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
| | - Jody Caldwell-Kurtzman
- Communication Sciences Research Center, Division of Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
| | - Lisa L Hunter
- Communication Sciences Research Center, Division of Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati, OH
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Petley L, Blankenship C, Hunter LL, Stewart HJ, Lin L, Moore DR. Amplitude Modulation Perception and Cortical Evoked Potentials in Children With Listening Difficulties and Their Typically Developing Peers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:633-656. [PMID: 38241680 PMCID: PMC11000788 DOI: 10.1044/2023_jslhr-23-00317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/01/2023] [Accepted: 11/09/2023] [Indexed: 01/21/2024]
Abstract
PURPOSE Amplitude modulations (AMs) are important for speech intelligibility, and deficits in speech intelligibility are a leading source of impairment in childhood listening difficulties (LiD). The present study aimed to explore the relationships between AM perception and speech-in-noise (SiN) comprehension in children and to determine whether deficits in AM processing contribute to childhood LiD. Evoked responses were used to parse the neural origins of AM processing. METHOD Forty-one children with LiD and 44 typically developing children, ages 8-16 years, participated in the study. Behavioral AM depth thresholds were measured at 4 and 40 Hz. SiN tasks included the Listening in Spatialized Noise-Sentences Test (LiSN-S) and a coordinate response measure (CRM)-based task. Evoked responses were obtained during an AM change detection task using alternations between 4 and 40 Hz, including the N1 of the acoustic change complex, auditory steady-state response (ASSR), P300, and a late positive response (late potential [LP]). Maturational effects were explored via age correlations. RESULTS Age correlated with 4-Hz AM thresholds, CRM separated talker scores, and N1 amplitude. Age-normed LiSN-S scores obtained without spatial or talker cues correlated with age-corrected 4-Hz AM thresholds and area under the LP curve. CRM separated talker scores correlated with AM thresholds and area under the LP curve. Most behavioral measures of AM perception correlated with the signal-to-noise ratio and phase coherence of the 40-Hz ASSR. AM change response time also correlated with area under the LP curve. Children with LiD exhibited deficits with respect to 4-Hz thresholds, AM change accuracy, and area under the LP curve. CONCLUSIONS The observed relationships between AM perception and SiN performance extend the evidence that modulation perception is important for understanding SiN in childhood. In line with this finding, children with LiD demonstrated poorer performance on some measures of AM perception, but their evoked responses implicated a primarily cognitive deficit. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25009103.
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Affiliation(s)
- Lauren Petley
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
- Department of Psychology, Clarkson University, Potsdam, NY
| | - Chelsea Blankenship
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
| | - Lisa L. Hunter
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
- Department of Otolaryngology, College of Medicine, University of Cincinnati, OH
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, OH
| | | | - Li Lin
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
| | - David R. Moore
- Communication Sciences Research Center, Cincinnati Children's Hospital Medical Center, OH
- Patient Services Research, Cincinnati Children's Hospital Medical Center, OH
- Department of Otolaryngology, College of Medicine, University of Cincinnati, OH
- Manchester Centre for Audiology and Deafness, The University of Manchester, United Kingdom
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Petley L, Blankenship C, Hunter LL, Stewart HJ, Lin L, Moore DR. Amplitude modulation perception and cortical evoked potentials in children with listening difficulties and their typically-developing peers. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.26.23297523. [PMID: 37961469 PMCID: PMC10635202 DOI: 10.1101/2023.10.26.23297523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Purpose Amplitude modulations (AM) are important for speech intelligibility, and deficits in speech intelligibility are a leading source of impairment in childhood listening difficulties (LiD). The present study aimed to explore the relationships between AM perception and speech-in-noise (SiN) comprehension in children and to determine whether deficits in AM processing contribute to childhood LiD. Evoked responses were used to parse the neural origin of AM processing. Method Forty-one children with LiD and forty-four typically-developing children, ages 8-16 y.o., participated in the study. Behavioral AM depth thresholds were measured at 4 and 40 Hz. SiN tasks included the LiSN-S and a Coordinate Response Measure (CRM)-based task. Evoked responses were obtained during an AM Change detection task using alternations between 4 and 40 Hz, including the N1 of the acoustic change complex, auditory steady-state response (ASSR), P300, and a late positive response (LP). Maturational effects were explored via age correlations. Results Age correlated with 4 Hz AM thresholds, CRM Separated Talker scores, and N1 amplitude. Age-normed LiSN-S scores obtained without spatial or talker cues correlated with age-corrected 4 Hz AM thresholds and area under the LP curve. CRM Separated Talker scores correlated with AM thresholds and area under the LP curve. Most behavioral measures of AM perception correlated with the SNR and phase coherence of the 40 Hz ASSR. AM Change RT also correlated with area under the LP curve. Children with LiD exhibited deficits with respect to 4 Hz thresholds, AM Change accuracy, and area under the LP curve. Conclusions The observed relationships between AM perception and SiN performance extend the evidence that modulation perception is important for understanding SiN in childhood. In line with this finding, children with LiD demonstrated poorer performance on some measures of AM perception, but their evoked responses implicated a primarily cognitive deficit.
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