Behavioural test in pediatric audiology

Behavioural test for hearing in children

1. Behavioural Test in Pediatric Audiology By Sakshi Gupta

2. Behavioral Observation Audiometry Age Range: 0 to 6 months Used to monitor auditory response when infant is in light sleep. Are accomplished without any reinforcement. Stimuli used: sudden onset of speech signal, narrow band noise Transducers: soundfield speakers. Presentation levels: 60 to 90 dBH L. Duration: 3 to 4 sec. Responses: eye blinking, eye widening, slight shudder of whole body, arm and body movements. Responses are true if are seen within 2 sec. of stimulus presentation.

3. Condition Orient Reflex Audiometry Given by: Suzuki and Ogiba Based on operant conditioning theory. Child is conditioned to correctly orient to sound presented from one of the two speakers. Child’s head turn is reinforced by blinking lighted toy. Age range: 6m to 1yr. Localization required

4. Equipment and procedure in CORA Place child between speaker and adjacent visual stimuli within a sound treated room. Initially toy draws attention of child which is unconditional. Once conditioning is achieved, the illumination provides reinforcement. Procedure: The test tone is presented through one of the speakers at an intensity level of approximately 30dB above the estimated threshold of the child followed immediately by the illumination of the toy on the same side. The child will instinctively orient or turn toward the source of the tone/light presentation. Once the child has turned toward the source of the sound, the toy is illuminated as reinforcement.

5. Procedure cont. The second step involves measurement of threshold. reducing the intensity of the test tone to near the estimated threshold of the child, and presenting the tone from one side. The intensity of the test tone is then reduced and the process repeated until the child fails to respond. Using this procedure, the child's hearing threshold for a given frequency can be obtained.

6. CORA Setup

7. Visual Reinforcement Audiometry Term coined By Liden and Kankkonen (1969). Same as CORA but utilizes only single sound field speaker. Transducers: insert earphones, loudspeakers, Earphones. Presentation level: 75dB or above Reinforcement should be placed 90 degree. Equipment and procedure same as CORA. The key difference between COR and VRA is that  COR is dependent on the child to have the ability to detect and localize the sound , whereas VRA only requires the child to have a head turn response after the auditory stimulus is presented, they do not need to accurately localize the sound as well.

8. VRA Setup

9. TROCA Tangible reinforcement operant conditioning Audiometry In this test Child will be provided with a positive or tangible reinforcement whenever he/she responses for auditory stimuli. Items such as candy, cereal, trinket etc. can be given. For false positive response negative reinforcement such as time out can be used. Age range: 2 to 4 yrs. Transducers: headphone, inserts, bone vibrator, loud speaker

10. TROCA Procedure Typically the child’s response behavior is conditioned to push a response button whenever sound is perceived. Tangible Reinforcement is usually accompanied by social Reinforcement.

11. Condition play Audiometry Condition play audiometry is a preferred behavioral technique to determine ear specific and frequency specific hearing thresholds. Age range: 2 to 4 yrs. CPA is a kind of audiometry is a form of operant conditioning in which child is taught to wait and listen carefully for a pure tone, Nbn , speech stimulus and then perform a task that is actually a sort of child’s game in response to presentation of stimuli. The conditioning phase includes review of planned task which require gross motor response from child Eg : dropping marbles into can, putting pegs in peg board, building tower etc.

12. CPA cond. Presentation level: 40 to 50 dB above expected threshold level. 3 to 4 trials before testing. Decrease the intensity till last response is present.

13. Speech Audiometry Speech Detection Threshold: The awareness or detection level is recorded as lowest decibel level at which child makes a response. During this test child just listen to the sound(speech stimulus). Responses can be eye widening, head movement, head turn, facial expression, hand raising, even sometimes babbling can be observed as response. Stimulus: Any speech stimulus like Papapa , bababa , aa, mamama , etc can be used.(Live voice is preffered ) Correlation with PTA should be within 6 to 8dB. Presentation level: Pta+20.

14. Speech Audiometry 2 . Speech reception threshold: Used to validate pure tone thresholds. Correlation within +- 12 dB with pta Presentation level = pta+20dB. And reduce by 10 dB steps. {bracketing method} Stimulus type: Spondee words.[baseball, football, handwash , hotdog] For young child use pictures of spondee words with which child is familiar with and ask to point the picture which he herd. For toddlers directly use pointing objects that are named. Eg . Pointing body part which is named. A 3 to 4 yr child may repeat the words verbally.

15. Speech Audiometry 3. Speech perception Testing Purpose: To determine chil’s auditory recognition of words presented at conversational and supra threshold level. Presentation level: Srt+40dB. Testing Young children: Use some form of pictures identification pointing response to a picture board. Child hears a word and attempts to identify correct picture. Speech perception can be 2 types: Open Set Closed Set

16. Speech Audiometry Closed set: Picture pointing technique. Open Set: Various word list are made PBK(phonetically balanced kindergarden )- given via live voice and consist of list of pb words which are in vocabulary of children. Tangible reinforcement (Smith and Hodgson, 1970). Other test: Discrimination by identification pictures(DIP), Word intelligibility by picture identification (WIPI) etc.