Behavioral Tests Flashcards
Pediatric Test Battery
No simple test battery–need to figure out what the goal of the appointment is–ME? SNHL? Prioritize and work fast
Pediatric Test Battery
If possible, obtain status of ME & peripheral auditory system, speech perception testing and interpret auditory behaviors
if audiogram is normal there could be underlying problems: autism, AN
Steps to take before beginning a test
- Cognitive Age
- Physical status
- Test room set up
Cognitive Age
Cognitive Age: think development issues, NOT chronological age–concerns about development, ask parent about development, ask if parent has talked to pediatrician –making best guestimate to see if they are capable to do a certain test
What kind of motor task can they do? Can they pick up cheerios?
Physical Status
Physical status: can they sit up? do a VRA, do they have head control, vision: any concerns with eyesight? if they have reduced visual capabilities then VRA may not be for them not going to differentiate that toy from the wall—kid’s ability to manipulate toys, cerebral palys cannot do CPA–give them big blocks instead
Test Room Set Up
Do you need a test assistant? What type of testing will you do
Choose test booth: Can this be done one-on-one? All in the same room, ideally you have a test assistant to help with this—is the kid easily distracted? Need to take toys outside so it is a blank canvus for the child
Behavioral Observation Audiometry
watching for change in child in response to sound
-either stop/start sucking when sound plays
can be used up to 6-7 months of age
Looking for an overt change in an infant’s behavior to the presence of sound—we think about 0-6 month old babies, baby is lying there and maybe eating bottle–suck away present sound, when they stop sucking that is your response – some kids might need behavioral observation and their face changes—extremely subjective and takes a lot of practice to get good at it
Case History Concerns
Complications while pregnant, during birth, gestational diabetes, born with umbilical cord wrapped around neck, did baby go home with parent, how many ear infections, ask development history, tell me how you think your kid hears–how does he respond to your voice, social history, does he make eye contact, smile appropriately—are their concerns about hearing, communication or how they will perform in the sound booth
Behavioral Audiology Goals
Obtain ear specific, frequency specific information about the child’s hearing -not always possible
Factors that Influence Testing
- Age
- presence of other impairments
- child’s state (hungry, tired)
- language development
- attention span
ASHA Guidelines Testing from Birth-6 months
ABR or BOA
ASHA guidelines 5-36 months
-VRA primarily, ABR if necessary, OAEs, functional assessment tools (speech inventories for parents, questionnaires)
ASHA 30 months-5 years
CPA or VRA with speech perception testing
Factors that can Influence BOA
Developmental age: if they are too old, they are not going to give you this reaction
Infant state: if they are sleepy and they are cuddled up with mom and hanging there, if they’re sleepy they will just leave, if they are too hungry it won’t happen either
Judge: can bring in your own biases–if you know they are delayed and there are risk factors, you as the AuD are gonna be biased even if the kid has very subtle signs—not consciously it’s what we do. Also if asked to help test a kid with CI, the kid wasn’t really responding and AuD was saying everything was a response
Stimuli: can impact outcomes, if using pure tones (standing waves in the sound booth also), use warble tones or narrow band noise (best speech for infant is speech—can almost always get a speech awareness threshold) soon as you switch to something more frequenncy specific, more salient because of extra energy (narrowband) are good stimuli also. warble tones or pure tones infants don’t have as much interest in it
Environment: too warm, too cold, too dark, mom comes in need comfortable chair with arms
BOA: Habituation & Response Repertoire
Response repertoire: what is this kid gonna do, what do they bring to the table? Might only have a suck response so baby will suck on the bottle whenever the sound comes off and when sound goes on will stop— on responder: his response to sound is to stop sucking–generally don’t shift mid stream
Habituation: Not exciting for a long time and kid will eventually get bored—may only get one response from a kid before they habituate to it, objective test measures can get more information from
BOA Responses
- cessation of movement
- movement
- eye movement
- crying
- startle
As get closer to threshold, responses will become more subtle
BOA: Observation Bias
Observer may become biased watching the child in sleep state, best to have test assistant/audiologist to help determine if it is a response to sound or not
-in a study, judge responded “Yes” 39% of the time when there was no stimulus present
Behavioral Audiometry Stimuli
- Narrowband Noise or Warble Tones for soundfield testing ( at least 500, 1000, 2000, 4000Hz)
- Pure tone testing if under headphones
- Speech (SAT/SRT)=very salient and children usually respond best to this –good way to start testing because can get valuable information
Transducer Types for Behavioral Audiometry
- inserts
- sound field
Test Stimuli: Pure Tones, Narrow Band, Speech
at 75 dB, worst stimulus is 4000 Hz at 3 months BUT if you use your voice or white noise these 3 month olds will respond every single time
Go down in volume, 4000Hz is still the hardest frequency to get information. Speech gets you the most information regardless of volume
Point is: Speech is most salient stimulus, narrowband noise would result in good responses also (fricative) noise factor
Speech vs Pure Tone: speech is a complex stimulus pure tone is very simple stimulus — babies respond more to complex stimuli
BOA Test Technique
Low-Moderate intensity: can get them to respond at 40dB you have ruled out a moderate/severe/profound hearing loss right off the bat
Change stimuli if baby starts to get habituated
Start at 40dB speech get a response drop down to 15dB to get as much bang for your buck—ask if i get a response at 40, where would you want me to go next. No response at 15dB, go up to 30dB get a response. Then he habituates so respond with a different sitmuli
test-restest is 5dB so can stop at children’s at 20dB can rule out significant HL
Visual Reinforcement Audiometry
6 months-2.5 years of age
kid is seated in room with speakers at 90 degrees away and when sound source comes on, waiting for them to search for a sound source—turning head to look and see where the sound came from. Light up toys when they turn their head—reduce habituation because it’s a fun thing to do. when i turn to see the sound, i get to see a toy light up
Considerations for VRA setup
Kid shouldn’t be leaning against their parents, get too comfy and don’t want to turn their head as much—high chair works well also — need to be forgiving because kid is looking for toy
In left ear kid has ear infection, they might look right when present sound left that is a good sign and reinforce it anyway–No ear specific information Results you get are for at least the better ear when doing sound field presentation–only under headphones can you give ear specific recommendations
Typically use sound field but as they get older can use headphones to get ear specific info
VRA Stimuli & Reinforcement
More complex stimuli, more of a response
More reinforcer, more of a response
social reinforcement: good job, you heard that–not very effective. Not a good tool to use instead of visual reinforcement
simple visual reinforcement (light pops on)
Complex reinforcer: puppet is the best
