Paediatric Speech Testing

Question 1

What is the purpose of speech testing?

Answer 1

Cross check audiogram
Alternative to VROA - broad idea of hearing ability
Compare performance under different conditions
Compare with norms
Differential diagnosis
Functional ability
Evaluate therapeutic, educational and/or rehabilitative procedures
High face validity
Difficult to malinger

Question 2

Cons of speech testing

Answer 2

Time
Working with kids with speech delays, child may not participate
Could worry parents more than necessary if child doesn’t respond to VROA or speech

Question 3

Factors to consider

Answer 3

Materials
Delivery
Response parameters

Question 4

Speech material considerations

Answer 4

Redundancy
- CV - CNC - Monosyllables - Spondees - Sentences

Acoustic content
- e.g. male vs, female, although research doesn’t suggest this is too important

Phonetic Balance

   - each list contain phonetic elements in approximately the same proportion that they occur in english
   - would need to have really long list
   - but this has also been found that it doesn't affect results

Word familiarity
- the more familiar the word the easier it is to recognise

Question 5

Speech test response parameters

Answer 5

Open/Closed sets

   - start speech testing at 2.5-3years all closed sets
   - can use pointing tests for some kids up to 8-9years old 

Number of items per list
- a lot of paeds tests have around 10 or so items

Question 6

Kendall toy test

Answer 6

Suitable for children 2.5years and up

Picture pointing task that is presented live voice (mouth covered) monitored by SLM

10 items, monosyllabic

Words would be in vocab of a normal hearing 2.5year old

Get toys out of box and ask what they are, there are pairs of similar vowel sounds , if we don’t have two to compare then we can’t use that vowel sound to test

Used to cross check PTA/VROA
- clinical folklore suggests that children obtain a score of 100% 20dB above threshold

Good way to build rapport

Not ear specific, does not specific nature of hearing loss

Question 7

KTT procedure

Answer 7

Check vocab

Start at 35dB after conditioning

Present first three items, 0-2/3 correct = raise by 5dB; 3/3 correct present all 10 items

<10/10 correct raise PL by 5dB

10/10 correct = end test

If they get 100% at 35dB their thresholds are around 15dB or better so happy with their hearing levels

Can be presented through audiometer but then there is no rapport building

Question 8

Live voice benefits

Answer 8

child doesn’t have to wear headphones

can make it like a game

less confronting

can control how quickly you present the words

younger children prefer

Can use carrier phrase to make it less formal, more like a game, working with the child rather than them doing a test for you

Question 9

Live voice cons

Answer 9

recorded presentation allows for easy manipulation of presentation levels

you have to control your voice

can’t test SRT with live voice

can’t be adaptive (up and down till we find SRT)

Question 10

Scoring method

Answer 10

Phonemes vs. whole words
-phoneme scoring have issues with production

Key word vs loose key word
- flexibility with pronunciation

Question 11

The SIP test

Answer 11

Speech Identification by Picture test (Birtles 2001)

Recorded, monosyllabic picture pointing test, 2.5 years and up

Aim to find SRT - AC or BC

For children who can tolerate headphones but can’t fully participate in play - basically a recorded KTT looking for SRT rather than 100%

3 lists of 5 words, 1 list of 5 words presented in a semirandomised order

Check vocab first

Hughson westlake thresholding used to determine SRT - where child can ID 2/3 words correctly

SRT within 5dB of 3FAHL - except for steeply sloping HF losses

Question 12

NU-CHIPS

Answer 12

North-Western University-Children’s Perception of Speech

3+years

50 monosyllabic nouns represented as simple line drawings, 1 target 3 foils per page

via headphones or loudspeaker

Vocab check (from back of book, various points in the page)

Question 13

NUCHIPs with MAST

Answer 13

Monosyllabic Adaptive Speech Test

Commonly used to

   - cross-check audiometric results
   - quantify the effects of hearing loss in relation to normal; we have normative values for different age groups
   - evaluate hearing aid/FM fitting
   - determine if amplification may be beneficial

Procedure

   - Present at 3FAHL + 30
   - Use 5dB steps to estimate 50% level (usually 3-4reversals
   - Use 2 dB steps for the testing 
   - continue until you have 13 reversals

Question 14

Mast Normative Values

Answer 14

3yrs - mean threshold 30.08dBSPL

5yrs - 25.32dBSPL

7yrs - 21.42dBSPL

MRL rather than SRT

Question 15

MAST as audiogram cross check

Answer 15

If you present through the headphones SRT (HL) should be 3FAHL +/- 10dB

Sound field the SRT (dBSPL) should be 3FAHL +25dB +/-10dB

For a steeply sloping loss it may be appropriate to use the average at 500Hz and 1000Hz rather than the 3FAHL

Within Normal Limits:

   - if SRT = PTA; as indicated by case history, concerns etc.
   - SRT >PTA; Retrocochlear? APD? Other?

Hearing loss

   - SRT < PTA; NOHL?
   - SRT = PTA; consistent
   - SRT> PTA; retrocochlear? APD? Other?

Question 16

Mast for Device Evaluation

Answer 16

Can compare SRT of aided vs unaided

if the aided SRT 10dB above the average SRT for their age aid fitting is recommended

Question 17

MAST contraindications

Answer 17

Do not use MAST to:

   - Compare SRTs between the ears for decisions about aiding unilaterally or bilaterally 
   - decide whether or not to continue aiding the poorer ear in an asymmetrical loss - binaural advantage extends beyond speech perception (localisation etc.)

Things like localisation are not taken into account

Question 18

BKB/A

Answer 18

Bamford-Kowel-Bench/Australian Version

Hearing impaired (3FAHL >95dBHL) children aged 8-15years and normal hearing children 6years and up

auditory or lip reading test

50 key words in 16 sentences

Used to

   - compare aided and unaided performance
   - measure progress of a rehab program

Scoring uses loose key word method

Can be performed in quiet, in noise, live voice or recorded or video

Children repeat what they have heard

Question 19

PBK-50

Answer 19

Phonetically Balanced-Kindergated 50’s

Test of word discrimination

5-6years and up

50 PB monosyllables (or abbreviated list of 30)

First 5 items are practice, the child has to repeat the whole word for it to be correct

   - open set
   - like AB list for child

Can be live voice or recorded
Can be used to find a PI function or determine aided benefit

Question 20

Paediatric Speech Intelligibility Test (PSI)

Answer 20

Children 3yrs and above

Sentences and Monosyllables

Picture pointing

The test can be administered in quiet or noise
- competing sentences/message can be played to the ipsi ear, or contra ear. ICM and CCM competing material varied in level and performance functions established

Used to assess central and peripheral auditory function
- competing messages to measure central

Question 21

The Plott Test

Answer 21

Children with profound hearing losses to help and inform rehab programs

5years and up

Performed with hearing aids

9 subtests, live voice, picture pointing

Can look at if they are using timing issues for example

Question 22

VRISD

Answer 22

Visual Reinforced Infant Speech Discrimination

requires child to detect a change in stimulus

head turn response rewarded by visual stimuli - sounds tested in pairs

habituate child to a sound e.g. ba, then change it e.g. da - head turn - reinforce
- takes time to habituate all the pairs

Used to look at

   - discrimination of place of articulation
   - perception of voice onset time
   - discrimination at different ages
   - aided ability - although time consuming and requires specialised equipment