A Cross-Cultural Adaptation of the Sniffin’ Sticks Olfactory Identification Test for US children

Abstract

Disorders associated with smell loss are common in adolescents. However, current odor identification tests focus on children from age 6 and older and no cross-cultural test has to date been validated and fully implemented. Here, we aimed to investigate how 3-to-11-year-old US children performed to an adapted and shortened (11 odors instead of 14) version of a European odor identification test-the Sniffin' Kids (Schriever VA, Mori E, Petters W, Boerner C, Smitka M, Hummel T. 2014. The "Sniffin'Kids" test: a 14-item odor identification test for children. Plos One. 9:e101086.). Results confirmed that cued odor identification performance increases with age and revealed little to no differences between girls and boys. Scores below 3 and below 6 may raise hyposmia concerns in US children aged 3-7 years and 8-10 years, respectively. Even though the completion rate of the task reached the 88%, suggesting that children below age 5 were able to finish the test, their performance was relatively poor. In comparing the overall identification performance of US children with that of German children, for whom the test was specifically developed, significant differences emerged, with higher scores obtained by the German sample. Analysis of errors indicated that a lack of semantic knowledge for the olfactory-presented objects may be at the root of poor identification skills in US children and therefore constitutes a problem in the development of an odor identification test for younger children valid across cultures.

Development of an International Odor Identification Test for Children: The Universal Sniff Test

“…To avoid the bias of age-dependent odor learning, we included young children who were old enough to understand and perform an odor identification task. Recently, Cavazzana and colleagues reported that odor identification tasks in children younger than 5 years of age to be unreliable 48 , considering previous studies 39,46 . Although some studies have claimed that children as young as 3-4 years are able to perform an odor identification task [28][29][30] , results must be evaluated with caution.…”

Olfactory threshold and odor discrimination ability in children – evaluation of a modified “Sniffin’ Sticks” test

“…Other studies examined even younger children starting at an age of 3 years 17, 23, 25, 26 . Some of them displayed difficulties like small sample size, incomplete measures 23 or unfamiliarity with the odors in the identification task 17, 26 while other results might be influenced through the instructions of parents 25 .…”

“…Some of them displayed difficulties like small sample size, incomplete measures 23 or unfamiliarity with the odors in the identification task 17, 26 while other results might be influenced through the instructions of parents 25 . Most of them showed poor results for children under an age of 5 years.…”

Odor Mixtures in Identification Testing Using Sniffin’ Sticks: The SSomix Test

“…Comprehensive tests for olfactory performance such as the Sniffin' Sticks test battery, including all three components of threshold, discrimination, and identification testing, can take up to one hour, requiring additional personnel resources. For this reason, shorter screening protocols such as the Sniffin' Sticks identification test [33][34][35][36][37][38][39][40][41][42] were frequently administered in clinical practice. These screening tests became increasingly popular and extensively used worldwide, but were often less accurate and inconclusive 17,18 .…”

“…We chose the 16-item Sniffin' Sticks identification test to serve as the technical basis, since these 16 items are represented in the most widely used olfactory assessment tool in German-speaking countries and have been further adapted and validated for various other countries [33][34][35][36][37][38][39][40][41][42] . Regarding the procedure, we agreed on using the "Odor-Lines-On-Paper" method which has been validated for odor identification, discrimination, and threshold testing in previous studies of our working group 25,26 and has the potential for self-administration.…”