Development of a Hearing Test Protocol for Profoundly Involved Multi-Handicapped Children

Abstract

The purpose of the present study was to develop a protocol for use in testing the hearing of profoundly involved multi-handicapped children. Behavioral observation audiometry, visual reinforcement audiometry, auditory brain stem response (ABR], and noisetonedifference tests were administered to 156 children with multiple handicaps. Eighty three percent of the children with normal middle ear function were estimated to haw normal heap ing or, a t worst, a mild hearing loss, by one or more of the tests. ABR was the single best test, followed by behavioral observation audiometry and noisetonedifference. However, only 65% of the children would have passed had they only been t e s l ed Hlith ABR. If agreement among two of the tests had been required, hearing loss would have been ruled out in only 34% of the children. A factor analysis revealed that the various hearing tests were associated with diffeFnt mudiial and physical conditions which might influence threshold estimation for multi-handicapped children. These results support use of a seriea=positii test battery proto= col in which individual tests are used sequentially with the purpose of ruling out moderate-profound sensorineural hearing loss.

Understanding Protocol Performance: Impact of Criterion and Test Correlation

“…Little is known about the correlation of audiological tests. Limited data indicate that some tests may have a small correlation (Gans and Gans, 1993). Other results indicate that the older behavioral audiological tests can be accurately modeled assuming a midpositive (MP) correlation (Turner, 1991).…”

Preliminary evaluation of a two-interval, two-alternative infant behavioral testing procedure

“…The two-interval observer-based procedure might also prove useful for obtaining reliable behavioral data from "difficult-to-test" listeners, including toddlers and children with severe physical and/or developmental disabilities. Clinical VRA is a conditioned head-turn procedure, requiring a developmental age greater than 5-6 months (e.g., Widen et al, 2000;Gans and Gans, 1993). The observer-based method has been shown to be effective with very young typically developing infants (e.g., Werner and Gillenwater, 1990); thus, it might also be useful in children with a developmental age younger than required for VRA testing.…”

“…Visual Reinforcement Audiometry (VRA) provides some control for examiner bias in the audiology clinic when control trials are used (e.g., Widen et al, 2000), but does not account for listener bias. Moreover, conditioned head-turn procedures such as VRA are generally not effective for typically developing infants younger than about 5 months (e.g., Moore et al, 1977), or for children with severe developmental disabilities (e.g., Gans and Gans, 1993), because these listeners do not reliably produce clear, short-latency head turns in response to sound. Olsho et al (1987) developed a single-interval, observerbased procedure for testing infants in the laboratory.…”

Double Checking the Cross-Check Principle

“…The data indicating mid-positive correlation are for tests that have little relevance to this application. Gans and Gans (1993) evaluated BOA, VRA, ABR, and the noise-tonedifference test (NTD) with multiply-impaired individuals. The NTD is an acoustic reflex based procedure for predicting threshold.…”