Fred Arthur Fisher

ASLP 4045 - Basic Rehabilitative Audiology

Module 4, Assignment 1: Assessing Infants and Toddlers

In 1993, only 5% of newborns were tested at birth for hearing loss. In 1993, the National Institutes of

Health endorsed the screening of all newborns for hearing loss. As a result, a state-by-state effort was

initiated to promote the mandatory screening of newborns. By 1997, 94% were tested before leaving the

hospital. That's not a rounding error. It worked. But while all newborns are screened for hearing loss, our

ability to measure their speech perception remains severely limited.

Prelingual hearing loss means young children miss phonemic cues that are crucial to language

development. Even if the sound is heard, distortion of what is heard can affect the ability to process

language. Children begin to demonstrate the ability to distinguish phonemes at 6 months. Impairment of

this can negatively impact a child's speech and hearing in the future. We can fit children with hearing

correction very early, but we do not yet have universal screening and assessment for children younger

than 3. The ability to measure when a child has a loss of speech perception is crucial in order to treat that

child.

When assessing speech perception in children we measure motor skills as well as phonological skills. A

battery of assessments are needed due to the many different chronological ages, linguistic ages,

communication modes and processing skills. Most speech perception in infants is performed with

questionnaires given to parents and criteria-referenced rating scales like the Ling Developmental Scales.

The Infant-Toddler: Meaningful Auditory Integration Scale is used to test the success of a child's cochlear

implant. While useful tools, these scales are far from objective forms of assessment.

Behavioral assessment can be performed with specialized testing to identify children with hearing loss but

is extremely difficult in infants. After infancy, measuring behavior of speech perception becomes much

easier with a wider variety of tools, such as the Northwestern University-Children's Perception of Speech

(NU-CHIPS, Elliott & Katz, 1980), Early Speech Perception (ESP) Test, and the Pediatric Speech

Intelligibility (PSI) Test.

There is a relatively new procedure to use a computer to test reaction time and scores for the PSI. The On-

line Imitative Test of Speech Pattern Contrast Perception (OLIMSPAC) tests a child's babbling and

jargon for phonologically significant contrasts at 3:0 and older. However, all of these tests for toddlers do

little to help in the assessment of infants. It has been established that children with hearing disabilities

need treatment as soon as possible to assist with speech processing and language comprehension.

There is a new test battery called the VRASPAC (Visual Reinforcement Assessment of the Perception of

Speech Pattern Contrasts). It tests whether a child can turn its head in response to a phonetic change,

rather than just a noise or voice. This test, while a wildly important tool, is still not sufficient in

measuring earlier identification of hearing loss. Because of this, we must develop new test batteries for to

assess the auditory abilities of infants and toddlers. More research and funding is needed for new

assessment tools under development.