Accepted Manuscript

Title: Age Related Changes in Auditory Processes in Children

Aged 6 to 10 years

Author: Asha Yathiraj C.S. Vanaja

PII: S0165-5876(15)00238-4
DOI: http://dx.doi.org/doi:10.1016/j.ijporl.2015.05.018
Reference: PEDOT 7594

To appear in: International Journal of Pediatric Otorhinolaryngology

Received date: 21-2-2015

Revised date: 13-5-2015
Accepted date: 16-5-2015

Please cite this article as: A. Yathiraj, C.S. Vanaja, Age Related Changes in Auditory
Processes in Children Aged 6 to 10 years, International Journal of Pediatric
Otorhinolaryngology (2015), http://dx.doi.org/10.1016/j.ijporl.2015.05.018

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Age Related Changes in Auditory Processes in Children Aged 6 to 10 years

Asha Yathiraj1 and C S Vanaja2

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1
Professor of Audiology

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All India Institute of Speech and Hearing, Mysore, India

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Email: asha_yathiraj@rediffmail.com

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2
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Professor of Audiology,

School of Audiology & Speech language pathology

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Bharati Vidyapeeth Deemed University, Pune, India

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Email: csvanaja@gmail.com
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Corresponding author:
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C S Vanaja

Professor of Audiology

Bharati Vidyapeeth Deemed University School of Audiology & Speech Language

Pathology, Pune, Maharashtra - 411043, India

Email: asha_yathiraj@rediffmail.com

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Page 1 of 43
Age Related Changes in Auditory Processes in Children Aged 6 to 10 years

Asha Yathiraj1 and Vanaja Chitnahalli Shankarnarayan2

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1
Professor of Audiology

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All India Institute of Speech and Hearing, Mysore, India

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Email: asha_yathiraj@rediffmail.com

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2
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Professor of Audiology,

School of Audiology & Speech language pathology

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Bharati Vidyapeeth Deemed University, Pune, India

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Email: csvanaja@gmail.com
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Corresponding author:
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C S Vanaja

Professor of Audiology

Bharati Vidyapeeth Deemed University School of Audiology & Speech Language

Pathology, Pune, Maharashtra - 411043, India

Email: asha_yathiraj@rediffmail.com

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Page 2 of 43
 Abstract

Objectives:

The study evaluated age related changes in auditory processing (separation / auditory

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closure, binaural auditory integration abilities, temporal processing abilities) and higher order

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cognitive function (auditory memory & sequencing abilities) in children. Additionally, the

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study aimed to assess the effect of gender on the auditory processes / higher cognitive

function as well as ear effect for the monaural tests that were administered.

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Methods:

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The cross-sectional experimental study evaluated 280 typically developing children

aged 6 to 10 years, divided into five age groups. They were evaluated on auditory processes /
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higher order cognitive functions reported to be frequently affected in children with auditory

processing disorders (Speech-in-Noise Test in Indian-English, Dichotic consonant-vowel test,

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Duration pattern test, & Revised Auditory Memory and Sequencing Test in Indian-English).
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Results:
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ANOVA and MANOVA revealed no significant gender effect in all four tests.
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However, a significant age effect was seen, with the rate at which maturation occurred,
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varying across the tests.

Conclusions:

Thus, the findings indicate that different auditory processes have different rates of

development. This reflects that the areas responsible for different auditory processes / higher

cognitive function do not develop at the same pace.

Key words: Separation, integration, temporal processing, auditory memory

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Page 3 of 43
 Introduction

Auditory processing is a complex phenomenon and consists of many processes that

include auditory closure or separation, binaural integration, and temporal processing. Studies

have indicated that children with auditory processing deficits frequently have difficulties in

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auditory separation or closure [1-3], binaural integration [1, 2, 4], and temporal processing [2,

4]. Additionally, auditory memory, a higher order cognitive function has also been found to

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be frequently affected in them [2].

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Age related changes of these processes or cognitive function in normal children have

been used to determine their development. Furthermore, such age related changes have been

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used in the identification and management of children with auditory processing disorders.

These age related changes can be attributed to the maturation of the brain. It has been
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substantiated that the cortical system is immature in children and continues to develop in

adolescents [5-7]. Past research also indicates that different auditory processes do not mature
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in a similar manner but take different maturational courses [8-13]. A possible reason for the
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difference in maturation could be on account of the different cortical or brainstem areas that
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control them.
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Perception of speech in noise, an auditory separation or closure process, involves

perception of spectro-temporal cues to identify the signal as well as ability separate signal
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from the background noise. Perception of speech in the presence of noise has been observed

to result in reduced activity of the left hemisphere along with increased activity in the right

hemisphere [14]. It has also been observed that noise entwined with speech results in a neural

delay that makes it difficult to segregate the two at the brainstem and cortex [15]. Earlier,

Efron, Crandall, Koss, Divenyi, and Yund [16] implied that the anterior temporal lobe was

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Page 4 of 43
responsible for perception of speech in the presence of noise since individuals with lesions in

this region exhibited difficulty in the task.

Duration pattern test, a test for assessing temporal processing, requires discrimination

of duration, perception of patterns or sequence as well as the ability to indicate the pattern

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heard. Functioning of both the hemispheres as well as the corpus callosum is required for

giving verbal response on this test [17, 18]. Auditory integration, as assessed by dichotic

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stimuli, involves the presentation of two different stimuli to the two ears simultaneously, both

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of which have to be identified by the listener. Dichotic tests are known to assess laterality,

specialization of the auditory cortex in addition to the functioning of the two hemispheres and

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corpus callosum [19]. Likewise, auditory memory is reported to depend on the functioning of

the hippocampus and amygdala that are located in the anterior temporal region of the brain
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[20]. The changes with age, in the areas responsible for the development of different

auditory processes, may find a parallel with the behavioral development of the same.
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Auditory processes have been reported to start developing after birth and continue to
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develop as the child grows older, in line with the development of the central auditory nervous
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system. Keith [9] noted that those aged 12 to 50 years performed similarly on the six subtests
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(2 filtered words subtests, 2 auditory figure-ground subtests, a competing words & a

competing sentences subtest) of SCAN-A. It can be construed from these findings that
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auditory closure or separation matures by 12 years of age. Further, Keith in 2000 reported

the mean raw score of SCAN-C increased and the standard deviations decreased with

increasing age in children aged 5 years to 11 years and 11 months. This variation in

performance with increase in age was considered to reflect the maturation of the central

auditory nervous system. Keith [9, 10] did not report whether the variation in performance

across the ages was statistically significant or not. However, an investigation by Amos and

Humes [8] did demonstrate the presence of a statistically significant difference in SCAN

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Page 5 of 43
scores in children aged 6 and 9 years (first graders & third graders). Thus, these findings

substantiate the presence of maturational changes in an auditory closure or separation task.

A review of literature indicates that variation in scores across ages depends not only

on the process evaluated, but also on the type of material used while evaluating a particular

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process. For example, Neijenhuis et al. [11] found no significant difference in a word-in-

noise test scores obtained by adolescents (aged 14-16 years) and by adults whereas they

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observed a significant difference between the two age groups for a sentence-in-noise test.

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Thus, depending on the type of stimuli used, maturation of auditory closure or separation task

varied. Similar to the word-in-noise test performance, Neijenhuis et al. [11] reported of no

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significant difference between adolescents and adults on a dichotic digit test. Additionally,

they also noticed that in children aged 6 to 16 years there was no age effect for a frequency
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pattern test. However, they reported of an age effect on seven other tests carried out in this

age group (words-in noise, filtered speech, binaural fusion, dichotic digits, duration patterns,
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backward masking, digit span). Based on their findings they concluded that maturation
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continues to develop even in adolescents.

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Similar to the findings of research on auditory closure or separation, the procedure

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and stimuli has been found to affect the results of tests for temporal processing. Lister,

Roberts, and Lister [21] observed that performance of 11 to 12 year old children was similar
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to that of adults on a gap detection test whereas the performance of the 7 to 8 year and 8 to 9

year old children were poorer that of adults. They reported that the developmental effects

observed by them were greater than most of those reported previously. Lister et al. [21]

attributed this difference to variations in stimuli and procedure used.

Maturational effects up to 12 years have also been documented by Stollman, Velzen,

et al. [13], based on the findings of a longitudinal study of 20 children aged 6 years through

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7, 8, 10 and 12 years. This was seen for 9 tests (filtered speech test, binaural fusion test,

frequency pattern test, duration pattern test, auditory word discrimination test, an auditory

synthesis test, an auditory closure test, & a number recall test), but not for a speech-in-noise

test. They noticed that in all ages, the children performed significantly poorer than their adult

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group, indicating that the processes evaluated continued to develop even after 12 years of

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age. Their findings substantiate the findings of Neijenhuis et al. [11] who also observed that

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maturation continued through adolescence.

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Due to the large variability in results, it has been recommended that tests used for the

evaluation of auditory processing should not be administered on children below the age of 7

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years [22]. However, Stollman, Neijenhuis et al. [12] demonstrated that auditory processing

tests that evaluated sustained auditory attention, binaural hearing, temporal processing, and
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phonological coding could be carried out effectively in children aged 4 to 6 years of age.

Although no gender difference was observed, the older children were found to perform better
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than the younger children on the battery of tests. The difference was most prominent for the
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dichotic word test and the phoneme awareness test.

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From the review of literature, it is evident that there exist considerable variations
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regarding the age related changes of the different auditory processes. This has been

attributed to different auditory processes requiring different levels of functioning in the

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auditory system. There is a need for additional information in the area of age related changes

in auditory processing to substantiate the developmental pattern seen in different auditory

processes. Thus, the current study was carried out with the aim to determine age related

changes in the performance of children on tests assessing different auditory processes or

higher cognitive abilities (auditory closure or separation, temporal patterning, binaural

integration, & auditory memory and sequencing). Additionally, the study aimed to evaluate

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Page 7 of 43
the effect of gender as well as the performance across the two ears for the auditory processes

or higher cognitive abilities.

Methods

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Using a cross-sectional experimental design, age related changes on a battery of

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auditory processing tests were evaluated on 280 normal hearing children who were divided

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into five age groups. The battery consisted of four different tests that tapped different

auditory processes or cognitive ability associated with auditory processing. The tests

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evaluated monaural auditory separation or closure, binaural auditory integration, temporal

patterning, and auditory memory. These aspects of auditory processing were selected since

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they have been noted to be more frequently affected in children with auditory processing

disorder.
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Participant selection
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The participants consisted of 280 school-going children (140 male & 140 female) in
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the age range of 6 to 10 years. The participants were recruited from two different centers in
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India having similar test facilities, one located in Mysore and the other in Pune. The
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participants tested in the two centers were matched in terms of gender and age. It was

ensured that children were ‘not at-risk’ for auditory processing disorder, based on the
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‘Screening Checklist for Auditory Processing’ developed by Yathiraj and Mascarenhas [23].

The children were categorized into five age groups (6 to 6;11 years, 7 to 7;11 years, 8

to 8;11 years, 9 to 9;11 years, & 10 to 10;11 years). The youngest age group had 40 children

and the four remaining age groups had 60 children each. All the children had average or

above average IQ on the Raven’s Progressive Colored or standard Matrices [24]. They

attended schools where the instruction was in English and were reported by their teachers to

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be proficient in the language. Additionally, they were all reported to be right handed. Only

those children with air conduction and bone conduction thresholds less than 15 dB HL in the

octave frequencies 250 Hz to 8 kHz and 250 Hz to 4 kHz respectively, were included in the

study. To confirm the presence of normal middle ear functioning, the participants were

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required to have 'A’ type tympanograms with ipsilateral and contralateral acoustic reflexes

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present for the frequencies 500 Hz, 1 kHz and 2 kHz. In addition, speech identification score

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in quiet was determined using the ‘Common Speech Discrimination Test for Indians [25], for

all the participants. This test, with 25 nonsense consonant-vowels, had norms established on

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children. The test, presented through headphones at 40 dB SL, was utilized to confirm that

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the participants had normal speech identification scores in quiet. Only those with scores

greater than 85% in quiet were included in the study. Additionally, the participants were
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required to have age appropriate language, which was assessed using on the Northwestern

Syntax Screening Test developed by Lee [26].

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Equipment
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A calibrated dual channel diagnostic audiometer (OB 922 - Version 2) with air
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conduction (TDH-39) and bone conduction (B-71) transducers was used to carry out pure-
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tone audiometry, speech audiometry and the auditory processing tests. The auditory

processing tests were played through a CD using a Compaq Presario 6000 laptop with Intel
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Pentium dual core processor. To ensure normal middle ear functioning, a calibrated

immittance meter was utilized. Similar instruments were used in both centers where the data

were collected.

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 Test Environment

All the audiological tests were carried out in a sound treated two-room suite with

permissible noise limits as specified by ANSI standards [27]. The screening checklist, the IQ

test and the language screening tests were administered in quiet, distraction-free rooms.

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Material

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The four auditory processing tests used to evaluate the children enrolled in the study

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included ‘Speech-in-Noise Test in Indian English’ (SPIN-IE) [28], ‘DCV’ [29], ‘DPT’ [18],

and ‘Revised Auditory Memory and Sequencing Test in Indian-English’ (RAMST-IE) [30].

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A sample of all the test material used for the study is given in Annexure 1. SPIN-IE and

RAMST-IE were developed as a part of a research project. The current study is an outcome
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of this project.

The SPIN-IE had 25 phonemically balanced words as stimuli and an eight-talker

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babble as noise. The speech stimuli and segments of the noise were inserted in two different
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audio tracks. The speech babble was interrupted to avoid auditory fatigue. The duration of the
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noise segments was semi-random and varied from 310 ms to 620 ms. The duration of the
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interruption was kept constant at 75 ms. It was however ensured that the interruption was not

present during the presentation of a stimulus. The interval between stimuli was kept constant
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at 5 seconds. The average amplitude of each noise segment was matched with that of each

word stimulus to ensure that the signal-to-noise ratio was zero. A 1 kHz calibration tone was

inserted prior to the SPIN-IE list.

The RAMST-IE had words familiar to children aged 6 years and above. The words

were grouped to form tokens containing 3-word to 8-word sequences. The test contained

varied number of tokens (groups of words) for the different word sequences. While the 3-

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word and 4-word sequences had two tokens each, the 5-word to 8-word sequences had four

tokens each. The total number of words per list was 118. The recorded material was spoken

by a female who had a neutral Indian-English accent. Within each token, the inter-stimulus

interval between words was 500 ms. This inter-stimulus interval was uniform for all word

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sequence. Between tokens, the inter-stimulus interval varied depending on the length of the

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word sequence. An inter-stimulus interval of 6 seconds was used between the tokens for the

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3-, 4- and 5-word sequences, and was increased to 12 seconds for the 6-, 7- and 8-word

tokens. The duration of the interval between tokens was based on the average time taken by a

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group of 5 children aged 6 to 7 years to respond to the stimuli. A goodness test, carried out

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on a group of 5 young adults and 5 children aged 6 to 7, confirmed that the quality of the

recording was good. A 1 kHz calibration tone, inserted prior to the list, was used to adjust
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the VU meter of the audiometer.

Procedure
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Prior to evaluation of the participants, consent was obtained from the caregivers, in
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compliance with the ‘Ethical guidelines for bio-behavioural research involving human
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subjects’ [31] of the All India Institute of Speech and Hearing, Mysore. All four tests were
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administered on each of the participant.

SPIN-IE [28] was used to evaluate monaural auditory separation or closure; DCV,
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recorded by Yathiraj [29] was utilized to test auditory integration; DPT, generated and

recoded by Gauri [32] using stimuli similar to the original test developed by Musiek [33],

was employed to evaluate temporal patterning; and RAMST-IE [30] was used to evaluate

higher order cognitive ability associated with auditory processing. All the tests were played

through a computer, the output of which was routed through a diagnostic audiometer at 40 dB

SL [Ref average pure tone thresholds at 0.5, 1 and 2 k Hz (PTA)] to sound field speakers or

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Page 11 of 43
TDH-39 earphones housed in MX-41/AR supra-aural ear cushions. The order in which these

tests were administered was randomized to prevent any test order effect. In addition, for the

monaural tests (SPIN-IE & DPT), half the participants were evaluated in the right ear first

and half in the left ear first, to avoid an ear order effect. The procedure used to administer the

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test-battery is described below.

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The SPIN-IE was tested in each ear independently, with the participants having to

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repeat the words heard by them. The tester marked the responses as correct or wrong on a

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response sheet. Each correct response was awarded a score of ‘1’ and each incorrect

response was scored as ‘0’. Both raw and percentage scores were noted for each ear of the

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participants.

The DCV test responses were obtained by instructing the participants to mark the
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syllables that were heard through headphones on a response sheet that had multiple choices.

Double correct responses were calculated by awarding a score of ‘1’ if the responses in both
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ears were correct. A score of ‘0’ was given if the response was incorrect in either of the ears.
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The DPT was administered separately on each ear of the participants. The participants
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were instructed to verbally report the pattern of length of the sounds heard. A correct
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response was given a score of ‘1’ and an incorrect response a score of ‘0’.
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The RAMST-IE was presented from a computer via an audiometer in two different

ways. Half the participants heard the material through two sound-field speakers, each placed

at 450 azimuth at a distance of one meter from the head of the participant. The other half

heard the material binaurally through headphones. The two different modes of presentations

were used to check if there was any difference in the presentation mode. The output through

both transducers was 40 dB SL (ref. PTA). The participants were asked to listen to each

word-sequence and repeat the words heard in the same order as they were presented. The

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Page 12 of 43
responses were noted by the evaluator on a scoring sheet. Both auditory memory and

auditory sequencing were scored separately. While calculating auditory memory, a score of

‘1’ was given for each correctly repeated word. To calculate the auditory sequencing score, a

score of ‘1’ was given only if the words were repeated in the correct order. Both auditory

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memory and sequencing scores were tabulated.

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Analyses

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Data obtained from the participants were tabulated and subjected to statistical

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analyses. The mean and standard deviation were calculated separately for data obtained for

the four tests (SPIN-IE, DCV, DPT, & RAMST-IE) from the males and females in each age

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group. A mixed design ANOVA with ear as within participant variable and age, gender as

between participant variables was carried out separately for SPIN-IE and DPT. Further, age
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and gender effects were investigated using ANOVA for DCV and MANOVA for auditory

memory and sequencing skills.

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Results
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The results of the four auditory processing tests (SPIN-IE, DCV, DPT, & RAMST-
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IE) are provided, highlighting the effect of age, gender and ear / score within each test.

Additionally, the percentage scores across the four tests are compared to determine the age
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related changes as a function of the auditory process or higher cognitive function that were

evaluated.

Effect of gender, ear and age on auditory processes & auditory memory

Speech in noise test (SPIN-IE)

The mean and standard deviation of the scores obtained for SPIN-IE (Table 1)

indicate that the scores in girls and boys increased with age in both ears. A mixed design

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Page 13 of 43
repeated measure ANOVA, with ear as the within subject variable and age as well as gender

as between group variables, showed no significant effect of ear on the scores [F(1, 268) =

0.11, p > 0.05]. Hence, for further analysis of the data, the scores of the left and right ears

were combined. Between groups analysis showed a significant effect of age [F(4, 268) =

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20.57, p < 0.01] but no significant effect of gender [F(1, 268) = 1.21, p < 0.01]. Further,

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there was no significant interaction among any of the variables.

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Pair-wise comparison, after Bonferroni correction (Figure 1) revealed a clear

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developmental trend with the performance of the 6-year-old children being significantly

lower than that of all the older age groups. Likewise, the score of the 7-year-old and 8-year

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old children were significantly different from that of 9- and 10-year-old children.

Insert Table 1
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Insert Figure 1
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Dichotic CV test (DCV)

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From the mean and standard deviation of the double correct scores for different age
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groups (Table 2), it can be observed that with increase in age the scores steadily increased.
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There was a high variability in the scores of 6 –year old children. ANOVA indicated that

there was a significant main effect for age [F(4, 222) = 9.39, p < 0.01] but not for gender
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[F(1, 222) = 0.23, p > 0.05]. Further, a pair-wise comparison with Bonferroni correction

(Figure 2) revealed that only the scores of the 6-year-old children were significantly lower

than that of the other age groups. .

Insert Table 2

Insert Figure 2.

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Page 14 of 43
 Duration Pattern Test (DPT)

The descriptive statistics of the DPT (Table 3) shows that the mean scores for the 6-

year-old children were lower and had high variability when compared to the older children.

As seen in the other tests, the performance of older children was better than that of younger

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children, with the performance of the boys and girls being similar. However, the mean scores

of the left ear were better than that of the right ear in all age groups. A mixed design repeated

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measure ANOVA showed a significant main effect of age [F(1, 270) = 5.22, p < 0.05] as well

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as ear [F(4, 270) = 31.37, p < 0.01] but no significant difference between the scores of males

and females [(1, 270) = 0.21, p > 0.05]. There was no two-way or three-way interaction.

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Pair-wise comparison with Bonferroni correction (Figure 3) highlighted that the

scores of the 6-year-old children differed significantly from those of all other age groups. On
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the other hand, the performance of the 7-year-old children did not differ significantly from

that of the 8-year-old children but it was significantly lower than that of the 9- and 10-year-
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old children. Likewise, the scores of the 8-year-old children did not differ significantly from
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that of the 9-year-old children but differed significantly from that of the 10-year-old children.
p

Although the scores of the 10-year-old children were higher than that of the 9-year-old
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children, there was no significant difference.

Insert Table 3
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Insert Figure 3

It can be observed from Figure 3 and Table 3 that the variability was very high in the

6-year-old children. Hence, repeated measure ANOVA was performed after eliminating the

data of the 6-year-old children. With the elimination of the 6-year-olds there continued to be

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Page 15 of 43
a significant effect of age [F(3, 234) = 13.67, p > 0.05], however the ear effect that was

present earlier disappeared [F(1, 234) = 2.32, p > 0.05].

Revised Auditory Memory and Sequencing Test in Indian-English (RAMST-IE)

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As half the participants were tested under headphones and the other half through

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loudspeakers, initially an independent sample t-test was carried out to compare the scores

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obtained through the two transducers. The results showed no significant difference between

the two groups for the auditory memory scores [t(275) = 1.48, p > 0.05] as well as the

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auditory sequencing scores [t(275) = 0.39, p > 0.05]. Hence, the data of the two groups were

combined for further analysis. The mean and standard deviation of the combined scores

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obtained on the RAMST-IE, in general tended to be higher with increase in age (Table 4).

This can be observed for both auditory memory and sequencing scores. From Table 4 it is
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also evident that the mean memory scores were much higher than the mean sequencing

scores. This pattern was constant across all the five age groups. MANOVA indicated the
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presence of a significant age effect for both memory [F(4, 272) = 11.74, p < 0.01] and
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sequencing [F(4, 272) = 6.46, p < 0.01] scores. Gender did not have a significant effect on
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memory [F(1, 272) = 1.95; p > 0.05] or sequencing scores [F(1, 272) = 0.73, p > 0.05].
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Additionally, there was no significant interaction between age and gender for the memory

scores [F(4, 272) = 2.25, p > 0.05] and for the sequencing scores [F(4, 272) = 0.1.82, p >
Ac

0.05].

Insert Table 4

Pair-wise comparisons with Bonferroni corrections were carried out to determine how

the different age groups varied from each other (Figure 4a & 4b). It was observed that the

mean auditory memory scores of the 6-year-old children were significantly lower than that of

the 8-, 9- and 10-year-old children. Similarly, the 7-year-old and 8-year-old children

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Page 16 of 43
performed significantly poorer than the 9- and 10-year-old children. For the auditory

sequencing scores, the younger children (6-, 7-, & 8-year-olds) performed significantly

poorer than the older children (9- & 10-year-olds). However, the sequencing scores were not

significantly different among the younger or among the older children.

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Insert Figures 4a & 4b.

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Insert Table 5

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Developmental trends for different tests

The mean raw scored of the performance of the five age groups on the four tests

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(SPIN-IE, DCV, DPT, & RAMST-IE) were converted to percentage. The percentage was

calculated as the maximum scores of each test varied. It can be observed from Figure 5 that
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auditory sequencing was the most difficult task and understanding speech in noise was the

easiest task for children in most of the age groups. A non-linear increase in performance,
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with a steep change from 6 to 7 years followed by a relatively gradual increase after 7 years
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of age, was observed for the scores of all the tests except auditory memory and sequencing.
p

Compared to the other tests, the auditory memory and sequencing abilities showed lesser
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enhancement in scores with increase in age. SPIN-IE was the only test where the children

did not have a steady increase in performance with increase in age. While the scores of most
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of the tests showed a plateau after 9 years of age, the scores of the DPT continued to increase

till 10 years of age, though the pair-wise comparison did not show a statistically significant

difference. The scores of DCV test showed a plateau after 8 years of age but the percentage

scores were lesser than that of SPIN-IE.

Insert Figure 5.

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Page 17 of 43
 Thus, the results indicated that depending on the test (SPIN-IE, DCV, DPT &

RAMST-IE), the performance of children of different ages differed. No significant

difference was observed between the performance of the 7- and 8-year-old children as well as

the 9- and 10-year-old children on any of the tests. This is evident from Table 5 and Figure 5

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that provide a summary of the significance of difference in the performance of the five age

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groups for each of the tests.

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Discussion

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The findings of the study indicate that the performance of children on auditory

processing or higher cognitive functioning tests increase with age. The gender of the
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participants was found to have no effect on the test performance. Additionally, there was no

interaction of gender with age or ear for any of the tests. This indicates that auditory
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processing is similar in boys and girls aged 6 to 10 years. Thus, it can be construed that for
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clinical purposes, separate norms for males and females are unnecessary. Earlier studies have

also reported of no gender differences in tests for auditory processing or higher cognitive
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functioning. These tests include speech-in-noise [12], DCV [34], DPT [35] as well as
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auditory memory and sequencing [36-38]. Neuroimaging studies of the brain of girls and

boys have documented structural differences in the volume of the brain [39]. It can be
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construed that the structural changes reported in the brain of males and females are not

significant enough to result in differences in auditory processing abilities.

The performance across the two ears, evaluated for DPT and SPIN-IE, were found to

be alike. Similar to the present study, the results of earlier investigations [18, 32] showed the

absence of an ear effect for DPT. However, the ear effect has not been reported for speech

perception in noise by the majority of the investigators who have studied this aspect.

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Page 18 of 43
 Findings regarding the age of the participants, in the current study revealed that most

of the tests can be administered on children as young as 6 years of age. In general, the 6 year

old children performed significantly poorer than the older age groups in most of the tests. An

exception to this was their performance in the RAMST-IE. Additionally, it was observed that

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the 7 year old children did not differ significantly from the older children, especially from the

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adjacent older group. This indicates that the change in performance was very gradual from 7

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to 8 years. However, there continued to be a significant increase in performance as the

children grew older. The growth in performance varied from test to test, as can be seen in

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Table 5 and Figure 5. Although there was no significant difference between the

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performances of 9 and 10 year old children, the scores did not show a plateau, especially for

DPT. Thus, the study highlights that age related changes continue even in the older age
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groups that were evaluated. The general increase in performance with age, observed in all

the tests, substantiates the need to obtain age appropriate normative data.
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The results obtained in the study are similar to those reported in literature earlier. The
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effect of age has been demonstrated for the speech-in-noise test [40, 41], DCV test [12, 42] ,
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DPT [18, 43] as well as auditory memory and sequencing test [37, 38, 44]. Although a direct
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comparison across studies is difficult as the age ranges studied and the stimuli used vary from

study to study, the consensus is that performance on auditory processing tests improves with
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age. The findings of the present study indicate that although the auditory processes that were

studied do not improve significantly in children from 9;11 years to 10;11 years, a marginal

improvement was seen. These results reinforce the consensus that the auditory processing is

not mature till 11 years of age.

The age related changes in performance have been attributed to morphological

changes that occur in the central auditory pathway. Luders, Thompson and Toga [45]

observed an increase in the thickness of the corpus callosum in children in the age range of 5

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Page 19 of 43
to 18 years and ascribed it to an increase in myelinated fibers. Based on a longitudinal MRI

study of the brain in children aged 4 to 20 years, Giedd et al. [46] reported an increase in

white matter and gray matter of the cortex in the preadolescent years. They further observed

that increase in gray matter in the temporal lobe was non-linear and region-specific. In the

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current study, with increase in age, non-linear improvement in auditory processing was

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observed. Thus, it can be inferred that the age related structural changes result in age related

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changes in processing of auditory signals. Investigations correlating neuroimaging findings

with results of audiological tests are required to corroborate this. Recommendation to

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conduct auditory processing tests only in children older than 7 years has led researchers to

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rarely provide auditory processing test norms for children younger than 7 years of age.

ASHA [22] does not advocate testing auditory processing in children having a mental age
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below 7 years as they are likely to find the task difficult, thereby affecting the test results.

Similarly, as per the AAA [47] guidelines for the ‘Diagnosis, Treatment and Management of
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Children and Adults with Central Auditory’, auditory processing tests are recommended to be
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carried out on those with a “minimum developmental age of seven or eight years, or a level of

cognitive functioning that is consistent with this age range” (pp 14). However, from the
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findings of the present study, it is evident that it is possible to carry out certain auditory
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processing tests (SPIN-IE , DCV and RAMST-IE) on children as young as 6 years of age.

Despite the 6 year old children obtaining significantly poorer scores than older children on
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most of these tests, the variability in performance was similar or less than that obtained by the

older children for these three tests. As the variability in performance in this age group was

not very large, the normative data obtained on them can be utilized usefully to make early

diagnosis of the condition. Unlike most studies reported in literature, Stollman, Neijenhuis et

al. [12], in a study on Dutch children, also demonstrated that tests for auditory processing can

be conducted on children as young as 4 years of age.

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Page 20 of 43
 While the 6-year-old children in the current study were able to carry out most of the

tests, the results indicate that it is difficult to administer DPT in this age group. It was

observed that on this test, only two children obtained scores greater than 21, while 6 obtained

scores between 10 and 20 and the remaining got scores of 0. The response mode used in the

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present study required linguistic labeling of the pattern that was heard. This probably made

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the task difficult as it tapped temporal processing as well as inter-hemispheric functioning. It

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has been reported that the functional development of inter-hemispheric connection undergoes

a significant change between 6 to 8 years of age [48]. Thus, DPT requiring verbal responses

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is not a good test to assess temporal processing in 6-year-old children. It needs to be

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investigated if the performance would be better for humming responses.

Double correct scores on DCV also showed large variability suggesting that binaural
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integration skills are difficult for 6- year old children. DCV again taps the functioning of

both the hemispheres as well as interhemispheric connections. The results obtained on

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double correct scores of DCV substantiates that there is a difference in the maturation rate of
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corpus callosum within children of this age group. The single correct scores were not
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considered for analysis in this study, however it was observed that there was not much
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variability for single correct scores of 6 year old children. Hence it is suggested that while

interpreting scores of 6 year old children on DCV, single correct scores can be used reliably
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but the double correct scores need to be interpreted with caution.

Thus, in the present study, the comparison of performance of the children indicated

that auditory closure and monaural separation abilities, assessed by SPIN-IE, is developed

early in childhood and stabilizes by 9 years of age. However, for DPT, the relatively poorer

performance seen in the younger age group could either be on account of temporal ordering

being developed later or due to immature corpus callosum. The latter would have resulted in

the children that have difficulty in labeling the tones heard by them. The former can be

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Page 21 of 43
confirmed only by evaluating DPT using humming responses. The results of DCV test

suggest that auditory capacity to integrate stimuli heard in the two ears is very poor in 6-year-

old children and reaches a plateau by 9 years of age. It is not clear whether poor auditory

integration is due to immature auditory system or due to immature cognitive functioning.

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The performance of the children on the RAMST-IE varied depending on whether

memory or sequencing abilities were assessed. In general it was observed that children in all

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age groups performed better when the ‘memory’ scores were calculated compared to when

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‘sequencing’ scores were calculated. This can be attributed to the difficulty of the tasks. In

the latter scoring procedure, the children were required to not only remember the words but

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also the correct sequence, while in the former scoring procedure they were not required to

remember the order of the stimuli. Although there were differences in the scores for
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‘memory’ and ‘sequencing’, both types of scores improved with increase in age. For the

memory scores, the younger three age groups did not differ from those in the adjacent age
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groups (i.e. 6 year olds did not differ from the 7 year olds and the 7 year olds did not differ
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from the 8 year olds). Likewise, the oldest two age groups did not differ from each other. An
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almost similar trend was seen for the sequencing scores also. In general it can be noted that
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in the younger (6 to 8 year olds) and older age groups (9 to 10 year olds), the growth in

auditory memory and sequencing was more gradual. However, it was more rapid between 8
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to 9 years of age (Table 5).

The findings of auditory memory and sequencing are similar to what has been

reported in the literature. Gathercole et al. [37] also observed a significant age effect for

auditory memory in children aged 4 years to 15 years using word, digit and non-word tasks.

Similarly, Devi et al. [36] reported an increase in auditory memory with increase in age on an

auditory memory and sequencing test in English, in children aged 6 to 12 years. Their results

indicated that auditory memory scores increased with an advance in age up to ten years, after

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Page 22 of 43
which a plateau was obtained. In a similar manner, Yathiraj and Vijayalakshmi [38] also

found a significant age effect on a Kannada auditory memory and sequencing test in children

aged 5 to 11 years. A significant difference was observed between each of the seven age

groups.

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From the findings of the present study, it can be inferred that performance on all four

tests that were evaluated (SPIN-IE, DCV, DPT & RAMST-IE) did improve with age.

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However, the rate at which the changes that took place varied from test to test. While certain

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tests had a steep increase in scores with increase in age (DCV & DPT) others had a gradual

increase with age (RAMST-IE & SPIN-IE). Thus, it can be construed that different auditory

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processes have different rates of development, which is a reflection of the development of the

different areas controlling the processes.

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Conclusion
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The present study was carried out with the aim to determine age related changes on a
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battery of four auditory processing tests (SPIN-IE, DCV, DPT and RAMST-IE) in 280

typically developing children aged 6 to 10 years. The tests tapped auditory closure or
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monaural separation, binaural auditory integration abilities, temporal processing abilities as

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well as auditory memory and sequencing abilities. The study also determined the effect of

gender for each of the tests. Ear effect was computed for the monaural tests that were
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evaluated (SPIN-IE & DPT). Analyses of the data showed that the older children performed

better than the younger children. Although age had an effect on the results of all the tests, the

rate of improvement in performance varied across the tests. A non-linear growth in

performance with increase in age was observed for all four tests that were administered. The

results indicated that the assessment of auditory processing abilities can be carried out on

children as young as 6 years. The 6-year-old children could be tested using all the tests

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Page 23 of 43
except DPT. While children aged 7 years and above could perform the DPT, those aged 6

years found the task too difficult and hence it is recommended that it should not be included

in the test battery for children below 7 years of age. While evaluating 6 year children on

DCV, double correct scores need to be interpreted with caution. Further, there was no

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significant difference between the performance of boys and girls. The performance in the

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two monaural tests (SPIN-IE & DPT) was similar in the right and left ears.

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Acknowledgements

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This study is an outcome of a research project funded by the All India Institute of

Speech and Hearing, Mysore. The All India Institute of Speech and Hearing, Mysore and
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Bharati Vidyapeeth Deemed University, Pune are acknowledged for providing the facilities to

carry out the project. The contribution of Ms. Muthuselvi T., research officer in the project, is
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highly appreciated. Mr. Swarup Mishra and Ms. Aparna Oak are acknowledged for having
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collected data at Pune.

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Annexure 1

Sample of Test Material used for the study

Insert Figure A

Insert Figure B

Insert Figure C

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Insert Table A

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 Table 1: Mean and SD scores for SPIN-IE

Right ear Left ear

Age in Years
M F T M F T

Mean 16.56 14.41 15.37 16.27 14.72 15.42

6

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SD 3.91 4.08 4.09 3.86 4.00 3.96

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Mean 18.54 18.27 18.41 18.90 18.20 18.56

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7
SD 3.25 3.87 3.53 4.11 3.75 3.92

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Mean 18.07 17.27 17.66 17.53 17.53 17.53
8
SD 3.52 3.01 3.27 3.46 3.76 3.58

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Mean 21.34 21.06 21.20 21.44 20.12 20.76
9
SD 1.87 2.27 2.08 1.84 2.77 2.44
M
Mean 19.50 20. 63 19.81 19.50 20. 34 19.95
10
SD 5.05 3.37 4.21 4.81 3.85 4.30
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Note. M = Males; F = Females; T = Males + Females

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Maximum possible score on SPIN-IE = 25

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Table 2: Mean and SD of the double correct scores on dichotic CV test across the age groups

Double correct score

Age in years
M F T

Mean 5.7 5.27 5.46

6

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SD 6.54 5.54 5.92

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Mean 10.51 9.68 10.11

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7
SD 5.19 4.66 4.92

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Mean 11.96 12.60 12.28
8
SD 5.85 7.28 6.56

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Mean 14.34 13.74 14.03
9
SD 5.81 6.85 6.32
M
Mean 13.39 12.78 13.06
10
SD 5.87 5.16 5.46
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Note. M = Males; F = Females; T = Males + Females

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Maximum possible single / double correct score = 30

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Table 3: Mean and SD of scores obtained for the Duration Pattern Test

Right ear Left ear

Age in years
M F T M F T

Mean 6.66 4.73 5.60 7.27 5. 54 6.32

6

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SD 6.76 3.91 5.40 7.45 4.90 6.15

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Mean 11.03 13.48 12.21 11.54 13.48 12.48

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7
SD 5.67 8.71 7.34 5.80 8.16 7.05

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Mean 15.90 14.20 15.05 15.66 15.16 15.41
8
SD 6.19 7.26 6.75 6.48 7.06 6.72

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Mean 17.06 17.19 17.13 17.24 17.35 17.30
9
SD 4.23 7.27 5.95 3.46 7.11 5.60
M
Mean 19.85 19.28 19.55 20.82 18.96 19.83
10
SD 6.10 7.47 6.81 6.43 7.28 6.90
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Note. M = Males; F = Females; T = Males + Females

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Maximum possible duration pattern score = 30

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Table 4: Mean and SD of scores obtained for auditory memory and sequencing

Memory Sequencing
Age in years
M F T M F T

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Mean 50.27 51.82 50.95 33.68 37.83 35.49

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6
SD 8.97 8.09 8.52 10.97 7.91 9.46

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Mean 49.41 55.97 52.80 39.23 34.24 36.82
7

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SD 8.65 7.39 8.61 10.50 9.59 10.27

Mean 58.26 54.2 56.23 40.70 36.40 38.55

8

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SD 11.95 11.85 11.98 12.83 11.03 12.06

Mean 60.97 61.66 61.3 44.16 41.62 42.93

9
M
SD 13.32 6.03 10.37 15.52 10.10 13.14

Mean 59.77 63.78 61.71 43.63 47.68 45.59

10
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SD 10.03 12.41 11.32 12.06 16.78 14.54

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Note. M = Males; F = Females; T = Males + Females;

Maximum possible memory score = 118;

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Maximum possible sequence score = 118.

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 Table 5: Summary of the effect of age of the participants on the four tests (SPIN-IE, DCV,

DPT & RAMST-IE)

RAMST-IE - RAMST-IE -
SPIN-IE # DCV – DC DPT#
Memory Sequencing

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Age

7 8 9 10 7 8 9 10 7 8 9 10 7 8 9 10 7 8 9 10

6 ** NS ** ** ** ** ** ** ** ** ** ** NS ** ** ** NS NS ** **

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7 NS ** NS NS ** * NS ** ** NS ** ** NS ** **

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8 ** ** NS NS NS ** ** ** * **

9 NS NS NS NS NS

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Note. ** = p < 0.01; * = p < 0.05; NS = Not significant; # Average of left and right ears
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 Table A. Sample of the word sequences of RAMST-IE

Word Stimuli

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Sequence

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3-word Dog Car Rose
4-word Home Chips Rope Stick
5-word Joy Fast Shout Pull Cake

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6-word Hide Rich Skirt Run Door Mouth
7-word Wright Bus Tap Head Sky Flag Soup
8-word Class Rat Sing Plate Cloud Duck Bring Pray

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Captions for Figures

Fig.1: Pair-wise comparison of age effect on SPIN-IE score

Fig2: Pair-wise comparison of age effect on DCV-DC score

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Fig 3: Pair-wise comparison of age effect on Duration Pattern Test

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Fig 4: Pair-wise comparison of age effect on auditory memory (4a) and auditory

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sequencing (4b)

Fig.5: Mean percentage scores of the different tests (SPIN-IE, DCV, DPT, RAMST-

IE)
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Fig A: Sample SPIN-IE with speech (bird, grapes, step, cloud) in upper track and

noise in lower track, with both tracks being directed to one channel / ear
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Fig B: Sample waveform of DCV

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Fig C: Sample waveform of DPT

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Figure(s)

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Figure(s)

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Figure(s)

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Figure(s)

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Figure(s)

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Figure(s)

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Figure(s)

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