Evaluation of Speech Perception in Infants and Children

Key Points

  • Speech perception testing is a critical part of the audiologic test battery. It provides information about how a child can be expected to function in daily listening situations.
  • Selecting a test at the appropriate language level is critical
  • Testing should be conducted with and without technology (hearing aids, cochlear implants, and FM systems)
  • Testing should be conducted at normal and soft conversational levels in quiet and with competing noise
  • Speech perception testing is the only part of the audiology test battery that functionally assesses auditory performance. Speech perception information can be used to determine how a child is functioning with and without technology, in quiet, and with competing noise. Speech perception information should be used to plan remediation, including suggesting modifications in technology and in selecting and managing educational placement
  • The audiologist who sees a child less frequently is in a better position to monitor changes in performance than teachers and other clinicians who see the child daily or weekly
  • Children with severe and profound hearing loss can be very visually alert. It is important that the audiologist be certain not to provide any visual cues when testing (looking toward the VRA reinforcer or dropping a toy in the bucket) that might suggest to the child that she should respond. To avoid accidentally reinforcing random behavior, it is essential that the audiologist provide no reinforcement to the child unless he is absolutely sure the child heard the sound

How Speech Perception is Evaluated

  1. Detection is the ability to tell when a stimulus is present. Detection is assessed using threshold tests (speech awareness threshold)
  2. Discrimination is the ability to determine whether two stimuli are the same or different. Discrimination is tested in such tasks as the Visually Reinforced Infant Speech Dicrimination procedure, in which an infant is tested on signaling when the stimulus changes
  3. Identification is the ability to recognize the stimulus being presented and to identify it by repeating, pointing or writing. Identification is assessed during word recognition testing. Repeating back without understanding the word is an identification task
  4. Comprehension is the ability to understand what the stimulus means. The child may point to a picture and indicate that he also comprehends the stimulus, or may simply repeat back the words without understanding, which indicates identification.​
  • MLV testing because it is for children than recorded testing and because it may be easier for the audiologist as well, will frequently show higher scores than recorded testing and thus overestimate the child's actual auditory abilities. Therefore it is important to use recorded tests whenever the child is capable of doing the task. Recorded testing will provide a more accurate representation of auditory performance.
  • Use of a carrier phrase
    • "Show me the"
    • "Where is the"
    • "Tell me"
  • Closed-Set Tests
    • Hearing in Pictures NU-CHIPS