Mood shapes the impact of reward on perceived fatigue from listening.

Knowledge of the underlying mechanisms of effortful listening could help to reduce cases of social withdrawal and mitigate fatigue, especially in older adults. However, the relationship between transient effort and longer term fatigue is likely to be more complex than originally thought. Here, we manipulated the presence/absence of monetary reward to examine the role of motivation and mood state in governing changes in perceived effort and fatigue from listening. In an online study, 185 participants were randomly assigned to either a "reward" (n = 91) or "no-reward" (n = 94) group and completed a dichotic listening task along with a series of questionnaires assessing changes over time in perceived effort, mood, and fatigue. Effort ratings were higher overall in the reward group, yet fatigue ratings in that group showed a shallower linear increase over time. Mediation analysis revealed an indirect effect of reward on fatigue ratings via perceived mood state; reward induced a more positive mood state which was associated with reduced fatigue. These results suggest that: (1) listening conditions rated as more "effortful" may be less fatiguing if the effort is deemed worthwhile, and (2) alterations to one's mood state represent a potential mechanism by which fatigue may be elicited during unrewarding listening situations.

Dual-tasking while using two languages: Examining the cognitive resource demands of cued and voluntary language production in bilinguals.

The way bilinguals switch languages can differ depending on the context. In cued dual-language environments, bilinguals select a language in response to environmental cues (e.g., a monolingual conversation partner). In voluntary dual-language environments, bilinguals communicating with people who speak the same languages can use their languages more freely. The control demands of these types of language-production contexts, and the costs of language switches, have been argued to differ (Adaptive Control Hypothesis). Here, we used a dual-task paradigm to examine how cued and voluntary bilingual production differ in cognitive resources used. Forty Mandarin-English bilinguals completed two language-switching paradigms as the primary task; one in response to cues and one while using two languages freely. At the same time, they also had to respond to the pitch of tones (secondary task). Response times (RTs) on the secondary task, as well as naming times on the primary task, were shorter under the voluntary- than cued-naming condition. Task workload ratings were also higher under the cued- than voluntary-naming condition. This suggests more attentional resources are needed in a cued-naming context to monitor cues and select languages accordingly. However, the costs associated with switching from one language to the other were similar in both voluntary- and cued-naming contexts. Thus, while cued-naming might be more effortful overall, cued and voluntary switching recruited similar levels of cognitive resources.

Development and Validation of a Brief Version of the Vanderbilt Fatigue Scale for Adults: The VFS-A-10.

OBJECTIVES: Listening-related fatigue can be a significant problem for adults who struggle to hear and understand, particularly adults with hearing loss. However, valid, sensitive, and clinically useful measures for listening-related fatigue do not currently exist. The purpose of this study was to develop and validate a brief clinical tool for measuring listening-related fatigue in adults. DESIGN: The clinical scale was derived from the 40-item version of the Vanderbilt Fatigue Scale for Adults (VFS-A-40), an existing, reliable, and valid research tool for measuring listening-related fatigue. The study consisted of two phases. Phase 1 ( N = 580) and Phase 2 ( N = 607) participants consisted of convenience samples of adults recruited via online advertisements, clinical records review, and a pool of prior research participants. In Phase 1, results from item response theory (IRT) analyses of VFS-A-40 items were used to identify high-quality items for the brief (10-item) clinical scale: the VFS-A-10. In Phase 2, the characteristics and quality of the VFS-A-10 were evaluated in a separate sample of respondents. Dimensionality was evaluated using exploratory factor analyses (EFAs) and item quality and characteristics were evaluated using IRT. VFS-A-10 reliability and validity were assessed in multiple ways. IRT reliability analysis was used to examine VFS-A-10 measurement fidelity. In addition, test-retest reliability was assessed in a subset of Phase 2 participants ( n = 145) who completed the VFS-A-10 a second time approximately one month after their initial measure (range 5 to 90 days). IRT differential item functioning (DIF) was used to assess item bias across different age, gender, and hearing loss subgroups. Convergent construct validity was evaluated by comparing VFS-A-10 responses to two other generic fatigue scales and a measure of hearing disability. Known-groups validity was assessed by comparing VFS-A-10 scores between adults with and without self-reported hearing loss. RESULTS: EFA suggested a unidimensional structure for the VFS-A-10. IRT analyses confirmed all test items were high quality. IRT reliability analysis revealed good measurement fidelity over a wide range of fatigue severities. Test-retest reliability was excellent ( rs = 0.88, collapsed across participants). IRT DIF analyses confirmed the VFS-A-10 provided a valid measure of listening-related fatigue regardless of respondent age, gender, or hearing status. An examination of associations between VFS-A-10 scores and generic fatigue/vigor measures revealed only weak-to-moderate correlations (Spearman's correlation coefficient, rs = -0.36 to 0.57). Stronger associations were seen between VFS-A-10 scores and a measure of perceived hearing difficulties ( rs = 0.79 to 0.81) providing evidence of convergent construct validity. In addition, the VFS-A-10 was more sensitive to fatigue associated with self-reported hearing difficulties than generic measures. It was also more sensitive than generic measures to variations in fatigue as a function of degree of hearing impairment. CONCLUSIONS: These findings suggest that the VFS-A-10 is a reliable, valid, and sensitive tool for measuring listening-related fatigue in adults. Its brevity, high sensitivity, and good reliability make it appropriate for clinical use. The scale will be useful for identifying those most affected by listening-related fatigue and for assessing benefits of interventions designed to reduce its negative effects.

Sensory-Processing Sensitivity Predicts Fatigue From Listening, But Not Perceived Effort, in Young and Older Adults.

PURPOSE: Listening-related fatigue is a potential negative consequence of challenges experienced during everyday listening and may disproportionately affect older adults. Contrary to expectation, we recently found that increased reports of listening-related fatigue were associated with better performance on a dichotic listening task. However, this link was found only in individuals who reported heightened sensitivity to a variety of physical, social, and emotional stimuli (i.e., increased "sensory-processing sensitivity" [SPS]). This study examined whether perceived effort may underlie the link between performance and fatigue. METHOD: Two hundred six young adults, aged 18-30 years (Experiment 1), and 122 older adults, aged 60-80 years (Experiment 2), performed a dichotic listening task and were administered a series of questionnaires including the NASA Task Load Index of perceived effort, the Vanderbilt Fatigue Scale (measuring daily life listening-related fatigue), and the Highly Sensitive Person Scale (measuring SPS). Both experiments were completed online. RESULTS: SPS predicted listening-related fatigue, but perceived effort during the listening task was not associated with SPS or listening-related fatigue in either age group. We were also unable to replicate the interaction between dichotic listening performance and SPS in either group. Exploratory analyses revealed contrasting effects of age; older adults found the dichotic listening task more effortful but indicated lower overall fatigue. CONCLUSIONS: These findings suggest that SPS is a better predictor of listening-related fatigue than performance or effort ratings on a dichotic listening task. SPS may be an important factor in determining an individual's likelihood of experiencing listening-related fatigue irrespective of hearing or cognitive ability. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21893013.

Development and Evaluation of Pediatric Versions of the Vanderbilt Fatigue Scale for Children With Hearing Loss.

PURPOSE: Growing evidence suggests that fatigue associated with listening difficulties is particularly problematic for children with hearing loss (CHL). However, sensitive, reliable, and valid measures of listening-related fatigue do not exist. To address this gap, this article describes the development, psychometric evaluation, and preliminary validation of a suite of scales designed to assess listening-related fatigue in CHL: the pediatric versions of the Vanderbilt Fatigue Scale (VFS-Peds). METHOD: Test development employed best practices, including operationalizing the construct of listening-related fatigue from the perspective of target respondents (i.e., children, their parents, and teachers). Test items were developed based on input from these groups. Dimensionality was evaluated using exploratory factor analyses (EFAs). Item response theory (IRT) and differential item functioning (DIF) analyses were used to identify high-quality items, which were further evaluated and refined to create the final versions of the VFS-Peds. RESULTS: The VFS-Peds is appropriate for use with children aged 6-17 years and consists of child self-report (VFS-C), parent proxy-report (VFS-P), and teacher proxy-report (VFS-T) scales. EFA of child self-report and teacher proxy data suggested that listening-related fatigue was unidimensional in nature. In contrast, parent data suggested a multidimensional construct, composed of mental (cognitive, social, and emotional) and physical domains. IRT analyses suggested that items were of good quality, with high information and good discriminability. DIF analyses revealed the scales provided a comparable measure of fatigue regardless of the child's gender, age, or hearing status. Test information was acceptable over a wide range of fatigue severities and all scales yielded acceptable reliability and validity. CONCLUSIONS: This article describes the development, psychometric evaluation, and validation of the VFS-Peds. Results suggest that the VFS-Peds provide a sensitive, reliable, and valid measure of listening-related fatigue in children that may be appropriate for clinical use. Such scales could be used to identify those children most affected by listening-related fatigue, and given their apparent sensitivity, the scales may also be useful for examining the effectiveness of potential interventions targeting listening-related fatigue in children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19836154.

Predictors of Listening-Related Fatigue Across the Adult Life Span.

Listening-related fatigue is a potentially serious negative consequence of an aging auditory and cognitive system. However, the impact of age on listening-related fatigue and the factors underpinning any such effect remain unexplored. Using data from a large sample of adults (N = 281), we conducted a conditional process analysis to examine potential mediators and moderators of age-related changes in listening-related fatigue. Mediation analyses revealed opposing effects of age on listening-related fatigue: Older adults with greater perceived hearing impairment tended to report increased listening-related fatigue. However, aging was otherwise associated with decreased listening-related fatigue via reductions in both mood disturbance and sensory-processing sensitivity. Results suggested that the effect of auditory attention ability on listening-related fatigue was moderated by sensory-processing sensitivity; for individuals with high sensory-processing sensitivity, better auditory attention ability was associated with increased fatigue. These findings shed light on the perceptual, cognitive, and psychological factors underlying age-related changes in listening-related fatigue.

Older adults show a more sustained pattern of effortful listening than young adults.

Listening to speech in adverse conditions can be challenging and effortful, especially for older adults. This study examined age-related differences in effortful listening by recording changes in the task-evoked pupil response (TEPR; a physiological marker of listening effort) both at the level of sentence processing and over the entire course of a listening task. A total of 65 (32 young adults, 33 older adults) participants performed a speech recognition task in the presence of a competing talker, while moment-to-moment changes in pupil size were continuously monitored. Participants were also administered the Vanderbilt Fatigue Scale, a questionnaire assessing daily life listening-related fatigue within four domains (social, cognitive, emotional, physical). Normalized TEPRs were overall larger and more steeply rising and falling around the peak in the older versus the young adult group during sentence processing. Additionally, mean TEPRs over the course of the listening task were more stable in the older versus the young adult group, consistent with a more sustained recruitment of compensatory attentional resources to maintain task performance. No age-related differences were found in terms of total daily life listening-related fatigue; however, older adults reported higher scores than young adults within the social domain. Overall, this study provides evidence for qualitatively distinct patterns of physiological arousal between young and older adults consistent with age-related upregulation in resource allocation during listening. A more detailed understanding of age-related changes in the subjective and physiological mechanisms that underlie effortful listening will ultimately help to address complex communication needs in aging listeners. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Development and validation of the Vanderbilt Fatigue Scale for Adults (VFS-A).

Listening-related fatigue can be a significant burden for adults with hearing loss (AHL), and potentially those with other health or language-related issues (e.g., multiple sclerosis, traumatic brain injury, second language learners) who must allocate substantial cognitive resources to the process of listening. The 40-item Vanderbilt Fatigue Scale for Adults (VFS-A-40) was designed to measure listening-related fatigue in such populations. This article describes the development, and psychometric properties, of the VFS-A-40. Initial qualitative analyses in AHL suggested listening-related fatigue was multidimensional, with physical, mental, emotional, and social domains. However, exploratory factor analyses revealed a unidimensional structure. Item and test characteristics were evaluated using Item Response Theory (IRT). Results confirmed that all test items were of high quality. IRT analyses revealed high marginal reliability and an analysis of test-retest scores revealed adequate reliability. In addition, an analysis of differential item functioning provided evidence of good construct validity across age, gender, and hearing loss groups. In sum, the VFS-A-40 is a reliable and valid tool for quantifying listening-related fatigue in adults. We believe the VFS-A-40 will be useful for identifying those most at risk for severe listening-related fatigue and for assessing interventions to reduce its negative effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effortful listening under the microscope: Examining relations between pupillometric and subjective markers of effort and tiredness from listening.

Effort during listening is commonly measured using the task-evoked pupil response (TEPR); a pupillometric marker of physiological arousal. However, studies to date report no association between TEPR and perceived effort. One possible reason for this is the way in which self-report effort measures are typically administered, namely as a single data point collected at the end of a testing session. Another possible reason is that TEPR might relate more closely to the experience of tiredness from listening than to effort per se. To examine these possibilities, we conducted two preregistered experiments that recorded subjective ratings of effort and tiredness from listening at multiple time points and examined their covariance with TEPR over the course of listening tasks varying in levels of acoustic and attentional demand. In both experiments, we showed a within-subject association between TEPR and tiredness from listening, but no association between TEPR and effort. The data also suggest that the effect of task difficulty on the experience of tiredness from listening may go undetected using the traditional approach of collecting a single data point at the end of a listening block. Finally, this study demonstrates the utility of a novel correlation analysis technique ("rmcorr"), which can be used to overcome statistical power constraints commonly found in the literature. Teasing apart the subjective and physiological mechanisms that underpin effortful listening is a crucial step toward addressing these difficulties in older and/or hearing-impaired individuals.

Behavioral Measures of Listening Effort in School-Age Children: Examining the Effects of Signal-to-Noise Ratio, Hearing Loss, and Amplification.

OBJECTIVES: Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on 2 commonly used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs). DESIGN: A total of 82 children (aged 6-13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort. RESULTS: Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs. CONCLUSIONS: This study compared dual-task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appear more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts, a decrement that could have a negative impact on learning and academic achievement in the classroom.

Measuring listening-related effort and fatigue in school-aged children using pupillometry.

Stress and fatigue from effortful listening may compromise well-being, learning, and academic achievement in school-aged children. The aim of this study was to investigate the effect of a signal-to-noise ratio (SNR) typical of those in school classrooms on listening effort (behavioral and pupillometric) and listening-related fatigue (self-report and pupillometric) in a group of school-aged children. A sample of 41 normal-hearing children aged 8-11years performed a narrative speech-picture verification task in a condition with recommended levels of background noise ("ideal": +15dB SNR) and a condition with typical classroom background noise levels ("typical": -2dB SNR). Participants showed increased task-evoked pupil dilation in the typical listening condition compared with the ideal listening condition, consistent with an increase in listening effort. No differences were found between listening conditions in terms of performance accuracy and response time on the behavioral task. Similarly, no differences were found between listening conditions in self-report and pupillometric markers of listening-related fatigue. This is the first study to (a) examine listening-related fatigue in children using pupillometry and (b) demonstrate physiological evidence consistent with increased listening effort while listening to spoken narratives despite ceiling-level task performance accuracy. Understanding the physiological mechanisms that underpin listening-related effort and fatigue could inform intervention strategies and ultimately mitigate listening difficulties in children.

Pupillometry reveals changes in physiological arousal during a sustained listening task.

Hearing loss is associated with anecdotal reports of fatigue during periods of sustained listening. However, few studies have attempted to measure changes in arousal, as a potential marker of fatigue, over the course of a sustained listening task. The present study aimed to examine subjective, behavioral, and physiological indices of listening-related fatigue. Twenty-four normal-hearing young adults performed a speech-picture verification task in different signal-to-noise ratios (SNRs) while their pupil size was monitored and response times recorded. Growth curve analysis revealed a significantly steeper linear decrease in pupil size in the more challenging SNR, but only in the second half of the trial block. Changes in pupil dynamics over the course of the more challenging listening condition block suggest a reduction in physiological arousal. Behavioral and self-report measures did not reveal any differences between listening conditions. This is the first study to show reduced physiological arousal during a sustained listening task, with changes over time consistent with the onset of fatigue.

Listening effort and fatigue: what exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group 'white paper'.

OBJECTIVE: There is growing interest in the concepts of listening effort and fatigue associated with hearing loss. However, the theoretical underpinnings and clinical meaning of these concepts are unclear. This lack of clarity reflects both the relative immaturity of the field and the fact that research studies investigating listening effort and fatigue have used a variety of methodologies including self-report, behavioural, and physiological measures. DESIGN: This discussion paper provides working definitions for listening effort and listening-related fatigue. Using these definitions as a framework, methodologies to assess these constructs are reviewed. RESULTS: Although each technique attempts to characterize the same construct (i.e. the clinical presentation of listening effort and fatigue), different assumptions are often made about the nature of these phenomena and their behavioural and physiological manifestations. CONCLUSION: We suggest that researchers consider these assumptions when interpreting their data and, where possible, make predictions based on current theoretical knowledge to add to our understanding of the underlying mechanisms of listening effort and listening-related fatigue. FOREWORD: Following recent interest in the cognitive involvement in hearing, the British Society of Audiology (BSA) established a Special Interest Group on Cognition in Hearing in May 2013. In an exploratory group meeting, the ambiguity surrounding listening effort and fatigue was discussed. To address this problem, the group decided to develop a 'white paper' on listening effort and fatigue. This is a discussion document followed by an international set of commentaries from leading researchers in the field. An approach was made to the editor of the International Journal of Audiology who agreed to this suggestion. This paper, and the associated commentaries that follow, are the result.