Development of the Children's English and Spanish Speech Recognition Test: Psychometric Properties, Feasibility, Reliability, and Normative Data.

OBJECTIVES: The Children's English and Spanish Speech Recognition (ChEgSS) test is a computer-based tool for assessing closed-set word recognition in English and in Spanish, with a masker that is either speech-shaped noise or competing speech. The present study was conducted to (1) characterize the psychometric properties of the ChEgSS test, (2) evaluate feasibility and reliability for a large cohort of Spanish/English bilingual children with normal hearing, and (3) establish normative data. DESIGN: Three experiments were conducted to evaluate speech perception in children (4-17 years) and adults (19-40 years) with normal hearing using the ChEgSS test. In Experiment 1, data were collected from Spanish/English bilingual and English monolingual adults at multiple, fixed signal-to-noise ratios. Psychometric functions were fitted to the word-level data to characterize variability across target words in each language and in each masker condition. In Experiment 2, Spanish/English bilingual adults were tested using an adaptive tracking procedure to evaluate the influence of different target-word normalization approaches on the reliability of estimates of masked-speech recognition thresholds corresponding to 70.7% correct word recognition and to determine the optimal number of reversals needed to obtain reliable estimates. In Experiment 3, Spanish/English bilingual and English monolingual children completed speech perception testing using the ChEgSS test to (1) characterize feasibility across age and language group, (2) evaluate test-retest reliability, and (3) establish normative data. RESULTS: Experiments 1 and 2 yielded data that are essential for stimulus normalization, optimizing threshold estimation procedures, and interpreting threshold data across test language and masker type. Findings obtained from Spanish/English bilingual and English monolingual children with normal hearing in Experiment 3 support feasibility and demonstrate reliability for use with children as young as 4 years of age. Equivalent results for testing in English and Spanish were observed for Spanish/English bilingual children, contingent on adequate proficiency in the target language. Regression-based threshold norms were established for Spanish/English bilingual and English monolingual children between 4 and 17 years of age. CONCLUSIONS: The present findings indicate the ChEgSS test is appropriate for testing a wide age range of children with normal hearing in either Spanish, English, or both languages. The ChEgSS test is currently being evaluated in a large cohort of patients with hearing loss at pediatric audiology clinics across the United States. Results will be compared with normative data established in the present study and with established clinical measures used to evaluate English- and Spanish-speaking children. Questionnaire data from parents and clinician feedback will be used to further improve test procedures.

Effects of Stimulus Type on 16-kHz Detection Thresholds.

OBJECTIVES: Audiometric testing typically does not include frequencies above 8 kHz. However, recent research suggests that extended high-frequency (EHF) sensitivity could affect hearing in natural communication environments. Clinical assessment of hearing often employs pure tones and frequency-modulated (FM) tones interchangeably regardless of frequency. The present study was designed to evaluate how the stimulus chosen to measure EHF thresholds affects estimates of hearing sensitivity. DESIGN: The first experiment used standard audiometric procedures to measure 8- and 16-kHz thresholds for 5- to 28-year olds with normal hearing in the standard audiometric range (250 to 8000 Hz). Stimuli were steady tones, pulsed tones, and FM tones. The second experiment tested 18- to 28-year olds with normal hearing in the standard audiometric range using psychophysical procedures to evaluate how changes in sensitivity as a function of frequency affect detection of stimuli that differ with respect to bandwidth, including bands of noise. Thresholds were measured using steady tones, pulsed tones, FM tones, narrow bands of noise, and one-third-octave bands of noise at a range of center frequencies in one ear. RESULTS: In experiment 1, thresholds improved with increasing age at 8 kHz and worsened with increasing age at 16 kHz. Thresholds for individual participants were relatively similar for steady, pulsed, and FM tones at 8 kHz. At 16 kHz, mean thresholds were approximately 5 dB lower for FM tones than for steady or pulsed tones. This stimulus effect did not differ as a function of age. Experiment 2 replicated this greater stimulus effect at 16 kHz than at 8 kHz and showed that the slope of the audibility curve accounted for these effects. CONCLUSIONS: Contrary to prior expectations, there was no evidence that the choice of stimulus type affected school-age children more than adults. For individual participants, audiometric thresholds at 16 kHz were as much as 20 dB lower for FM tones than for steady tones. Threshold differences across stimuli at 16 kHz were predicted by differences in audibility across frequency, which can vary markedly between listeners. These results highlight the importance of considering spectral width of the stimulus used to evaluate EHF thresholds.

Predictors of Susceptibility to Noise and Speech Masking Among School-Age Children With Hearing Loss or Typical Hearing.

OBJECTIVES: The purpose of this study was to evaluate effects of masker type and hearing group on the relationship between school-age children's speech recognition and age, vocabulary, working memory, and selective attention. This study also explored effects of masker type and hearing group on the time course of maturation of masked speech recognition. DESIGN: Participants included 31 children with normal hearing (CNH) and 41 children with mild to severe bilateral sensorineural hearing loss (CHL), between 6.7 and 13 years of age. Children with hearing aids used their personal hearing aids throughout testing. Audiometric thresholds and standardized measures of vocabulary, working memory, and selective attention were obtained from each child, along with masked sentence recognition thresholds in a steady state, speech-spectrum noise (SSN) and in a two-talker speech masker (TTS). Aided audibility through children's hearing aids was calculated based on the Speech Intelligibility Index (SII) for all children wearing hearing aids. Linear mixed effects models were used to examine the contribution of group, age, vocabulary, working memory, and attention to individual differences in speech recognition thresholds in each masker. Additional models were constructed to examine the role of aided audibility on masked speech recognition in CHL. Finally, to explore the time course of maturation of masked speech perception, linear mixed effects models were used to examine interactions between age, masker type, and hearing group as predictors of masked speech recognition. RESULTS: Children's thresholds were higher in TTS than in SSN. There was no interaction of hearing group and masker type. CHL had higher thresholds than CNH in both maskers. In both hearing groups and masker types, children with better vocabularies had lower thresholds. An interaction of hearing group and attention was observed only in the TTS. Among CNH, attention predicted thresholds in TTS. Among CHL, vocabulary and aided audibility predicted thresholds in TTS. In both maskers, thresholds decreased as a function of age at a similar rate in CNH and CHL. CONCLUSIONS: The factors contributing to individual differences in speech recognition differed as a function of masker type. In TTS, the factors contributing to individual difference in speech recognition further differed as a function of hearing group. Whereas attention predicted variance for CNH in TTS, vocabulary and aided audibility predicted variance in CHL. CHL required a more favorable signal to noise ratio (SNR) to recognize speech in TTS than in SSN (mean = +1 dB in TTS, -3 dB in SSN). We posit that failures in auditory stream segregation limit the extent to which CHL can recognize speech in a speech masker. Larger sample sizes or longitudinal data are needed to characterize the time course of maturation of masked speech perception in CHL.

Building on the Academic Legacy of Pat Stelmachowicz and other Pioneers in Developmental Psychoacoustics and Pediatric Audiology: The Children's English/Spanish Speech Recognition Test (ChEgSS).

Basic research investigating auditory development often has implications for clinical diagnosis and treatment of hearing loss in children, but it can be challenging to translate those findings into practice. Meeting that challenge was a guiding principle of Pat Stelmachowicz's research and mentorship. Her example inspired many of us to pursue translational research and motivated the recent development of the Children's English/Spanish Speech Recognition Test (ChEgSS). This test evaluates word recognition in noise or two-talker speech, with target and masker speech produced in either English or Spanish. The test uses recorded materials and a forced-choice response, so the tester need not be fluent in the test language. ChEgSS provides a clinical measure of masked speech recognition outcomes for children who speak English, Spanish, or both, including estimates of performance in noise and two-talker speech, with the goal of maximizing speech and hearing outcomes for children with hearing loss. This article highlights several of Pat's many contributions to pediatric hearing research and describes the motivation and development of ChEgSS.

Speech-in-speech recognition in preschoolers.

OBJECTIVE: The purpose of this study was to 1) characterise word recognition in a speech masker for preschoolers tested using closed-set, forced-choice procedures and 2) better understand the stimulus and listener factors affecting performance. DESIGN: Speech recognition thresholds (SRTs) in a two-talker masker were evaluated using a picture-pointing response with two sets of disyllabic target words. ChEgSS words were previously developed for children ≥5 years of age, and simple words were developed for preschoolers. Familiarisation ensured accurate identification of target words before testing. STUDY SAMPLE: Participants were 3- and 4-year olds (n = 21) and young adults (n = 10) with normal hearing. RESULTS: Preschoolers and adults had significantly lower SRTs for the simple words than the ChEgSS words, and lower SRTs for early-acquired than later-acquired ChEgSS words. For both word sets, SRTs were approximately 11-dB higher for preschoolers than adults, and child age was associated with SRTs. Preschoolers' receptive vocabulary size predicted performance for ChEgSS words but not simple words. CONCLUSIONS: Preschoolers were more susceptible to speech-in-speech masking than adults, with a similar child-adult difference for the ChEgSS and simple words. Effects of receptive vocabulary in preschoolers' recognition of ChEgSS words indicate that vocabulary size is an important consideration, even when using closed-set methods.

"I think it impacts all areas of his life": Perspectives on hearing from mothers of individuals with Down syndrome.

BACKGROUND: Individuals with Down syndrome are known to have high rates of hearing loss, but it is unclear how this impacts their ability to communicate and function in real-world environments. METHODS: Sixteen English-speaking and Spanish-speaking mothers of individuals with Down syndrome ages 6-40 years participated in individual, semi-structured interviews using a videoconferencing platform. Session transcripts were analysed using applied thematic analysis. RESULTS: Mothers described listening environments, the impact of hearing on daily life, barriers to successful listening, and strategies to overcome communication barriers for their children with Down syndrome. CONCLUSIONS: Hearing was largely discussed in terms of challenges and detriments, suggesting that hearing experiences are predominately considered to negatively impact the functional abilities of individuals with Down syndrome. Background noise and hearing loss were sources of communication difficulties. Parent-reported barriers and strategies can inform ecologically valid research priorities aimed at improving outcomes for individuals with Down syndrome.

Can Closed-Set Word Recognition Differentially Assess Vowel and Consonant Perception for School-Age Children With and Without Hearing Loss?

PURPOSE: Vowels and consonants play different roles in language acquisition and speech recognition, yet standard clinical tests do not assess vowel and consonant perception separately. As a result, opportunities for targeted intervention may be lost. This study evaluated closed-set word recognition tests designed to rely predominantly on either vowel or consonant perception and compared results with sentence recognition scores. METHOD: Participants were children (5-17 years of age) and adults (18-38 years of age) with normal hearing and children with sensorineural hearing loss (7-17 years of age). Speech reception thresholds (SRTs) were measured in speech-shaped noise. Children with hearing loss were tested with their hearing aids. Word recognition was evaluated using a three-alternative forced-choice procedure, with a picture-pointing response; monosyllabic target words varied with respect to either consonant or vowel content. Sentence recognition was evaluated for low- and high-probability sentences. In a subset of conditions, stimuli were low-pass filtered to simulate a steeply sloping hearing loss in participants with normal hearing. RESULTS: Children's SRTs improved with increasing age for words and sentences. Low-pass filtering had a larger effect for consonant-variable words than vowel-variable words for both children and adults with normal hearing, consistent with the greater high-frequency content of consonants. Children with hearing loss tested with hearing aids tended to perform more poorly than age-matched children with normal hearing, particularly for sentence recognition, but consonant- and vowel-variable word recognition did not appear to be differentially affected by the amount of high- and low-frequency hearing loss. CONCLUSIONS: Closed-set recognition of consonant- and vowel-variable words appeared to differentially evaluate vowel and consonant perception but did not vary by configuration of hearing loss in this group of pediatric hearing aid users. Word scores obtained in this manner do not fully characterize the auditory abilities necessary for open-set sentence recognition, but they do provide a general estimate.

Observational Study to Preliminarily Characterize the Audiological Profile of Children With Down Syndrome.

PURPOSE: Down syndrome occurs in one of 700 births, and high rates of hearing loss are reported in this population. This puts children with Down syndrome at risk for communication, learning, and social development difficulties, compounding known language and cognitive vulnerabilities in this population. The purpose of this study was to comprehensively characterize audiological profiles in children with Down syndrome, including the use of extended high-frequency sensitivity and speech intelligibility index assessment. METHOD: Participants were 18 children with Down syndrome between 5 and 17 years of age. Audiological profiles were characterized using behavioral audiometry, tympanometry, and wideband acoustic immittance (WAI). Audibility was characterized using the speech intelligibility index. RESULTS: Of the participants successfully completing behavioral audiometry, hearing loss of a moderate or greater degree was observed in one or both ears for 46% of the participants at conventional audiometric test frequencies and 85% of the participants at frequencies above 8 kHz. Seven children met criteria for amplification based on the speech intelligibility index, but only two wore hearing aids. Abnormal middle ear function was found in approximately 50% of the participants for whom WAI or tympanometry were successfully measured. CONCLUSIONS: Consistent with prior research, high rates of hearing loss and middle ear dysfunction were observed. The high prevalence of hearing loss above 8 kHz suggests the importance of including extended high-frequency assessment in audiologic characterization of children with Down syndrome. Few children meeting audibility-based guidelines for amplification wore hearing aids, putting them at additional risk for speech/language and educational difficulties. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21200422.

Masked-Speech Recognition for Linguistically Diverse Populations: A Focused Review and Suggestions for the Future.

PURPOSE: Twenty years ago, von Hapsburg and Peña (2002) wrote a tutorial that reviewed the literature on speech audiometry and bilingualism and outlined valuable recommendations to increase the rigor of the evidence base. This review article returns to that seminal tutorial to reflect on how that advice was applied over the last 20 years and to provide updated recommendations for future inquiry. METHOD: We conducted a focused review of the literature on masked-speech recognition for bilingual children and adults. First, we evaluated how studies published since 2002 described bilingual participants. Second, we reviewed the literature on native language masked-speech recognition. Third, we discussed theoretically motivated experimental work. Fourth, we outlined how recent research in bilingual speech recognition can be used to improve clinical practice. RESULTS: Research conducted since 2002 commonly describes bilingual samples in terms of their language status, competency, and history. Bilingualism was not consistently associated with poor masked-speech recognition. For example, bilinguals who were exposed to English prior to age 7 years and who were dominant in English performed comparably to monolinguals for masked-sentence recognition tasks. To the best of our knowledge, there are no data to document the masked-speech recognition ability of these bilinguals in their other language compared to a second monolingual group, which is an important next step. Nonetheless, individual factors that commonly vary within bilingual populations were associated with masked-speech recognition and included language dominance, competency, and age of acquisition. We identified methodological issues in sampling strategies that could, in part, be responsible for inconsistent findings between studies. For instance, disparities in socioeconomic status (SES) between recruited bilingual and monolingual groups could cause confounding bias within the research design. CONCLUSIONS: Dimensions of the bilingual linguistic profile should be considered in clinical practice to inform counseling and (re)habilitation strategies since susceptibility to masking is elevated in at least one language for most bilinguals. Future research should continue to report language status, competency, and history but should also report language stability and demand for use data. In addition, potential confounds (e.g., SES, educational attainment) when making group comparisons between monolinguals and bilinguals must be considered.

Maturation of Speech-in-Speech Recognition for Whispered and Voiced Speech.

PURPOSE: Some speech recognition data suggest that children rely less on voice pitch and harmonicity to support auditory scene analysis than adults. Two experiments evaluated development of speech-in-speech recognition using voiced speech and whispered speech, which lacks the harmonic structure of voiced speech. METHOD: Listeners were 5- to 7-year-olds and adults with normal hearing. Targets were monosyllabic words organized into three-word sets that differ in vowel content. Maskers were two-talker or one-talker streams of speech. Targets and maskers were recorded by different female talkers in both voiced and whispered speaking styles. For each masker, speech reception thresholds (SRTs) were measured in all four combinations of target and masker speech, including matched and mismatched speaking styles for the target and masker. RESULTS: Children performed more poorly than adults overall. For the two-talker masker, this age effect was smaller for the whispered target and masker than for the other three conditions. Children's SRTs in this condition were predominantly positive, suggesting that they may have relied on a wholistic listening strategy rather than segregating the target from the masker. For the one-talker masker, age effects were consistent across the four conditions. Reduced informational masking for the one-talker masker could be responsible for differences in age effects for the two maskers. A benefit of mismatching the target and masker speaking style was observed for both target styles in the two-talker masker and for the voiced targets in the one-talker masker. CONCLUSIONS: These results provide no compelling evidence that young school-age children and adults are differentially sensitive to the cues present in voiced and whispered speech. Both groups benefit from mismatches in speaking style under some conditions. These benefits could be due to a combination of reduced perceptual similarity, harmonic cancelation, and differences in energetic masking.

Face Masks Impact Auditory and Audiovisual Consonant Recognition in Children With and Without Hearing Loss.

Teachers and students are wearing face masks in many classrooms to limit the spread of the coronavirus. Face masks disrupt speech understanding by concealing lip-reading cues and reducing transmission of high-frequency acoustic speech content. Transparent masks provide greater access to visual speech cues than opaque masks but tend to cause greater acoustic attenuation. This study examined the effects of four types of face masks on auditory-only and audiovisual speech recognition in 18 children with bilateral hearing loss, 16 children with normal hearing, and 38 adults with normal hearing tested in their homes, as well as 15 adults with normal hearing tested in the laboratory. Stimuli simulated the acoustic attenuation and visual obstruction caused by four different face masks: hospital, fabric, and two transparent masks. Participants tested in their homes completed auditory-only and audiovisual consonant recognition tests with speech-spectrum noise at 0 dB SNR. Adults tested in the lab completed the same tests at 0 and/or -10 dB SNR. A subset of participants from each group completed a visual-only consonant recognition test with no mask. Consonant recognition accuracy and transmission of three phonetic features (place of articulation, manner of articulation, and voicing) were analyzed using linear mixed-effects models. Children with hearing loss identified consonants less accurately than children with normal hearing and adults with normal hearing tested at 0 dB SNR. However, all the groups were similarly impacted by face masks. Under auditory-only conditions, results were consistent with the pattern of high-frequency acoustic attenuation; hospital masks had the least impact on performance. Under audiovisual conditions, transparent masks had less impact on performance than opaque masks. High-frequency attenuation and visual obstruction had the greatest impact on place perception. The latter finding was consistent with the visual-only feature transmission data. These results suggest that the combination of noise and face masks negatively impacts speech understanding in children. The best mask for promoting speech understanding in noisy environments depend on whether visual cues will be accessible: hospital masks are best under auditory-only conditions, but well-fit transparent masks are best when listeners have a clear, consistent view of the talker's face.

Effects of word familiarity and receptive vocabulary size on speech-in-noise recognition among young adults with normal hearing.

Having a large receptive vocabulary benefits speech-in-noise recognition for young children, though this is not always the case for older children or adults. These observations could indicate that effects of receptive vocabulary size on speech-in-noise recognition differ depending on familiarity of the target words, with effects observed only for more recently acquired and less frequent words. Two experiments were conducted to evaluate effects of vocabulary size on open-set speech-in-noise recognition for adults with normal hearing. Targets were words acquired at 4, 9, 12 and 15 years of age, and they were presented at signal-to-noise ratios (SNRs) of -5 and -7 dB. Percent correct scores tended to fall with increasing age of acquisition (AoA), with the caveat that performance at -7 dB SNR was better for words acquired at 9 years of age than earlier- or later-acquired words. Similar results were obtained whether the AoA of the target words was blocked or mixed across trials. Differences in word duration appear to account for nonmonotonic effects of AoA. For all conditions, a positive correlation was observed between recognition and vocabulary size irrespective of target word AoA, indicating that effects of vocabulary size are not limited to recently acquired words. This dataset does not support differential assessment of AoA, lexical frequency, and other stimulus features known to affect lexical access.

Spatial Hearing and Functional Auditory Skills in Children With Unilateral Hearing Loss.

Purpose The purpose of this study was to characterize spatial hearing abilities of children with longstanding unilateral hearing loss (UHL). UHL was expected to negatively impact children's sound source localization and masked speech recognition, particularly when the target and masker were separated in space. Spatial release from masking (SRM) in the presence of a two-talker speech masker was expected to predict functional auditory performance as assessed by parent report. Method Participants were 5- to 14-year-olds with sensorineural or mixed UHL, age-matched children with normal hearing (NH), and adults with NH. Sound source localization was assessed on the horizontal plane (-90° to 90°), with noise that was either all-pass, low-pass, high-pass, or an unpredictable mixture. Speech recognition thresholds were measured in the sound field for sentences presented in two-talker speech or speech-shaped noise. Target speech was always presented from 0°; the masker was either colocated with the target or spatially separated at ±90°. Parents of children with UHL rated their children's functional auditory performance in everyday environments via questionnaire. Results Sound source localization was poorer for children with UHL than those with NH. Children with UHL also derived less SRM than those with NH, with increased masking for some conditions. Effects of UHL were larger in the two-talker than the noise masker, and SRM in two-talker speech increased with age for both groups of children. Children with UHL whose parents reported greater functional difficulties achieved less SRM when either masker was on the side of the better-hearing ear. Conclusions Children with UHL are clearly at a disadvantage compared with children with NH for both sound source localization and masked speech recognition with spatial separation. Parents' report of their children's real-world communication abilities suggests that spatial hearing plays an important role in outcomes for children with UHL.

Sex-mismatch benefit for speech-in-speech recognition by pediatric and adult cochlear implant users.

This project investigated whether pediatric (5-14 years) and adult (30-60 years) cochlear implant (CI) users benefit from a target/masker sex-mismatch for speech-in-speech recognition. Speech recognition thresholds were estimated in a two-male-talker or a two-female-talker masker. Target and masker speech were either sex-matched or sex-mismatched. For both age groups, performance for sex-matched talkers was worse for male than female speech. Sex-mismatch benefit was observed for the two-male-talker masker, indicating CI users can benefit from a target/masker sex mismatch. No benefit was observed for the two-female-talker masker, suggesting this effect may depend on the relative contributions of energetic and informational masking.

A Simplified Approach to Quantifying a Child's Bilingual Language Experience.

Purpose Bilingual children's linguistic experience can vary markedly from child to child. For appropriate audiological assessment and intervention, audiologists need accurate and efficient ways to describe and understand a bilingual child's dynamic linguistic experience. This report documents an approach for quantitatively capturing a child's language exposure and usage in a time-efficient manner. Method A well-known pediatric bilingual language survey was administered to 83 parents of bilingual children, obtaining information about the child's exposure to (input) and usage of (output) Spanish and English for seventeen 1-hr intervals during a typical weekday and weekend day. Results A factor analysis indicated that capturing linguistic exposure and usage over three grouped-time intervals during a typical weekday and weekend day accounted for ≥ 74% of the total variance of the linguistic information captured with the full-length survey. Conclusions Although further confirmation is required, these results suggest that collecting language exposure and usage data from parents of bilingual children for three grouped-time intervals provides similar information as a comprehensive hour-by-hour approach. A time-efficient method of capturing the dynamic bilingual linguistic experience of a child would benefit pediatric audiologists and speech-language pathologists alike.

Effects of Hearing Loss on School-Aged Children's Ability to Benefit From F0 Differences Between Target and Masker Speech.

OBJECTIVES: The objectives of the study were to (1) evaluate the impact of hearing loss on children's ability to benefit from F0 differences between target/masker speech in the context of aided speech-in-speech recognition and (2) to determine whether compromised F0 discrimination associated with hearing loss predicts F0 benefit in individual children. We hypothesized that children wearing appropriately fitted amplification would benefit from F0 differences, but they would not show the same magnitude of benefit as children with normal hearing. Reduced audibility and poor suprathreshold encoding that degrades frequency discrimination were expected to impair children's ability to segregate talkers based on F0. DESIGN: Listeners were 9 to 17 year olds with bilateral, symmetrical, sensorineural hearing loss ranging in degree from mild to severe. A four-alternative, forced-choice procedure was used to estimate thresholds for disyllabic word recognition in a 60-dB-SPL two-talker masker. The same male talker produced target and masker speech. Target words had either the same mean F0 as the masker or were digitally shifted higher than the masker by three, six, or nine semitones. The F0 benefit was defined as the difference in thresholds between the shifted-F0 conditions and the unshifted-F0 condition. Thresholds for discriminating F0 were also measured, using a three-alternative, three-interval forced choice procedure, to determine whether compromised sensitivity to F0 differences due to hearing loss would predict children's ability to benefit from F0. Testing was performed in the sound field, and all children wore their personal hearing aids at user settings. RESULTS: Children with hearing loss benefited from an F0 difference of nine semitones between target words and masker speech, with older children generally benefitting more than younger children. Some children benefitted from an F0 difference of six semitones, but this was not consistent across listeners. Thresholds for discriminating F0 improved with increasing age and predicted F0 benefit in the nine-semitone condition. An exploratory analysis indicated that F0 benefit was not significantly correlated with the four-frequency pure-tone average (0.5, 1, 2, and 4 kHz), aided audibility, or consistency of daily hearing aid use, although there was a trend for an association with the low-frequency pure-tone average (0.25 and 0.5 kHz). Comparisons of the present data to our previous study of children with normal hearing demonstrated that children with hearing loss benefitted less than children with normal hearing for the F0 differences tested. CONCLUSIONS: The results demonstrate that children with mild-to-severe hearing loss who wear hearing aids benefit from relatively large F0 differences between target and masker speech during aided speech-in-speech recognition. The size of the benefit increases with increasing age, consistent with previously reported age effects for children with normal hearing. However, hearing loss reduces children's ability to capitalize on F0 differences between talkers. Audibility alone does not appear to be responsible for this effect; aided audibility and degree of loss were not primary predictors of performance. The ability to benefit from F0 differences may be limited by immature central processing or aspects of peripheral encoding that are not characterized in standard clinical assessments.

Feasibility of remote assessment of the binaural intelligibility level difference in school-age children.

This work evaluated the feasibility and reliability of remotely assessing masked speech recognition and the binaural intelligibility level difference (BILD) in children. Participants were 28 children (6-17 years) and 11 adults (22-45 years) with self-reported normal hearing. A three-alternative forced-choice word recognition task was completed using participants' personal hardware (headphones and computer) and custom software that uploaded results to a central database. Results demonstrate that assessment of masked speech recognition and the BILD is feasible and generally reliable in a remote setting. Variability of results across individuals would likely have been reduced by distributing or specifying appropriate headphones.

Independent and Combined Effects of Fundamental Frequency and Vocal Tract Length Differences for School-Age Children's Sentence Recognition in a Two-Talker Masker.

Purpose The purpose of this study was to examine the independent and combined contributions of fundamental frequency (F0) and vocal tract length (VTL) differences on children's speech-in-speech recognition in the presence of a competing two-talker masker. Method Participants were 64 children (5-17 years old) and 25 adults (18-39 years old). Sentence recognition thresholds were measured in a two-talker masker. Target sentences had either the same mean F0 and VTL of the masker or were digitally altered so that the target and masker differed in F0 (Experiment 1), differed in VTL (Experiment 2), or differed in both F0 and VTL (Experiment 3). To determine the benefit, masking release was computed by subtracting thresholds in each shifted condition from the threshold in the unshifted condition. Results Results demonstrate that children's ability to benefit from either F0 or VTL differences (Experiments 1 and 2) depended on listener age, with younger children showing less improvement in speech reception thresholds compared to older children and adults. Age effects were also evident in the combined-cue conditions (Experiment 3), but children showed greater improvements compared to F0-only or VTL-only manipulations. Conclusions There was a prolonged pattern of development in children's ability to benefit from F0 or VTL differences between target and masker speech. Young children failed to capitalize on F0 and VTL differences to the same extent as older children and adults but did show a robust benefit when the cues were combined, supporting the hypothesis that younger children rely more heavily on redundant cues compared to older children and adults.

Contribution of Stimulus Variability to Word Recognition in Noise Versus Two-Talker Speech for School-Age Children and Adults.

BACKGROUND: Speech-in-speech recognition scores tend to be more variable than the speech-in-noise recognition scores, both within and across listeners. This variability could be due to listener factors, such as individual differences in audibility or susceptibility to informational masking. It could also be due to stimulus variability, with some speech-in-speech samples posing more of a challenge than others. The purpose of this experiment was to test two hypotheses: (1) that stimulus variability affects adults' word recognition in a two-talker speech masker and (2) that stimulus variability plays a smaller role in children's performance due to relatively greater contributions of listener factors. METHODS: Listeners were children (5 to 10 years) and adults (18 to 41 years) with normal hearing. Target speech was a corpus of 30 disyllabic words, each associated with an unambiguous illustration. Maskers were 30 samples of either two-talker speech or speech-shaped noise. The task was a four-alternative forced choice. Speech reception thresholds were measured adaptively, and those results were used to determine the signal-to-noise ratio associated with ≈65% correct for each listener and masker. Two 30-word blocks of fixed-level testing were then completed in each of the two conditions: (1) with the target-masker pairs randomly assigned prior to each block and (2) with frozen target-masker pairs. RESULTS: Speech reception thresholds were lower for adults than for children, particularly for the two-talker speech masker. Listener responses in fixed-level testing were evaluated for consistency across listeners. Target sample was the best predictor of performance in the speech-shaped noise masker for both the random and frozen conditions. In contrast, both the target and masker samples affected performance in the two-talker masker. Results were qualitatively similar for children and adults, and the pattern of performance across stimulus samples was consistent, with differences in masked target audibility in both age groups. CONCLUSIONS: Although word recognition in speech-shaped noise differed consistently across target words, recognition in a two-talker speech masker depended on both the target and masker samples. These stimulus effects are broadly consistent with a simple model of masked target audibility. Although variability in speech-in-speech recognition is often thought to reflect differences in informational masking, the present results suggest that variability in energetic masking across stimuli can play an important role in performance.

The Clear-Speech Benefit for School-Age Children: Speech-in-Noise and Speech-in-Speech Recognition.

Purpose Talkers often modify their speech when communicating with individuals who struggle to understand speech, such as listeners with hearing loss. This study evaluated the benefit of clear speech in school-age children and adults with normal hearing for speech-in-noise and speech-in-speech recognition. Method Masked sentence recognition thresholds were estimated for school-age children and adults using an adaptive procedure. In Experiment 1, the target and masker were summed and presented over a loudspeaker located directly in front of the listener. The masker was either speech-shaped noise or two-talker speech, and target sentences were produced using a clear or conversational speaking style. In Experiment 2, stimuli were presented over headphones. The two-talker speech masker was diotic (M0). Clear and conversational target sentences were presented either in-phase (T0) or out-of-phase (Tπ) between the two ears. The M0Tπ condition introduces a segregation cue that was expected to improve performance. Results For speech presented over a single loudspeaker (Experiment 1), the clear-speech benefit was independent of age for the noise masker, but it increased with age for the two-talker masker. Similar age effects for the two-talker speech masker were seen under headphones with diotic presentation (M0T0), but comparable clear-speech benefit as a function of age was observed with a binaural cue to facilitate segregation (M0Tπ). Conclusions Consistent with prior research, children showed a robust clear-speech benefit for speech-in-noise recognition. Immaturity in the ability to segregate target from masker speech may limit young children's ability to benefit from clear-speech modifications for speech-in-speech recognition under some conditions. When provided with a cue that facilitates segregation, children as young as 4-7 years of age derived a clear-speech benefit in a two-talker masker that was similar to the benefit experienced by adults.