Determining Listening Challenges

Speech perception and listening accuracy cannot be assumed by looking at the audiogram – it must be assessed. Teacher’s voices, room acoustics, and classroom management vary so identifying listening challenges – and specific accommodations – needs to be done for students who are hard of hearing each school year. New information about the Listening Inventory For Education – Revised will help guide consideration of what typical listening challenges look like for students with normal hearing, so that we can better quantify these challenges for students who are hard of hearing.

 

Why challenged listening?

The primary difference between students with hearing loss and their typically hearing peers is that they do not access speech as fully. This reality is often unrecognized by school staff who ‘know’ that the child can hear them just fine. While all children under the age of 15 years have an immature auditory cortex, and therefore greater challenges listening as accurately as adults, those with hearing loss are more impacted.

Classrooms are often noisy and the person the child needs to hear is often more than 3 feet from the hearing aid microphones. While individuals can detect sound occurring beyond 3 feet, to truly perceive sounds like s, f, t, p (as in cat, cap, cast, calf) speech must be within the student’s listening bubble, or the range of hearing within which speech can be fully heard. 

For most classroom communication students who are hard of hearing must work harder to listen, resulting in fewer cognitive resources available to process what was said so that it can be comprehended and remembered. Because they expend more effort to listen and pay attention, they experience greater listening fatigue as compared to typically hearing peers. Greater effort for less comprehension, at a higher level of fatigue, all play a role in reducing the pace of learning and an increasing gap in achievement across school years. Refer to the Cascading Impact of Hearing Loss handout for more information.

How well a student is able to perceive speech in a classroom will impact educational performance. These impacts are often overlooked or misunderstood by school staff as they review whether it is necessary to evaluate a student with hearing loss to determine eligibility for sufficiently intensive specialized services and accommodations.

Almost 5 years ago (November 2014) the US Department of Education and US Department of Justice clarified that, under Title II of the ADA, schools are required to ensure that communication for students who are deaf and hard of hearing “are as effective as communication for others” [ADA Title II 28 C.F.R. 35.160 (a)(1)] through the provision of appropriate aids and services “affording an equal opportunity to obtain the same result, to gain the same benefit, or to reach the same level of achievement as that provided to others” [ADA Title II 28 C.F.R. 35.130 (b)(1)(iii)]. (Read more about ADA.)

To determine if communication is “as effective as others” we need to apply what is known about typically hearing children.

Functional Assessment

Performance under typical school conditions is necessary to assess either directly with the Functional Listening Evaluation (FLE), or indirectly, with checklists like the Children’s Home Inventory of Listening Difficulties (CHILD) or the Listening Inventory For Education-Revised (LIFE-R).

The Functional Listening Evaluation has become a mainstay in the field of DHH education and is commonly performed by educational audiologists and teachers of the deaf/hard of hearing. The FLE is a means to estimate how well a student is able to access verbal instruction, and to what degree speechreading, distance and noise effect performance.

90-95% = Typical Hearing Average

The FLE can be performed with a variety of age-appropriate stimuli including single words, phrases, nonsense phrases and sentences depending upon if the desired information is about the precision of speech perception (words/nonsense material) or to estimate access to classroom communication (phrases for young children, sentences for grade 1 and above). A steady source of background noise and a means to control the loudness of the noise in comparison to the presenter’s voice is needed to perform the FLE in a valid manner. The Recorded FLE Using Sentences was created to simplify and add consistency to FLE administration. See the 2-minute video demonstration of using the Recorded FLE Using Sentences on YouTube. A free 10-minute classroom noise file can be downloaded from this Supporting Success webpage for instructional use or to aid in assessment. Collected data (1999)1 on children age 3 to 17 with typical hearing listening in quiet and noise found that the typical score listening in quiet averaged 95+% and in noise 90+%, regardless of age and without the use of visual cues.

The Listening Inventory For Education was revised in 2012 (LIFE-R) resulting in a suite of checklists for students, classroom teachers and parents. Most frequently used is the LIFE-R Student Appraisal which is a self-report measure for students grade 3, or age 8, and above. Students must consider each of the 15 school listening situations and decide the how difficult it is for them to hear and understand. Via this rating, a potential score of 100% is possible on the LIFE-R Student Appraisal.

72% = Typical Hearing Average

Two recent research studies provide helpful insight into interpretation of LIFE-R results. In 20181, researcher in Belgium translated the LIFE-R verbatim into Dutch and it was completed by 187 secondary students with normal hearing. Even though a score of 100% is possible, the typical listening situations in a classroom can be challenging for students with normal hearing as well as those with hearing loss. The average score for students with normal hearing was 72% with the most difficult listening situations being when classmates were noisy or when listening to responses during class discussion. The first ten questions on the LIFE-R relate directly to instructional classroom situations, in which students score significantly higher than the five questions related to social or group listening situations.

57% = DHH Average

A second study2 analyzed the data collected from use of the online LIFE-R over a period of 4 years (no identifying information), resulting in 3500-5000 responses, depending on the question analyzed. In every listening situation, students with severe to profound hearing loss showed greater hearing difficulty than all other groups, including cochlear implant users. The total average score for all 15 listening situations across students of different grades, hearing technology and hearing levels was 57%. Of the data analyzed, 509 had grade level indicated. Students in grades 3-6 reported poorer listening (53%) than those in grade 7-9 (61%) for all 15 situation responses. The most challenging situation was trying to listen to the teacher when other students were making noise, while difficult for all respondents, was even more so for the younger students. The second most difficult scenario was listening in a large room or school assembly.

If a student with hearing loss scores less than 90% on the FLE, or less than 72% on the LIFE-R it is evidence that communication is not as effective as peers and that auxiliary aids and services MUST BE PROVIDED to close this gap.

 

Formal Assessment

When students are present in classrooms it is assumed that they will hear and understand instruction. Hearing loss impacts this basic assumption and the question “to what degree is this student impacted” must be addressed. Although it is expensive to purchase norm-referenced tests, it is necessary to have the ability to collect data that is relevant to children with hearing loss in both a norm-referenced and functional performance (informal) format. The following are felt to be the best tools available to gather this information to identify areas of weakness, which make results advantageous to eligibility discussions and planning.

  • Developmental Test of Auditory Perception (DTAP): age 6-18. Takes 30 minutes to administer via CD. Results in language and non-language auditory perception index scores and background noise and no background noise index scores. The DTAP and FLE are a powerful combination to provide evidence of the impact of hearing loss on access to communication.
  • Assessment of Story Comprehension (ASC): Pre-K and K, age 3-5 years. Takes 3 minutes to administer and 1 to score. Teacher reads a story and student answers literal and inferential questions.
  • Oral Passage Understanding Scale (OPUS): age 5-21 years. Takes 10-20 minutes. Teacher reads a passage and student answers questions. It identifies knowledge and use of words, word combinations, syntax, and use of language in which meaning is not directly available from the words used. Yields more information than simply whether the individual can comprehend; deeper processing abilities.
  • Listening Comprehension Test – 2 / Listening Comprehension Test – Adolescent: ages 6-11 and 12-18 years. Takes 35 minutes to administer. Results are a good predictor of how well a student will be able to function in the mainstream classroom. Subtests are listening for the main ideas, details, reasoning, vocabulary and understanding messages. Results can readily be used to develop intervention goals.

 

References

  1. 1. Bodkin, K., Madell, J., & Rosenfield, R. (1999). Word recognition in quiet and noise for normally developing children. American Academy of Audiology Convention, Miami, FL – Poster session.
  2. 2. Krijger, L. DeRaeve, K. L. Anderson & I. Dhooge (2018). Translation and validation of the Listen Inventory for Education Revised into Dutch. International Journal of Pediatric Otorhinolaryngology, 107, 62-68. Online article.
  3. 3. Nelson, K. Anderson, J. Whicker, T. Barrett, K. Munoz, & K. White (2019). Classroom Listening Experiences of Students who are DHH using LIFE-R. Submitted manuscript.
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