Making Sense of Listening: The IMAP Test Battery

This video demonstrates a procedure to rapidly obtain reliable measures of core cognitive and listening skills in children age six to 11 years. After providing clear instructions for the tests of listening skills, a short demonstration test is used to check that the child understands what is required. The first test in the IMAP sequence of tests is then initiated.

Each test comprises a track of 20 trials of increase in difficulty, which rapidly converge on a perceptual threshold using an adaptive procedure, positive feedback is provided to maintain the child's engagement throughout the track and in preparation for the next test. In the sequence, the output is a pattern of responses for each trial in the track, which provides an assessment of the child's overall listening skills. The main advantage of this technique over other methods to tests for specifically for listening skills in children is that it's language free and also the tests can be rapidly completed using standard psychoacoustic test.

But importantly, the tests are delivered in a a fun, child-friendly environment that promotes engagement with the child to make sure that they do the very best that they can. We have successfully used this method in testing nearly 2000 children, and this has allowed us to develop robust standardized measures of listening skills and children. Furthermore, we've been able to obtain reliable listening and data from children as young as the age of three.

Yeah, though this method can provide insight into listening skills in children and also adults, we've also extended the methodology for furthering understanding of heritability of listening skills. We use a highly flexible platform called star, and this can be modified so that we can provide auditory training programs both for adults and for children as well. We first had the idea for using this method when we were planning how to do a large population based study of listening skills in young children in non-ideal listening environments such as schools.

So there were many challenges, some of which were that we had to be able to do the test quickly, but we also had to preserve test a reliability. The IMAP test Battery provides a comprehensive auditory and cognitive assessment, which can be administered in about one hour. It comprises a total of 10 tasks, five psychoacoustic tasks based on non-linguistic materials, a speech in noise task two, sustained attention tasks and four cognitive tasks that assess reading, verbal short-term memory, working memory, and nonverbal intelligence.

During testing, auditory stimu are delivered through comfortable, high quality headphones and the child responds via a colorful three button box. The IMAP test batteries presented via a software platform called the IHR system for testing auditory responses. This software platform comprises a suite of programs for generating stimuli, controlling the order of presentation of AP and cognitive tests, and ensuring that test protocols are adhere to.

Two tracks are presented for each test of listening skills. Each track includes 20 trials, comprising a sequence of three stimuli, two identical standard stimuli, and a different target stimulus. The location of the target stimulus is varied randomly within the sequence, and the child is required to identify the odd one.

Out here we show a schematic of one task showing two identical stimuli and one different one, and here is an example of what the child would hear during testing. The relevant parameters for the target are varied according to the child's previous response, using an adaptive staircase method, which is designed to converge quickly on an estimate of threshold. Now let's watch a demonstration of a successful child-centric test session.

Well done, Lily. That was absolutely fantastic. You were a real star playing that game.

In fact, you were one of the best children I've seen do this all day. Specific elements internal and external to the software are used to enhance and maximize the child's engagement with the protocol internal to the software. You should note the use of fun graphics, which change from task to task.

The red ball bounces over the head of each figure to attract the child's attention to it as it makes a sound. The clock shows the child how much of the task they have completed. It is essential to establish a good rapport between the tester and the child.

This includes talking directly to the child using age appropriate language, and presenting the test session in the context of fun activities. Couched as games to play rather than a test to perform. Testing should be conducted in a quiet room with no auditorial visual distractions.

Ideally, only the child and tester should be present during testing before the testing begins, a familiarization phase is performed. That includes presentation of easy to identify super threshold stimuli alongside impossible to detect stimuli. This ensures that the test format is understood.

Familiarization is further facilitated by the beginning of each track, starting off with easily identifiable stimuli, so the child an immediate sense of success. Auditorium visual feedback is given after each response and there is an indicator to show how far the child has progressed through the game. It's important to remember that although the procedural aspects of the testing are controlled by IHR Star, the tester must also provide plenty of motivational feedback throughout testing to keep the child motivated for the next tasks.

Cartoon stickers and certificates are given on completion of testing and stickers may be used as rewards during testing if necessary. Now, let's see the steps for conducting a session. Begin the session by welcoming the child and parent and briefly describe what will happen.

Right, Lily, what are we going to do now? You're going to come with me and we are going to place some of the games on the computer over there, and mom, if you could just take a seat in the observation room and you're about to go and see Lily through the window here. Okay, thank you.Okay.

Say bye-bye to mommy.Okay. You want come through? You take a seat on that chair.

After a pseudo randomized test sequence is assigned, introduce the first AP game display to the child and explain the test procedure. Then place the headphones on the child and start the familiarization phase for the test. Okay, let me put the headphones on.

First, I want you to listen really, really carefully to the sounds. This phase ends automatically when a preset criterion, for example, a positive response of four outta five trials is reached. The child can then enter the main testing phase of the protocol.

Nice one.Okay. That was great. Tests are presented automatically, according to the computer controlled sequence prior to each test.

Instruct the child as appropriate for the new test and give frequent positive feedback and further encouragement. Well done, Rachel. That was really great.

Now this time we are going to do exactly the same thing. Play another game of odd man out, but this time the sounds are gonna be ever so different.Okay. On completion of the test sequence, reward the child with a sticker and a certificate, provide the parent with a verbal summary of their child's results compared against age specific norms to account for developmental differences between children, and She's done really, really well.

It's a whole hour that we've been doing all these listening and thinking tests, and she's got through it all. Her results are all shown to be absolutely normal. Now let's look at some representative test results.

Here are examples of good and poor performances for two different children. In the good performance, the child consistently identifies the odd one out and both tracks rapidly converge to the same threshold for intensity level. In other words, both the between and within track responses are highly consistent with minimal deviation.

This performance suggests on-task attention has been maintained throughout both tests. Here are responses from a younger child. It is clear from the rapid convergence to threshold on the first track that the child has understood the task.

However, variations in on-task attention are also apparent in the first and second tracks. In the first track, the child responds with reasonable consistency up to the last four trials. He then provides a succession of errors resulting in a higher final threshold that might have been predicted earlier in the track.

During the second track, the child fails to achieve performance comparable to the lowest level of detection that was observed in the earlier portion of the first run. There is a succession of six incorrect responses resulting in a progressive increase in the presentation level of the target, up to approximately 40 decibels above that of the first track. Correct responses, then follow at a round trial 13, and the child continues with a series of correct responses until the track finishes the large in trial track response variation in conjunction with the large in inter track difference for the second track suggests a lapse in attention rather than a problem with listening per se.

I think what's impressive about this protocol is it can provide a measure of a broad range of listening skills and cognitive skills, and once mastered be done in under an hour. Although the presentation and the management of the protocol is largely automated to get the best outta the child, it's important for the tester throughout the session to maintain a high level of engagement and enthusiasm with the child. After watching this video, you should be able to use the IMAP test battery for assessing listening skills in children quickly and reliably.

You should also be able to present the instructions to the child in child friendly language, and you should be able to maintain the child's engagement in the task throughout.