Evaluation of a New Method for Measuring Pediatric Hearing

By Angela Yarnell Bonino, Ph.D., CCC-A

Little is known about auditory development during the toddler and preschool years. The primary reason for this gap in knowledge is due to difficulty obtaining reliable behavioral data from young children. Recent work in my laboratory has focused on developing a method for testing this population called the Play Observer–Based, Two Interval (PlayO2I) Method.  

In our method, a child is trained to perform a play-based task when a signal is heard (e.g., put a block into a bucket). An experimenter—called an observer—watches the child’s behavior to determine when the signal was played. In contrast to clinical testing methods, the signal is randomly placed in one of two intervals for each trial by the computer program. Based on the child’s behavior, the observer determines the interval with the signal. The benefit of this approach is it is time efficient and can guard against some forms of bias. Additionally, because the child is unaware that there are two intervals, it minimizes the cognitive demand for the task.

Based on data from the offline observers, Bonino and team computed the proportion of trials in which each of the eight auditory behaviors were coded for the variable-level condition. The pattern of behavior is shown for individual children, rank ord…

Based on data from the offline observers, Bonino and team computed the proportion of trials in which each of the eight auditory behaviors were coded for the variable-level condition. The pattern of behavior is shown for individual children, rank ordered by age. For reference, the average pattern of performance is provided in the last column. Trials in which no behavior was observed were excluded.

Our recent paper in the American Journal of Audiology examined the interrater reliability of this method for a group of 2- to 4-year-old children who are developing typically. Children were asked to detect a pure-tone signal in one of two conditions: fixed-level testing, where the signal is presented at the same clearly audible intensity throughout testing; or variable-level testing, where the signal is presented at different levels that are near the child’s anticipated threshold. 

All test sessions were video recorded and were then coded by three observers (one real-time, two offline). Comparing data from the three observers from each test session, we answered two research questions: How often do the observers agree on which interval the signal occurred in? Is the resulting summary data for the test session—total percent correct score or threshold—similar for the three observers?

Results from this study confirmed strong interrater reliability for the PlayO2I Method. Reliability estimates were affected by the signal intensity level and the type of behavior provided by the child. Resulting summary data was similar across the three observers for both test conditions evaluated. These results indicate that the PlayO2I method is a powerful tool for researchers who are evaluating hearing abilities in young children. 

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Angela Yarnell Bonino, Ph.D., CCC-A, is an assistant professor in the department of speech, language, and hearing sciences at the University of Colorado Boulder. Bonino is a 2017 Emerging Research Grants scientist generously funded by the General Grand Chapter Royal Arch Masons International.  


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