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The Persian Version of the Auditory Behavior in Everyday Life Questionnaire

January 2018
Journal of School Health 5(1):e55952

DOI:10.5812/intjsh.55952

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CC BY-NC

Authors:

Majid Oryadi-Zanjani

Soroush (Re)Habilitation Center for Children with Hearing Loss

Maryam Vahab

Shiraz University of Medical Sciences

Suzanne Carolyn Purdy

University of Auckland

Abstract Objectives: The auditory behavior in everyday life (ABEL) questionnaire is a valid tool that was translated and adapted to Persian languagebyOryadi-Zanjani et al. (2015). Thisstudyaimedat establishingthefinalPersianversionof theABELquestionnaire(ABEL-P). Methods: This study was a cross-sectional, observational study, conducted during a 12-month period. The questionnaires were com- pleted by 113 mothers of 1- to 6-year-old children with hearing loss using hearing aids or cochlear implants. The subjects were re- cruited from children studying in a rehabilitation Centre for Persian children with hearing loss in Shiraz, Iran. This study had 4 main aims, including (a) specifying internal consistency of the questionnaire in a larger sample size, (b) comparing the 26-item ABEL-P and the 24-item ABEL-P, (c) factor analysis to examine the factor structure of the ABEL-P, and (d) assessing the capability of the tool in order to determine the auditory development of children with HL during a 12-month period. Results: Both the 24-item (α = 0.95) and the 26-item (α = 0.96) ABEL-P had high reliability. There was a good correlation between the items in all the 3 factors. According to the results of factor analysis, all items of the ABEL-P questionnaire had relatively high loadings (0.60 to 0.83) on a single factor. There was a significant difference among the means of the subject’s ABEL scores within a 12-month period (P value < 0.001). Conclusions: The 23-item ABEL-P questionnaire is a valid and reliable assessment tool that could be used to measure the auditory development in Persian-language children.

The Scree Plot of the ABEL-p

…

The Means and 95% Confidence Intervel of the Subjects' ABEL-P Scores Within a 12-Month Period

…

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Int J School Health. 2018 January; 5(1):e55952.

Published online 2017 November 6.

doi: 10.5812/intjsh.55952.

Research Article

The Persian Version of the Auditory Behavior in Everyday Life

Questionnaire

Mohammad Majid Oryadi-Zanjani,1,2,* Maryam Vahab,1,2 and Suzanne C Purdy3

1Speech Therapy Department, Shiraz University of Medical Sciences, Shiraz, Iran

2Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

3Department of Speech Pathology and Audiology, University of Auckland, Auckland, New Zealand

*Corresponding author: Mohammad Majid Oryadi-Zanjani, Abiverdi 1, Chamran Blvd, P.O. Box 71345-1733, Shiraz, Iran. Tel: +98-7136271551, Fax: +98-7136272495, E-mail:

oryadi@sums.ac.ir

Received 2017 June 21; Revised 2017 October 02; Accepted 2017 October 17.

Abstract

Objectives: The auditory behavior in everyday life (ABEL) questionnaire is a valid tool that was translated and adapted to Persian

language by Oryadi-Zanjani et al. (2015). This study aimed at establishing the ﬁnal Persian version of the ABEL questionnaire (ABEL-P).

Methods: This study was a cross-sectional, observational study, conducted during a 12-month period. The questionnaires were com-

pleted by 113 mothers of 1- to 6-year-old children with hearing loss using hearing aids or cochlear implants. The subjects were re-

cruited from children studying in a rehabilitation Centre for Persian children with hearing loss in Shiraz, Iran. This study had 4

main aims, including (a) specifying internal consistency of the questionnaire in a larger sample size, (b) comparing the 26-item

ABEL-P and the 24-item ABEL-P,(c) factor analysis to examine the factor structure of the ABEL-P, and (d) assessing the capability of the

tool in order to determine the auditory development of children with HL during a 12-month period.

Results: Both the 24-item (α= 0.95) and the 26-item (α= 0.96) ABEL-P had high reliability. There was a good correlation between

the items in all the 3 factors. According to the results of factor analysis, all items of the ABEL-P questionnaire had relatively high

loadings (0.60 to 0.83) on a single factor. There was a signiﬁcant diﬀerence among the means of the subject’s ABEL scores within a

12-month period (P value < 0.001).

Conclusions: The 23-item ABEL-P questionnaire is a valid and reliable assessment tool that could be used to measure the auditory

development in Persian-language children.

Keywords: Hearing loss, Children, Development, Questionnaires, Persian language, ABEL-P

1. Background

Recent studies indicated that children, who use hear-

ing aids (HAs) or cochlear implants (CIs), greatly vary in

their spoken word and sentence recognition skills depend-

ing on their auditory skills development (1,2). Early diag-

nosis and hearing aid ﬁtting or cochlear implantation are

associated with improved language outcomes for children

with a wide range of hearing losses (3). Therefore, speciﬁc

assessment tools are needed, such as questionnaires for 2

main aims: (a) to diagnose children with hearing loss as

soon as possible; and (b) to assess their auditory develop-

ment during the intervention.

The auditory behavior in everyday life (ABEL) question-

naire is a valid and reliable tool (4) that was translated and

adapted to various languages, such as Brazilian Portuguese

(5), Hebrew and Arabic (6), and Korean (7) in order to assess

auditory development in children with hearing loss (HL).

The ﬁndings of previous studies have indicated that the

ABEL, as a parental questionnaire, had good internal con-

sistency (5-9). In addition, a correlation was found between

the ABEL’s score with the degree of HL (5,9), age at implan-

tation (6), chronological age (8), and duration of HAs or CIs

use (5,7,8).

Oryadi-Zanjani et al. translated and adapted the ABEL

to Persian (8). The study was performed on 43 parents of

Persian speaking children with HL. Their ﬁndings showed

that the Persian version of ABEL questionnaire (ABEL-P)

could be used as a valid and reliable tool to evaluate the de-

velopment of auditory behaviors in Persian children wear-

ing HAs and/or CIs. Thus, they proposed that the ABEL

questionnaire could be applied by parents/caregivers, clin-

icians, and researchers to follow the children’s auditory be-

haviors in everyday life. The original version of the ABEL

questionnaire, however, has 26 items categorized to 3 fac-

tors, including auditory-oral (11 items), auditory awareness

(10 items), and conversational/social skills (5 items). Actu-

4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the

original work is properly cited.

Oryadi-Zanjani MM et al.

ally, items 9 and 11 of the auditory-oral section are repeated

in the auditory awareness in items 5 and 8, respectively. Ac-

cording to Oryadi-Zanjani et al.’s study, some parents an-

swered these repeated items diﬀerently because they had

considered it as a diﬀerent item (8). Although Purdy et al.

did not report the same issue in their study on the original

version of the ABEL (4), the ﬁndings of Oryadi-Zanjani et

al.’s study should be considered due to its potential eﬀect

on children’s scores. Therefore, the researchers decided to

compare the original ABEL-P to a 24-item questionnaire by

removing items 5 and 8 from the auditory awareness while

their scores were added to the total score of the question-

naire. Overall, the study’s aim was to establish the ﬁnal Per-

sian version of the ABEL.

2. Objectives

This study had 4 main aims, including (a) specifying

internal consistency of the questionnaire in a larger sam-

ple size, (b) comparing the 26-item ABEL-P and the 24-item

ABEL-P, (c) factor analysis to examine the factor structure

of the ABEL-P, and (d) assessing the capability of the tool to

determine the auditory development of children with HL

during a 12-month period.

3. Methods

This study was a cross-sectional and observational

study, conducted during a 12-month period. This study was

approved by the ethical committee of Shiraz University of

Medical Sciences. Informed consent was obtained from

parents of patients participating in the study. As the sub-

jects should have the same educational history, the sam-

ples had to be recruited from one center. There are only

2 rehabilitation centers for Persian children with hearing

loss in Shiraz, Iran. Therefore, the subjects were recruited

through the consecutive sampling method from the cen-

ter with the largest sample size; i.e. Soroush rehabilita-

tion Centre for Persian Children with Hearing Loss. Accord-

ingly, the researchers recruited all the 113 children study-

ing at this center. Therefore, the questionnaires were com-

pleted by 113 mothers of 1- to 6-year-old children with HL

using HAs or CIs. The reliability of the 2 Persian versions

of the ABEL-P (26-items and 24-items) was compared as the

second aim. To achieve the fourth aim, 53 mothers ﬁlled

out the questionnaire 6 times in every 2-month interval.

The inclusion criteria for the subjects were bilateral mild-

to-profound, congenital sensory-neural hearing loss, use

of HAs or CIs, use of oral language as a communication

method, same educational history, and no other disabili-

ties. All the subjects had unilateral CIs or bilateral HAs. The

original ABEL questionnaire had a 7-point rating scale, in-

cluding 0 = never, 1 = hardly ever, 2 = occasionally, 3 = about

half the time, 4 = frequently, 5 = almost always, and 6 = al-

ways (4). According to a survey on 30 parents, the research

found that there was no diﬀerence between “hardly ever”

and “occasionally” as well as between “frequently” and “al-

most always” in Persian language and culture. Thus, “occa-

sionally” and “frequently” were chosen in the ABEL-P. As a

result, the ABEL-P questionnaire has been modiﬁed to a 5-

point rating scale, including 0 = never, 1 = occasionally, 2 =

about half the time, 3 = frequently, and 4 = always.

Speciﬁcally, Cronbach’s Alpha was used to determine

internal consistency of the 2 versions of the ABEL-P (26

items and 24 items). Furthermore, factor analysis was used

to investigate the factor structure of the ABEL-P question-

naire. In addition, repeated measures was used to com-

pare the results of 6 times administration of the question-

naire, and LSD post hoc test was used to determine which

times were signiﬁcantly diﬀerent. The IBM SPSS statistics

software 21 was used to analyze the data.

4. Results

Table 1 displays the distribution of the children with

hearing loss based on 3 variables of age, ampliﬁcation de-

vice, and severity of hearing loss.

Table1. The Distribution of Children Based on Age, Ampliﬁcation Device, and Sever-

ity of Hearing Lossa

Variables Value

Gender

Girl 48

Boy 65

Age, mo

Mean 39.48

SD 16.67

Ampliﬁcation device

HA 55

CI 58

Severity of hearing loss

MildI 1

ModerateII 11

Moderately SevereIII 21

SevereIV 67

ProfoundV 13

Abbreviations: CI, Cochlear Implant; HA, Hearing Aid; SD, Standard Deviation;

aI, 26 - 40 dB; II, 41 - 55 dB; III, 56 - 70 dB; IV,71 - 90 dB; V > 91 dB.

2Int J School Health. 2018; 5(1):e55952.

Oryadi-Zanjani MM et al.

Table 2 illustrates the Cronbach’s Alpha of the 26-item

and the 24-item Persian version of the ABEL-P, when each

item was deleted in the 3 factors, including auditory-oral,

auditory awareness, and conversational/social skills. Over-

all, both the 26-item and the 24-item ABEL-P had good in-

ternal consistency reliability with Alpha = 0.96 and Alpha

= 0.95, respectively.

Table2. TheCronbach’s Alpha of the26- and 24-Item Questionnaires Removing Each

Item

Factors 26-Item Questionnaire 24-Item Questionnaire

Deleted

Item

Cronbach’s

Alpha

Deleted

Item

Cronbach’s

Alpha

Auditory-oral

1 0.93 1 0.92

2 0.92 2 0.91

3 0.93 3 0.92

4 0.93 4 0.92

5 0.93 5 0.92

6 0.93 6 0.92

7 0.93 7 0.92

8 0.93 8 0.91

9 0.93 9 0.92

10 0.94 10 0.92

11 0.93 11 0.92

Auditory

awareness

1 0.92 1 0.88

2 0.91 2 0.86

3 0.91 3 0.87

4 0.92 4 0.90

5 0.91 5 0.88

6 0.92 6 0.87

7 0.91 7 0.88

8 0.92 8 0.89

9 0.92

10 0.92

Conversational/

social skills

1 0.63 1 0.61

2 0.64 2 0.59

3 0.63 3 0.57

4 0.77 4 0.76

5 0.66 5 0.59

Principal factor analysis was used to examine the fac-

tor structure of the ABEL-P. According to Table 3, the results

of factor analysis showed that all items of the ABEL-P ques-

tionnaire had relatively high loadings (0.60 to 0.83) on a

single factor. The item 4 of the factor 3, however, had low

correlation with the other items of this factor including: 4

and 1 = 0.24, 4 and 2 = 0.17, 4 and 3 = 0.08, and 4 and 5 = 0.13.

Therefore, Figure 1 displays the scree plot of the ABEL-P af-

ter removing item 4. Accordingly, the eigenvalues of the 4

items were more than 1 associated with 68.2% of the vari-

ance. In other words, these items had the most important

eﬀect in the questionnaire compared to the other items.

Component Number

Eigenvalue

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Figure 1. The Scree Plot of the ABEL-p

Based on Figure 2, there was a signiﬁcant diﬀerence

among the means of the subject’s ABEL-P scores within a 12-

month period (df = 5, F = 35.67, P value < 0.001). However,

according to the results of LSD post hoc test, there was no

signiﬁcant diﬀerence between months 1 and 2 (P > 0.05),

and 4 and 5 (P > 0.05).

5. Discussion

Based on the ﬁndings, both versions of the ABEL-P had

high internal consistency reliability (Alpha for the 26-item

= 0.96 and Alpha for the 24-item = 0.95). This ﬁnding was

congruent with the results provided by Purdy et al. (4),

Souza et al. (5), Souza and Iorio (9), Geal-Dor et al. (6),

Oryadi-Zanjani et al. (8), and Choi et al. (7).

Besides, internal consistency reliability of the 2 ver-

sions was the same. In other words, removing items 5 and 8

from the factor of auditory-awareness had no eﬀect on the

subjects’ scores. This ﬁnding was associated with the re-

sults of Purdy et al.’s, which found that the 24-item of ABEL

had an excellent overall reliability of 0.95 (4).

Int J School Health. 2018; 5(1):e55952. 3

Oryadi-Zanjani MM et al.

Table3. Factor Analysis of the ABEL-P

Items Components

1a2b3c

Initiates spoken conversations with familiar people 0.81 -0.10 -0.12

Says a person’s name to gain their attention 0.82 0.00 -0.01

Says “please” or “thank you” without being reminded 0.75 -0.33 0.06

Responds verbally to greeting from familiar people 0.79 -0.26 -0.20

Asks for help in situations where it is needed 0.76 0.32 -0.17

Shows interest in spoken conversations around him/her 0.80 0.06 -0.17

Responds verbally to greeting from unfamiliar person(s) 0.78 -0.35 -0.04

Says the names of siblings, family members, classmates 0.81 0.05 -0.15

Asks about sounds heard around him/her (e.g., planes, trucks, animals) 0.83 0.08 -0.14

Plays cooperatively in a small group without adult supervision 0.63 -0.06 -0.05

Sings 0.75 0.01 0.56

Answers telephone appropriately 0.78 -0.28 0.02

Responds to own name spoken in the same room 0.73 0.30 0.12

Responds to a door bell or knock 0.76 0.32 -0.11

Will whisper a personal message 0.74 -0.14 0.32

Knows when making loud sounds (e.g., slamming doors, stomping) 0.67 0.39 -0.05

Is aware when telephone is ringing 0.70 0.43 0.02

Knows when hearing aid(s) or cochlear implant(s) are not working 0.60 0.31 0.17

Experiments with newly discovered sounds 0.69 0.11 -0.08

Initiates spoken conversations with unfamiliar people 0.79 -0.26 0.09

Takesturns in conversations 0.72 -0.34 0.11

Talksusing a normal voice level 0.77 -0.14 -0.24

Quietens activity when asked to do so 0.68 -0.10 -0.15

aAuditory-oral.

bAuditory awareness.

cConversational/social skills.

On one hand, according to the results of factor analy-

sis, all the items of the ABEL-P had relatively high loadings

(0.60 - 0.83) on just a single factor (Table 3). In other words,

it was not possible to arrange the items of the Persian ver-

sion of the ABEL questionnaire to 3 factors. Consequently,

the ABEL-P could be used to assess the development of au-

ditory behavior in Persian children. However, further stud-

ies with a larger sample size on the Persian version of the

ABEL questionnaire may reveal three factors similar to the

original questionnaire.

On the other hand, it was decided to remove item 4

from factor 3 in the original questionnaire, because of low

loadings of this item with the other items of the factor. To

sum up, the ﬁnal ABEL-P includes 23 items due to removal

of repeated items 5 and 8 of factor 1 and item 4 of factor 3

in the original 26-item questionnaire.

The administration of ABEL-P on children with HL

within a 12-month period at 2-month intervals indicated

that this assessment tool is sensitive to developmental

changes of auditory behaviors in children that are speak-

ers of the Persian language. Therefore, it is important to

point out that the 23-item version of the ABEL-P question-

naire is qualiﬁed to be used for the assessment of auditory

development in Persian speakers.

6. Conclusion

The 23-item Persian version of the ABEL is a strong

valid and reliable assessment tool that can be used to mea-

4Int J School Health. 2018; 5(1):e55952.

Oryadi-Zanjani MM et al.

51.75 52.8

60.46

65.44 66.33

70.66

39.11 41.43

49.12

54.41 54.76

59.94

45.43 47.11

54.79

59.92 60.55

65.3

1 2 3 4 5 6

Subjects' ABEL-P scores Within a 12-Month Period

The Two-Month Intervals Within a 12-Month Period

The Means and Error Bars for 95% Conﬁdence Interval

Figure 2. The Means and 95% Conﬁdence Intervel of the Subjects’ ABEL-P Scores

Within a 12-Month Period

sure the development of auditory behaviors in Persian-

language speakers.

Acknowledgments

The authors would like to thank the children and their

parents enrolling at Soroush rehabilitation Centre for Per-

sian children with hearing loss in Shiraz, Iran, who partic-

ipated in the study. Mrs. Zahra Zandi is appreciated for

her cooperation in collecting the data. Besides, the authors

would especially like to thank Mrs. Farzaneh Mobasheri for

her worth consultation in analyzing the data.

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Int J School Health. 2018; 5(1):e55952. 5

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Full-text available

Aug 2024

Background: Longitudinal studies highlight the importance of early intervention and timely device fitting for language development in children with congenital or early acquired hearing loss. Due to the variability in hearing loss, comorbidities, family circumstances, and service access, individualised monitoring of listening development is essential to inform decision-making. The Functional Listening Index—Paediatric (FLI-P), a 64-item hierarchical checklist of listening skills, has been validated for children with hearing loss aged 0–6 years. This study aimed to develop benchmarks for the FLI-P in typically hearing children, allowing for comparison with individual children with hearing loss. Methods: FLI-P scores were obtained from parents/caregivers of 561 typically hearing children aged 0–72 months. Each child’s FLI-P score was categorised into a 6-month age block, with a minimum of 36 data points per block. Quantile regression was employed to establish percentiles of FLI-P scores by age. Results: FLI-P scores were successfully recorded for all 561 children. Regression analysis determined that the 16th and 84th percentiles of FLI-P scores corresponded to approximately ±1 standard deviation from the median score for each age group. A graphical representation of these percentile trajectories was created to facilitate comparison between children with hearing loss and the normative data. Conclusion: A normative dataset of FLI-P scores from typically hearing children has been established, allowing for comparisons with the scores and developmental trajectories of individual children with hearing loss. The study demonstrates how FLI-P can guide early intervention decisions and effectively monitor progress.

Speech-in-Noise Recognition in School-Aged Children with Hearing Loss: Evidence of a Critical Condition

Article

Dec 2023

Previous research findings demonstrated that cochlear implants (CIs) users have essential challenges with speech recognition in the presence of background noise. Therefore, this study aimed to determine speech-in-noise (SiN) perception in Persian school-aged children with CIs/hearing aids (HAs) compared to their peers with normal hearing (NH). The research was administered as a cross-sectional study. Speech-in-noise performance in thirty-three school-aged children with hearing loss (19 unilateral CIs users and 14 bilateral HAs users) was compared to twenty school-aged children with normal hearing by using the Persian Lexical Neighborhood Tests (PLNTs). To make sure that floor or ceiling effects would not affect the children’s performance, the PLNTs were performed by the sound field at different levels of signal-to-noise ratio (SNR). The SiN performance on all four subscales of the PLNTs was significantly poorer in Persian school-aged CIs/HAs users than their peers with NH for all stepwise increases in the SNR (P < 0.001). The Persian school-aged CIs users experience a critical condition related to listening spectrally degraded speech in noisy environments such as home, school, and classroom due to SiN perception insufficiency.

Speech-in-Noise Recognition in School-Aged Children with Hearing Loss: Evidence of a Critical Condition

Article

Full-text available

Dec 2023

Previous research findings demonstrated that cochlear implants (CIs) users have essential challenges with speech recognition in the presence of background noise. Therefore, this study aimed to determine speech-in-noise (SiN) perception in Persian school-aged children with CIs/hearing aids (HAs) compared to their peers with normal hearing (NH). The research was administered as a cross-sectional study. Speech-in-noise performance in thirty-three school-aged children with hearing loss (19 unilateral CIs users and 14 bilateral HAs users) was compared to twenty school-aged children with normal hearing by using the Persian Lexical Neighborhood Tests (PLNTs). To make sure that floor or ceiling effects would not affect the children's performance, the PLNTs were performed by the sound field at different levels of signal-to-noise ratio (SNR). The SiN performance on all four subscales of the PLNTs was significantly poorer in Persian school-aged CIs/HAs users than their peers with NH for all stepwise increases in the SNR (P < 0.001). The Persian school-aged CIs users experience a critical condition related to listening spectrally degraded speech in noisy environments such as home, school, and classroom due to SiN perception insufficiency.

Evaluation of auditory brainstem implant (ABI) users’ auditory behavior in everyday life

Article

Full-text available

Jun 2023
Eur Arch Oto Rhino Laryngol

Purpose This study aims to evaluate the everyday listening status of pediatric ABI users using the Turkish ABEL questionnaire. Methods The study included 33 parents of children with auditory brainstem implant, and 28 parents of children with cochlear implant were included as a control group. All implant users were between the ages of 4–14. Parents answered the ABEL questionnaire to assess their child's auditory behavior in their daily living environment. In addition, Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scales were used to evaluate speech perception and production. Results Auditory-aural, auditory awareness and ABEL total score of ABI users were statistically significantly lower than the CI group (p < 0.05). There was no statistically significant difference between the groups in the Conversational/Social skills subgroups. It was found that as the duration of ABI use increased, auditory-verbal, social skills and total scores increased significantly. In addition, correlations were obtained between ABEL total and subscale scores and CAP and SIR scores. Conclusions Parents believe that their children adapt nicely to ABI and are aware of environmental sounds. This study reveals the auditory, aural, and social skills of children using ABI through the regards of their parents. This study showed that the ABEL questionnaire, which was used in previous studies to express parental views of children with hearing aids and cochlear implants, can also be used for parents of children using ABI.

A systematic review of speech recognition assessment tools for Persian-speaking children with and without hearing disorders

Article

Full-text available

Dec 2022

Majid Oryadi-Zanjani

Background Speech recognition is a significant component of speech perception assessment as a main clinical target in children with hearing disorders. So, this article presents a systematic review designed to provide clinical and research guideline for the speech recognition assessment in Persian-speaking children with and without hearing disorders. Methods A systematic search was conducted to determine the research evidence dedicated to the assessment of speech recognition in Persian-speaking children with and without hearing disorders. Therefore, peer-reviewed journal articles published between 1982 and December 2021 were identified using the following electronic databases: PubMed, Scopus, MEDLINE, Web of Science,Magiran, IranMedex, Scientific Information Database (SID), and Google Scholar. The included papers were analyzed according to different variables including: test age, vocabulary competency, cognitive demands, response format, presentation mode, stimulus format,stimulus variability, stimulusmode, and test condition. Results The review identified four papers related to the development of five assessment tools to measure speech recognition in Persian-speaking children including: Persian Monosyllabic Lexical Neighborhood Tests (PMLNTs), Persian Disyllabic Lexical Neighborhood Tests (PDLNTs), Persian version of the words-in-noise (WIN), Tavana(test for evaluating auditory skills), and closed-set speech recognition test for Persian speaking children. The properties and the limitations of each test were considered in this review article. Conclusion According to this systematic review, there are just four speech recognition assessment tools to measure specifically spoken word recognition in Persian-speaking children. The results of this review article can be used as a clinical and research guideline for the speech recognition assessment in Persian-speaking children with hearing disorders.

Speech-in-noise perception in school-age cochlear implants users compared to their peers with normal hearing: evidence of a critical condition

Preprint

Full-text available

Jul 2022

Mohammad Majid Oryadi-Zanjani

Background: Although cochlear implants (CIs) is the state-of-the-art therapy for individuals with hearing impairment to process the acoustic-phonetic cues of speech during the sensitive period of spoken language development and to access optimal auditory performance, previous research findings demonstrated that the users have essential challenges with speech recognition in the presence of background noise. Therefore, the aim of this study was to determine speech-in-noise (SiN) perception in Persian school-age CIs/hearing aids (HAs) users compared to their peers with normal hearing (NH). Methods: The research was administered as a cross-sectional study. Speech-in-noise performance in thirty-three school-age children with hearing loss (19 unilateral CIs users and 14 bilateral HAs users) was compared to twenty school-age children with normal hearing by using the Persian Lexical Neighborhood Tests (PLNTs) include: Persian Monosyllabic Lexical Neighborhood Test (PMLNT)-easy, PMLNT-hard, Persian Disyllabic Lexical Neighborhood Test (PDLNT)-easy, and PDLNT -hard. To make sure that floor or ceiling effects would not effect on the children’s performance, the PLNTs were performed by sound field at different levels of signal to noise ratio (SNR). Results: The SiN performance on all four the subscales of the PLNTs was significantly poorer in Persian school-age CIs/HAs users than their peers with NH for all stepwise increases in the SNR (P < 0.001). Conclusions: The Persian school-age CIs users experience a critical condition related to listening spectrally degraded speech in noisy environments such as home, school, and classroom due to SiN perception insufficiency. Accordingly, it can be concluded that they are potentially at-risk of literacy difficulties. Therefore, it is suggested that SiN perception in school-age CIs users be systematically assessed and monitored through valid tests in order to managing their listening problems in the situations with background noise.

Validity and Reliability of Korean Version of the Auditory Behavior in Everyday Life Questionnaire

Article

Full-text available

Jan 2017

Purpose: The Auditory Behavior in Everyday Life (ABEL) questionnaire has been proven for its reliability and validity across various cultures for assessing auditory behaviors of children with hearing loss. The study’s purpose was to translate the ABEL questionnaire into Korean and verify reliability and validity of Korean version of ABEL (ABEL-K). Method: After translation, the ABEL-K evaluated for appropriateness, and back translated by a bilingual user to compare to the original regarding semantic equivalence. ABEL-K was completed by 48 parents of children (from ages 3-15 years) with hearing loss (9 children with hearing aids and 39 children with cochlear implants). Among the 48 children, 11 were in preschool, 16 in elementary, and 21 in secondary. Internal consistency reliability of ABEL-K was verified by Chronbach’s alpha. The mixed factorial ANOVA was conducted to compare the age group and the evaluation areas (aural-oral, auditory awareness, and social/conversational skills). The Pearson Correlation Coefficient between the scores and chronological age, and scores and period of CI experience were evaluated, respectively. Results: The results indicated that although ABEL-K showed good internal consistency reliability (α = 0.90), there seems to be issues in its validity due to ambiguous expression and the cultural differences. The ABEL scores among age groups were not significantly different. However, there was a significant difference in ABEL scores between auditory awareness and social/conversational skill areas. There was significant correlation with CI experience, but not with chronological age. Conclusion: Thus, this study suggests a way that ABEL-K should be utilized, taking precautions in the interpretation of the results.

Questionário ABEL - Auditory Behavior in Everyday Life: estudo da confiabilidade - consistência interna da versão brasileira e reprodutibilidade no teste-reteste

Article

Full-text available

Dec 2014

PURPOSE: to check the reliability (reproducibility and internal consistency) of the Portuguese version of the questionnaire Auditory Behavior in Everyday Life and the score associations with anamnesis and with interviewed people's schooling. METHODS: we interviewed 18 parents of children between four and 13 years and 11 months, hearing aids users. The Portuguese version of the questionnaire was administered on two occasions. We verified the reproducibility of the test-retest and internal consistency and we investigated whether the values of the questionnaire could be associated with variables of anamnesis and with interviewee's schooling. RESULTS: the questionnaire proved to be reproducible and had high internal consistency (Cronbach's Alpha>0.7). There was an association between the degree of hearing loss and scores in item "Answers telephone appropriately" (p=0.004*) and "Says the names of siblings, family members, classmates" (p=0.032*) and scores on Auditory Awareness Factor (p=0.039*). There was an association between interviewee's schooling and the scores in item "Asks for help in situations where it is needed" (p=0.027*). CONCLUSIONS: the Portuguese version of ABEL showed reliability - reproducibility and internal consistency. There is an association between the degree of hearing loss and scores on specific items and in Auditory Awareness Factor. There is an association between interviewee's schooling and the score in item "Asks for help in situations where it is needed".

Translation and adaptation of the ABEL: Auditory Behavior in Everyday Life questionnaire into Brazilian Portuguese

Article

Full-text available

Dec 2011

To translate and adapt the ABEL--Auditory Behavior in Everyday Life--questionnaire into Brazilian Portuguese, and to establish the profile of auditory behavior in a group of children who use hearing aids. The ABEL questionnaire was translated and back translated. This version was compared to the original version regarding semantic equivalence, generating a new version in Portuguese. After that, 31 parents of children fitted with hearing aids answered an anamnesis and the Portuguese version of the ABEL questionnaire. The scores obtained were related to the variables investigated in the anamnesis. Differences were found in the analysis of the aural-oral score for the variables degree of hearing loss and time of daily use of the hearing aid: children with milder degrees of hearing loss and/or children who use the hearing aid for longer periods showed better performances. There were also differences in total and auditory awareness scores for the variable time of daily use of the hearing aid, indicating that children who user their hearing aids for longer periods daily showed better performances. There was consistency between the versions generated during the translation of the questionnaire, allowing the formulation of its final version in Portuguese. Children with lower degrees of hearing loss and/or who use their hearing aids for longer periods have their daily activities less affected by the hearing loss. The ABEL questionnaire is an appropriate instrument to detail the development of auditory behaviors in children who use hearing aids.

A Parental Questionnaire to Evaluate Children's Auditory Behavior in Everyday Life (ABEL)

Article

Full-text available

Jan 2003

The Auditory Behavior in Everyday Life (ABEL) questionnaire was developed to assess parental perceptions of their children's auditory behavior. The original 49-item questionnaire was intended to assess auditory communication, environmental awareness, functional independence, and social/ communication skills. Our goal was to capture some of the changes in children's everyday auditory behavior in a reliable and easily quantifiable manner. Parents of 28 children aged 4 to 14 years with varying degrees of hearing loss (mild-profound) completed the questionnaire. The results were used to examine the reliability and factor structure of the questionnaire. Eleven items had poor item-total correlations. After these items were removed, the questionnaire had an overall reliability of 0.94 (Cronbach's alpha), and three factors accounted for 20.5% of the variance in the data. In a pilot investigation of the ABEL to determine its appropriateness for children with cochlear implants, questionnaires were also given to a separate group of parents of seven children aged 3 to 12 years who were about to receive a cochlear implant. Questionnaire and speech perception results were obtained preimplant and at 6, 12, 18, 24, and 36 months. Complete (6 visits) or near-complete (4 visits) results were obtained for four children. There were significant improvements over time for both speech perception and questionnaire ratings and there was significant agreement between the two measures. Overall the results indicate excellent reliability and validity of the ABEL questionnaire. Our intent was to develop a simple, quick tool for parents to rate children's auditory skills in everyday life. A shorter questionnaire can be achieved by eliminating items with the poorest reliability and factor loadings. The resultant 24-item ABEL questionnaire has an excellent overall reliability of 0.95. The items fall within three factors, "Aural-oral," "Auditory Awareness," and "Social/Conversational Skills." Children's auditory behavior can be assessed using an overall rating or separately for the three factors. Further research is needed to evaluate this short version of the questionnaire in children wearing hearing aids and cochlear implants.

Effects of Early Auditory Experience on the Spoken Language of Deaf Children at 3 Years of Age

Article

Full-text available

Jul 2006

By age 3, typically developing children have achieved extensive vocabulary and syntax skills that facilitate both cognitive and social development. Substantial delays in spoken language acquisition have been documented for children with severe to profound deafness, even those with auditory oral training and early hearing aid use. This study documents the spoken language skills achieved by orally educated 3-yr-olds whose profound hearing loss was identified and hearing aids fitted between 1 and 30 mo of age and who received a cochlear implant between 12 and 38 mo of age. The purpose of the analysis was to examine the effects of age, duration, and type of early auditory experience on spoken language competence at age 3.5 yr. The spoken language skills of 76 children who had used a cochlear implant for at least 7 mo were evaluated via standardized 30-minute language sample analysis, a parent-completed vocabulary checklist, and a teacher language-rating scale. The children were recruited from and enrolled in oral education programs or therapy practices across the United States. Inclusion criteria included presumed deaf since birth, English the primary language of the home, no other known conditions that interfere with speech/language development, enrolled in programs using oral education methods, and no known problems with the cochlear implant lasting more than 30 days. Strong correlations were obtained among all language measures. Therefore, principal components analysis was used to derive a single Language Factor score for each child. A number of possible predictors of language outcome were examined, including age at identification and intervention with a hearing aid, duration of use of a hearing aid, pre-implant pure-tone average (PTA) threshold with a hearing aid, PTA threshold with a cochlear implant, and duration of use of a cochlear implant/age at implantation (the last two variables were practically identical because all children were tested between 40 and 44 mo of age). Examination of the independent influence of these predictors through multiple regression analysis revealed that pre-implant-aided PTA threshold and duration of cochlear implant use (i.e., age at implant) accounted for 58% of the variance in Language Factor scores. A significant negative coefficient associated with pre-implant-aided threshold indicated that children with poorer hearing before implantation exhibited poorer language skills at age 3.5 yr. Likewise, a strong positive coefficient associated with duration of implant use indicated that children who had used their implant for a longer period of time (i.e., who were implanted at an earlier age) exhibited better language at age 3.5 yr. Age at identification and amplification was unrelated to language outcome, as was aided threshold with the cochlear implant. A significant quadratic trend in the relation between duration of implant use and language score revealed a steady increase in language skill (at age 3.5 yr) for each additional month of use of a cochlear implant after the first 12 mo of implant use. The advantage to language of longer implant use became more pronounced over time. Longer use of a cochlear implant in infancy and very early childhood dramatically affects the amount of spoken language exhibited by 3-yr-old, profoundly deaf children. In this sample, the amount of pre-implant intervention with a hearing aid was not related to language outcome at 3.5 yr of age. Rather, it was cochlear implantation at a younger age that served to promote spoken language competence. The previously identified language-facilitating factors of early identification of hearing impairment and early educational intervention may not be sufficient for optimizing spoken language of profoundly deaf children unless it leads to early cochlear implantation.

Audiovisual Sentence Repetition as a Clinical Criterion for Auditory Development in Persian-Language Children with Hearing Loss

Article

Dec 2016
Int J Pediatr Otorhinolaryngol

Objectives: It is important for clinician such as speech-language pathologists and audiologists to develop more efficient procedures to assess the development of auditory, speech and language skills in children using hearing aid and/or cochlear implant compared to their peers with normal hearing. So, the aim of study was the comparison of the performance of 5-to-7-year-old Persian-language children with and without hearing loss in visual-only, auditory-only, and audiovisual presentation of sentence repetition task. Methods: The research was administered as a cross-sectional study. The sample size was 92 Persian 5-7 year old children including: 60 with normal hearing and 32 with hearing loss. The children with hearing loss were recruited from Soroush rehabilitation center for Persian-language children with hearing loss in Shiraz, Iran, through consecutive sampling method. All the children had unilateral cochlear implant or bilateral hearing aid. The assessment tool was the Sentence Repetition Test. The study included three computer-based experiments including visual-only, auditory-only, and audiovisual. The scores were compared within and among the three groups through statistical tests in α = 0.05. Results: The score of sentence repetition task between V-only, A-only, and AV presentation was significantly different in the three groups; in other words, the highest to lowest scores belonged respectively to audiovisual, auditory-only, and visual-only format in the children with normal hearing (P < 0.01), cochlear implant (P < 0.01), and hearing aid (P < 0.01). In addition, there was no significant correlationship between the visual-only and audiovisual sentence repetition scores in all the 5-to-7-year-old children (r = 0.179, n = 92, P = 0.088), but audiovisual sentence repetition scores were found to be strongly correlated with auditory-only scores in all the 5-to-7-year-old children (r = 0.943, n = 92, P = 0.000). Conclusions: According to the study's findings, audiovisual integration occurs in the 5-to-7-year-old Persian children using hearing aid or cochlear implant during sentence repetition similar to their peers with normal hearing. Therefore, it is recommended that audiovisual sentence repetition should be used as a clinical criterion for auditory development in Persian-language children with hearing loss.

Audiovisual spoken word recognition as a clinical criterion for sensory aids efficiency in Persian-language children with hearing loss

Article

Nov 2015
Int J Pediatr Otorhinolaryngol

Auditory Behavior in Everyday Life (ABEL) questionnaire in Hebrew and in Arabic and its association with clinical tests in cochlear-implanted children

Article

Aug 2014

Background: The aim of this study was to describe the results of the Auditory Behavior in Everyday Life (ABEL) questionnaire adapted to Hebrew and to Arabic and its association to clinical test results in children with cochlear implants. As assessment of hearing by audiometry does not always adequately reflect performance in daily life, questionnaires have been developed to assess functioning in natural surroundings and to track progress. In order to evaluate cochlear-implanted children's verbal and communicative abilities, the parental ABEL questionnaire was developed in 2002. The advantages of the ABEL questionnaire are that it is intended for a wide age range, is quick to administer, and is filled out by parents themselves. Methods: The ABEL questionnaire was translated into Hebrew and into Arabic and routinely used in the clinic. A total of 61 questionnaires were thus filled out by parents of children with cochlear implants (ages 3.9-14.3 years) when they came for routine mapping. Retrospectively, data were analyzed and questionnaire results were compared with performance with the implant on several clinical tests: audiometric thresholds, discrimination (percentage) of vowel-consonant-vowel nonsense syllables, and results of speech perception tests with monosyllabic and bisyllabic words and with sentences in quiet and in noise. Results: A correlation was found between the different sections of the questionnaire, and age at implantation had a significant effect on questionnaire scores. However, correlations between questionnaire score and clinical tests were found only for speech perception tests in noise and not in quiet or to audiogram and speech reception threshold. Conclusions: As has been reported previously, self-evaluation or parental evaluation does not always correlate with all measured results of hearing performance. However, the subjective information collected through questionnaires can be valuable for evaluation of progress, for counseling and rehabilitation training, as well as for mapping.

Translation and adaptation of the auditory behavior in everyday life

M M Oryadi-Zanjani
S C Purdy
M Vahab
J Rasouli
M Vasfinia
E Lotf

Oryadi-Zanjani MM, Purdy SC, Vahab M, Rasouli J, Vasfinia M, Lotf E. Translation and adaptation of the auditory behavior in everyday life.

Questionnaire ABEL -auditory behavior in everyday life: A study of reliability -internal consistency of the Brazilian version and reproducibility for test-retest

Jan 2014
1763-1774

Mrf Souza
Mcm Iorio

Souza MRF, Iorio MCM. Questionnaire ABEL -auditory behavior in everyday life: A study of reliability -internal consistency of the Brazilian version and reproducibility for test-retest. Rev CEFAC. 2014;16(6):1763-74.