Behavioral Measures of Listening Effort in School-Age Children: Examining the Effects of Signal-to-Noise Ratio, Hearing Loss, and Amplification

Objectives: Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on 2 commonly used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs). Design: A total of 82 children (aged 6–13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort. Results: Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs. Conclusions: This study compared dual-task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appear more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts, a decrement that could have a negative impact on learning and academic achievement in the classroom. ACKNOWLEDGMENTS: The authors would like to acknowledge the contributions of Hilary Davis and the many graduate students who assisted in participant recruitment and data collection. The authors also thank Wes Grantham for the development of the coding software, as well as Nick Bennett, Elizabeth Geller, Stone Dawson, Quela Royster, and Beth Suba for their help with coding and reliability checks. This work was supported by the Dan and Margaret Maddox Charitable Trust, and the Institute of Education Sciences (IES), U.S. Department of Education, through Grant R324A110266 to Vanderbilt University (Nashville, TN; awarded to Fred H. Bess, PI). The content expressed are those of the authors and do not necessarily represent the views of the Institute of Education Sciences, or the U.S. Department of Education. The authors declare no other conflict of interest. Received June 9, 2017; accepted April 27, 2018. Address for correspondence: Ronan McGarrigle, Department of Psychology, University of Chester, Parkgate Road, Chester, United Kingdom. E-mail: r.mcgarrigle@chester.ac.uk. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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