Instructional Programming To Prepare Children With Multiple Disabilities To Take A Hearing Test Carol Cummings, Kathryn J. Saunders, Dean Williams, & Yusuke Hayashi Life Span Institute, University of Kansas Introduction Results Discrimination Training Background Unremediated hearing loss delays language acquisition. Behavioral hearing tests are required to produce an audiogram, a record of the child’s hearing level across a range of volumes and frequencies. The audiogram is essential to prescribing and adjusting corrective devices such as hearing aids and cochlear implants. Various screening methods are available, but they only provide a gross estimation of the loss and they do not provide an audiogram. For the behavioral hearing test, a child must learn to press a button when a tone is presented, and not to respond in the tone’s absence (i.e., a successive discrimination). (Martin & Clark, 2012) 40% of children with hearing loss have additional disabilities, including intellectual disabilities, blindness, and cerebral palsy (Rosenhall et. al., 1999; Herer, 2012; Park et.al., 2012) Audiogram For these children, the additional time and the expertise required for teaching the successive discrimination can be insurmountable barriers to evaluation in the audiology clinic. All too often, such children are deemed untestable behaviorally. Purpose Our primary goal is to develop computer-assisted instruction that BCBA’s, teachers, and paraprofessionals, can use to teach the successive discrimination before the child goes to the clinic. 108 290 Method A laptop computer with custom software presents stimuli and records data. Response button Participant Trainer Acquisition data for all subjects. The percentage of tone presentations (S+) with responses and the percentage of no-tone periods (S-) with responses, in the three steps of discrimination training, shown in 5 trial blocks. Step numbers shown on the x-axis. Clinical Hearing Test Generalization Training Procedure The trainer initiates a trial when the participant’s hands are away from the button and s/he is not consuming a reinforcer. AS Hz 500 1000 1500 2000 2500 3000 4000 6000 8000 dB 10   20 30 40 50 60 80 JW Hz 500 1000 1500 2000 2500 3000 4000 6000 8000 dB 10   20 30 40 50 60 80 Trial Configuration Training Steps Discrimination training without headphones (2000Hz @ 60dB; sound field) No S- period between beginning of trial and tone onset // tone ends after response S- Period (no tone) of 2-8 seconds, average 5s before tone// tone ends after response S- period of 2-8 seconds // tone ends after response, or after 8 seconds Headphones training Generalization training with headphones Various frequencies at 60dB Various frequencies at various dB levels Audiologist administers hearing test in clinic BH Hz 500 1000 1500 2000 2500 3000 4000 6000 8000 dB 10   20 30 40 50 60 80 PR Hz 500 1000 1500 2000 2500 3000 4000 6000 8000 dB 10   20 30 40 50 60 80 EJ Hz 500 1000 1500 2000 2500 3000 4000 6000 8000 dB 10   20 30 40 50 60 80 NA* Hz 500 1000 1500 2000 2500 3000 4000 6000 8000 dB 10   20 30 40 50 60 80 Participants Selected because of previous failed attempt(s) by an audiologist to produce conclusive results from a hearing exam Did not learn the discrimination with instructions and prompting during our initial assessment Responses to the first presentation of each generalization tone in Steps 4 & 5. Colored blocks show tested stimuli. Red indicates no response, and green indicates a correct response. Cells with red and green indicate that a correct response was obtained on the second presentation of the tone. Frequency in Hertz (Hz) and volume in decibels (dB) are shown at the top and to the left respectively. *NA was trained at 80dB and was not tested on lower volumes. Participant Participant Description Age (years) Individualized Procedures Tested in the Clinic AS ID Down Syndrome Non-verbal 12 --- Y BH Minimal-verbal 4 EJ Was given toys to manipulate during the ITI for all sessions N/A JW 5 PR 7 NA Possible Brain Damage Blind / Motor Impairments Removed overhead light Step 1: Increased from 60dB to 70dB, then to 80dB Step 2-5: S- Period was VT3s instead of VT5s Discussion The program shows great promise for training non-verbal children to take a hearing exam All participants who underwent clinical hearing tests were successful following training; testing had been unsuccessful prior to training. These data were collected to inform the development of a teaching technology ultimately for dissemination to practitioners. We also have taken the first step in developing procedures for easily training practitioners to use the instructional program. Currently a degree of basic knowledge of behavioral principles and practices seems necessary to use this program, e.g., those with training for BCBA certification or previous experience with difficult to teach children. Additional materials to train trainers in methods of response shaping, prompt fading, and reinforcement selection may be needed to train less technically skilled trainers Acknowledgements Funded by the Office of Special Education Programs (DED 68248). Additional support from NICHD HD002528 and NIDCD DC005803. Special thanks to Kat Stremmel-Thomas, who provided the impetus for this research program, and to Joe Spradlin. We thank Carlos Sanchez and Sam Jordan for assistance in conducting sessions. For consultation, we thank Dr. Tiffany Johnson and Dr. Angela Reeder (Department of Speech/Language/Hearing-KU), Audiologists Alicia Troike and Ceri Loflin  (Greenbush Educational Service Center), and Audiologist Becky Dhoogie (Parsons State Hospital).