PEDIATRIC AND MENTALLY RETARDED POPULATIONS

Minimum Response Levels (MRL’s) No response at threshold Respond at supra-threshold levels Response = hearing No response = hearing still possible

Hearing and Language Development Babbling (6 months) still present in hearing impaired Lalling (6mos - 9mos.) Echolalia ( mos.) is NOT present with hearing impaired child True Speech ( mos.) - delayed in many hearing impaired 2 ½ years is normal Dx of hearing impairment in US

We must answer these questions……. Can we detect hearing loss in the infant Can we diagnose the loss Can we do any treatment about it

Apgar Test Respiratory Muscle tone Heart rate Color Reflex irritability Values at 1, 5, & 10 minutes after birth

Warble tone Downs (1967) Startle response (3KHz at 90 dBSPL- Moro reflex 1-3 mos) Risk factors (high risk registry for inclusion in testing) Combine ABR’s with acoustic reflex and OAE’s A pure tone that is frequency modulated (modulation is expressed as a percentage, i.e. 5%)

Neonates ( days) Infants (29 days - 3 years) Pre-school (3 - 5 yrs.)

Screening ABR OAE’s Acoustic reflex

Infant testing Noise makers Behaviorial Observation Audiometry (BOA) keys, cellophane etc.) Sound field/free field Conditioned Orientation Reflex (COR) Visual Response Audiometry (VRA)

Ewing & Ewing 1944 rattles paper noise makers cup and spoon

Auditory localization - 8 months or later they search for sound source cease activity awaken from a light sleep facial expression changes vocalize

1 - 5 years Speech Audiometry Pure tone Audiometry Operant Conditioning Audiometry Tangible Reinforcement Operant Conditioning Audiometry (TROCA) Electrophysiological hearing tests  Electro-dermal audiometry (EDA)  cardiotachometry

1- 5 Yrs ( continued) Play Audiometry (peg board)  Child must be motivated  Must have his attention  Reinforcement must be strong Central Auditory Processing Disorder (CAPD or L.D.)  May have normal hearing but processing poor  poor listening skills  Short attention span  Poor memory  Reading comprehension deficient  Hyperactive + trouble discriminating in presence of noise

School Age Group ScreeningTests Sweep Check Tests Individual pure tone thresholds Tympanometry