1. Duration Can Be Adjusted (FT or VT)
 Preparing Children with Multiple Disabilities to Take a Hearing Test: A Technology-Transfer Project Carol Cummings, Yusuke Hayashi, Kathryn J. Saunders, & Dean Williams Life Span Institute, University of Kansas
Introduction
Participant
Method cont.
The participant was a non-verbal, 12-year-old boy with Down Syndrome.
His audiology report indicated that he was untestable, but a hearing impairment was suspected.
Background
Unremediated hearing loss adversely affects language acquisition. Behavioral hearing tests are essential to the precise evaluation of hearing that is necessary for prescribing and adjusting hearing aids and cochlear implants.
For the behavioral hearing test, a child must learn to make a response, such as pressing a button, when a tone is presented, and not to respond in the absence of the tone (i.e., a successive discrimination). For typical children, instructions and/or brief demonstration suffice to establish the successive discrimination.
 40% of individuals with hearing loss have additional disabilities, including intellectual disabilities, blindness, and cerebral palsy. For such 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.
Purpose
Our primary goal is to develop computerized instructional programming that teachers, therapists, or parents can use to teach the successive discrimination before the child goes to the clinic.
Procedure
The following describes conditions in effect beginning with
Session 3
The operator initiates the trial when the participant’s hands are away from the button and s/he is not consuming a reinforcer.
Results
Figure 2: Once the discrimination was taught, we varied the frequency of a 60dB tone from 500 to 8000 Hz --a range used in the clinic. The figure shows the percentage of S- periods that contained a response, and the percentage of S+ periods with an unprompted response. Tones on the x-axis are in order of presentation.
Figure 3: Percentage of S- periods that contain a response, and the percentage of S+ periods that contain an unprompted response as a function of tone frequency and decibel level. Tones are in order of presentation during session.
Figure 1: The training stimulus was a 60dB, 2000Hz warble tone. The figure shows the percentage of S- periods that contained a response, and the percentage of S+ periods that contained an unprompted response. Sessions are divided into thirds. Session 3 used the procedures shown in the diagram. Sessions 1 and 2 were the same, except that there was no VT 5s S- Period and prompts were discontinued.
No Response
Tone Ends
5s Tone Presented
Response (S- Error)
ITI: No Tone
Tone Ends After Specified Time
Reset S-
S- Period
Duration Can Be Adjusted (FT or VT)
(omission error)
Give SR+
Response (Correct)
If Participant is “Ready”
Response (S- Error)
Press “Start S-” Key
Method
A laptop computer with custom-written software controls session events (i.e., presentation of tone) and records data.
A response button is placed between speakers
The participant sits in front of the button
Operator actions are prompted by the computer
Discussion
The participant responded discriminately within 3 sessions, and showed generalization across frequencies and amplitudes
He returned to the audiology clinic and was tested successfully for the first time in his life, thus showing generalization not only to the setting, but also to a bone conduction test
These results suggest that the current version of the program shows great promise for training non-verbal children to take a hearing exam
Development of Technology
The program is being developed in the steps shown below.
Step 1: 3 participants who had normal hearing and no disability served to develop and test the software.
Step 2: 3 participants who had ID and no suspected hearing loss.
Step 3: Included our first nonverbal participant without suspected hearing loss.
Step 4: The 3 participants to date are nonverbal, have suspected hearing loss, and were described as “untestable” by their Audiologists.
Each step has informed changes in the teaching program. We have completed Steps 1-3. Here, we show data from the first Step-4 participant to be assessed in an Audiology clinic following training.
Current and Future Directions
Scripting the procedures such that they can be implemented by individuals with little-to-no training in behavior analysis
Tailoring the training to children with multiple disabilities, including blindness and cerebral palsy
Developing scripted procedures to overcome headphone refusal
Developing procedures for very young children with cochlear implants
Acknowledgements
Included in Program
Not Included in Program
Funded by the Office of Special Education Programs (DED 68248). Additional support from NICHD HD and NIDCD DC 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).