1.  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 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 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).