Purpose:
To analyze the parent responses on the LEAQ and establish milestones of the hearing development of children with different degrees of hearing loss, which can be used later as a basis for clinical evaluation of a child’s auditory development with hearing loss.
Research Questions:
- What are the average total scores on the LEAQ by age and degree of hearing loss?
- What is the percentage of age appropriate scores on the LEAQ by age and degree of hearing loss?
- What percentage of items on the LEAQ were achieved by 80% of children by age and degree of hearing loss?
- 4) What percentage of children have accomplished each task on the LEAQ by age and degree of hearing loss?
Methods:
Parental responses (n=230) on the LEAQ were retrospectively analyzed for children with hearing loss enrolled in the Colorado Home Intervention Program (CHIP). Only children with normal cognition, as determined using the Kent Inventory of Developmental Skills and/or the Minnesota Child Development Inventory, were included. Packets with auditory skills assessments were sent out at 6 months, 15, and 21 months and the average ages of completion were 8 months, 15 months and 21 months. The following hearing loss categories were used: Mild, moderate-moderate severe, and severe-profound. CI users were separated into their own hearing loss group. The responses were separated into 3 approximate age groups: 8 months, 15 months, and 21 months. There were no CI users within the 8 month age group, 3 CI users within the 15 month age group and 9 CI users within the 15 month age group. CI users were placed in their chronological age group, and hearing age was not considered. Only children with normal cognition at the time of assessment were included in the study.
Descriptive analysis was used to analyze response on the LEAQ. Total scores of the LEAQ were compared between each age group and amongst each degree of hearing loss. Using the LEAQ’s scoring system, scores were calculated by age to determine if the child’s auditory behavior was age appropriate, or not age appropriate. The extent to which children’s auditory behavior was age appropriate was considered for the different age groups and degrees of hearing loss. An item analysis was completed to determine the percentage of children who had achieved each item by each age group and degree of hearing loss. The percent of items achieved by 80% of children based on age and degree of hearing loss were calculated. Each question was analyzed to determine what percentage of children had mastered each task as a function of degree of hearing loss.
In the 15 month age group, the cochlear implanted children were 12 and 13 months at activation, and therefore had hearing ages of 3 and 2 months at the time of assessment. One of these children was also included in the 21 month assessment despite having a greater hearing age than their peers within the same category. In the 21 month age group, the cochlear implant children were 12, 14, 15, 16, and 18 months at activation, and therefore had hearing ages of approximately 9, 7, 6, 5 and 3 months at the time of assessment.
Results:
Average total scores on the LEAQ by age and degree of hearing loss
See appendix 1 for graphs. Within each age group, as hearing loss increases total scores on the LEAQ decrease. As children age, total scores on the LEAQ increase.
With amplification, the majority of children with mild-moderate-severe degrees of hearing loss appear to have acquired the majority of LEAQ skills by ~15 months of age (See tables 1 and 2). Children with mild-moderate severe degrees of hearing loss have similar total scores on the LEAQ. Children with profound hearing loss (pre-implantation) scored above expectations, despite being CI candidates.
At 8 months of age, the mild hearing loss group had an average total score of 20.11, the moderate/moderate-severe hearing loss group had an average score of 16.75, and the severe/profound hearing loss group had an average score of 5.71. At 15 months of age, the mild hearing loss group had a score of 28.16, the moderate/moderate-severe hearing loss group had an average score of 26.19, the severe/profound hearing loss group had an average score of 11.71 and the cochlear implant users had an average score of 23.33. At 21 months of age, the mild hearing loss group had an average score of 32.74, the moderate/moderate-severe hearing loss group had an average score of 30.63, the severe/profound hearing loss group had an average score of 13.33, and the cochlear implant users had an average score of 21.11.
Percentage of age appropriate scores on the LEAQ by age and degree of hearing loss
See appendix 2 for graphs. The LEAQ uses normative data based on normal hearing children to determine if a child has achieved age appropriate scores. Using these norms, each hearing loss group was analyzed to determine what percentage of these children had age-appropriate scores. A common finding was that as severity of hearing loss increase, age appropriate scores decrease, and as severity of hearing loss increase, percent of age appropriate scores decrease. Percent of age-appropriate scores are similar for the mild and moderate/moderate-severe hearing loss groups.
At 8 months of age, 84.97% of children with mild hearing loss, 91.67% of children with moderate/moderate-severe hearing loss, and 17.65% of children with severe/profound hearing loss had achieved age-appropriate scores according to the LEAQ normative data. At 15 months of age, 93.55% of children with mild hearing loss, 100% of children with moderate/moderate-severe hearing loss, 17.65% of children with severe/profound hearing loss, and 66.67% of children with cochlear implants had achieved age-appropriate scores. At 21 months of age, 94.29% of children with mild hearing loss, 87.5% of children with moderate/moderate-severe hearing loss, 33.33% of children with severe/profound hearing loss, and 22.22%.
The age appropriate scores for the cochlear implant users reduced greatly between 15 and 21 months of age. This could be due to the increase in the number of users from 15 months (n=3) to 21 months (n=9) and the amount of hearing experience these users had.
Percentage of items on the LEAQ achieved by 80% of children by age and degree of hearing loss
See appendix 3 for graphs. As age increases, the percentage of items achieved by 80% of children increases for children in the mild and moderate/moderately-severe hearing loss groups. No items were achieved by 80% of the children with severe-profound hearing losses at 8 and 15 months. Only 3% of the items were achieved by 80% of children with severe-profound hearing loss at 21 months.
Percentage of children that have accomplished each task on the LEAQ by age and degree of hearing loss.
This table show the skills acquired by children with mild hearing loss by age level from 8 to 21 months of age.
| Skills acquired by each age: Mild | ||
| ~8 months | ~15 months | ~21 months |
| #1: Does your child respond to a familiar voice? | #1: Does your child respond to a familiar voice? | #1: Does your child respond to a familiar voice? |
| #2: Does your child listen to somebody speaking? | #2: Does your child listen to somebody speaking? | #2: Does your child listen to somebody speaking? |
| #3: When somebody is speaking, does your child turn his/her head towards the speaker? | #3: When somebody is speaking, does your child turn his/her head towards the speaker? | #3: When somebody is speaking, does your child turn his/her head towards the speaker? |
| #4: Is your child interested in toys producing sound or music? | #4: Is your child interested in toys producing sound or music? | #4: Is your child interested in toys producing sound or music? |
| #5: Does your child look for a speaker he/she cannot see? | #5: Does your child look for a speaker he/she cannot see? | #5: Does your child look for a speaker he/she cannot see? |
| #6: Does your child listen when the radio/CD player/tape player is turned on? | #6: Does your child listen when the radio/CD player/tape player is turned on? | #6: Does your child listen when the radio/CD player/tape player is turned on? |
| #7: Does your child respond to distant sounds | #7: Does your child respond to distant sounds? | #7: Does your child respond to distant sounds? |
| #8: Does your child stop crying when you speak to him/her without him/her seeing you? | #8: Does your child stop crying when you speak to him/her without him/her seeing you? | #8: Does your child stop crying when you speak to him/her without him/her seeing you? |
| #9: Does your child respond with alarm when hearing an angry voice? | #9: Does your child respond with alarm when hearing an angry voice? | |
| #10: Does your child “recognize” acoustic rituals? | #10: Does your child “recognize” acoustic rituals? | #10: Does your child “recognize” acoustic rituals? |
| #11: Does your child look for sound sources located at the left, right or back? | #11: Does your child look for sound sources located at the left, right or back? | #11: Does your child look for sound sources located at the left, right or back? |
| #12: Does your child react to his/her name when called? | #12: Does your child react to his/her name when called? | #12: Does your child react to his/her name when called? |
| #13: Does your child look for sound sources located above or below? | #13: Does your child look for sound sources located above or below? | #13: Does your child look for sound sources located above or below? |
| #14: When your child is sad or moody, can he/she be calmed down or influenced by music? | #14: When your child is sad or moody, can he/she be calmed down or influenced by music? | #14: When your child is sad or moody, can he/she be calmed down or influenced by music? |
| #15: Does your child listen on the telephone and does he/she recognize that somebody is talking? | #15: Does your child listen on the telephone and does he/she recognize that somebody is talking? | |
| #16: Does your child respond to music with rhythmical movements? | #16: Does your child respond to music with rhythmical movements? | |
| #17: Does your child know that a certain sound is related to a certain object or event? | #17: Does your child know that a certain sound is related to a certain object or event? | |
| #18: does your child respond to short and simple remarks appropriately? | #18: does your child respond to short and simple remarks appropriately? | |
| #19: Does your child respond to “No” by typically interrupting his/her current activity? | #19: Does your child respond to “No” by typically interrupting his/her current activity? | |
| #20: Does your child know family members’ name? | #20: Does your child know family members’ name? | |
| #21: Does your child imitate sounds when asked? | #21: Does your child imitate sounds when asked? | |
| #22: Does your child follow simple commands? | #22: Does your child follow simple commands? | |
| #23: Does your child understand simple questions? | #23: Does your child understand simple questions? | |
| #24: Does your child bring items when asked? | ||
| #25: Does your child imitate sounds or words you say? | ||
| #26: Does your child produce the right sound to a toy? | ||
| #27: Does your child know that certain sounds go with certain animals? | ||
| #28: Does your child try to imitate environmental sounds? | ||
| #29: Does your child correctly repeat a sequence of short and long syllables you have said? | ||
| #30: Does your child select the right object from a group of objects when asked | ||
| #31: Does your child try to sing along when hearing a song? | ||
| #32: Does your child repeat certain words when asked? | ||
| #33: Does your child like being read to? | #33: Does your child like being read to? | |
| Skills acquired by each age: Moderate/Moderate-Severe | ||
| ~8 months | ~15 months | ~21 months |
| #1: Does your child respond to a familiar voice? | #1: Does your child respond to a familiar voice? | #1: Does your child respond to a familiar voice? |
| #2: Does your child listen to somebody speaking? | #2: Does your child listen to somebody speaking? | #2: Does your child listen to somebody speaking? |
| #3: When somebody is speaking, does your child turn his/her head towards the speaker? | #3: When somebody is speaking, does your child turn his/her head towards the speaker? | #3: When somebody is speaking, does your child turn his/her head towards the speaker? |
| #4: Is your child interested in toys producing sound or music? | #4: Is your child interested in toys producing sound or music? | #4: Is your child interested in toys producing sound or music? |
| #5: Does your child look for a speaker he/she cannot see? | #5: Does your child look for a speaker he/she cannot see? | #5: Does your child look for a speaker he/she cannot see? |
| #6: Does your child listen when the radio/CD player/tape player is turned on? | #6: Does your child listen when the radio/CD player/tape player is turned on? | |
| #7: Does your child respond to distant sounds? | #7: Does your child respond to distant sounds? | |
| #8: Does your child stop crying when you speak to him/her without him/her seeing you? | ||
| #9: Does your child respond with alarm when hearing an angry voice? | #9: Does your child respond with alarm when hearing an angry voice? | |
| #10: Does your child “recognize” acoustic rituals? | #10: Does your child “recognize” acoustic rituals? | |
| #11: Does your child look for sound sources located at the left, right or back? | #11: Does your child look for sound sources located at the left, right or back? | #11: Does your child look for sound sources located at the left, right or back? |
| #12: Does your child react to his/her name when called? | #12: Does your child react to his/her name when called? | #12: Does your child react to his/her name when called? |
| #13: Does your child look for sound sources located above or below? | #13: Does your child look for sound sources located above or below? | #13: Does your child look for sound sources located above or below? |
| #14: When your child is sad or moody, can he/she be calmed down or influenced by music? | #14: When your child is sad or moody, can he/she be calmed down or influenced by music? | |
| #15: Does your child listen on the telephone and does he/she recognize that somebody is talking? | ||
| #16: Does your child respond to music with rhythmical movements? | ||
| #17: Does your child know that a certain sound is related to a certain object or event? | #17: Does your child know that a certain sound is related to a certain object or event? | |
| #18: does your child respond to short and simple remarks appropriately? | #18: does your child respond to short and simple remarks appropriately? | |
| #19: Does your child respond to “No” by typically interrupting his/her current activity? | #19: Does your child respond to “No” by typically interrupting his/her current activity? | |
| #20: Does your child know family members’ name? | #20: Does your child know family members’ name? | |
| #21: Does your child imitate sounds when asked? | ||
| #22: Does your child follow simple commands? | ||
| #23: Does your child understand simple questions? | ||
| #24: Does your child bring items when asked? | ||
| #25: Does your child imitate sounds or words you say? | ||
| #26: Does your child produce the right sound to a toy? | ||
| #27: Does your child know that certain sounds go with certain animals? | ||
| #32: Does your child repeat certain words when asked? | ||
| #33: Does your child like being read to? | #33: Does your child like being read to? | |
| Skills acquired by each age: Severe/Profound | ||
| ~8 months | ~15 months | ~21 months |
| #4: Is your child interested in toys producing sound or music? | ||
| Skills acquired by each age: CI | |
| ~15 months | ~21 months |
| #1: Does your child respond to a familiar voice? | #1: Does your child respond to a familiar voice? |
| #2: Does your child listen to somebody speaking? | #2: Does your child listen to somebody speaking? |
| #3: When somebody is speaking, does your child turn his/her head towards the speaker? | #3: When somebody is speaking, does your child turn his/her head towards the speaker? |
| #4: Is your child interested in toys producing sound or music? | #4: Is your child interested in toys producing sound or music? |
| #5: Does your child look for a speaker he/she cannot see? | |
| #6: Does your child listen when the radio/CD player/tape player is turned on? | #6: Does your child listen when the radio/CD player/tape player is turned on? |
| #9: Does your child respond with alarm when hearing an angry voice? | |
| #11: Does your child look for sound sources located at the left, right or back? | #10: Does your child “recognize” acoustic rituals? |
| #12: Does your child react to his/her name when called? | |
| #13: Does your child look for sound sources located above or below? | |
| #16: Does your child respond to music with rhythmical movements? | #16: Does your child respond to music with rhythmical movements? |
| #18: does your child respond to short and simple remarks appropriately? | |
| #19: Does your child respond to “No” by typically interrupting his/her current activity? | #19: Does your child respond to “No” by typically interrupting his/her current activity? |
| #21: Does your child imitate sounds when asked? | |
| #33: Does your child like being read to? | |
Discussion:
The LEAQ was originally designed to assess pre-candidacy for cochlear implants for children age birth to 2 years. Normative data for normally hearing children was established by MedEl, however the lack of information for children with different degrees of hearing loss remained a need. By looking at the average total scores, it appears that children have acquired most skills by approximately 15 months of age. By looking at the percent of children with age appropriate scores as determined by the LEAQ scoring guidelines, it appears that the majority of children with hearing loss ranging from mild to moderate-severe hearing have age appropriate scores by 15 months of age. Combined, these results suggest that the LEAQ may not be sufficiently sensitive to assess the auditory development of children up to 24 months of age.
Study Limitations:
Limitations exist in this research study. Separating the groups based on degree of hearing loss and controlling for cognition resulted in some groups with few subjects. The number of participants varied for different age groups, which may have affected some of the trends that were observed in data analysis.
Age of cochlear implantation could not be controlled, so some participants in this group may have had more hearing experience than others and only chronological age, not hearing age, was considered when separating participants into their age groups, which may have affected results. In addition, results from normal hearing children on each item have not been acquired. In general, a limitation of using parental questionnaires is the issue of not having any standardized measure for validating these questionnaires at the time of the assessment. For these ages, we have to rely on parent report to determine what skills these children have acquired in order to assess both a baseline and progress made with amplification or cochlear implants.
Limitations exist for the LEAQ. Few items on the LEAQ address discrimination, and instead are more focused on detection. For higher developmental levels, the questions analyze language abilities rather than just auditory skills which is the main interest in using this questionnaire.
Future Directions:
Future directions of this research should aim to increase the number of participants in each hearing loss and age group. This data can be used as a baseline to analyze other variables such as cognition, maternal level of education in addition to the analysis completed on degree of hearing loss. This was a descriptive study using descriptive statistics, future analysis should statistically analyze the changes over time outlined in this study for each item by age and degree of hearing loss. In addition, the results of the LEAQ can be compared with other auditory questionnaires to determine the relationships between other widely used auditory questionnaires.