Speech Perception Training in Children: The Retention of Benefits and Booster Training.

OBJECTIVES: Speech perception training can be a highly effective intervention to improve perception and language abilities in children who are deaf or hard of hearing. Most studies of speech perception training, however, only measure gains immediately following training. Only a minority of cases include a follow-up assessment after a period without training. A critical unanswered question was whether training-related benefits are retained for a period of time after training has stopped. A primary goal of this investigation was to determine whether children retained training-related benefits 4 to 6 weeks after they completed 16 hours of formal speech perception training. Training was comprised of either auditory or speechreading training, or a combination of both. Also important is to determine if "booster" training can help increase gains made during the initial intensive training period. Another goal of the study was to investigate the benefits of providing home-based booster training during the 4- to 6-week interval after the formal training ceased. The original investigation ( Tye-Murray et al. 2022 ) compared the effects of talker familiarity and the relative benefits of the different types of training. We predicted that the children who received no additional training would retain the gains after the completing the formal training. We also predicted that those children who completed the booster training would realize additional gains. DESIGN: Children, 6 to 12 years old, with hearing loss who had previously participated in the original randomized control study returned 4 to 6 weeks after the conclusion to take a follow-up speech perception assessment. The first group (n = 44) returned after receiving no formal intervention from the research team before the follow-up assessment. A second group of 40 children completed an additional 16 hours of speech perception training at home during a 4- to 6-week interval before the follow-up speech perception assessment. The home-based speech perception training was a continuation of the same training that was received in the laboratory formatted to work on a PC tablet with a portable speaker. The follow-up speech perception assessment included measures of listening and speechreading, with test items spoken by both familiar (trained) and unfamiliar (untrained) talkers. RESULTS: In the group that did not receive the booster training, follow-up testing showed retention for all gains that were obtained immediately following the laboratory-based training. The group that received booster training during the same interval also maintained the benefits from the formal training, with some indication of minor improvement. CONCLUSIONS: Clinically, the present findings are extremely encouraging; the group that did not receive home-based booster training retained the benefits obtained during the laboratory-based training regimen. Moreover, the results suggest that self-paced booster training maintained the relative training gains associated with talker familiarity and training type seen immediately following laboratory-based training. Future aural rehabilitation programs should include maintenance training at home to supplement the speech perception training conducted under more formal conditions at school or in the clinic.

Word learning and lexicalization in a second language: Evidence from the Prime lexicality effect in masked form priming.

In a masked form priming lexical decision task, orthographically related word primes cause null or inhibitory priming relative to unrelated controls because of lexical competition between primes and targets, whereas orthographically related nonword primes lead to facilitation because nonwords are not lexically represented and hence do not evoke lexical competition. This prime lexicality effect (PLE) has been used as an index of new word lexicalization in the developing lexicon by using to-be-learned words and their orthographic neighbors as primes and targets, respectively. Experiment 1 confirmed an inhibitory effect of -46 ms among native English speakers and faciliatory effects of 52 ms by Japanese English learners without critical word training. In Experiment 2, Japanese English learners studied novel English words while performing a meaning-based, form-based, or no task during learning. Recall measures indicated a dissociation between these two types of processing, with a form-based task leading to greater recall of L2 words and a meaning-based task leading to greater recall of L1 words. Results indicated that all three learning conditions produced neither facilitation nor inhibition (null priming effect). Taken together, the results of the two experiments demonstrate that the PLE can occur in a second language (L2) and that the training procedure can yield at least partial lexicalization of new L2 words.

Teaching Children With Hearing Loss to Recognize Speech: Gains Made With Computer-Based Auditory and/or Speechreading Training.

OBJECTIVES: Transfer appropriate processing (TAP) refers to a general finding that training gains are maximized when training and testing are conducted under the same conditions. The present study tested the extent to which TAP applies to speech perception training in children with hearing loss. Specifically, we assessed the benefits of computer-based speech perception training games for enhancing children's speech recognition by comparing three training groups: auditory training (AT), audiovisual training (AVT), and a combination of these two (AT/AVT). We also determined whether talker-specific training, as might occur when children train with the speech of a next year's classroom teacher, leads to better recognition of that talker's speech and if so, the extent to which training benefits generalize to untrained talkers. Consistent with TAP theory, we predicted that children would improve their ability to recognize the speech of the trained talker more than that of three untrained talkers and, depending on their training group, would improve more on an auditory-only (listening) or audiovisual (speechreading) speech perception assessment, that matched the type of training they received. We also hypothesized that benefit would generalize to untrained talkers and to test modalities in which they did not train, albeit to a lesser extent. DESIGN: Ninety-nine elementary school aged children with hearing loss were enrolled into a randomized control trial with a repeated measures A-A-B experimental mixed design in which children served as their own control for the assessment of overall benefit of a particular training type and three different groups of children yielded data for comparing the three types of training. We also assessed talker-specific learning and transfer of learning by including speech perception tests with stimuli spoken by the talker with whom a child trained and stimuli spoken by three talkers with whom the child did not train and by including speech perception tests that presented both auditory (listening) and audiovisual (speechreading) stimuli. Children received 16 hr of gamified training. The games provided word identification and connected speech comprehension training activities. RESULTS: Overall, children showed significant improvement in both their listening and speechreading performance. Consistent with TAP theory, children improved more on their trained talker than on the untrained talkers. Also consistent with TAP theory, the children who received AT improved more on the listening than the speechreading. However, children who received AVT improved on both types of assessment equally, which is not consistent with our predictions derived from a TAP perspective. Age, language level, and phonological awareness were either not predictive of training benefits or only negligibly so. CONCLUSIONS: The findings provide support for the practice of providing children who have hearing loss with structured speech perception training and suggest that future aural rehabilitation programs might include teacher-specific speech perception training to prepare children for an upcoming school year, especially since training will generalize to other talkers. The results also suggest that benefits of speech perception training were not significantly related to age, language level, or degree of phonological awareness. The findings are largely consistent with TAP theory, suggesting that the more aligned a training task is with the desired outcome, the more likely benefit will accrue.

Vocabulary Acquisition as a By-Product of Meaning-Oriented Auditory Training for Children Who Are Deaf or Hard of Hearing.

Purpose A meaning-oriented auditory training program for children who are deaf or hard of hearing (d/hh) was assessed with regard to its efficacy in promoting novel word learning. Method While administering the auditory training program, one of the authors (Elizabeth Mauzé) observed that children were learning words they previously did not know. Therefore, we systematically assessed vocabulary gains among 16 children. Most completed pretest, posttest, and retention versions of a picture-naming task in which they attempted to verbally identify 199 color pictures of words that would appear during training. Posttest and retention versions included both pictures used and not used during training in order to test generalization of associations between words and their referents. Importantly, each training session involved meaning-oriented, albeit simple, activities/games on a computer. Results At posttest, the percentage of word gain was 27.3% (SD = 12.5; confidence interval [CI] of the mean: 24.2-30.4) using trained pictures as cues and 25.9% (CI of the mean: 22.9-29.0) using untrained pictures as cues. An analysis of retention scores (for 13 of the participants who completed it weeks later) indicated strikingly high levels of retention for the words that had been learned. Conclusions These findings favor auditory training that is meaning oriented when it comes to the acquisition of different linguistic subsystems, lexis in this case. We also expand the discussion to include other evidence-based recommendations regarding how vocabulary is presented (input-based effects) and what learners are asked to do (task-based effects) as part of an overall effort to help children who are d/hh increase their vocabulary knowledge.

Auditory Training for Adults Who Have Hearing Loss: A Comparison of Spaced Versus Massed Practice Schedules.

Purpose: The spacing effect in human memory research refers to situations in which people learn items better when they study items in spaced intervals rather than massed intervals. This investigation was conducted to compare the efficacy of meaning-oriented auditory training when administered with a spaced versus massed practice schedule. Method: Forty-seven adult hearing aid users received 16 hr of auditory training. Participants in a spaced group (mean age = 64.6 years, SD = 14.7) trained twice per week, and participants in a massed group (mean age = 69.6 years, SD = 17.5) trained for 5 consecutive days each week. Participants completed speech perception tests before training, immediately following training, and then 3 months later. In line with transfer appropriate processing theory, tests assessed both trained tasks and an untrained task. Results: Auditory training improved the speech recognition performance of participants in both groups. Benefits were maintained for 3 months. No effect of practice schedule was found on overall benefits achieved, on retention of benefits, nor on generalizability of benefits to nontrained tasks. Conclusion: The lack of spacing effect in otherwise effective auditory training suggests that perceptual learning may be subject to different influences than are other types of learning, such as vocabulary learning. Hence, clinicians might have latitude in recommending training schedules to accommodate patients' schedules.

Task- and Talker-Specific Gains in Auditory Training.

PURPOSE: This investigation focused on generalization of outcomes for auditory training by examining the effects of task and/or talker overlap between training and at test. METHOD: Adults with hearing loss completed 12 hr of meaning-oriented auditory training and were placed in a group that trained on either multiple talkers or a single talker. A control group also completed 12 hr of training in American Sign Language. The experimental group's training included a 4-choice discrimination task but not an open-set sentence test. The assessment phase included the same 4-choice discrimination task and an open-set sentence test, the Iowa Sentences Test (Tyler, Preece, & Tye-Murray, 1986). RESULTS: Improvement on 4-choice discrimination was observed in the experimental group as compared with the control group. Gains were (a) highest when the task and talker were the same between training and assessment; (b) second highest when the task was the same but the talker only partially so; and (c) third highest when task and talker were different. CONCLUSIONS: The findings support applications of transfer-appropriate processing to auditory training and favor tailoring programs toward the specific needs of the individuals being trained for tasks, talkers, and perhaps, for stimuli, in addition to other factors.

Auditory Training With Frequent Communication Partners.

PURPOSE: Individuals with hearing loss engage in auditory training to improve their speech recognition. They typically practice listening to utterances spoken by unfamiliar talkers but never to utterances spoken by their most frequent communication partner (FCP)-speech they most likely desire to recognize-under the assumption that familiarity with the FCP's speech limits potential gains. This study determined whether auditory training with the speech of an individual's FCP, in this case their spouse, would lead to enhanced recognition of their spouse's speech. METHOD: Ten couples completed a 6-week computerized auditory training program in which the spouse recorded the stimuli and the participant (partner with hearing loss) completed auditory training that presented recordings of their spouse. RESULTS: Training led participants to better discriminate their FCP's speech. Responses on the Client Oriented Scale of Improvement (Dillon, James, & Ginis, 1997) indicated subjectively that training reduced participants' communication difficulties. Peformance on a word identification task did not change. CONCLUSIONS: Results suggest that auditory training might improve the ability of older participants with hearing loss to recognize the speech of their spouse and might improve communication interactions between couples. The results support a task-appropriate processing framework of learning, which assumes that human learning depends on the degree of similarity between training tasks and desired outcomes.

The Effects of Meaning-Based Auditory Training on Behavioral Measures of Perceptual Effort in Individuals with Impaired Hearing.

There has been considerable interest in measuring the perceptual effort required to understand speech, as well as to identify factors that might reduce such effort. In the current study, we investigated whether, in addition to improving speech intelligibility, auditory training also could reduce perceptual or listening effort. Perceptual effort was assessed using a modified version of the n-back memory task in which participants heard lists of words presented without background noise and were asked to continually update their memory of the three most recently presented words. Perceptual effort was indexed by memory for items in the three-back position immediately before, immediately after, and 3 months after participants completed the Computerized Learning Exercises for Aural Rehabilitation (clEAR), a 12-session computerized auditory training program. Immediate posttraining measures of perceptual effort indicated that participants could remember approximately one additional word compared to pretraining. Moreover, some training gains were retained at the 3-month follow-up, as indicated by significantly greater recall for the three-back item at the 3-month measurement than at pretest. There was a small but significant correlation between gains in intelligibility and gains in perceptual effort. The findings are discussed within the framework of a limited-capacity speech perception system.

Using patient perceptions of relative benefit and enjoyment to assess auditory training.

BACKGROUND: Patients seeking treatment for hearing-related communication difficulties are often disappointed with the eventual outcomes, even after they receive a hearing aid or a cochlear implant. One approach that audiologists have used to improve communication outcomes is to provide auditory training (AT), but compliance rates for completing AT programs are notoriously low. PURPOSE: The primary purpose of the investigation was to conduct a patient-based evaluation of the benefits of an AT program, I Hear What You Mean, in order to determine how the AT experience might be improved. A secondary purpose was to examine whether patient perceptions of the AT experience varied depending on whether they were trained with a single talker's voice or heard training materials from multiple talkers. RESEARCH DESIGN: Participants completed a 6 wk auditory training program and were asked to respond to a posttraining questionnaire. Half of the participants heard the training materials spoken by six different talkers, and half heard the materials produced by only one of the six talkers. STUDY SAMPLE: Participants included 78 adult hearing-aid users and 15 cochlear-implant users for a total of 93 participants who completed the study, ages 18 to 89 yr (M = 66 yr, SD = 16.67 yr). Forty-three females and 50 males participated. The mean better ear pure-tone average for the participants was 56 dB HL (SD = 25 dB). INTERVENTION: Participants completed the single- or multiple-talker version of the 6 wk computerized AT program, I Hear What You Mean, followed by completion of a posttraining questionnaire in order to rate the benefits of overall training and the training activities and to describe what they liked best and what they liked least. DATA COLLECTION AND ANALYSIS: After completing a 6 wk computerized AT program, participants completed a posttraining questionnaire. Seven-point Likert scaled responses to whether understanding spoken language had improved were converted to individualized z scores and analyzed for changes due to AT. Written responses were coded and categorized to consider both positive and negative subjective opinions of the AT program. Regression analyses were conducted to examine the relationship between perceived effort and perceived benefit and to identify factors that predict overall program enjoyment. RESULTS: Participants reported improvements in their abilities to recognize spoken language and in their self-confidence as a result of participating in AT. Few differences were observed between reports from those trained with one versus six different talkers. Correlations between perceived benefit and enjoyment were not significant, and only participant age added unique variance to predicting program enjoyment. CONCLUSIONS: Participants perceived AT to be beneficial. Perceived benefit did not correlate with perceived enjoyment. Compliance with computerized AT programs might be enhanced if patients have regular contact with a hearing professional and train with meaning-based materials. An unheralded benefit of AT may be an increased sense of control over the hearing loss. In future efforts, we might aim to make training more engaging and entertaining, and less tedious.

Tailoring auditory training to patient needs with single and multiple talkers: transfer-appropriate gains on a four-choice discrimination test.

OBJECTIVE: Our long-term objective is to develop an auditory training program that will enhance speech recognition in those situations where patients most want improvement. As a first step, the current investigation trained participants using either a single talker or multiple talkers to determine if auditory training leads to transfer-appropriate gains. DESIGN: The experiment implemented a 2 × 2 × 2 mixed design, with training condition as a between-participants variable and testing interval and test version as repeated-measures variables. Participants completed a computerized six-week auditory training program wherein they heard either the speech of a single talker or the speech of six talkers. Training gains were assessed with single-talker and multi-talker versions of the Four-choice discrimination test. Participants in both groups were tested on both versions. STUDY SAMPLE: Sixty-nine adult hearing-aid users were randomly assigned to either single-talker or multi-talker auditory training. RESULTS: Both groups showed significant gains on both test versions. Participants who trained with multiple talkers showed greater improvement on the multi-talker version whereas participants who trained with a single talker showed greater improvement on the single-talker version. CONCLUSION: Transfer-appropriate gains occurred following auditory training, suggesting that auditory training can be designed to target specific patient needs.

Stimulus variability and the phonetic relevance hypothesis: effects of variability in speaking style, fundamental frequency, and speaking rate on spoken word identification.

Three experiments were conducted to examine the effects of trial-to-trial variations in speaking style, fundamental frequency, and speaking rate on identification of spoken words. In addition, the experiments investigated whether any effects of stimulus variability would be modulated by phonetic confusability (i.e., lexical difficulty). In Experiment 1, trial-to-trial variations in speaking style reduced the overall identification performance compared with conditions containing no speaking-style variability. In addition, the effects of variability were greater for phonetically confusable words than for phonetically distinct words. In Experiment 2, variations in fundamental frequency were found to have no significant effects on spoken word identification and did not interact with lexical difficulty. In Experiment 3, two different methods for varying speaking rate were found to have equivalent negative effects on spoken word recognition and similar interactions with lexical difficulty. Overall, the findings are consistent with a phonetic-relevance hypothesis, in which accommodating sources of acoustic-phonetic variability that affect phonetically relevant properties of speech signals can impair spoken word identification. In contrast, variability in parameters of the speech signal that do not affect phonetically relevant properties are not expected to affect overall identification performance. Implications of these findings for the nature and development of lexical representations are discussed.