Adopting a child perspective for exposome research on mental health and cognitive development - Conceptualisation and opportunities.

Mental disorders among children and adolescents pose a significant global challenge. The exposome framework covering the totality of internal, social and physical exposures over a lifetime provides opportunities to better understand the causes of and processes related to mental health, and cognitive functioning. The paper presents a conceptual framework on exposome, mental health, and cognitive development in children and adolescents, with potential mediating pathways, providing a possibility for interventions along the life course. The paper underscores the significance of adopting a child perspective to the exposome, acknowledging children's specific vulnerability, including differential exposures, susceptibility of effects and capacity to respond; their susceptibility during development and growth, highlighting neurodevelopmental processes from conception to young adulthood that are highly sensitive to external exposures. Further, critical periods when exposures may have significant effects on a child's development and future health are addressed. The paper stresses that children's behaviour, physiology, activity pattern and place for activities make them differently vulnerable to environmental pollutants, and calls for child-specific assessment methods, currently lacking within today's health frameworks. The importance of understanding the interplay between structure and agency is emphasized, where agency is guided by social structures and practices and vice-versa. An intersectional approach that acknowledges the interplay of social and physical exposures as well as a global and rural perspective on exposome is further pointed out. To advance the exposome field, interdisciplinary efforts that involve multiple scientific disciplines are crucial. By adopting a child perspective and incorporating an exposome approach, we can gain a comprehensive understanding of how exposures impact children's mental health and cognitive development leading to better outcomes.

Examining the Auditory Selective Attention Switch in a Child-Suited Virtual Reality Classroom Environment.

The ability to focus ones attention in different acoustical environments has been thoroughly investigated in the past. However, recent technological advancements have made it possible to perform laboratory experiments in a more realistic manner. In order to investigate close-to-real-life scenarios, a classroom was modeled in virtual reality (VR) and an established paradigm to investigate the auditory selective attention (ASA) switch was translated from an audio-only version into an audiovisual VR setting. The new paradigm was validated with adult participants in a listening experiment, and the results were compared to the previous version. Apart from expected effects such as switching costs and auditory congruency effects, which reflect the robustness of the overall paradigm, a difference in error rates between the audio-only and the VR group was found, suggesting enhanced attention in the new VR setting, which is consistent with recent studies. Overall, the results suggest that the presented VR paradigm can be used and further developed to investigate the voluntary auditory selective attention switch in a close-to-real-life classroom scenario.

Differential Effects of Task-Irrelevant Monaural and Binaural Classroom Scenarios on Children's and Adults' Speech Perception, Listening Comprehension, and Visual-Verbal Short-Term Memory.

Most studies investigating the effects of environmental noise on children's cognitive performance examine the impact of monaural noise (i.e., same signal to both ears), oversimplifying multiple aspects of binaural hearing (i.e., adequately reproducing interaural differences and spatial information). In the current study, the effects of a realistic classroom-noise scenario presented either monaurally or binaurally on tasks requiring processing of auditory and visually presented information were analyzed in children and adults. In Experiment 1, across age groups, word identification was more impaired by monaural than by binaural classroom noise, whereas listening comprehension (acting out oral instructions) was equally impaired in both noise conditions. In both tasks, children were more affected than adults. Disturbance ratings were unrelated to the actual performance decrements. Experiment 2 revealed detrimental effects of classroom noise on short-term memory (serial recall of words presented pictorially), which did not differ with age or presentation mode (monaural vs. binaural). The present results add to the evidence for detrimental effects of noise on speech perception and cognitive performance, and their interactions with age, using a realistic classroom-noise scenario. Binaural simulations of real-world auditory environments can improve the external validity of studies on the impact of noise on children's and adults' learning.

Early environmental quality and life-course mental health effects: The Equal-Life project.

BACKGROUND: There is increasing evidence that a complex interplay of factors within environments in which children grows up, contributes to children's suboptimal mental health and cognitive development. The concept of the life-course exposome helps to study the impact of the physical and social environment, including social inequities, on cognitive development and mental health over time. METHODS: Equal-Life develops and tests combined exposures and their effects on children's mental health and cognitive development. Data from eight birth-cohorts and three school studies (N = 240.000) linked to exposure data, will provide insights and policy guidance into aspects of physical and social exposures hitherto untapped, at different scale levels and timeframes, while accounting for social inequities. Reasoning from the outcome point of view, relevant stakeholders participate in the formulation and validation of research questions, and in the formulation of environmental hazards. Exposure assessment combines GIS-based environmental indicators with omics approaches and new data sources, forming the early-life exposome. Statistical tools integrate data at different spatial and temporal granularity and combine exploratory machine learning models with hypothesis-driven causal modeling. CONCLUSIONS: Equal-Life contributes to the development and utilization of the exposome concept by (1) integrating the internal, physical and social exposomes, (2) studying a distinct set of life-course effects on a child's development and mental health (3) characterizing the child's environment at different developmental stages and in different activity spaces, (4) looking at supportive environments for child development, rather than merely pollutants, and (5) combining physical, social indicators with novel effect markers and using new data sources describing child activity patterns and environments.

The role of spatial separation of two talkers' auditory stimuli in the listener's memory of running speech: listening effort in a non-noisy conversational setting.

OBJECTIVE: To investigate the role of the spatial position of conversing talkers, that is, spatially separated or co-located, in the listener's short-term memory of running speech and listening effort. DESIGN: In two experiments (between-subject), participants underwent a dual-task paradigm, including a listening (primary) task wherein male and female talkers spoke coherent texts. Talkers were either spatially separated or co-located (within-subject). As a secondary task, visually presented tasks were used. Experiment I involved a number-judgement task, and Experiment II entailed switching between number and letter-judgement task. STUDY SAMPLE: Twenty-four young adults who reported normal hearing and normal or corrected to normal vision participated in each experiment. They were all students from the RWTH Aachen University. RESULTS: In both experiments, similar short-term memory performance of running speech was found independently of talkers being spatially separated or co-located. Performance in the secondary tasks, however, differed between these two talkers' auditory stimuli conditions, indicating that spatially separated talkers imposed reduced listening effort compared to their co-location. CONCLUSION: The findings indicated that auditory-perceptive information, such as the spatial position of talkers, plays a role in higher-level auditory cognition, that is, short-term memory of running speech, even when listening in quiet.

Children's intentional switching of auditory selective attention in spatial and noisy acoustic environments in comparison to adults.

Children's development and education take place in educational buildings with highly complex acoustic scenes, including spatially distributed target speakers, many surrounding distracting sounds, and general background noises. Auditory selective attention, therefore, is a valuable tool to orient oneself, to focus on specific sound sources, and to extract relevant information. Until now, it is unknown to what extent children have developed the cognitive processes of intentional attention control in spatial situations and how they differ from adults. This work provides a paradigm to examine children's intentional switching of auditory selective attention that also allows to examine effects due to noisy and spatial sound environments presented virtually via headphones. A listening experiment was conducted in Germany with 24 children (6-10 years, 50% female) and 24 young adults (18-26 years, 50% female). First, results revealed higher error rates and lower reaction times in conditions with noise (relative to conditions without noise) for children, but not for adults. This assumes that children are more sensitive to noise and conclude faster with noise trials, taking errors into account. Second, although auditory attention flexibility reflected in attention switch and relevant information selection was comparable between children and adults, it was found that adults benefited from spatial cues when selecting the relevant information. This was not observed to the same extent in children. These results suggest that children's cognitive processes are affected at significantly lower noise levels than adults and that noise effect assessment methods should consider spatial aspects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Spatial release from masking in reverberation for school-age children.

Understanding speech in noisy environments, such as classrooms, is a challenge for children. When a spatial separation is introduced between the target and masker, as compared to when both are co-located, children demonstrate intelligibility improvement of the target speech. Such intelligibility improvement is known as spatial release from masking (SRM). In most reverberant environments, binaural cues associated with the spatial separation are distorted; the extent to which such distortion will affect children's SRM is unknown. Two virtual acoustic environments with reverberation times between 0.4 s and 1.1 s were compared. SRM was measured using a spatial separation with symmetrically displaced maskers to maximize access to binaural cues. The role of informational masking in modulating SRM was investigated through voice similarity between the target and masker. Results showed that, contradictory to previous developmental findings on free-field SRM, children's SRM in reverberation has not yet reached maturity in the 7-12 years age range. When reducing reverberation, an SRM improvement was seen in adults but not in children. Our findings suggest that, even though school-age children have access to binaural cues that are distorted in reverberation, they demonstrate immature use of such cues for speech-in-noise perception, even in mild reverberation.

Towards Child-Appropriate Virtual Acoustic Environments: A Database of High-Resolution HRTF Measurements and 3D-Scans of Children.

Head-related transfer functions (HRTFs) play a significant role in modern acoustic experiment designs in the auralization of 3-dimensional virtual acoustic environments. This technique enables us to create close to real-life situations including room-acoustic effects, background noise and multiple sources in a controlled laboratory environment. While adult HRTF databases are widely available to the research community, datasets of children are not. To fill this gap, children aged 5-10 years old were recruited among 1st and 2nd year primary school children in Aachen, Germany. Their HRTFs were measured in the hemi-anechoic chamber with a 5-degree × 5-degree resolution. Special care was taken to reduce artifacts from motion during the measurements by means of fast measurement routines. To complement the HRTF measurements with the anthropometric data needed for individualization methods, a high-resolution 3D-scan of the head and upper torso of each participant was recorded. The HRTF measurement took around 3 min. The children's head movement during that time was larger compared to adult participants in comparable experiments but was generally kept within 5 degrees of rotary and 1 cm of translatory motion. Adult participants only exhibit this range of motion in longer duration measurements. A comparison of the HRTF measurements to the KEMAR artificial head shows that it is not representative of an average child HRTF. Difference can be seen in both the spectrum and in the interaural time delay (ITD) with differences of 70 µs on average and a maximum difference of 138 µs. For both spectrum and ITD, the KEMAR more closely resembles the 95th percentile of range of children's data. This warrants a closer look at using child specific HRTFs in the binaural presentation of virtual acoustic environments in the future.

fNIRS Assessment of Speech Comprehension in Children with Normal Hearing and Children with Hearing Aids in Virtual Acoustic Environments: Pilot Data and Practical Recommendations.

The integration of virtual acoustic environments (VAEs) with functional near-infrared spectroscopy (fNIRS) offers novel avenues to investigate behavioral and neural processes of speech-in-noise (SIN) comprehension in complex auditory scenes. Particularly in children with hearing aids (HAs), the combined application might offer new insights into the neural mechanism of SIN perception in simulated real-life acoustic scenarios. Here, we present first pilot data from six children with normal hearing (NH) and three children with bilateral HAs to explore the potential applicability of this novel approach. Children with NH received a speech recognition benefit from low room reverberation and target-distractors' spatial separation, particularly when the pitch of the target and the distractors was similar. On the neural level, the left inferior frontal gyrus appeared to support SIN comprehension during effortful listening. Children with HAs showed decreased SIN perception across conditions. The VAE-fNIRS approach is critically compared to traditional SIN assessments. Although the current study shows that feasibility still needs to be improved, the combined application potentially offers a promising tool to investigate novel research questions in simulated real-life listening. Future modified VAE-fNIRS applications are warranted to replicate the current findings and to validate its application in research and clinical settings.

Auditory and Visual Response Inhibition in Children with Bilateral Hearing Aids and Children with ADHD.

Children fitted with hearing aids (HAs) and children with attention deficit/hyperactivity disorder (ADHD) often have marked difficulties concentrating in noisy environments. However, little is known about the underlying neural mechanism of auditory and visual attention deficits in a direct comparison of both groups. The current functional near-infrared spectroscopy (fNIRS) study was the first to investigate the behavioral performance and neural activation during an auditory and a visual go/nogo paradigm in children fitted with bilateral HAs, children with ADHD and typically developing children (TDC). All children reacted faster, but less accurately, to visual than auditory stimuli, indicating a sensory-specific response inhibition efficiency. Independent of modality, children with ADHD and children with HAs reacted faster and tended to show more false alarms than TDC. On a neural level, however, children with ADHD showed supra-modal neural alterations, particularly in frontal regions. On the contrary, children with HAs exhibited modality-dependent alterations in the right temporopolar cortex. Higher activation was observed in the auditory than in the visual condition. Thus, while children with ADHD and children with HAs showed similar behavioral alterations, different neural mechanisms might underlie these behavioral changes. Future studies are warranted to confirm the current findings with larger samples. To this end, fNIRS provided a promising tool to differentiate the neural mechanisms underlying response inhibition deficits between groups and modalities.

A socio-cultural perspective of sound and location perception: A case study in Aachen, Germany.

This study aim is to understand the socio-cultural aspects of urban soundscapes through the users' profile. A systemic overview of the urban environment realized with questions related to location, soundscape, noise control perception and soundscape wish from three study areas in Aachen, Germany. To achieve this aim, subjective responses collected through soundwalks with invited participants (90 participants evaluated three spots generating 270 evaluations). Furthermore, interviews with residents and workers (97 participants) will be analysed with the use of a Two-Step Cluster Analysis in five steps, which analysed in each step clusters resulted from the four investigated topics and summarised in the fifth step, a user's profile. The main findings showed that residents and soundwalks participants have different priorities related to the location and sonic environment, which could influence socio-cultural aspects such as nationality, time and motivation for the participants live in the investigated area or the city of Aachen.

The Cross-Modal Effects of Sensory Deprivation on Spatial and Temporal Processes in Vision and Audition: A Systematic Review on Behavioral and Neuroimaging Research since 2000.

One of the most significant effects of neural plasticity manifests in the case of sensory deprivation when cortical areas that were originally specialized for the functions of the deprived sense take over the processing of another modality. Vision and audition represent two important senses needed to navigate through space and time. Therefore, the current systematic review discusses the cross-modal behavioral and neural consequences of deafness and blindness by focusing on spatial and temporal processing abilities, respectively. In addition, movement processing is evaluated as compiling both spatial and temporal information. We examine whether the sense that is not primarily affected changes in its own properties or in the properties of the deprived modality (i.e., temporal processing as the main specialization of audition and spatial processing as the main specialization of vision). References to the metamodal organization, supramodal functioning, and the revised neural recycling theory are made to address global brain organization and plasticity principles. Generally, according to the reviewed studies, behavioral performance is enhanced in those aspects for which both the deprived and the overtaking senses provide adequate processing resources. Furthermore, the behavioral enhancements observed in the overtaking sense (i.e., vision in the case of deafness and audition in the case of blindness) are clearly limited by the processing resources of the overtaking modality. Thus, the brain regions that were previously recruited during the behavioral performance of the deprived sense now support a similar behavioral performance for the overtaking sense. This finding suggests a more input-unspecific and processing principle-based organization of the brain. Finally, we highlight the importance of controlling for and stating factors that might impact neural plasticity and the need for further research into visual temporal processing in deaf subjects.

The Contribution of Individual Differences in Memory Span and Language Ability to Spatial Release From Masking in Young Children.

Purpose Working memory capacity and language ability modulate speech reception; however, the respective roles of peripheral and cognitive processing are unclear. The contribution of individual differences in these abilities to utilization of spatial cues when separating speech from informational and energetic masking backgrounds in children has not yet been determined. Therefore, this study explored whether speech reception in children is modulated by environmental factors, such as the type of background noise and spatial configuration of target and noise sources, and individual differences in the cognitive and linguistic abilities of listeners. Method Speech reception thresholds were assessed in 39 children aged 5-7 years in simulated school listening environments. Speech reception thresholds of target sentences spoken by an adult male consisting of number and color combinations were measured using an adaptive procedure, with speech-shaped white noise and single-talker backgrounds that were either collocated (target and back-ground at 0°) or spatially separated (target at 0°, background noise at 90° to the right). Spatial release from masking was assessed alongside memory span and expressive language. Results and Conclusion Significant main effect results showed that speech reception thresholds were highest for informational maskers and collocated conditions. Significant interactions indicated that individual differences in memory span and language ability were related to spatial release from masking advantages. Specifically, individual differences in memory span and language were related to the utilization of spatial cues in separated conditions. Language differences were related to auditory stream segregation abilities in collocated conditions that lack helpful spatial cues, pointing to the utilization of language processes to make up for losses in spatial information.

Spatial Release From Masking Under Different Reverberant Conditions in Young and Elderly Subjects: Effect of Moving or Stationary Maskers at Circular and Radial Conditions.

Purpose Normal-hearing and hard-of-hearing listeners suffer from reduced speech intelligibility in noisy and reverberant environments. Although daily listening environments are in constant motion, most researchers have only studied speech-in-noise perception for stationary masker locations. The aim of this study was to investigate the spatial release from masking (SRM) of circularly and radially moving maskers under different room acoustic conditions for young and elderly subjects. Method Twelve young subjects with normal hearing and 12 elderly subjects with normal hearing or mild hearing loss were tested. Several different room acoustic conditions were simulated and reproduced via headphones using binaural synthesis. The target speech stream consisted of German digit triplets, and masker stream consisted of quasistationary noise with matched long-term averaged speech spectra. During the experiment, the position of the masker was changed to be in different stationary positions, or varied continuously. In the latter case, it was moved either on a circular trajectory spanning a 90° azimuth angle or on a radial trajectory linearly increasing the distance to the receiver from 0.5 m to 1.8 m. Absorption characteristics of the virtual room's surfaces were changed, recreating an anechoic room, a treated room with mean reverberation times (RT60) = 0.48 s, and an untreated room with mean RT60 = 1.26 s. Results For the circular condition, a significant difference was found between moving and stationary maskers, F(4, 44) = 20.91, p < .001, with a bigger SRM for stationary maskers than moving masker conditions. Also, both age groups displayed a significant decrease in SRM over the reverberation conditions: F(2, 22) = 12.24, p < .001. For the radial condition, both age groups showed a significant decrease in SRM over the reverberation conditions, F(2, 22) = 13.62, p < .001, as well as the moving and stationary masker conditions, F(8, 88) = 29.23, p < .001. In general, the SRM of a moving masker decreased when the reverberation increased, especially for elderly subjects. Conclusions A radially moving masker led to improved SRM in an anechoic environment for both age groups, whereas a circularly moving masker caused degraded SRM, especially for elderly subjects in the highly reverberant environment. Supplemental Material https://doi.org/10.23641/asha.9795371.

The binding of an auditory target location to a judgement: A two-component switching approach.

In a two-component switching paradigm, in which participants switched between two auditory attention selection criteria (attention component: left vs. right ear) and two judgements (judgement component: number vs. letter judgement), we found high judgement switch costs in attention criterion repetitions, but low costs in attention criterion switches. This finding showed an interaction of components. Previous two-component switching studies observed differently emphasised interaction patterns. In the present study, we explored whether the strength of the interaction pattern reflects the strength of the binding of target location and judgement. Specifically, we investigated whether exogenous target location cueing led to weaker binding than endogenous cueing, and whether preparation for ear selection could influence the binding. Attention switches with auditory exogenous target location cues did not affect the component interaction pattern, whereas a prolonged preparation interval led to a more emphasised pattern. Binding between target location and judgement may therefore be rather automatic and may not necessarily require concurrent component processing. Sufficient time for target location switches with long preparation time may activate the previous trial's episode or facilitate switches of the subsequent judgement.

Palliative care in everyday practice of radiation oncologists : Results from a web-based survey among medical members of the German Society for Radiation Oncology (DEGRO).

PURPOSE: Little is known about the attitudes of radiation oncologists towards palliative care, about their competences in this field, and about the collaboration with palliative care specialists. Our aim was to close this gap and understand more about the importance of an additional qualification in palliative care. METHODS: Medical members of the German Society for Radiation Oncology (DEGRO) were electronically surveyed during November-December 2016. RESULTS: The survey was emailed successfully to 1110 addressees, whereas a total of 205 questionnaires were eligible for analysis (response rate 18.4%). 55 (26.8%) of the respondents had an additional qualification in palliative care. Physicians who had an additional qualification in palliative care (PC qualification) reported palliative care needs for their patients more frequently than the other respondents (89.0 vs. 82.7%, p = 0.008). Furthermore, they were most likely to report a high confidence in palliative care competences, such as "communication skills & support for relatives" (83.6 vs. 59.3%, p = 0.013), "symptom control," and "pain management" (94.5 vs. 67.7%, p < 0.001 and 90.9 vs. 73.3%, p = 0.008, respectively). Respondents with a PC qualification more often involved palliative care specialists than the other respondents (63.3 vs. 39.3%, p = 0.007). Perceived main barriers regarding palliative care in radiation oncology included time aspects (9.2%), stigmata (8.5%), and the lack of interdisciplinary collaboration (8.5%). CONCLUSIONS: This analysis demonstrated that aspects of palliative care strongly impact on daily practice in radiation oncology. Additional qualifications and comprehensive training in palliative medicine may contribute to improved patient care in radiation oncology.

An Extended Binaural Real-Time Auralization System With an Interface to Research Hearing Aids for Experiments on Subjects With Hearing Loss.

Theory and implementation of acoustic virtual reality have matured and become a powerful tool for the simulation of entirely controllable virtual acoustic environments. Such virtual acoustic environments are relevant for various types of auditory experiments on subjects with normal hearing, facilitating flexible virtual scene generation and manipulation. When it comes to expanding the investigation group to subjects with hearing loss, choosing a reproduction system which offers a proper integration of hearing aids into the virtual acoustic scene is crucial. Current loudspeaker-based spatial audio reproduction systems rely on different techniques to synthesize a surrounding sound field, providing various possibilities for adaptation and extension to allow applications in the field of hearing aid-related research. Representing one option, the concept and implementation of an extended binaural real-time auralization system is presented here. This system is capable of generating complex virtual acoustic environments, including room acoustic simulations, which are reproduced as combined via loudspeakers and research hearing aids. An objective evaluation covers the investigation of different system components, a simulation benchmark analysis for assessing the processing performance, and end-to-end latency measurements.

The effect of language, spatial factors, masker type and memory span on speech-in-noise thresholds in sequential bilingual children.

This study considers whether bilingual children listening in a second language are among those on which higher processing and cognitive demands are placed when noise is present. Forty-four Swedish sequential bilingual 15 year-olds were given memory span and vocabulary assessments in their first and second language (Swedish and English). First and second language speech reception thresholds (SRTs) at 50% intelligibility for numbers and colors presented in noise were obtained using an adaptive procedure. The target sentences were presented in simulated, virtual classroom acoustics, masked by either 16-talker multi-talker babble noise (MTBN) or speech shaped noise (SSN), positioned either directly in front of the listener (collocated with the target speech), or spatially separated from the target speech by 90° to either side. Main effects in the Spatial and Noise factors indicated that intelligibility was 3.8 dB lower in collocated conditions and 2.9 dB lower in MTBN conditions. SRTs were unexpectedly higher by 0.9 dB in second language conditions. Memory span significantly predicted 17% of the variance in the second language SRTs, and 9% of the variance in first language SRTs, indicating the possibility that the SRT task places higher cognitive demands when listening to second language speech than when the target is in the listener's first language.

Auditory attention switching and judgment switching: Exploring multicomponent task representations.

An auditory attention-switching paradigm was combined with a judgment-switching paradigm to examine the interaction of a varying auditory attention component and a varying judgment component. Participants heard two dichotically presented stimuli-one spoken by a female speaker and one spoken by a male speaker. In each trial, the stimuli were a spoken letter and a spoken number. A visual explicit cue at the beginning of each trial indicated the auditory attention criterion (speaker sex/ear) to identify the target stimulus (Experiment 1) or the judgment that had to be executed (Experiment 2). Hence, the attentional selection criterion switched independently between speaker sexes (or between ears), while the judgment alternated between letter categorization and number categorization. The data indicate that auditory attention criterion and judgment were not processed independently, regardless of whether the attention criterion or the judgment was cued. The partial repetition benefits of the explicitly cued component suggested a hierarchical organization of the auditory attention component and the judgment component within the task set. We suggest that the hierarchy arises due to the explicit cuing of one component rather than due to a "natural" hierarchy of auditory attention component and judgment component.