Research reported in this publication was supported by the National Institute on Deafness and Other Communication Disorders of the National Institutes of Health under award number R01DC014460. Video production and editing was carried out by Robert Ladd and Barbara Rochen Renner of the Health Sciences Library at The University of North Carolina at Chapel Hill, with support from a National Library of Medicine of the National Institutes of Health Administrative Supplement for Informationist Services in NIH-funded Research Projects under award number R01DC011038. Children were recruited through the Research Participant Registries of the IDDRC at The University of North Carolina at Chapel Hill (NIH-NICHD award number U54HD079124). We appreciate Emily Buss' comments on this procedure and a previous version of this article. The authors would also like to thank Steve Lockhart for programming support and members of the Human Auditory Development Laboratory for testing assistance: Jenna Browning, Lauren Charles, Nicole Corbin, Molly Drescher, Hannah Hodson McLean, Heather Porter and Dani Warmund. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

<html>该机构审查委员会在北卡罗来纳大学教堂山分校批准了这项研究。 1.人员和空间要求<ol><li> 在声音隔离房间进行测试。配置了房间，桌子和椅子，如图1。 </li></ol><img alt="图2" src="/files/ftp_upload/54788/54788fig1.jpg" /> 图1:测试环境。助理和听众的声音展台内一台就座。孩子的父母可以选择坐在里面或外展位。观察员坐在展位上，定位在窗口助理和儿童能见度良好的正面之外。电脑屏幕和键盘控制运行时的计算机都可以访问观察者，让他/她来启动试验和输入的响应。ARGET ="_空白"&gt;点击此处查看该图的放大版本。 <ol start="2"><li> 用两个实验者测试幼儿和学龄前儿童;一个"助手"谁坐在与孩子和一个"观察者"谁是在相邻的控制室内展台内。 注:展位里面助手的作用是:（1）训练孩子进行简单游戏为主的运动反应（例如，堆积砖），只要目标信号也听见了。 （2）提供再指示必要时; （3）社会参与整个测试环节的孩子; （4）改变孩子是基于兴趣的孩子的水平玩游戏;和（5）提供社会加强件（例如，鼓掌或欢呼）以下试验，其中儿童进行有针对性的运动反应。 注:展位之外坐在观察员的作用是:（1）通过观察窗展台内的儿童和助手; （2）开始测试试验当孩子安静，"就绪"的位置; （3）表示孩子是否听到下面通过点击计算机软件用户界面相应的响应按钮，每个测试试验中的1 第一或第二区间的声音。这一决定是完全基于孩子的反应。 注:实验者的经验水平会影响所获得的收益率和数据。在这个实验中，所有的观察员和助理至少有两年的经验检验幼儿和学龄前儿童的听力诊所和/或研究实验室。 </li><li>定位在中控室计算机和硬件。电脑显示器位置以使观察者可以查看监控以及儿童和展台内的助手。 </li><li>装备与观察者和助手之间的双向通信系统中的测试空间。 注:该系统允许两个测试人员一起工作，以确保审判开始当孩子警觉，并面向任务。 </li></ol> 2.硬件和软件配置<ol><li>在本例中，定制的软件控制一个实时处理器，该路由的声音到插入式耳机。可替代地，可以使用具有刺激定时的精确控制声卡系统。 </li><li>选择一个目标信号。在本实施例中，信号是一个500毫秒，1000赫兹颤音乐音。 </li><li>通过适当地校准，以保证提供给听者的声级的耳机呈现的刺激是准确的和安全的。 </li><li>编程定制软件控制两个观察间隔每次试验的时间。 注意:在这个例子中，每个观测间隔的持续时间为1065毫秒，和时间间隔是由一个300毫秒刺激间隔隔开。因此，每次试验的总持续时间是2,430毫秒。 </li><li>试点收集的数据，以帮助在信号选择合适的持续时间，该observat离子间隔和刺激间间隔。最佳持续时间可以根据不同的刺激和人口和/或孩子的年龄被测试而变化。 </li><li>程序中的软件来提供音频和视觉提示两个区间标记。在本例中，音频提示是女性讲话者说"一"和一个语音录音"二"。无论是观察者和助手听到声音提示。视觉提示出现在监视器屏幕上闪烁的黑圈。仅观察者看到的可视化显示。 注:观察者使用这些时间锁定听觉和视觉间隔的指标，在​​与听者的行为的观察相结合，以确定哪些间隔包含所述目标信号。 </li><li>程序软件来指示哪个区间包含观察者已经进入了一个只响应后的信号。 </li><li> 编程定制软件以执行测试协议的三个阶段。的目的和主要FEA各阶段的Tures的如下: <ol><li>在第一阶段，在固定和清晰可闻的水平存在信号，始终处于区间2.选择基于导频的数据训练水平的强度。经过第一阶段三项试验，程序软件观察者提示要么重复第一阶段或第二阶段启动2。 注:第1阶段的目的，操作性条件反射的阶段，是教听众只要他/她听到信号执行为主打，运动反应。 </li><li>在第2阶段，程序的软件，以允许发生在任一时间间隔1或间隔2的信号，以相等的先验概率。在第1阶段计划第2阶段使用要持续到观察者正确判断含有4出5个连续试验信号的观测间隔相同闻的水平存在信号。 注:第2阶段的目的，验证阶段，以确保观察者能够可靠地判断包含仅基于所述信号的间隔对孩子的行为。 </li><li>项目第3阶段收集实验数据。在这个例子中，软件是程序在任一时间间隔1或间隔2运行在阶段3的自适应通道程序时，会出现的信号，以相等的先验概率。 注意:本实施例使用2向下，1-向上自适应跟踪过程来估计与71％的正确检测16相关联的信号电平。轨道持续8逆转，并且阈值是基于过去6逆转。 </li><li>编程软件中也存在阶段试验探头3.探测试验的反应体现在整个测试环节超阈值的信号反应的一致性。期间的探针试验中，在两个训练阶段（阶段1和阶段2）中使用的相同的清楚可听电平呈现该信号。目前随机试验探头，每12项试验的两倍。考虑无效的轨道，如果平均探头命中率&lt;80％。 </li></ol></li><li>对全部三个阶段，程序的软件所需要的观察者通过点击在用户界面的响应框以启动试验。 </li><li>程序的用户界面，使观察者点击一个对话框提示该区间包含的信号。输入了响应之后，提供反馈以观察者指示包含的信号的时间间隔。 </li><li> 程序软件激活两个机械玩具与分布在考场黑暗有机玻璃盒子灯。 <ol><li>使用机械玩具增援，除了一个助理在测试展位提供社会加固。 </li><li>设计程序以保持信号和玩具的激活，而不管如果在间隔1中发生的信号在时间间隔1或2发生信号，机械玩具立即被激活之后观察者的响应之间的一致的延迟。如果在时间间隔2中，机械玩具出现信号激活由间隔持续时间加上刺激间间隔（1365毫秒在此示例）延迟。 </li><li>激活机械玩具只有当观察者正确地判断出包含在信号的时间间隔。 </li></ol></li></ol> 3.数据收集<ol><li>子到达实验室之前，如在图1详述准备环境。 </li><li>选择4到6场比赛根据孩子的年龄的测试环节中，电机控制和利益。例子包括将钉成板，把块成桶，完成一个谜，置感受到件到电路板上，使一个场景。 </li><li>完成实验刺激和观察者助理通信系统的听力检查。 </li><li>只要子和父在实验室到达，在参与研究取得知情同意。 </li><li>指导孩子和家长进入展位。儿童通常prefeR，它将父母坐在旁边的摊位内，并在某些情况下，孩子坐在父母的腿上。 </li><li>使用儿童友好的语言，给孩子和家长的任务的概述。形容声音（s）表示，孩子会听到和有针对性的运动响应模型。 </li><li> 有实验者或助理的地方对孩子插入耳机或贴耳式耳机。 <ol><li>在眼平子的位置，并让孩子看，并事先安置感受到插入耳机或耳机。 </li><li>通过让他/她选择在哪里夹传感器，或让孩子帮助实验者将耳机提供控制感的孩子。 </li><li>如果孩子不愿意戴耳机，放置在家长或玩偶模型的过程传感器。 </li><li>如果终止测试环节，万一孩子不愿意穿传感器或成为DIStressed。 </li></ol></li><li>如果父倾向于在测试期间控制室，有观察者护送父到控制室。让父母听到，看到孩子从控制室。 </li><li>让助手确认展位门（S）关闭。 </li><li>对他/她的耳朵助理地方耳机才能听到中控室观察者，以及音频提示标记每个区间。 </li><li>让助手给孩子一个玩具（ 例如 ，块），并指导孩子放置对象对他/她的躯干或脸颊。玩具的这个位置被称为"准备"的位置;儿童使用整个测试该位置。 </li><li>要求观察者开始试用只有当孩子在准备位置。 </li><li>有观察者启动调节阶段（阶段1）。这个阶段的目标是要调理孩子做出了明确，时间锁定运动反应时，他/她听到Ť他的目标信号。 </li><li> 为了方便学习任务，有助手和孩子开始"一起听"使用交接手技术。 <ol><li>让助手把他/她的手放在孩子的手。具有助理移动至孩子的手当助手听到听觉间隔标记，以便在他/她的耳机的第二时间间隔，因为信号始终是第1阶段期间存在于区间2。 </li><li>可替代地，有助理平行于子执行的任务。 </li><li>让助手减少与后续试验的援助水平。 </li><li>如果孩子反应慢，鼓励孩子，因为他/她听到的目标信号尽快响应或让孩子"种族"的助手。 </li></ol></li><li> 继续在第一阶段提出的试验，直到观察者相信孩子的反应是刺激控制之下。 <ol><li>有观察者米AKE这一决定根据（1）的儿童是否能够没有协助执行电机的任务，和（2）儿童是否能够使该信号，即观察者可以判断快速，时间锁定响应。 </li><li>需要在这个阶段至少3项试验。 </li></ol></li><li> 有观察者开始测试第二阶段。 注意:在此阶段，无论观察者也不助理知道哪个测试间隔包含信号。观察者必须准确判断4，满分5连续试验，成功地完成这个阶段。 注意:这孩子被认为是受过训练的有1阶段的顺利完成2.如果需要多个会话，在这一点上暂停测试环节。所以建议测试两周内恢复。在第二次访问，提出了一些提醒试验（用第1阶段）之前开始测试第三阶段。 </li><li>启动第三阶段收集实验数据。正如在第2阶段，有OBSERV呃密切关注该区间包含信号监听和判断。除了电机为主打的响应，有微妙的行为观察者手表。 </li><li>注意:孩子常常表现出细微的行为听起来，包括眼睛或头部的运动，面部表情的变化，活动17,18平息。已经观察者使用这些细微的行为判断哪个间隔包含在信号时，信号电平是接近儿童的阈值。 </li><li>让助手切换游戏每10-15试验，以最大限度地提高孩子的兴趣和习惯减少9的风险。让助手给孩子提供频繁的社交加固从事儿童和塑造和维护孩子的行为。 </li><li> 如果孩子停止以一致的方式作出反应，孩子可能已经"忘记了"是什么信号听起来像或者可能已经习惯了在游戏为主的任务。采用以下策略，以增加孩子的参与: <ol><li>让助手reinstruct孩子和孩子的反应模型。让助手推出一个新游戏。 </li><li>通过从助理增加社会增强或激活的定制软件控制的机械玩具提供更多的强化。 </li></ol></li><li>对于2,3岁的孩子，终止第3阶段的完成对于孩子谁是4年或更旧的测试之后，如果需要运行一个第二自适应轨道。在此之前启动第二轨道，给孩子一个短暂的休息（5-10分钟）播放。 </li><li>在测试结束时，完成筛选鼓室评估中耳功能。在访问结束时进行筛选，因为有些孩子在测试环境中花费时间和熟悉的测试后更容易接受此过程。 </li><li>补偿与会者ND安排随访，如果需要的话。 </li></ol> 4.数据分析<ol><li>平均信号电平在自适应轨道计算检测阈值的最后6逆转。 </li><li>计算最后6逆转水平的标准偏差。为了使阈值被认为是有效的，标准偏差必须建立一个标准以下，基于导频数据。高标准偏差表明逆转水平间距很大，可能是由于不一致的观察者的判断或听众因素，如培训效果，疲劳或关闭任务的行为。 </li><li>通过确定探测信号试验该被正确由观察者测试阶段3期间判断该比例计算为探针试验的命中率。为了使阈值被认为是有效的，探针的命中率必须达到0.80的最低标准。如果不能满足这个标准是因为要SUPR不一致的反应一阈值的信号，其可以指示疲劳，关任务的行为，或者对听众和/或观察者训练不足。 </li></ol>

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The authors declare that they have no competing financial interests.

本文描述了用于在2至4岁的儿童测量听力能力的两间隔，强迫选择行为过程。在此过程中，观察者判断在间隔1的信号是否被呈现或间隔2上的听者的行为完全基于。孩子的行为被成形为以时间锁定通过训练他们执行到声音播放基于响应于该信号的表示。我们的初步结果表明，该方法是测试2听觉灵敏度到4岁的儿童可行和可靠的。 该程序的意义有与此方法相关联的一些优点。第一个优点是，它可以被用来测试孩子年仅2.0年发育年龄。阈值已成功为5测量出8 2岁的孩子的。类似的产率（〜60-70％）已经在文献中报道为听觉灵敏度的测定我N 2岁的孩子使用空调播放听力的声场9，21。至于条件播放听力7，8，阈值已成功为所有，但3岁的孩子中的一个测量，并全部4岁的孩子。这种方法的第二个优点是，它可以防范观察者响应偏差。观察员必须立足他/她的判断仅仅根据孩子的行为，对孩子的敏感性或行为不影响结果，因此之前的预期。这种方法的第三个优点是，它可以是用于观察者判断哪个区间包含的信号，而不是做出关于一个信号的存在或不存在下一个是 - 否的决定更加容易。在本发明的两间隔任务，观察者能够在两个间隔比较孩子的行为，而不是比较多个试验的行为，如在单间隔任务是必需的。因此，在观察者的存储器负载可以是用于在两个间隔相对于单间隔任务小。此外，寻找行为的时间锁定的变化可能会使观察者适应孩子的行为测试会话期间发生的变化。 限制有一些限制，采用此方法时要考虑的问题。第一，需要导频数据来确定适当的参数 - 训练条件，开始水平，刺激间间隔值，并且换能器 - 使用为不同的年龄组和刺激。特别是调整检测参数可能会影响到2岁的孩子谁可以成功地做任务，并提供可用的实验数据的数量。 2岁的孩子收益率可通过声场或耳机，而不是插入耳机呈现的刺激得到改善。但是，必须采取预防措施时，在声场进行测试，以防止助理和家长不听信号（参见莱博尔德等 22细节。）较长的刺激间隔可能需要比年龄较大的儿童年幼的孩子，如果年轻的听众需要更长的时间来完成游戏为主的反应。此外，2年的年轻人，可能需要更多的培训，比年龄较大的儿童可能会疲劳得更快。为了防止疲劳，建议经常更换玩具9和测试提供经常休息。回想一下，我们测试三个年幼的孩子过两次访问，而不是一个。其次，目前尚不清楚有多少经验是必需的观察员和助理来获得使用此过程可靠的结果。在这个例子中，所有的观察员和助理一直在使用游戏为主的听力实验室检测婴/ O至少两年的经验检验幼儿和学龄前儿童的听力诊所，以及至少一个的经验增加一年- [R学龄儿童。建议建立协议培训新观察员和确保训练的观察家一致的性能。需要进一步研究以确定横跨观察员和实验室此方法的可靠性。 未来应用有可能修改该程序，以测试孩子谁是无法执行常规的电机的响应。例如，该条件反应可以是眼睛的运动，头部转，或在活动水平14的变化。以前的工作已经表明，受过训练的观察者能够可靠地使用这些替代行为测试婴儿年仅1个月，使用单一的时间间隔，观察者基于方法23岁。此外，单的时间间隔，基于观测器的方法已被用来测量在特殊人群听觉灵敏度，包括2至12个月大的婴儿唐氏综合症24和26至36月大的婴儿与人工耳蜗植入25。来自这些先前的研究结果支持测试孩子的可行性谁不能产生为主打​​，电机具有两间隔范例响应。 而目前的研究中安静评估检测阈值，该过程也可以用于评估掩蔽检测或歧视。在掩蔽噪声的情况下，与单间隔，基于观测器的步骤进行测试婴儿以前的研究表明，掩蔽被连续地自适应轨道的过程中，为了避免对掩蔽起始点和/或偏移26响应播放。类似地，为了评估判别的能力，一个标准的声音从信号间隔，在此期间，所述信号刺激将得到27呈现反复开。对于所有的刺激条件下，听者将空调时，他/她检测到stimulu的变化作出反应的时候，那些变化是增加了一个声音（检测）或声音（歧视）的变化。而目前的研究中所用的自适应过程来估计阈值，可以使用相同的方法在一个固定的信号和/或掩蔽电平来评估正确百分比性能。另一种可能的修改是，刺激可以通过其他的换能器呈现，包括声场13,22。 总之，这里介绍的游戏为主，两区间的过程提供了有关幼儿和学龄前儿童的听觉能力可靠的行为数据。使用这种方法，研究人员将能够研究听觉系统在幼儿和学龄前儿童年如何改变 - 我们知之甚少听觉行为的时间段。

这是很难获得幼儿和学龄前儿童的行为听阈的可靠估计。用于测试在临床和实验室婴儿操作性技术不一般，在这个年龄段的孩子们工作得很好，因为幼儿和学龄前儿童往往使其习惯的婴儿比1,2快。另一方面，幼儿和学龄前儿童往往缺乏完成了用于评估儿童4岁及以上3,4标准强迫选择行为测试过程所需的认知成熟。因此，也有在我们的婴儿期和学龄早期的人类听觉发展的认识显著差距。 单间隔，称为空调播放听力测试5（CPA）自适应过程中的听力诊所通常用来评估赫林对于约2.5和5年6之间的发育年龄的孩子落下g灵敏度。 CPA依靠使用一玩基于运动活动的（ 例如 ，堆叠块）以建立与听觉信号的时间锁定条件反应。测试助手提供了孩子积极的社会加固，进一步塑造响应行为。来自多项研究的结果表明，使用CPA的产生常规临床听力为典型的开发3年的孩子7,8超过90％。大大降低了收益率已经报道了年幼的孩子。例如，Thompson等。 9日报道，一个条件对声音的反应可能会在2岁儿童68％使用CPA成立。 尽管在临床听力学的广泛使用CPA的，它不适合的听觉行为大多数基于实验室的调查。CPA是旨在最大限度地提高效率和病人接受单区间自适应过程，但它易受观察者和听众反应偏差。注册会计师过程中的观察员启动信号演示，并可能因此等因素对孩子的听觉灵敏度和他们倾向响应10先验的预期的影响。试验中，没有声音呈现- -的"捕获"试验列入有时被用来量化和适应考官反应偏差11。 在本报告中所描述的方法的总的目标是有效地估计在使用游戏为主，两间隔，强迫选择行为测试过程幼儿和学龄前儿童听觉阈。用于使用强迫选择范例的理由是，它守卫对一些形式的反应偏差10的，因此允许更直接comparis整个组件采用高效的自适应过程不同年龄和/或刺激。传统的两层和三个间隔，强迫选择方法需要特定的，预定响应于收听者的部分（例如，推的几个按钮之一），以指示哪个区间包含的信号。儿童年仅4〜5岁才能执行此任务的12，但程序的要求，使这些方法不适合年轻的听众和发育迟缓的许多听众。 此处所描述的方法建立在Browning 等的工作。 13，其评价的可行性和估计使用基于观测器的心理过程14的两间隔，强迫选择适应婴儿行为阈值的效率。在此方法中，信号在两个观测间隔之一期间呈现。每个间隔被指示为实时机器人观察者^ h视觉和听觉，但是观察者没有告诉该区间包含的信号。婴儿，另一方面，没有给出一个观察发生的任何指示从信号的演示间隔开。每次试验后，观察者选择包含基于对婴儿行为的信号的时间间隔。通过Browning 等报道的结果。 13表明，这一过程是可行和有效的与7至9个月大的婴儿使用。测试幼儿和学龄前儿童的方法紧随测试婴儿的程序，需要提醒的是孩子们的反应听起来是使用与注册会计师常用的方法形成的。 在这篇文章中，一个简单的实验旨在衡量安静的孩子们的音调检测。该信号是通过插入耳机提出了500毫秒，1000 Hz的啭音。请注意，我们还成功地使用此协议驴在更复杂的听音任务，如在一个噪声掩蔽15语音检测的性能。在该协议如下所述，儿童被教导当信号听到执行播放基于条件的运动反应。然而，任何行为反应可以使用，只要它是时间锁定对刺激的呈现，并且可以可靠地判断。由于这里证明，这个任务是适当的测试通常发育的儿童年仅2岁。

<table><tbody><tr><td>RZ6 auditory processor</td><td>Tucker-Davis Technologies (TDT)</td><td></td><td></td></tr><tr><td>ER1 insert earphone</td><td>Etymotic Research</td><td></td><td></td></tr><tr><td>IntellegentVRA mechanical toys and control box</td><td>Intelligent Hearing Systems</td><td></td><td>System modified by company to interface with TDT system</td></tr></tbody></table>

behavioral assessment of hearing in 2 to 4 year-old children: a two-interval, observer-based procedure using conditioned play-based responses

从幼儿和学龄前儿童收集可靠的行为数据是具有挑战性的。其结果是，有在我们对这些年龄组人类听觉发展的认识显著差距。本文介绍用于测量与两间隔，两替代强迫选择范例听觉灵敏度基于观测器的过程。年轻的孩子被训练来执行游戏为主，运动反应（ 例如 ，把一个块的桶）时，他们听到的目标信号。实验者观察孩子的行为，使一对信号是否被所述第一或第二观察间隔期间呈现判断;实验者失明的真实信号的时间间隔，所以该判定仅基于孩子的行为。这些程序被用来测试2至4岁儿童（33），没有已知的听力问题。该信号被一个1000赫兹颤声音在安静呈现，以及信号电平调整为估计阈Çorresponding 71％-correct检测。对儿童的82％得到有效的阈值。这些结果表明，这两个间隔过程是与幼儿和学龄前儿童利用可行和可靠。在本文所描述的两个区间，基于观测器的过程是因为它可以防范对实验者的部分反应偏向幼儿听力评估的有力工具。

三十三个孩子是从谁的孩子通常发展的一个数据库招募，根据父母的报告。纳入标准包括没有已知的听力下降，不超过三个中耳炎发作史，中耳炎的前一个月的测试没有发作。 8个2岁的孩子，十八3年的孩子，七4年的孩子符合这些纳入标准。招募的儿童，三不会容忍插入式耳机和检测未尝试。 其余的30名儿童中，除了一名儿童（2岁）成功地完成了两个阶段的训练（第1阶段和第2阶段）。平均而言，儿童需要4.8试验（SD = 2.4;最大= 12）在第1阶段和4.1的试验（SD = 0.3;最大= 5）在第2阶段两个2岁的孩子以及一个3岁的只能够在首次访华期间完整的培训;其中两个孩子返回第二次访问并成功完成第3阶段。其余所有的孩子在完成单个会话的协议。平均而言，孩子需要40.0试验完成第3阶段（SD = 7.9;分钟= 27;最大= 57）。所有28名儿童谁完成第三阶段的测试遇见≥0.80探头率标准;所有探头信号的试验测试会话的75％正确识别。基于过度波动只有一个孩子的个人信息被排除在外;在这种情况下，反转值的标准偏差超过4.4分贝的标准。 图2显示了个别儿童的阈值作为年龄的函数。与正常的中耳功能的基础上，对测试日鼓室所有儿童的阈值，由圆圈所示。另外六个孩子（21％）有异常鼓室图，表明可能中耳功能障碍（ 如中耳液）。充满符号显示的数据表明AB<html>基于鼓室正常中耳功能:顺应性降低（B型;方）或过多的负压（C型;三角形）。一个额外的孩子绝不会容忍测试程序筛选鼓室，所以他的中耳状态未知（钻石）。从谨慎，因为不正常的中耳状态与阈值升高19相关的异常中耳功能的孩子解释阈值。儿童获得阈值与该年龄组以前的数据大体一致。例如， 在施耐德人。 20估计心理功能学龄前儿童在1,000Hz检测噪声的倍频宽带。定义的阈值与65％正确关联的水平，平均阈值为约21分贝声压级3岁的孩子和14分贝声压级4岁的孩子。 G"/&gt; 图2: 啭音检测阈值。检测阈值被绘制为儿童年龄的函数。只从每个侦听获得的第一阈值被示出。符号形状反映了听者的中耳状态:A型（圆），B型（方形），C型（三角形），或不能测试（CNT;金刚石）。而A型表示正常中耳导纳，B型（平面）和C型（负压）通常具有降低的中耳功能相关联，由于流体，拥塞，或耳部感染。 <a href="http://ecsource.jove.com/files/ftp_upload/54788/54788fig2large.jpg" target="_blank">请点击此处查看该图的放大版本。</a> 阈值也被测定为一组年轻人的听力正常的灵敏度和中耳状态上测试的当天（8; 20 - 25年）。由于两个年龄组之间的程序修改，CAU比较儿童和成人数据时化是必要的。两个年龄组之间的主要协议不同的是，测试成人在展台内的助手并不在场。相反，谁是通过与助理社会参与提供增强儿童，成年人只用试通过试用反馈通过机械玩具活化提供。成年人完成了一个测试会话两个连续的自适应轨道。但是，仅仅从第一自适应轨道运行的门槛在这里考虑。对于颤声刺激的平均成年门槛为2.4 dB声压级（SD = 1.7 dB为单位）。在本研究中，成年人和3岁的孩子之间的阈值的组间差异，与正常中耳功能，为7.2分贝。这种观察到的儿童成年差比在一些研究中20已经报道小。但是，子成年差的大小由两个整体的过程和任何很可能影响儿童和成人之间执行程序的修改。需要进一步研究，以更好地了解儿童和成人的刺激的敏感性是通过修改本文描述的两个区间，基于观测过程的影响。

Watch this Scientific Journal Video about Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses at JoVE.com

Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses

本文介绍了测量2听觉灵敏度至4岁儿童的过程。孩子们被训练，当他们听到的目标信号来执行游戏为主的反应。阈值，然后在两间隔，两替代强迫选择范例估计，基于孩子的行为的观察。

2听证会，以4岁儿童的行为评估:两区间，观测为基础的应用程序基于条件性播放响应

Collecting reliable behavioral data from toddlers and preschoolers is challenging. As a result, there are significant gaps in our understanding of human ...

behavioral-assessment-hearing-2-to-4-year-old-children-two-interval

Research

JoVE Journal

Behavior

29.0K 次观看.  The University of North Carolina at Chapel Hill. 本文介绍了测量2听觉灵敏度至4岁儿童的过程。孩子们被训练，当他们听到的目标信号来执行游戏为主的反应。阈值，然后在两间隔，两替代强迫选择范例估计，基于孩子的行为的观察。 

视频: Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses

Making Sense of Listening: The IMAP Test Battery

The ability to hear is only the first step towards making sense of the range of information contained in an auditory signal. Of equal importance are the abilities to extract and use the information encoded in the auditory signal. We refer to these as listening skills (or auditory processing AP). Deficits in these skills are associated with delayed language and literacy development, though the nature of the relevant deficits and their causal connection with these delays is hotly debated.
When a child is referred to a health professional with normal hearing and unexplained difficulties in listening, or associated delays in language or literacy development, they should ideally be assessed with a combination of psychoacoustic (AP) tests, suitable for children and for use in a clinic, together with cognitive tests to measure attention, working memory, IQ, and language skills. Such a detailed examination needs to be relatively short and within the technical capability of any suitably qualified professional. Current tests for the presence of AP deficits tend to be poorly constructed and inadequately validated within the normal population. They have little or no reference to the presenting symptoms of the child, and typically include a linguistic component. Poor performance may thus reflect problems with language rather than with AP. To assist in the assessment of children with listening difficulties, pediatric audiologists need a single, standardized child-appropriate test battery based on the use of language-free stimuli.
We present the IMAP test battery which was developed at the MRC Institute of Hearing Research to supplement tests currently used to investigate cases of suspected AP deficits. IMAP assesses a range of relevant auditory and cognitive skills and takes about one hour to complete. It has been standardized in 1500 normally-hearing children from across the UK, aged 6-11 years. Since its development, it has been successfully used in a number of large scale studies both in the UK and the USA. IMAP provides measures for separating out sensory from cognitive contributions to hearing. It further limits confounds due to procedural effects by presenting tests in a child-friendly game-format. Stimulus-generation, management of test protocols and control of test presentation is mediated by the IHR-STAR software platform. This provides a standardized methodology for a range of applications and ensures replicable procedures across testers. IHR-STAR provides a flexible, user-programmable environment that currently has additional applications for hearing screening, mapping cochlear implant electrodes, and academic research or teaching.

A test battery (IMAP) for performing an in-depth assessment of auditory and cognitive abilities contributing to listening skills is described. It is quick to administer, child-friendly and free from linguistic confounds. Stimulus generation and protocol management are controlled via a software platform (IHR-STAR) to ensure replicable procedures.

听力：IMAP测试电池的决策意识

The ability to hear is only the first step towards making sense of the range of information contained in an auditory signal. Of equal importance are the ...

科研

医学

Quantitative Assessment of Cortical Auditory-tactile Processing in Children with Disabilities

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology to quantitatively assess children&#39;s cortical processing of light touch, speech sounds and the multisensory processing of the 2 stimuli, without requiring active subject participation or causing children discomfort. To accomplish this we developed a dual channel, time and strength calibrated air puff stimulator that allows both tactile stimulation and sham control. We combined this with the use of event-related potential methodology to allow for high temporal resolution of signals from the primary and secondary somatosensory cortices as well as higher order processing. This methodology also allowed us to measure a multisensory response to auditory-tactile stimulation.

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology to quantitatively assess infants and children&#39;s cortical processing of light touch, speech sounds, and the multisensory processing of the 2 stimuli, without requiring active subject participation or causing discomfort in vulnerable patients.

皮质听觉，触觉加工的残疾儿童定量评价

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology ...

行为学

Infant Auditory Processing and Event-related Brain Oscillations

Rapid auditory processing and acoustic change detection abilities play a critical role in allowing human infants to efficiently process the fine spectral and temporal changes that are characteristic of human language. These abilities lay the foundation for effective language acquisition; allowing infants to hone in on the sounds of their native language. Invasive procedures in animals and scalp-recorded potentials from human adults suggest that simultaneous, rhythmic activity (oscillations) between and within brain regions are fundamental to sensory development; determining the resolution with which incoming stimuli are parsed. At this time, little is known about oscillatory dynamics in human infant development. However, animal neurophysiology and adult EEG data provide the basis for a strong hypothesis that rapid auditory processing in infants is mediated by oscillatory synchrony in discrete frequency bands. In order to investigate this, 128-channel, high-density EEG responses of 4-month old infants to frequency change in tone pairs, presented in two rate conditions (Rapid: 70 msec ISI and Control: 300 msec ISI) were examined. To determine the frequency band and magnitude of activity, auditory evoked response averages were first co-registered with age-appropriate brain templates. Next, the principal components of the response were identified and localized using a two-dipole model of brain activity. Single-trial analysis of oscillatory power showed a robust index of frequency change processing in bursts of Theta band (3 - 8 Hz) activity in both right and left auditory cortices, with left activation more prominent in the Rapid condition. These methods have produced data that are not only some of the first reported evoked oscillations analyses in infants, but are also, importantly, the product of a well-established method of recording and analyzing clean, meticulously collected, infant EEG and ERPs. In this article, we describe our method for infant EEG net application, recording, dynamic brain response analysis, and representative results.

High-density electroencephalography (dEEG) is being used increasingly to study brain development and plasticity in the early years of life. Here we present an application of sophisticated analysis techniques that builds on traditional EEG recording to understand the oscillatory dynamics of rapid auditory processing in the infant brain.

婴儿听觉处理和事件相关的脑振荡

Rapid auditory processing and acoustic change detection abilities play a critical role in allowing human infants to efficiently process the fine spectral ...

Testing Sensory and Multisensory Function in Children with Autism Spectrum Disorder

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are now recognized as a core symptom in autism spectrum disorder (ASD). Our ability to perceive and interact with the external world is rooted in sensory processing. For example, listening to a conversation entails processing the auditory cues coming from the speaker (speech content, prosody, syntax) as well as the associated visual information (facial expressions, gestures). Collectively, the &#8220;integration&#8221; of these multisensory (i.e., combined audiovisual) pieces of information results in better comprehension. Such multisensory integration has been shown to be strongly dependent upon the temporal relationship of the paired stimuli. Thus, stimuli that occur in close temporal proximity are highly likely to result in behavioral and perceptual benefits &#8211; gains believed to be reflective of the perceptual system&#39;s judgment of the likelihood that these two stimuli came from the same source. Changes in this temporal integration are expected to strongly alter perceptual processes, and are likely to diminish the ability to accurately perceive and interact with our world. Here, a battery of tasks designed to characterize various aspects of sensory and multisensory temporal processing in children with ASD is described. In addition to its utility in autism, this battery has great potential for characterizing changes in sensory function in other clinical populations, as well as being used to examine changes in these processes across the lifespan.

We describe how to implement a battery of behavioral tasks to examine the processing and integration of sensory stimuli in children with ASD. The goal is to characterize individual differences in temporal processing of simple auditory and visual stimuli and relate these to higher order perceptual skills like speech perception.

测试儿童的感官和多感官功能自闭症谱系障碍

In addition to impairments in social communication and the presence of restricted interests and repetitive behaviors, deficits in sensory processing are ...

Portable Intermodal Preferential Looking (IPL): Investigating Language Comprehension in Typically Developing Toddlers and Young Children with Autism

One of the defining characteristics of autism spectrum disorder (ASD) is difficulty with language and communication.1 Children with ASD's onset of speaking is usually delayed, and many children with ASD consistently produce language less frequently and of lower lexical and grammatical complexity than their typically developing (TD) peers.6,8,12,23 However, children with ASD also exhibit a significant social deficit, and researchers and clinicians continue to debate the extent to which the deficits in social interaction account for or contribute to the deficits in language production.5,14,19,25
Standardized assessments of language in children with ASD usually do include a comprehension component; however, many such comprehension tasks assess just one aspect of language (e.g., vocabulary),5 or include a significant motor component (e.g., pointing, act-out), and/or require children to deliberately choose between a number of alternatives. These last two behaviors are known to also be challenging to children with ASD.7,12,13,16
We present a method which can assess the language comprehension of young typically developing children (9-36 months) and children with autism.2,4,9,11,22 This method, Portable Intermodal Preferential Looking (P-IPL), projects side-by-side video images from a laptop onto a portable screen. The video images are paired first with a 'baseline' (nondirecting) audio, and then presented again paired with a 'test' linguistic audio that matches only one of the video images. Children's eye movements while watching the video are filmed and later coded. Children who understand the linguistic audio will look more quickly to, and longer at, the video that matches the linguistic audio.2,4,11,18,22,26
This paradigm includes a number of components that have recently been miniaturized (projector, camcorder, digitizer) to enable portability and easy setup in children's homes. This is a crucial point for assessing young children with ASD, who are frequently uncomfortable in new (e.g., laboratory) settings. Videos can be created to assess a wide range of specific components of linguistic knowledge, such as Subject-Verb-Object word order, wh-questions, and tense/aspect suffixes on verbs; videos can also assess principles of word learning such as a noun bias, a shape bias, and syntactic bootstrapping.10,14,17,21,24 Videos include characters and speech that are visually and acoustically salient and well tolerated by children with ASD.

Portable Intermodal Preferential Looking IPL: Investigating Language Comprehension in Typically Developing Toddlers and Young Children with Autism

A reliable home-based way to assess the language comprehension of very young typically developing children, as well as those with autism, is described. The method analyzes children's eye gaze while viewing side-by-side images but hearing an audio that matches only one image. Stimuli are designed with young participants in mind.

便携式联运优惠展望（IPL）：研究语言理解在通常情况下发展幼儿和儿童自闭症

One  of the defining characteristics of autism spectrum disorder (ASD) is difficulty  with language and communication.1  Children with ASD's onset of ...

An Electrophysiology Protocol to Measure Reward Anticipation and Processing in Children

We present a protocol designed to measure the neural correlates of reward in children. The protocol allows researchers to measure both reward anticipation and processing. Its purpose is to create a reward task that is appropriate for young children with and without autism while controlling reward properties between two conditions: social and nonsocial. The current protocol allows for comparisons of brain activity between social and nonsocial reward conditions while keeping the reward itself identical between conditions. Using this protocol, we found evidence that neurotypical children demonstrate enhanced anticipatory brain activity during the social condition. Furthermore, we found that neurotypical children anticipate social reward more robustly than children with autism diagnoses. As the task uses snacks as a reward, it is most appropriate for young children. However, the protocol may be adapted for use with adolescent or adult populations if snacks are replaced by monetary incentives. The protocol is designed to measure electrophysiological events (event-related potentials), but it may be customized for use with eye-tracking or fMRI.

This protocol is designed to measure reward anticipation and processing in young children with and without autism. Specifically, the protocol is designed to study the neural correlates of reward during social and nonsocial conditions while controlling for reward between conditions.

儿童奖励预期与处理的电生理学协议

We present a protocol designed to measure the neural correlates of reward in children. The protocol allows researchers to measure both reward anticipation ...

Systematic Hearing Performance Evaluation Process for Adolescents with Cochlear Implantation at Early Ages

Cochlear implant (CI) provision is the most effective clinical treatment to restore hearing performance in individuals with profound sensorineural hearing loss (SNHL). It has been successful in providing improved speech perception outcomes, especially in quiet environments. However, speech perception performance within complex environments, lexical tone recognition, and music perception have been shown to only improve with newer fine structure coding strategies or related techniques. Therefore, the methods used to assess hearing performance in noisy environments, lexical tone recognition, and music perception are of vital importance. These assessments must reflect the postoperative outcomes and also provide guidance for the programming, rehabilitation, and application of new coding strategies. In this study, hearing performance in simple and complex situations was evaluated before and after upgrading to a fine structure strategy. The participants were a cohort of Mandarin-speaking adolescents, who were experienced CI users. The comprehensive clinical workflow involved assessments of speech in quiet conditions, speech in noisy conditions, lexical tone recognition, and music perception. This battery of tests is explained in detail, from the coding strategy to the test methods, including the test process, environment, device, material, and order. The details that require special attention are discussed, such as the position of the participants, the angle of the loudspeaker, the intensity of the sound, the noise type, the practice test, and the way of answering questions. Each test step, method, and material for speech, lexical tone, and music perception is presented in detail. Finally, the clinical results are discussed.

This paper describes a battery of tests used to clinically assess the hearing performance of adolescent, Mandarin-speaking, experienced cochlear implant users upgraded to a new fine structure coding strategy. The battery of tests include speech in quiet conditions, speech in noisy conditions, lexical tone, and music perception.

早期植入人工耳蜗的青少年系统听力表现评估过程

Cochlear implant (CI) provision is the most effective clinical treatment to restore hearing performance in individuals with profound sensorineural hearing ...

Toddler and Preschool Child Exam

Source: Heather Collette&#160;and Jaideep Talwalkar; Yale School of Medicine
The key to a successful exam of a toddler or preschool-age child is building rapport and trust between them and the provider. Toddlers, in particular, may be wary of strangers and unwilling to cooperate with the physical exam, which is expected age-appropriate behavior. In order to provide good care and create a comfortable patient experience, clinicians need to tailor their interaction to the child&#39;s developmental stage. Ensuring positive medical encounters for children will increase their likelihood of seeking medical care as they age into adulthood. Clinicians must be creative and flexible as they work with children to achieve their care goals. Suggestions on how to facilitate these interactions will be covered in this video, with less of a focus on specific organ system components, as these are similar to other age groups.
Toddlerhood through preschool age is a time of significant physical and developmental growth. Progression of language, motor, and social skills is a reflection of children&#39;s brain growth and social environment. Normal development follows a typical progression, but exact time points for achieving developmental milestones can vary among children. Achieving a specific milestone a few months later than another child or based on a time point listed on a development chart does not necessarily indicate a problem. Providers must ensure that children meet developmental milestones as expected and, if not, refer them early for special services to promote the best outcome possible.&#160;

幼儿和学龄前儿童考试

Source: Heather Collette&#160;and Jaideep Talwalkar; Yale School of Medicine
The key to a successful exam of a toddler or preschool-age child is building ...

教育

JoVE Science Education

临床技能

Physical Examinations IV

The Costs and Benefits of Natural Pedagogy

Source: Laboratories of Nicholaus Noles, Judith Danovitch, and Asheley Landrum&#8212;University of Louisville
Children have many tools they use over the course of development to learn from adults. Perhaps the earliest tool is imitation, simply copying what they see an adult do or say. However, children actually learn much more effectively than one might expect if they were only imitating. This is because, when it comes to learning and teaching, children and adults have a special relationship. Children treat adults as if they are helpful and knowledgeable teachers, and adults teach children information in a manner that is usually efficient and effective. Through these interactions, children can learn much better than if they were simply using trial-and-error or copying adults exactly. This way of interacting is referred to as natural pedagogy, and it is one of the reasons that young humans are gifted learners.
One of the most impressive aspects of natural pedagogy is that no one teaches adults how to be good teachers, and children treat adults as teachers without having to be trained to do so. However, natural pedagogy also entails costs. Children are curious and intrinsically motivated to explore, so children do some of their best learning when given opportunities to learn and explore on their own. Thus, the result of natural pedagogy is that children learn information taught to them very effectively, but explicit teaching restricts their curious, exploratory behaviors. There is a tradeoff between efficient learning and self-driven exploration.
This video demonstrates the method by which Elizabeth Bonawitz, Patrick Shafto, and colleagues1 showed the effects of natural pedagogy on young learners.

Investigating the Benefits and Limitations of Natural Pedagogy

成本和收益的自然教育学

Source: Laboratories of Nicholaus Noles, Judith Danovitch, and Asheley Landrum&#8212;University of Louisville
Children have many tools they use over the ...

心理学

发展心理学

Piaget's Conservation Task and the Influence of Task Demands

Source: Laboratories of Judith Danovitch and Nicholaus Noles&#8212;University of Louisville
Jean Piaget was a pioneer in the field of developmental psychology, and his theory of cognitive development is one of the most well-known psychological theories. At the heart of Piaget&#8217;s theory is the idea that children&#8217;s ways of thinking change over the course of childhood. Piaget provided evidence for these changes by comparing how children of different ages responded to questions and problems that he designed.
Piaget believed that at age 5, children lack mental operators or logical rules, which underlie the ability to reason about relationships between sets of properties. This characteristic defined what he called the preoperational stage of cognitive development. One of Piaget&#8217;s classic measures of children&#8217;s ability to use mental operations is his conservation task. In this task, children are shown two identical objects or sets of objects. Children are first shown that the objects are the same on one key property (number, size, volume, etc.). Then, one of the objects is modified so it appears different than the other one (e.g., it is now longer, wider, or taller), but the key property remains the same. Following this transformation, children are asked to judge if the two objects or sets of objects are now the same or different with respect to the original key property.
Piaget reported that children in the preoperational stage (approximately ages 2-7) typically judged the objects to be different after the transformation, even though the key property had not changed. He attributed children&#8217;s incorrect responses to their excessive focus on the change, rather than on the fact that the key property remained the same. However, over the years, researchers have argued that Piaget&#8217;s conservation task is an invalid measure of children&#8217;s reasoning skills. These critics have suggested that children&#8217;s poor performance is due to task demands, such as assumptions about the experimenter&#8217;s goals and expectations when the question about the key property is repeated.
This video demonstrates how to conduct Piaget&#8217;s classic conservation task,1&#8211;2 and how a small modification in the task design can dramatically change children&#8217;s accuracy (based on the methods developed by McGarrigle and Donaldson3).

Piaget&#039;s Conservation Task and the Influence of Task Demands

皮亚杰的守恒任务和任务需求的影响

Source: Laboratories of Judith Danovitch and Nicholaus Noles&#8212;University of Louisville
Jean Piaget was a pioneer in the field of developmental ...