Age-Appropriate Measurement

The measurement was a huge challenge because we were taking six months to six years of age, and so we need developmentally appropriate measures across all of these ages. And you don’t want to change your measures at every age, because then it’s complex to look longitudinally. So we had to carefully select measurements and create measurements that allowed us to address our research questions.

It took a toll on our examiners. They had to learn different batteries for different ages. And be skilled at working with an infant — and the next hour they might meet a child who was five years of age. So there was a lot of flexibility required on the part of the examiners.

We thought long and hard about, “How does the research guide us? And what’s important?” So certainly we looked at speech, language, psychosocial, academic, pre-academic development, cognitive, audiological.

Developing New Measurement Procedures

We’ve invested a lot in very careful audiological measurement and measurement of the hearing aid itself. That was a gap in the research. It is really kind of interesting that if you look back at the literature, the studies would report on the children’s pure-tone average, but often it wasn’t even mentioned if they were wearing amplification. And if they were wearing amplification, there wasn’t much comment on what the amplification was providing.

The technology has advanced since then, and now we have real ear measures, we have verification of amplification, and so our study did a lot with speech intelligibility index and using that as a predictor of language outcome, for example.

Audiological measurement was something we really were able to enhance in this grant.

A couple thing I’d like to say about measurement. I’m creative, I like to think beyond what’s available in standardized procedures, and that sort of comes from my clinical background. Sometimes I have to rein that in. You want to think ahead, what is a reviewer going to want to see?

One thing a reviewer wants to see is that you’re using standard procedures that are well accepted in the science. So that’s one thing we have to think about. What is an accepted, standardized procedure that is going to allow us to appropriately measure these skills in children?

But beyond that, in children who are hard of hearing we know that learning the morphology of English is particularly complicated because their hearing aids have restricted bandwidth. It doesn’t give them very good access to sounds that are in the high frequency region. So we know that could be a challenging area. The materials that were available don’t sample that aspect of our language very often. So we created some elicitation procedures, and we used language sampling procedures in addition to the standardized test. I would say thinking about, what do you want to answer? We were already evolving some theories about what aspects of language learning might be fragile in children who are heard of hearing. And there we developed more procedures.

We also used surveys, we created online surveys for service providers so we could measure intervention. We did in-depth interviews of our families over the phone. So you can see it was really a varied procedure in terms of the measurements that we created.

Balancing Research Goals with Reality

And there’s constant tension. It’s almost like you think, “My eyes are bigger than my stomach.” This is an 18 month old child, this child can’t go through a five-hour battery of testing. So there are real practical realities. What’s reasonable to do with a young child. At the same time, you’re thinking about, “What are the measures that are going to be absolutely essential to tell a story.

I think there’s constant tension between those goals of getting everything that you want, but doing that within a reasonable framework that is child-friendly, that a child is able to withstand, that a family will withstand. We want these families to come back. We want to promote attrition, so we want it to be a positive experience for them. One that they learn from. We value their contribution, so it’s not just that we’re taking your data.

There’s a give and take here. Making it reasonable for the family as they are contributing. At the same time, getting a compilation of scores. So some of that was also the way we spread things. When you have families coming in, let’s say, at two years of age, then they return when the child is three years of age, it’s easy to lose contact with that family. So we planned the family interview six months in between those visits, that way the family is getting another contact with the research team. Our interviewer happened to be a parent of children with hearing loss. And she was really family friendly. Parents looked forward to her visit, and they told her a lot.

You can see that we thought about this — there are ways to spread some of our measurement. Some of the forms the families need to fill out, and so forth, can be spread to stay in contact with the family. Remind them you’re part of this important research, we value your contribution.