CI Atlas · Audiological Evaluation · Module 12

12Paediatric speech perception

Knowing a child's thresholds is not the same as knowing what they can do with sound, and for a deaf child being considered for — or recovering from — an implant, the second question is the one that matters. Paediatric speech testing climbs a ladder, from simply detecting that a sound is present, through telling two sounds apart and identifying which was heard, to genuinely comprehending meaning, and the right rung is chosen by the child's language age rather than their birthday. The materials run from a parent's checklist of everyday listening to open-set word lists and sentences in noise, with closed-set picture tasks in between that must be read against the level of lucky guessing. This module covers how children's speech perception is measured and tracked; how those scores feed candidacy belongs to the next chapter.

TErber's hierarchy

Children's speech testing follows Erber's hierarchy — detection → discrimination → identification → comprehension — choosing the level by language age, not chronological age, and allowing for immature articulation when scoring. Lower rungs probe sensory access; higher rungs recruit language.

Children's speech perception is tested up a hierarchy — detection → discrimination → identification → comprehension — choosing the level by the child's language age, not birthday, and allowing for immature articulation when scoring. Lower rungs probe sensory access (does the signal get in?); higher rungs recruit language, which is why a child can detect sound yet not comprehend it. The paediatric minimum battery climbs this ladder from caregiver checklists to open-set words and sentences in noise. Schematic.

CThe paediatric battery

The Pediatric Minimum Speech Test Battery progresses from caregiver tools (the Auditory Skills Checklist with the Ling Six Sounds; LittlEARS, 35 yes/no items normed birth–24 months) through closed-set picture tasks (ESP, NU-CHIPS, WIPI, Mr Potato Head) to open-set word tests (MLNT, LNT, PBK, CNC) and BKB-SIN sentences in noise.[2006]

The paediatric battery is a graded set, chosen by language age and ability: parent-report scales (IT-MAIS, LittlEARS, CAP) when formal testing is impossible, closed-set picture tasks (ESP, NU-CHIPS, WIPI) that isolate speech-feature perception but must be corrected for chance, and open-set word and sentence tests (LNT, PBK, BKB-SIN) that recruit real-world language. Lexically-controlled lists probe how a child uses vocabulary, not just acoustic detection. The candidacy thresholds these feed live in the Candidacy chapter. Schematic.

CClosed vs open set

Closed-set tests isolate sensory speech-feature perception but must be corrected for chance (e.g. 25% on a four-alternative task), while open-set tasks recruit top-down language and better simulate real listening — children score well below adults at the same candidacy stage. Lexically-controlled tests (LNT/MLNT, easy vs hard words) probe how the child uses vocabulary structure, not just acoustic detection.

CSelection frameworks & parent report

Two frameworks organise the choice: the CID hierarchical model (stop at a ceiling; classify into categories) versus the Indiana age-based fixed battery; the CDaCI study used a hybrid, dropping a measure after two consecutive ceiling intervals. When formal testing fails, parent- report scales (MAIS/IT-MAIS, CAP 0–7, PEACH, FAPI, ELF) document real-world auditory development — and an auditory-skills assessment checks the child actually uses residual hearing, which the audiogram alone cannot show. The candidacy thresholds these feed are in the next chapter.[2009]

Paediatric speech tests progress from closed-set (choose among pictures or objects) toward open-set (repeat what you heard with no choices) as the child develops. The catch is the chance floor: with a 4-picture closed set a child scores 25% by guessing alone, so closed-set scores can overstate ability. Open-set word and sentence recognition has no such floor and is the most meaningful measure of benefit — which is why it is both the goal of testing and the benchmark for cochlear-implant outcomes. Schematic.

Case 10.12 · Choosing the right test

A 3-year-old implant user has limited expressive vocabulary. The audiologist must pick a speech-perception measure.

What is the appropriate choice and caveat?

Self-assessment — Module 122 questions

Question 1 · Trainee

What is Erber's hierarchy of auditory skill?

Question 2 · Clinician

What must be accounted for when scoring a closed-set speech test?

Tracked locally in your browser — see /progress for the dashboard.