Hearing is an extremely important sensory mode for child’s ability to develop speech language ability. Child developmentally shows ability of speech reception, discrimination and finally comprehension sequentially. Children with hearing impairment shows speech perception ability defect depending on degree of hearing loss and its type. The rehabilitation therapist must understand effect of hearing impairment on speech perception ability. The rehabilitation therapist needs to check routinely development of speech perception ability to assess prognosis. In the clinical set up speech therapists are using set of test battery in the areas of speech, language, reading and cognitive ability. Recent data suggest that 260 million populations are using Hindi as first language. Therefore, to cover huge number of population great need felt to develop Hindi early speech perception test for clinical use. Close set Hindi picturable items were kept in three subsections. Each section was having 12 picture items. Each section was having separate scoring procedure. The field testing was included from 3-7 years age range of normal hearing children. Four groups were formed consisting 226 subjects in each groups. Independent‘t’ tail test was used to compare means score of speech perception across different age range. Inter tester, test- retest reliability and contain validity score were obtained for each age group. There was significant age effect was seen over speech perception ability. Higher age group showed significant higher score in the mean speech perception ability. There was no significant gender effect was seen over speech perception ability
Keywords: Hindi speech perception; Monosyllable words; Bisyllable words; Vowel Perception; Normal hearing
Hearing is an extremely important sensory mode for child’s to develop speech language ability. The importance of hearing can be viewed in children with hearing impairment and their speech and language delay [1-3]. Child sequentially develops speech reception, discrimination and finally comprehension. The role of normal hearing becomes important in the reception and discrimination stages [4-8]. Children with hearing impairment shows impaired speech perception ability depending on degree of hearing loss and its type [5,9-12]. The rehabilitation therapist must understand effect of hearing impairment on speech, Language and communication ability [4,5,13-15]. The rehabilitation therapist needs to check routinely development of speech perception ability to assess effectiveness of treatment Programme. In the clinical set up speech therapist are using set of test battery in the areas of speech, language, reading and cognitive ability [4,13,16-24].
The construct validity of the test can be increased by combining results from several areas [20,25-30]. Currently, numbers of speech perception tests are available which measures hierarchy of skills in children [13,14,16,22-24,31-35]. There are three important highlights reported in the literature about speech perception utility in clinical set up. Speech perception
skill is essential ability- to measures in regular audiological
assessment. The information of speech perception is required to planning audiological rehabilitation that includes placement and monitoring of sensory devices and planning therapy strategies for young children with hearing loss [5,19,36-40]. The speech perception assessment tool for pediatric population differs substantially from older children, adults and therefore contain validity plays important role [23,24,28,41,42]. The pediatric assessment tool should have appropriate consideration for the selection of target stimulus. There are two general approach have been reported in the literature [43,44]. The first approach by Geer & Moog 1989 assumed that children with hearing impairment acquire speech perception skills in a hierarchical manner . Second approach doesn’t assume auditory development, rather believes of administration of battery of tests evaluating a range of speech perception abilities and obtained each test score .
Speech of particular language contains vowels and consonants which are important for daily communication, test should utilizing speech sound are essential for speech perception assessment [28,46-48]. The particular sound of speech has specific acoustic property, that can utilized to measures the extent of speech perception ability got impaired due to hearing loss
[7,13,15,49-52]. This information not only useful to diagnosis
of type and severity of the hearing loss but also facilitate to
monitor aural rehabilitation [16,28,53-56,]. There are internal
and external parameters which need to give consideration while
assessing young children with hearing impairment [14,43,50,57-
59]. The internal parameters include child’s receptive vocabulary,
language competency, chronological age and cognitive ability
[3,41,60-66]. Whereas, external parameters contain design of
response task, reinforcement, amount of memory load in the
response task. Before selecting speech perception test clinician
needs to verify the above mentioned parameters [15,43,67-70].
Speech perception ability cannot be directly measured; it can
only be inferred by child’s response to sound. If child doesn’t
have cognitive ability, unable to follow response task, or got
bored with performance activity then actual speech perception
ability difficult to measure [54,71-73]. There are several types of
factors such as live voice presentation, taped presentation, open
set test, closed set test, unrestricted task, and restricted task
which one should understand.
Haskin 1949 developed phonetically balanced monosyllabic
open set test, which has 50 monosyllabic words, which child
need to hear and repeat . Sanderson and Rintelmann (1976)
indicated that 3½ years young children with normal hearing
scored significant lower score compared to other group .
Therefore, they recommended that clinician must use with
caution by assuring good receptive and expressive vocabulary.
Bench et al 1979 used open sentence test, they emphasized
that use of sentence gives more valid measurement of speech
perception ability by indicating how young child cops during
daily communication with others . Word Intelligibility by
Picture Identification test was developed by Ross & Larman,
which has 25 picture plates and each plate contains six pictures
. The researchers used acoustically similar words as test
foils based on distinctive features. The reliability coefficients
ranged from 0.87 to 0.94 with standard error of measurement
ranged from 4.7 to 7.7 were observed by researchers. Hodgson
(1973) compared WIPI test in open set form and close set form.
Results indicated that only 10% improved score seen in close
set form presentation. Jones and Studebaker 1974 reported
that close set appears more productive for children with severe
hearing losses whose receptive vocabulary level was very low
. The Northwestern University – Children’s Perception of
Speech (NU-CHIPS) was developed by Elliott & Katz . They
identified 67 monosyllabic word pictures, which were within
the receptive level of 3 year old children. The test reported
high test-retest score ranged from 0.83 to 0.92. Researcher had
given regression score with pure tone sensitivity, chronological
age and vocabulary level to predict speech perception ability.
Siegenthaler & Hespiel 1966 were assessed discrimination
by identification of pictures test. Researcher used distinctive
features separated 48 monosyllabic picture words . This
test showed good reliability score. Finitzo-Hieber et.al used
environmental sound to measure speech perception capability of
young children to overcome vocabulary and linguistic capability.
Jerger et al 1982 used 30 monosyllabic words to develop
Pediatric Speech Intelligibility (PSI) test . The score of this
test did not differ with chronological age, child’s vocabulary
level and receptive language ability.
Geer & Moog assumed that children with hearing
impairment acquire speech perception skills in a hierarchical
manner . They developed test tool having three sub sections.
The early speech perception test is used to assess the closed
set perception of single words through auditory alone. This
test can be used for children with severe to profound hearing
loss with limited vocabulary and language skills. The first part
of the test uses monosyllabic – trochee - spondee test items for
assessing basic level. Pattern perception, spondee identification
and monosyllable identification subsections are arranged in
hierarchical form. Each section has 12 stimulus items. The
administration of subsection is depending upon criteria score.
The child should score at least 70-75% score to attend further
hierarchical level. The item selection for the test should fulfill
three criteria. The test words should be familiar to most of
hearing impaired children by the age of six year, word should
be picturable form that can be used for the children who cannot
read, and last test should be quick i.e. administration time less
than 30 minutes. Geer and Moog 1994 measured reliability
and validity data for the early speech perception test . The
standard version early speech perception test, 27 children
between 8 -15 years was tested and re-tests over a 30 days
period. Test-retest reliability was observed ranging from 0.78
from pattern perception to 0.94 from category placement. For
the low verbal version early speech perception test, reliability
data were obtained ranging from 24 children aged 4-6 years.
The reliability was observed ranging from 0.75 from pattern
perception to 0.89 from category placement.
Speech perception test helps therapist to assess clinical
management of the children with hearing loss and for evaluating
the efficacy of their amplification devices. The assessment of
children’s spoken word perception is clinically relevant because,
it helps therapist to monitor progress following implantation
or hearing aids fitment. Further, this assessment not only helps
for setting or mapping each individual child’s cochlear implant
signal processor but also helps to determining appropriate
auditory training goal. The assessing speech perception skills
in the children with profound hearing loss, who use a given
hearing aids allows therapist to compare the effectiveness
of amplification devices, this impact on issues of cochlear
implant candidacy. Indian states are using Hindi language most
commonly in India. States like Delhi, Uttar Pradesh, Uttarakhand,
Chhattisgarh, Himachal Pradesh, Chandigarh, Bihar, Jharkhand,
Madhya Pradesh, Haryana, and Rajasthan most of people uses
Hindi Language as their mother tongue (Kuiper 2010) .
NSSO reported that 422,048,642 i.e. 41% of total population of India using Hindi as first language . Recent data suggest
that 260 million populations in Indian are using Hindi as first
language (Ethnologue 2018) . The Rights of Persons with
Disabilities Act, (2016) indicates use of speech perception score
helps to decide severity of hearing impairment . Therefore,
catered huge numbers of population, great need felt to develop
Hindi early speech perception test. Hindi language has 11 vowels
and 33 consonants, therefore, we only tried to cover all most
frequent occurring consonant in test items.
Subjects were Hindi speaking children who speak only Hindi
as their mother tongue, recruited from several kindergartens
around Mumbai and different part of Hindi belt. All subjects
had normal hearing, speech, vision and physical development
as reported by their parents and teachers. Detail audiological
testing was conducted to for assessing normal hearing skills
. The number of participants and subject age groups were
different for each phase of the study.
First Phase: Familiarity Checks and Item Selection
In first phase of the study mainly targeted to collect
vocabulary sample. The 350 picturable words list was formed
from the KG and comic books of young children.
A pilot study was conducted in the second phase which
involved 20 children between three to six years of age. There
were further modification was incorporated in the monosyllabic
perception section (Table 1).
The final phase has three sections; each section has different
numbers of subjects. Field testing was done by subjecting 226
normal hearing subjects in each age group (i.e. 2years to 2year
11month, 3years to 3 years 11 months, 4 years to 4 years 11
months, 5 years to 5 years -6years). All subjects were using
Hindi as their mother tongue and studding in Hindi medium
school. Hindi mother tongue subjects were enrolled in the study,
56 of the subjects involved in the final phase participated in the
test-retest reliability study and another 56 subjects participated
in the inter-rater reliability study
The development of speech perception test for young
children is challenging task due to their limited vocabulary and
language skills [19,20,41,49,58,60,80, 85-86]. Similarly, young
children are not able to read or write because limited academic
skills. It is very important to make sure that test items are
selected from their vocabulary list only to correct interpretation
of speech perception ability [19-21,39,41,54,58,60,68,77,87,85].
Speech perception ability of young children only can be inferred
by child response. There are intrinsic and extrinsic factors need
to consider before constriction of speech perception test by
researcher [4,20,21,39,41,49,58,68,77,85-87]. Similarly, factors
like therapist’s aptitude to work with the pediatric hearingimpaired
population, the general feels of the facility, and
caregiver attitudes and behaviors towards speech assessment
can also influence the test results. In the present study, it was
insured that all selected test items were picturable form and
most familiar to young children. The close set, picture pointing
response task was used for testing speech perception ability. It
was insured that, limitation of vocabulary and language ability of young children should not influence test results. The selected
consonant and vowels were based on frequency of occurrence of
consonant in Hindi language.
The first phase of the study, 350 words list was formed. All
selected items were picturable taken from the KG, Comic, senior
Hindi books. 42 parents of young children were given selected
item list to check familiarity. The three point scale was used
to rate the familiarity level (i.e. familiar, fairly familiar and not
familiar). Similarly, to avoid parental biases all the 42 young
children subjected for receptive vocabulary test individual basis.
4 point forced choice test method was used, one target picture
with three distracters by researcher. The parental rating and the
receptive vocabulary test obtained score ware cross checked for
making final word list. After finalization of word list artist made
black and white stimulus plates were formed.
Final versions of test items were administered on control
20 subjects. The following age groups were studied 2-3 years,
3-4years, 4-5 years, 5-6 years, and 6-7 years by five subjects in
each age group. The necessary changes were incorporated based
on pilot finding.
The test was administered in a quiet room with minimum
or no visual and audible distractions. It was insured that the
adequate lighting conditions in the test room to facilitate good
visibility of picture plates. Child and researcher were seated next
to each other with the tester’s chair slightly behind that of child’s
chair to avoid any visual cues.
Speech perception test was having three components; first
section contains 12 items for assessing word length perception
in which mono-syllable, bi-syllable and tri-syllable words. The
second section contains 12 bi-syllable words items, and final
section contains 12 mono-syllable words items.
Syllable Length Perception: In Hindi language pattern
words are not seen which generally observed in English
language. Therefore, while adapting the test we used syllable
length perception to measure durational aspect. The word is
counted correct for syllable length perception, if a word with
the same number of syllable is selected. For example, if the
word given was /gubaaraa/ and the child pointed to the picture
of the /Almari/, the response would be counted as correct for
perception of syllable length. The word need not be correctly
identified to be scored as correct since identification of number
of syllable is all that is being evaluated in this section.
Scoring: Each word was presented twice, so a perfect score
was 24 words correctly categorized. Responses were marked
on part of the response sheet that has been printed with boldoutlined
boxes to illustrate words of similar category. This
makes it easy to score, as words contained within the boldoutlined
boxes were considered correct for syllable length.
A child who scores at least 17 out of 24 meets the criteria to
qualify for administration of further section i.e. bi-syllable test
Bi Syllable Identification Test: The Bi-syllable
identification subtest evaluates word recognition ability of
profoundly hearing-impaired children who demonstrate the
ability to perceive durational patterns in words (i.e., they scored
at least 17 correct out of 24 on the pattern perception subtest).
The 12 bi-syllable with widely differing vowels and consonants
that comprise. The words were presented like /medhak/, /
hiran/ etc. in Hindi version of test. The words were presented
auditory-only in random sequence until each word has been
presented twice. The child was expected to point to the picture
representing the spoken word.
Scoring: The score sheets for the word identification subtests
having A1, A2, and AV in three spaces for responses. For each
word one for the audiovisual response in the column headed by
AV, and two for the listening or auditory-only condition headed
by A-l and A-2. A plus (+) can be given if the word was correctly
identified, a minus (-) if the word was incorrectly identified.
A perfect score on this test is 24 words correctly identified. A
child who correctly identifies 8 out of 24 words demonstrates
sufficient word recognition skill for conducting further section
i.e. monosyllable perception test.
Monosyllable Identification Test: The closed set of Monosyllabic
words was designed to provide a more challenging
test of word recognition ability. Twelve quite similar words are
included in this set identification of the words requires finer
vowel discriminations than was required in the bi-syllable set.
The administration procedures were the same as those just
described for the bi-syllable identification subtest./t/, /k/
phonemes were used for Hindi language which having different
vowel in combination.
Scoring: Responses to the monosyllable identification
subtest were recorded and scored same as the disyllabic
Field-Testing: All test items were field-tested 224 subjects
on each age group 2-3 years, 3-4years, 4-5 years, 5-6 years, and
6-7 years. The similar protocol of pilot study was used while
field testing. The Mean, standard deviation and other scores
were recorded for further analysis.
Content Validity: Content validity evidence of the for all
test items were collected from experience group of panelists
that consisted of five audiologist & five speech therapist,
five postgraduate audiology & speech sciences students. All
members of the panel were native Hindi speakers and received
Hindi education in primary and secondary schools. The
members had experiences in administering speech tests and had
basic knowledge on language development. Content validity was
performed prior to pilot study.
To check mean difference of Hindi early speech perception
test score between different age groups independent “t” tail
was used. The mean score of early speech perception test
results of 3-4 years age group was compared with the 4-5 years
group. Similarly, 4-5 years group compared with 5-6 years and
5-6 years compared with 6-7 years. The Table 2 indicates that
means Hindi early speech perception test scores have statistical
significant difference across all age groups. The 5-6 years and
6-7 years group’s subtest 1 and subtest 2 showed statistical no
significant differences (i.e. subtest 1 sig value 0.755 and subtest
2 sig value 0.698).
The gender effect was analyzed with independent‘t’ tail
test. The mean of Hindi early Speech Perception scores ware
compared between female and male subjects. (Table 3) Showing
descriptive analysis of male and female subject’s Hindi early
speech perception test score across different age groups. The
(Table 4) indicates that there was no significant difference
was seen in the mean score of female and male subjects. The
gender effect over the speech perception ability found to be no
The Table 5 indicating that Pearson Correlation test score i.e.
0.89 when same test was administered by two different testers.
Result of the test indicated that 0.89 score, which shows that
Hindi early speech perception test score highly correlated and
reliable between two testers.
Hindi early speech perception test was conducted over the
56 subjects after 30 days by the researcher and the means score
was compared with statistical test. The Table 6 indicating that
Pearson Correlation test score i.e. 0.864 when same test was
administered after 30 days. Result of the test indicated that 0.86
score, which shows that Hindi early speech perception test score
highly correlated and reliable when same test administered after
All of the members of the panel (100%) rated the test item.
Some panel members suggested that certain items were difficult
for the three-year-olds. The test items were modified based on
the panel’s comments.
Newly Developed Normative Data of Hindi Early Speech
The present test was arranged in hierarchical manner to
increase fine speech perception ability. The first section was
having 12 items for measuring syllabic length perception, as
Indian language doesn’t contain trochee words. Therefore, we
tried to measure syllabic length perception to evaluate durational
aspect of syllable. Similarly, we used simple bisyllable word
perception in the second section. In the last section, it was very
difficult to find picturable monosyllabic words with constant
phoneme - acoustic with varying in vowel. Therefore, we used
/p/ and /b/ two phonemes to measure vowel perception ability.
In the last section most of the item words were not fully master
by young children, therefore showed lower score even in normal
Several items modifications were done after the pilot
study result. The present Hindi Early Speech Perception test
has developed normative value for different age groups (i.e.
3-7 years). The 6-7 years age group showed maximum scored
reached in most of the areas. The test reliability was checked by
repeated administration of test after 30 days and high correlation
value was obtained. It indicates that the test results are reliable
and repeatable. Similarly, inter tester reliability was measured
by administering same test by two speech therapist. The mean
score again showed high correlation value indicating reliability
of the test. Contain validity was tried to increase by taking rate on
three point scale from the parents. Similarly, we limited parental
biases by measuring individual child’s receptive vocabulary. The
analysis results revealed that all subjects performed well in the
all test items. We tried to kept items from the vocabularies that
were mastered by children as young as three years old. Hence,
the present test is suitable for as young as three year-old.
India has multi lingual culture and follows three languages
educational policy. Young child need to learn first language as
the mother tongue mainly regional language. India has been
divided different state on the basis of regional language used.
The three language policy includes regional language, English as
second language and Hindi as national language. The literature
reported that Indian children face multi-lingual situation, which
make us difficult to measure speech perception ability due to
their limited receptive language ability [88,89]. All items used in
present study were organized on the basis of acoustical property
of words. Thus, potential users of this test should use cautiously,
when interpreting the test result, as present study result showed
that even normal hearing children had different scores in each
age group and section.
All the age groups were compared with same age group with
female and male gender difference. There was no significant
difference was observed in all age groups. It indicates that female
and male gender difference doesn’t effect speech perception
ability. In the same age group female and male perceive speech
similar level. Previous literature reported that speech perception
ability in developing children did have gender effect [33,49].
Present results various with literature indicate that speech and
language development found to be superior among females.
The speech perception ability among female and male could
not reflect difference may be due to smaller sample size. Larger
test group required to generalize the comment on the speech
perception differences. Present result shows that all three subsections
have statistical significant difference with age. The
higher age shows better ability to discriminate and perception
speech. The age group 5-6 and 6-7 years first two subtest did
not showed significant difference. The syllable length perception
and bisyllabic perception showed ceiling effect as reached
maximum score by the age of 5 years. The finding of present
study was consistent with previous literatures which reported
in India [88,89].
The criterion of test-retest and inter-rater reliability were
met, if the correlation coefficient between tests were 0.90 and
above . However, some social researcher might argue that the
90% criterion for reliability was too high given the complexity
of speech and language functioning and disorders. Additionally,
the variability in daily performance that arises from different
speech and language disorders suggests that 0.90 criterion is
fairly high. Thus, Jacob Cohen 1988 suggested that correlation
coefficient as low as 0.80 was considered as the threshold of
acceptability for reliability. Thus, the present study set 0.76 and 0.8 correlation coefficients as the standard for strong reliability.
In any study involving test-retest and inter rater reliability, an
appropriate length of test-retest interval is important. A short
interval between the tests will lead to learning practice effect,
yet, a long interval between the tests might be invalids a result of
maturation effect [65,55]. Garson 2008 suggested that a typical
interval of several weeks (i.e. 3-4 weeks) . Hence, in the
present study, the test-retest interval selected was one month.
The reliability study showed that the test-retest and interrater
correlation coefficients the set criterion for correlation
The implementation of newborn hearing screenings and
early identification of hearing loss across the country, there is
increased interest in measures to assess the speech perception
abilities of children. Hindi speech perception test was developed
in this study to quantify the ability of Hindi speech sound
perception in the age range between three to seven-years
old. The present test had three sub-sections for measuring
hierarchical speech perception ability. The study reported
normative data for each age group of normal hearing children.
The mean score of each age group are varying due to complicity
of the test items. The phoneme acoustic property of words was
kept in final section, which showed variation in score as children
had not fully mastered few items. Hence, tester should check
the normative data before interpretation of speech perception
ability. The gender effect was not seen in the female and male
group. The test was also found to be reliable and valid. Hence,
it is recommended that this test can be used in clinical setting
for assessment, management and monitoring of intervention
strategies for young children.
The individual differences seen in the performance of speech
perception ability due to cognitive and attention contribute.
While, measuring speech perception ability speech therapist
should aim to check the effect of auditory memory, visual
memory, selective attention and integration of auditory and
visual information [25,27,48,71,72]. Future study should try to
explore the various reasons for variation in speech perception
development with cochlear implant and hearing aids users.
Currently clinical used test are aimed to asses primary level
of feature and phoneme discrimination and identification or
identification of single word perception in constrained conditions
[4,19,35]. We need to assess speech perception ability in open
set word recognition form to predict real item comprehension of
larger units of spoken language like in sentence level or longer
paragraph or connected speech. Speech perception is not isolated
task but an integral part of the daily communication. Children
with hearing impairment receives degraded signals though
their amplification devices to acquire speech perception ability.
Speech perception alone does not adequately document the
nature of communication difficulty, nor does it provide sufficient
information to implement aural rehabilitation activities. We
must examine new ways to relate speech perception abilities to
speech perception. We should develop test to measure not only
in isolated single word production but also to generalize it in
new listening skills into every day situation. This auditory input
from their hearing aids or cochlear implant helps to develop
spoken language skills.