The study attempted to trace age-related changes in speech perception in typically developing children (≥3 to ≤6 years) using the “Early Speech Perception (ESP)” in Tamil. The test was developed in line with the original English version of ESP but adapted to suit the linguistic requirement of the Tamil language.
Using a cross-sectional design, the test was administered to 205 children with normal hearing who were classified into three age groups (≥3 to ≤4, >4 to ≤5, and >5 to ≤6 years). The developed test had three subtests (syllable categorization, bisyllable word identification, and trisyllable word identification).
All three age groups obtained perfect or near-perfect scores on the three subtests of ESP. There was no significant difference observed between the two adjacent age groups (≥3 to ≤4 vs. >4 to ≤5 years, >4 to ≤5 vs. >5 to ≤6 years) for all three subtests. However, significant differences were seen only between the youngest and the oldest age groups for the three subtests (≥3 to ≤4 vs. >5 to ≤6 years).
The results indicated that ESP in Tamil can be performed effectively in all the three age groups studied.
Audition plays a major role in the development of spoken language and communication in children. However, children with hearing loss have speech perception deficits that vary with the degree of hearing loss [
The assessment of speech perception is clinically relevant for various reasons. First, it helps to identify the specific listening deficits due to hearing loss. Second, it is useful to monitor the performance of a child with an amplification device, thus indirectly measuring the benefits of the device [
In English, there are many standard hierarchical tests to document developmental changes in children with hearing impairment [
The need to develop ESP test in Tamil was felt necessary due to several reasons besides the nature of the test. Due to the initiation of the government funded cochlear implant program in the state of Tamil Nadu in 2013, more than 3,500 children have been implanted in the state that has a rural population of 40 million [
Most studies of speech perception outcomes reported in Tamil speaking population have only used parental perspectives and rating scales to document perceptual abilities in children with hearing loss [
The study was conducted using a cross-sectional design and was approved by the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research (Ref: IEC-NI/15/FEB/45/10). Initially, the standard version of ESP in Tamil was developed, after which it was validated on children aged ≥3 to ≤6 years.
The participants included 205 children with normal hearing in the age range of ≥3 to ≤6 years (118 boys and 87 girls). The children were divided into three age groups: group I (≥3 to ≤4 years, n=63), group II (>4 to ≤5 years, n=25), and group III (>5 to ≤6 years, n=117). Children with Tamil as a primary language were recruited from local schools and district schools of Tamil Nadu. Children diagnosed with obvious sensory, cognitive, or behavioural additional needs, as per-school records, were excluded from the study, after consultation with schoolteachers. Otoscopy was carried out on all children to rule out any problem in the external ear canal and middle ear. The children were selected only if their pure-tone average for the frequencies 500, 1,000, and 2,000 Hz was below 15 dB HL.
The test was adapted from the original ESP in English [
The ESP in Tamil was developed for children aged ≥3 to ≤6 years to have three subtests (syllable categorization, bisyllable word identification, and trisyllable word identification). The words for the subtest were chosen from picture books, story books, and school textbooks appropriate for the target age group. Only words that were picturable were selected. Initially, 35 words for syllable categorization subtest, 15 words for bisyllable word identification subtest, and 12 words for trisyllable word identification subtest were selected. The words were validated by two parents and two primary school teachers to confirm whether the words were in the vocabulary of the youngest age group. Additionally, the teachers rated the word on a three-point rating scale as being very familiar, familiar, or unfamiliar. Only words that were rated as being very familiar and were used across different dialects of Tamil were selected for the test.
Further, the pictures for the corresponding words were selected and purchased from an online website. The pictures were loaded on to a tablet (Samsung Galaxy 12-inch Tab; Seoul, Korea). The pictures for each subtest were grouped and displayed on separate pages. To confirm if the words were in the vocabulary of the youngest age group as well as the appropriateness of the pictures, five children aged ≥3 to ≤4 years were asked to name each picture. The children were asked to point to the pictures when the examiner named them. The stimuli were selected only if 90% of the children could carry out the tasks. From the words that were familiar to the children, for the syllable categorization subtest 12 words that included four bisyllabic, four trisyllabic, and four polysyllabic words were selected (
The words selected for the test were recorded by a native female Tamil speaker in sound recording studio using professional voice recording and editing software Nuendo (Version 6.0; Steinberg, Hamburg, Germany), using a 44,000 Hz sampling rate and 16-bit resolution. The stimuli were edited using Adobe Audition (Version 3.0, Adobe Inc., San Jose, CA, USA) software to normalize the intensity across the words. A calibration tone of 1 kHz was added in the beginning of the word list. The word list was subjected to a goodness test on 10 adults who were native speakers of Tamil, to ensure that all the recorded words could be identified. The recorded material was loaded on to the tablet that contained the pictures.
A pilot study was carried out using the final test material on 15 typically developing children, five from each of the three age groups. The children were instructed to point to the appropriate picture on the tablet. The pilot study was carried out to ensure that children were able to perform the test and to rectify any challenges during test administration. As all the children were able to perform the tasks, no further changes were incorporated in test material.
The test was administered in a sound-treated room with minimal distraction. The stimuli were presented at 50 dB HL through a diagnostic audiometer (Piano-Inventis, Padova, Italy) to a loudspeaker placed 1 m from the head of the children at 0° azimuth. The children were initially familiarized with the test material and were instructed to respond to the words heard by them by touching the appropriate picture on the tablet. Short breaks were provided if the children showed signs of fatigue or restlessness.
The scoring for syllable categorization and word identification subtests were calculated separately. For syllable categorization, a score of 1 was given for each correct identification within the category. The response was scored correct as long as the word identified had the same number of syllables as the test stimulus. For the word identification subtests, a correct response was given a score of 1 and incorrect response was scored 0. The total score for the syllable categorization subtest was 12, bisyllabic word identification subtest was 10, and trisyllabic word identification subtest was 10. The overall total score was 32.
The collected data were analysed with SPSS statistics software (23.0 Version; IBM Corp., Armonk, NY, USA). Both descriptive and inferential statistics were done. A Shapiro-Wilks test indicated that the data were not normally distributed, hence non-parametric tests were used. To find the significant difference among the age groups Kruskal-Wallis test was used followed by the Mann-Whitney U test. Freidman test was used to compare the performance across all age groups for each subtest of ESP, followed by Wilcoxon signed rank test for pair-wise comparison.
The findings of the study are provided in terms of the variation in scores for each of the subtests across the three age groups as well as variation in performance across the subtests within each of the age groups. The median and interquartile range (IQR) of the three age groups of the three subtests are given in
To establish the overall difference in performance across the three age groups Kruskal-Wallis test was used. The results indicated that there was a significant difference (
Freidman test was used to evaluate the overall difference in performance in the three subtests of ESP in Tamil (syllable categorization, bisyllable word identification, and trisyllable word identification). As the maximum possible score for the three subtests were different, the comparison was done with the percentage scores. The Friedman test indicated the presence of a significant main effect [
The findings of the age-related changes in typically developing children on the adapted ESP test in Tamil and the difference in scores across the subtests (syllable categorization, bisyllable word identification, and trisyllable word identification) are discussed. No significant difference was seen between the adjacent age groups (Group I vs. Group II, Group II vs. Group III) for all three subtests. However, significant differences were seen only between the youngest and the oldest age groups for the three subtests (Group I vs. Group III). The relatively low-effect size for majority of the subtests indicated that this difference between the youngest and oldest age groups probably occurred due to some covariables. The near-perfect scores obtained by the three age groups (
Further, as the stimuli selected for the ESP in Tamil were similar across various dialects of the language, the test can be administered on different regions where the language is spoken. Although dialectal analysis was not carried out in the present study, the near-perfect scores obtained by children across the three subtests indicate that dialect had a minimal effect of the test performance. This may be due to the selection of the stimuli that was familiar across the different regions of the state. These findings are in agreement with the results reported by Zheng, et al. [
In conclusion, the findings of the study demonstrate that ESP in Tamil can be performed by typically developing children between the age range of ≥3 to ≤6 years. It is recommended that all three subtests of the test be administered as significant differences occurred between them. The test can be used in evaluating young children with hearing loss who have limited vocabulary to make judgements about their speech perception in comparison to typically developing children. The test can be used to select the type of device to be used by young children with hearing impairment. Additionally, it can be used to evaluate the progress made by these children subsequent to any form of listening training.
The online-only Data Supplement is available with this article at
Early Speech Perception Test in Tamil Wordlist
The authors would like to acknowledge the institution and the children who participated in the study. The authors did not receive any funding to conduct the study.
The authors have no financial conflicts of interest.
Conceptualization: all authors. Data curation: Gladys Prathiba Dawson. Formal analysis: Gladys Prathiba Dawson. Investigation: Gladys Prathiba Dawson. Methodology: all authors. Supervision: Prakash Boominathan, Asha Yathiraj. Validation: Prakash Boominathan, Asha Yathiraj. Writing—original draft: Gladys Prathiba Dawson. Writing—review & editing: Asha Yathiraj, Prakash Boominathan, Ravikumar Arunachalam. Approval of final manuscript: all authors.
Median scores of syllable categorization, bisyllable and trisyllable word identification subtests in typically developing children, with the three age groups combined.
Performances with the Early Speech Perception test in Tamil across age groups for syllable categorization, bisyllable word identification, and trisyllable word identification
Subtests | Group I (n=63) |
Group II (n=25) |
Group III (n=117) |
Total (n=205) |
|||
---|---|---|---|---|---|---|---|
Median (% |
IQR | Median (% |
IQR | Median (% |
IQR | Median for all age groups combined (% |
|
Syllable categorization | 12 (100) | 0.00 | 12 (100) | 0.00 | 12 (100) | 0.00 | 12 (100) |
Bisyllable word identification | 10 (100) | 0.00 | 10 (100) | 0.00 | 10 (100) | 0.00 | 10 (100) |
Trisyllable word identification | 9 (90) | 1.00 | 10 (100) | 1.00 | 10 (100) | 1.00 | 9.6 (97) |
Percentage scores.
Age group: Group I, ≥3 to ≤4 years; Group II, >4 to ≤5 years; Group III, >5 to ≤6 years. Maximum possible scores for syllable categorization subtest=12; maximum possible scores for the bisyllable word identification subtest=10; maximum possible scores for the trisyllable word identification subtest=10. IQR, interquatile range
Pair-wise comparison of the age groups for each of the subtests of the Early Speech Perception test in Tamil, measured using Mann-Whitney U test
Subtests | Group I vs. Group II |
Group I vs. Group III |
Group II vs. Group III |
||||||
---|---|---|---|---|---|---|---|---|---|
U | d | U | d | U | d | ||||
Syllable categorization | 776.0 | 0.853 | 0.11 | 3312.0 | 0.007 | 0.15 | 1327.5 | 0.038 | 0.42 |
Bisyllable word identification | 661.0 | 0.088 | 0.20 | 3059.0 | 0.001 | 0.58 | 1446.5 | 0.847 | 0.01 |
Trisyllable word identification | 608.5 | 0.068 | 0.51 | 2749.0 | 0.001 | 0.45 | 1383.5 | 0.595 | 0.003 |
Age group: Group I, ≥3 to ≤4 years; Group II, >4 to ≤5 years; Group III, >5 to ≤6 years. Effect size measured using Cohen’s d