J Am Acad Audiol 3: 208-214 (1992)

Auditory-Visual Word Identification Test Materials : Computer Application with Children June Antablin McCullough* Leslie A. Cunningham* Richard H. Wilson}

Abstract

The purpose of this investigation was to obtain performance data from normal-hearing children using the written word portion of existing auditory-visual word identification materials, for example, the Picture Identification Task (Wilson and Antablin, 1980) . The response foils, consisting of four written words (target and alternative words) were entered into computer memory so that responses were made by pointing to a computer monitor. Subjects were 24 fourth graders with normal hearing who repeated auditory-stimulus words in noise in oral conditions, and pointed to written words representing the stimulus words in pointing conditions . Mean percent correct performance scores were higher in the pointing conditions than in the oral conditions, reflecting closed- versus open-set tasks. The results indicated that the written word portion of the Picture Identification Task can be utilized to assess the word identification performance of children who read at a fourth grade level or above.

Key Words: Auditory-visual materials, computer-assisted audiology, speech intelligibility, word identification performance, word recognition performance

T

he conventional protocol forassessing word recognition performance invol-ves the presentation of auditory-stimu-

lus words or sentences through earphones or loudspeakers in conjunction with an oral re-sponse from the listener . Patients unable to respond orally, however, owing to aphasia or other communicative difficulties, present a chal-lenge to the audiologist . In this situation, stimuli are presented in the auditory mode but the patient can respond by pointing to a visual stimulus, such as a written word or picture that represents the auditory-stimulus item. Audi-tory-visual materials also are used to estimate the word recognition performance of children, who may be limited by speaking abilities from repeating stimulus words but who may be able to respond by pointing to a written word or

*Communication Disorders and Sciences, San Jose State Universityand tAudiologySection, DVA Medical Center, Long Beach and University of California, Irvine, California

Reprint requests : June Antablin McCullough, Commu-nication Disorders and Sciences, Sweeney Hall Rm 115, San Jose State University, San Jose, CA 95192-0079

picture that represents the stimulus item . Cur-rently, there are several standardized and pro-fessionally recorded picture-pointing tasks for use with children, including the Word Intelligi-bility by Picture Identification (WIPI) by Ross and Lerman (1970) ; the Northwestern Univer-sity Children's Perception of Speech (NU-CHIPS) by Katz and Elliott (1978) ; and the Pediatric Speech Intelligibility Test (PSI) by Jerger et al (1980) .

Several years ago, auditory-visual test materials known as the Picture Identification Task were developed to estimate the word recog-nition performance of nonverbal adults (Wilson and Antablin, 1980) . These materials contain (1) an auditory-stimulus portion consisting of four lists of 50 monosyllabic words, and (2) a visual response portion consisting of either written words or pictures that correspond to the stimulus words and rhyming alternative re-sponses. Following standardization, the distri-bution of the materials was limited, due in part to the costs associated with the duplication of color picture plates . With the advent of personal computers in the clinic for test automation/ administration, however, the response foils

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originally designed for the paper/plastic me-dium were adapted for the computer monitor. In addition to the obvious cost effectiveness of this strategy, utilizing a computer monitor in the word identification assessment is well suited to the "modern" pediatric patient who is televi-sion oriented.

The purpose of the present research was to obtain performance data from children on the written word portion of the Picture Identifica-tion Task . Since the stimuli and alternative words represent common items, these materi-als were considered applicable to elementary school-aged children . To obtain performance data, the word identification task was adapted to a computer format by entering the response foils into computer memory so that responses could be made by pointing to a computer moni-tor. To minimize the initial hardware and soft-ware requirements, the response portion con-sisted of written words representing the audi-tory stimuli (target words) and the alternative responses. A future report will describe the more costly process of scanning pictures into computer memory and normalizing this re-sponse format with a pre-reading pediatric popu-lation .

METHOD

Test Materials

Lists lA and 2A of the Picture Identifica-tion Task (Wilson and Antablin,1980) served as the auditory-stimulus portion of the test . These lists, which consist of 50 monosyllabic words each, were recorded professionally and are in-cluded on the "Speech Recognition and Identifi-cation Materials, Disc 1" audio compact disc (produced by the Department of Veterans Af-fairs Medical Center, Long Beach) . The target words and response alternatives that comprised the two lists totaled 216 vocabulary items (Ap-pendix A) . Beside each word in the appendix is the number of the grade level (1-6) in which the word should be incorporated into the reading vocabulary of children . The grade levels were derived from a standard reference text on the reading ability of elementary school children (Johnson et al, 1983). Of the 216 target/re-sponse words, 192 (89%) were determined to be at or below the reading vocabulary of fourth graders. In fact, one half of the words were at or below a second grade reading vocabulary . Of the remaining 24 more difficult words, only 10 were

Word Identification Test Materials/McCullough et al

target words (gown, leak, mop, noose, shawl, sub, thief, veil, wig, yam), representing 10 per-cent of the 100 target items. The target words differed from the alternative responses by more than one phonetic feature.

The written words representing the target and three alternatives were entered into com-puter memory (Eltec, Model 9870) to appear in a quadrant arrangement. The target word was positioned randomly in one of the quadrants. The stimuli were printed in dark, oversized lowercase letters on a white background to produce maximal visual contrast.

Subjects

Subjects were 24 fourth graders (9.1 to 11.4 years; mean = 10 .1 years) who were recruited from a local public elementary school . The sub-jects were given a hearing evaluation consisting of otoscopy, tympanometry, screening acoustic reflex, and pure-tone, air-conduction thresh-olds . All subjects exhibited normal pure-tone thresholds in the test ear (<_15 dB HL re : ANSI, 1989, at octave intervals from 250 Hz to 8000 Hz), single-peaked 226-Hz tympanograms (±100 daPa), and a present ipsilateral acoustic reflex at 1000 Hz (95-dB HL).

Additionally, all subjects took the Reading Level l Portion of the Wide Range Achievement Test (Jastak and Jastak, 1978). This test con-sists of 75 printed vocabulary items succes-sively increasing in difficulty from "cat" to "abo-rigines." The subjects were required to read 31 consecutive words (from "cat" to "struck") that produced a raw score of 56, which corresponds to a fourth grade reading level. Although the subjects were either completing or entering the fourth grade, the first 24 subjects who were evaluated met the reading level criterion.

Procedures

Percent correct identification scores were obtained at two signal-to-noise (S/N) ratios in oral (open set) and pointing (closed set) re-sponse modes . Both oral and pointing condi-tions were employed to establish the relation-ship between the two response paradigms, as well as to provide normative data for the point-ing task in a computer format . The auditory-stimulus words were reproduced by a compact disc player (Sony, Model D-25) and delivered through an audiometer (GSI, Model 16) via

Journal of the American Academy of Audiology/Volume 3, Number 3, May 1992

earphones (TDH 50P, MX-41/AR cushions) to the randomly chosen test ear of each subject. The subjects were seated in a double-walled sound room in front of and within pointing dis-tance of a computer monitor (Positive Corp, Model MN-1468J).

A broadband noise generated by the audi-ometer was fixed in the test ear at 80 dB SPL. Eight half-lists (25 words) were presented ip-silaterally to each subject during the 45-minute test session . The presentation level of the audi-tory stimuli was varied to give a 2-dB or 8-dB S/N (oral, open-set response mode) or a-4-dB or 8-dB S/N (pointing, closed-set response mode). These signal-to-noise ratios were chosen to re-flect two points (above inaudibility and below 100% performance) on the psychometric func-tion . During the course of the test session, each of the four SIN conditions was repeated twice so that the percent correct identification per con-dition could be calculated on the basis of a full word list (50 words) . The order of half-list pres-entation as well as response mode (oral or pointing) was counterbalanced among subjects to minimize order and learning effects .

For the oral open-set response mode, the subjects responded by repeating aloud what was heard, and the examiner wrote down the response . For the pointing closed-set response mode, the subjects responded by pointing to one of the four written words on the computer monitor. The examiner was seated behind the right shoulder of the subject to observe the pointing response . Once the subject responded, the examiner recorded the response and initi-ated the next set of response foils . At the conclu-sion of the test session, each subject was asked to judge which of the response modes was easier, and to give a reason forhis orher choice . Percent correct responses for the four conditions were calculated for each subject, and the data were averaged for all 24 subjects to determine mean performance.

RESULTS AND DISCUSSION

P ercent correct identification scores for the individual subjects in the four experimen-

tal conditions (oral 2-dB S/N, oral 8-dB SIN,

Table 1 Percent Correct Performance Scores for the Individual Subjects in the Four Experimental Conditions

Subject Ear Age (yr. mo)

Sex Oral 2-d8 SIN

Oral 8-d8 SIN

Pointing -4-d8 SIN

Pointing 8-d8 SIN

1 L 9.6 F 40 70 58 90 2 L 10 .4 F 36 58 26 88 3 L 10 .4 F 38 66 58 88 4 R 11 .2 F 38 50 48 90 5 L 11 .4 F 16 40 32 76 6 L 10 .11 F 42 60 66 86 7 L 10 .6 F 22 66 60 88 8 L 10 .7 F 36 52 36 86 9 R 10 .8 F 32 50 50 88 10 R 10.2 M 46 78 42 86

11 R 10 .4 F 48 68 70 86 12 R 10 .8 F 32 62 62 88 13 R 10 .6 M 26 64 48 82

14 R 9.7 M 42 68 36 84 15 R 9 .1 F 38 44 52 92 16 R 10.7 M 16 58 44 86 17 L 9.9 M 38 50 66 94 18 L 9 .3 M 24 56 52 86 19 L 9.6 F 20 30 52 84 20 L 9 .4 F 32 56 38 82 21 L 9.6 M 30 68 42 78

22 R 9 .2 M 36 76 66 90

23 L 9 .5 M 62 88 56 90 24 L 10 .2 F 34 64 42 86

34 .4 60 .1 50 .1 86 .4 Mean (x) 10 .1 10 .5 12 .7 11 .9 4 .1 SD

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pointing -4-dB S/N, and pointing 8-dB SIN) are given in Table 1. The mean percent correct per-formance scores and standard deviations for each condition also are listed in Table 1 . Mean performance for the oral response conditions was 34.4 percent (2-dB SIN) and 60.1 percent (8-dB S/N) . For the pointing response conditions, mean performance was 50.1 percent and 86.4 percent for the -4-dB SIN and 8-dB SIN condi-tions, respectively . Standard deviations ranged from 10.5 to 12.7 across all conditions except for the 8-dB S[N pointing response condition, in which variability was reduced to 4 .1 because of ceiling effects.

The differences in the data for the two response paradigms are reflective of the differ-ent response modes (open versus closed set), with the open-set response being more difficult. Although a similar relationship between scores in open- and closed-set conditions has been reported by Wilson and Antablin (1980, 1982) and Jerger and Jerger (1982), absolute perform-ance both in open- and closed-set conditions was poorer for children in the current investigation than for adults at the same signal-to-noise ratio (Wilson and Antablin, 1982). Specifically, per-

Word Identification Test Materials/McCullough et al

formance was poorer for children in closed-set conditions (86% versus 95% for children and adults, respectively) and particularly in open-set conditions (60% versus 88% for children and adults, respectively) . The finding that recogniz-ing and identifying auditory stimuli at equal signal-to-noise ratios is more difficult for chil-dren than adults probably reflects differences in linguistic and/or cognitive strategies between children and adults, particularly when listen-ing in noise.

An item analysis was performed to deter-mine the number of correct responses for each target word, both for the pointing conditions (Table 2) and for the oral conditions (Table 3) . The purpose of the analysis was to determine in a qualitative way if certain stimuli were more difficult for children than others, and to high-light more difficult words for further analysis . Several items of interest can be seen from the analysis of the pointing conditions (see Table 2) . First, similar identification performance oc-curred for all lists at equal signal-to-noise ra-tios, with the exception of list 1A at -4-dB S/N. Here, percent correct performance was 40.5 per-cent, whereas scores of 54 percent were obtained

Table 2 Mean Percent Correct Performance Scores for the Target Words in the Pointing Response Conditions

List

1A

-4-dB

SIN

8-dB

SIN

List

1B

-4-dB

SIN

8-dB

SIN

List

2A

-4-dB

SIN

8-dB

SIN

List

2B

-4-dB

SIN

8-de

SIN

wing 29 100 head 72 100 gun 35 100 tool 20 47 yam 22 100 bed 43 100 dam 35 80 path 50 67 pearl 07 55 sun 86 100 chalk 71 100 sing 60 100 juice 29 100 run 72 100 chief 88 100 cheese 60 100 ship 29 100 noose 29 65 load 42 100 dice 50 100 wave 57 91 but 43 100 jail 82 100 hill 90 94 chain 57 100 rug 43 94 catch 12 00 rain 80 100 nose 50 100 chair 100 100 pass 24 80 bug 60 87 goose 22 91 bath 43 53 door 77 80 hose 50 94 match 29 09 town 29 94 nail 88 100 gown 20 87 tire 43 91 kite 72 100 wig 71 100 net 50 94 lake 43 100 cash 14 71 sail 94 100 shed 40 100 rose 50 100 boat 43 82 shop 35 100 robe 00 13 shawl 36 100 laugh 43 59 wet 53 100 rock 80 100 sub 43 100 dog 43 76 Iamb 41 100 bone 30 87 pill 43 91 mop 100 100 jar 71 100 face 60 80 sock 57 100 leak 72 100 vine 65 100 thief 40 94 cage 64 55 thumb 72 94 sick 47 100 lick 90 100 dive 29 55 book 29 82 mail 30 40 toad 40 94 wheat 64 91 girl 86 100 back 53 60 page 60 47 pan 72 91 road 57 24 map 35 80 night 70 100 coat 43 55 light 57 94 man 65 100 hair 80 100 dig 22 91 jet 43 100 feet 41 100 wheel 50 94 fire 36 100 veil 29 88 cave 47 100 rat 30 100 top 36 73 mill 43 88 cut 53 100 log 90 87

Mean 40 .5 85 .6 54 .5 86 .6 54 .4 88 .8 54.0 86.6

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Journal of the American Academy of Audiology/Volume 3, Number 3, May 1992

Table 3 Mean Percent Correct Performance Scores for the Target Words in the Oral Response Conditions

List 2-dB 8-dB List 2-dB 8-dB List 2-dB 8-dB List 2-dB 8-dB 1 A S/N S/N 1 B S/N S/N 2A S/N S/N 213 S/N S/N

wing 12 47 head 43 91 gun 55 94 tool 27 43 yam 25 47 bed 57 100 dam 09 53 path 20 43 pearl 25 53 sun 79 100 chalk 45 60 sing 33 86 juice 63 80 run 43 82 chief 27 40 cheese 33 100 ship 37 94 noose 00 36 load 64 60 dice 47 86 wave 25 73 but 22 55 jail 00 53 hill 67 72 chain 37 47 rug 64 91 catch 00 47 rain 40 57 nose 37 87 chair 86 100 pass 19 60 bug 47 57 goose 25 73 bath 29 91 door 19 94 hose 47 100 match 00 33 town 22 45 nail 00 53 gown 40 72 tire 25 67 kite 29 36 wig 55 87 net 60 29 lake 50 53 cash 00 45 sail 09 47 shed 53 43 rose 12 67 boat 38 91 shop 00 40 robe 13 14 shawl 00 60 laugh 29 55 wet 19 67 rock 80 86 sub 25 80 dog 38 82 lamb 36 67 bone 13 57 pill 37 67 mop 38 55 jar 00 60 face 80 86 sock 25 80 leak 00 09 vine 45 80 thief 00 29 cage 25 20 thumb 38 73 sick 73 80 lick 20 43 dive 12 33 book 22 73 mail 36 47 toad 20 14 wheat 12 40 girl 57 100 back 27 40 page 13 14 pan 37 60 road 50 91 map 27 53 night 40 43 coat 15 73 light 29 91 man 55 73 hair 67 86 dig 25 60 jet 64 91 feet 36 67 wheel 33 57 fire 12 80 veil 29 45 cave 09 27 rat 27 29 top 00 20 mill 43 91 cut 27 53 log 47 29

Means (x) 23 .9 59 .8 38.0 72 .8 27 .7 60 .1 38 .7 55 .0

on the other lists . The reason for the increased percentage of errors for list lA at the -4-dB S/ N level is unclear, but probably is not related to the level of reading difficulty since list 1B con-tained more target words exceeding a fourth grade reading level than the other lists. The scores at the 8-dB S/N were virtually identical (85.6% to 88.8%) on all of the lists .

Few errors were made by the children in the 8-dB S/N pointing condition. The item analysis revealed, however, that most of the errors that were made occurred for the same target words. These target words were "match," "road," "catch," "mail," "tool," "robe," and "page." Because the words were distributed among the four lists, it is unlikely that identification performance for these words would significantly affect the over-all performance of an individual .

All of the consistently missed target words were well within the fourth grade reading level (Appendix A) . In fact, the more difficult reading vocabulary items (e.g ., gown, mop, sub) usually were identified correctly, suggesting that these errors probably cannot be attributed to reading difficulty . To explore whether the consistently

212

missed target words were in some way less audible than other target words, percent cor-rect performance for these words in the 8-dB S/N pointing condition was compared to per-formance in the 8-dB S/N oral condition (see Table 3) . With the exception of"robe" and "page," the target words that were consistently missed in the pointing condition were correctly recog-nized in the oral condition, suggesting that the errors were not attributable to acoustic factors.

The most likely explanation for the consist-ency of target-word errors is related to the rhyme scheme ofthe response foils . For a major-ity ofthe target words, the response foils rhymed in the final consonant portion and were differ-ent in the initial consonant portion (e.g ., sing, king, ring, wing). Many ofthe consistently missed words ("match," "road," "catch," and "robe") had alternatives that rhymed in the initial conso-nant portion and were different in the final portion (e.g ., match, map, man, mask). The Cohort model of auditory word recognition (Marslen-Wilson and Welch, 1978) suggests that, in a closed-set task, a listener may identify a target word by hearing only the initial portion

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of the word while at times ignoring the final portion of the auditory stimulus . This listening strategy would work against the correct identi-fication of target words that rhymed in the initial consonant portion. The relative impor-tance of initial acoustic information to correct auditory word recognition recently has been demonstrated in time-gated word recognition paradigms (Craig and Kim, 1990),

Finally, when the children were asked to identify which task was easier, 18 of the 24 sub-jects (75%) stated that the pointing response paradigm was easier than the oral response mode . Most of the children cited the reason as the idea that they could see and hear and have a choice of response alternatives . This result was not unexpected since the children appeared interested in and comfortable with the compu-ter task .

In summary, the present results indicate that the written word portion of the Picture Identification Task can be utilized in a compu-ter format to assess the word identification performance of children who read at a fourth grade level or above . Based on the percent correct performance data, good performance can be expected when auditory stimuli are pre-sented at signal-to-noise ratios of 10-dB or greater.

Acknowledgment. This project was funded in part by IBM Corporation, San Jose, California . The authors express their gratitude to Jim Jhao for

computer programming support and to the three anony-mous reviewers of this manuscript.

Word Identification Test Materials/McCullough et al

REFERENCES

ANSI . (1989).American National Standard Specification for Audiometers. New York : American National Stand-ards Institute. ANSI S3.6-1989.

Craig CH, Kim BW. (1990) . Effects of time gating and word length on isolated word-recognition performance. J Speech Hear Res33:808-815 .

JastakJF, Jastak S. (1978) . The Wide RangeAchievement Test : Manual . 2nd Ed . Wilmington, DE : Jastak Associates Inc.

Jerger S, Jerger J. (1982) . Pediatric speech intelligibility test : performance intensity characteristics. Ear Hear 3:325-334 .

Jerger S, Lewis S, Hawkins J, Jerger J. (1980) . Pediatric speech intelligibility test . 1 . Generation of test materials. Int J Pediatr Otorhinolaryngol 2:217-230 .

Johnson DD, Moe AJ, Baumann JF . (1983). The Ginn Word Book for Teachers . Lexington, MA : Ginn .

Katz D, Elliott L. (1978). Development ofa New Children .s Test of Speech Discrimination A paper presented to the annual convention of the American Speech-Language and Hearing Association . San Francisco, CA .

Marslen-Wilson W, Welsh A. (1978) . Processing interac-tions and lexical access during word-recognition in con-tinuous speech . Cogn Psychol 10:29-63 .

Ross M, Lerman J. (1970) . A picture identification test for hearing-impaired children . J Speech Hear Res 13:44-53 .

Wilson RH, Antablin JK. (1980) . A picture identification task as an estimate of the word-recognition performance of non-verbal adults . J Speech Hear Disord 45:223-237 .

Wilson RH, Antablin JK . (1982) . A reply to Dillon . J Speech Hear Disord 47:111-112 .

Appendix A follows on next page

Journal of the American Academy of Audiology/Volume 3, Number 3, May 1992

APPENDIX A

An Alphabetical Listing of the Picture Identification Task Target and Alternative Words and Corresponding Reading Grade Level for Each Vocabulary Item

back 1 cone 1 jar 3 pack 2 sing 1 badge 5 cook 2 jet 3 page 1 sled 4 ball 1 core 4 jog 6 pan 2 slice 3 bar bat

2 2

crook >6 jug 4 pass 1 snake 2

bath 3 cub 6 juice 3 path 2 sock 3

beak 4 curl 3 keys 2 peak 4 stage 2

bear 1 cut 1 king 1 pear 3 star 2 bed 1 dam 3 kite 4 pearl 4 stick 1 beef >6 dial 4 knees 2 peel 4 stone 2 bees 2 dice 3 knock 1 pet 2 stool 4 bill 2 dig 2 lace 5 phone 3 stop 1 bite 2 dime 4 lake 2 pig 1 store 1 boat 1 dive 3 Iamb 2 pill 4 sub 6 bone 2 dog 1 lamp 3 plane 1 sun 1 book 1 doll 2 lap 3 pool 1 tack 5 bows 3 door 1 laugh 1 pour 2 thief 5 bug 2 drum 3 leaf 3 putt >6 thumb 4 bum >6 face 1 leak 6 race 1 tire 3 cab 5 fan 3 lick 2 rain 1 toad 2 cage cake

2 2

feet 1 light 1 rake 3 toes 1 calf 4

fire 1 lip 3 rat 3 tool 3 can 1 frown 4 load 2 rice 3 top 1 cane 3 gauge 5 lock 2 ring 2 town 1 cap 2 girl 1 log 2 road 1 tub 4 car 1 goat 2 mail 3 roast 5 twig 5 cash 4 goose 2 man 1 robe 4 twirl 4 cat 1 gown 5 map 2 rock 1 vase 5 catch 1 grave 3 mask 3 rope 2 veil 6 cave 2 gum 3 match 2 rose 2 vine 3 chain 3 gun 2 meat 2 rug 3 wall 1 chair 1 hair 1 mice 2 run 1 wave 1 chalk 4 ham 4 mill 3 sack 3 wet 2 cheek 3 hat 1 mine 1 sail 2 wheat 3 cheese 3 hawk 3 moose 5 school 1 wheel 2 chick chief

3 2

head 1 mop 6 seat 2 whip 3 ship 4

heel 3 mowed 6 shack 6 wig 5 choir 6 hill 1 nail 3 shave 5 wine 3 clock 2 hog 4 net 3 shawl 5 wing 2 clown 3 hook 3 night 1 shed 3 wire 2 club 2 hose 4 noose >6 ship 1 yam 5 coat 2 hug 3 nose 2 shop 2 coke 5 but 3 note 2 sick 2 comb 3 jail 2 nut 3 sign 2