0196/0202/84/0503-0166$02.00/0 EARAND HEARING Copyright 0 1984 by The Williams & Wilkins Co.

Vol. 5 , No. 3 Printed in U.S.A.

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SPEECH AUDIOMETRY

A Childrens Spanish Word Discrimination Test For NonSpanish-Speaking Clinicians

Cathryn L. Comstock, and Frederick N. Martin
West Texas Rehabilitation Center, San Angelo, Texas [C. L. C.], and The University of Texas, Austin, Texas [F. N. M.]

ABSTRACT A picture-pointingspeech discrimination test which can be efficiently administered by English-speaking clinicians to Spanishspeaking children was developed. The test consists of four lists of 25 bisyllabic words. Two-syllable words were chosen as stimuli instead of the traditional monosyllabic words because of the limited number of concrete monosyllabic words in Spanish. These words were recorded in Spanish on the first channel of an audio tape and in English on the second channel. The purpose of this dual recording was to present the Spanish stimuli to the subjects at the same time the clinicians monitored the appropriateness of responses in English.

Assessment of speech discrimination is typically measured by asking patients to repeat monosyllabic words presented at a predetermined sensation level. This openset word-repetition procedure does not always provide for an accurate assessment in many populations. Children constitute one group for whom modifications of the traditional method of measuring speech discrimination are necessary. These changes typically involve altering the vocabulary to be more familiar to the younger populationand using a picture-pointing activity to maintain their attention to the task and to preclude the necessity 17. for verbal responses..-. Modifications of speech discrimination testing are also often necessary in persons whose dominant language is not native to the area where the assessment is being performed. It is important that non-native listeners be presented with stimuli which have the unique linguistic characteristics of their original language.6 This problem is often solved by presenting non-native speaking patients with prerecorded word-repetition speech discrimination tests in their native language. In the United States there are numerous non-native speaking populations, one of which is the Hispanic group. The initial studies on Spanish speech discrimination

testing for audiological purposes appear to have been performed by Cancel-Hardigree. Because of the limited number of monosyllabic words in the Spanish language, she developed lists of bisyllabic words. Tosi et al. constructed a speech discrimination test based on CancelHardigrees word lists which consisted of a multiple choice test with two forms: this test proved to be acceptable for clinical purposes. Another attempt at developing Spanish discrimination testing was made by Ferrer.x This Venezuelan used phonetically balanced monosyllabic nonsense syllables as stimuli to better follow the criteria established for English speech discrimination tests. Since there is good correspondence between the phonetic and graphic forms of the Spanish language, requiring patients to write the correct answer did not pose a significant problem. These five lists also proved to be homogeneous for clinical purposes. Rosenblut6developed a speech discrimination test for the population native to Chiles dialect. Three lists of 50 monosyllabic words each were constructed based on word familiarity and frequency of use. An attempt in Mexico to develop lists of phonetically balanced bisyllabic words was undertaken by Berruecos and Rodriquez. The lists were never tested for intelligibility; however, a discrimination test was later developed using a combination of Berruecos and Rodriquez and Cancel-Hardigrees lists. Within the population of people whose original language is Spanish, there are large dialectal variations, depending upon geographic location. There is the Puerto Rican influence in New York, the Cuban influence in Florida, and the Mexican influence in Texas and California.4 The dialectal differences are further noted within a single state, varying among communities as well as between urban and rural environments. For example, in Texas the dialect spoken close to the Mexican border is very similar to that spoken in northern Mexico, whereas the dialect of people living further north in the state has been influenced more by the exposure to English.

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These dialectal variations must be taken into consideration when administering Spanish speech discrimination tests. These differences become particularly important when using a picture-pointing task, since it is necessary to attach meaning to the words being presented. Because of this, the geographic area in which any one group of words would be appropriate is limited. To date most research in Spanish speech discrimination testing has been concerned with developing material appropriate to the native Spanish-speaking population in Latin and South America. Very few studies have investigated discrimination testing for the monolingual Spanish-speaking population in the United States. An investigation into the development of a prerecorded spondee threshold test for Spanish-speaking children in central Texas was reported by Martin and Hart.I4 The objectives of the procedure were two-fold. First, the goal was to develop a picture-pointing activity that was reliable when administered to 2- to 5-yr-old children. The second objective was to develop a means so that non-Spanishspeaking clinicians may accurately administer the test to Spanish-speaking children. This second objective was met by taping the Spanish stimuli on one channel of a twochannel tape and the English translation of the stimuli on the second channel. This enables the patients to listen to Spanish words while permitting clinicians to monitor the appropriateness of the responses by listening to the English translation. This method proved to be successful for English-speaking clinicians to obtain spondee threshold (ST) information on monolingual Spanish-speaking children. Although another study also investigated the development of a spondee threshold procedure for the Spanishspeaking population in an urban environment,20 there appear to be no apparent publications reporting on the development of a picture-pointing discrimination test for the monolingual Spanish-speaking population. Although word repetition discrimination tests designed for the South American native Spanish-speaking adult population are often presented to Spanish-speaking adults in the United States, little emphasis has been placed on developing a test which is efficient to administer to Spanish-speaking children. It was the intent of this study to develop such a test that will effectively and efficiently assess the speech discrimination ability of these children. In doing this, the following protocols were used: 1. The words used as stimuli were within the vocabularies of central Texas preschool children whose dominant language was Spanish. 2. In order to elicit the cooperation of the younger children, the testing was centered around a picturepointing activity. 3. Because of the limited number of monosyllabic words in the Spanish language, the words were bisyllabic. In order to reduce the amount of linguistic information that was provided, the final vowel in each set of consonant-vowel-consonant-vowel (CVCV) words remained constant. 4. To eliminate the problem of non-Spanish-speaking clinicians identifying the appropriateness of an an-

swer. both the Spanish and English translations of the test items were recorded on separate channels of the same stereo tape. This enabled the subjects to listen to the Spanish version while the clinicians monitored the English version. Once the system was designed, two questions were asked: I . Can the four lists be used interchangeably to assess the speech discrimination ability of normal hearing Spanish-speaking adults? Adults were used to answer this first question in order to obtain a more accurate assessment of the lists equivalency than can be obtained from children. 2. Are preschool children, whose dominant language is Spanish, able to perform the task of identifying the appropriate picture when the discrimination stimuli are presented at a comfortable listening level?
METHOD

Equipment A single-walled, sound-treated booth was used to collect the data for both experiments. A Grason-Stadler 1701 two-channel audiometer was used to obtain pure-tone thresholds for each subject. The prerecorded speech stimuli were played on a Wollensack model 4760 audio cassette tape recorder, which was routed through the speech circuit of the audiometer. Only one ear of each subject was used throughout the data collection period. Prior to testing, and periodically throughout the study, appropriate equipment was used to ensure proper calibration.
Stimulus Material Four lists of 25 words each were compiled using the criteria described above (Table I). After the lists were developed, a tape recording was made of the words using a male native Texan speaker who was fluent in Spanish. A carrier phrase, Apunta con el dedo. meaning point with your finger was used prior to each word. The last word of the carrier phrase always peaked at 0 VU and the first words of each phrase were separated by 5 sec. After taping the Spanish stimuli, the English translation of each word was recorded on the second track of the tape. Each English word was recorded so that it could be heard as the last word of the carrier phrase was repeated on the first track.

Illustrations The illustrations of the items consisted of black and white line drawings. Care was taken to draw the pictures so that one did not appear to be more eye-appealing or distracting than another. They were simple. concrete pictures that preschool children could readily identify. Six pictures. four of which were stimuli and two of which were foils. were copied onto an 8 x 1 1 inch plate. A group of 25 plates comprised the picture booklet (see the sample drawing in Fig. I).
Subjects

Experiment 1 Fifteen adults who met the following criteria were used for this study: ( I ) to be able to pass a pure-tone screening test at a level of 10 dB HL for the frequencies 250 through 4000 Hz in the test ear, and (2) to be native Spanish speakers who were raised in Texas. Experiment 2 Twenty children whose dominant language was Spanish, and who lived all of their lives in the central Texas area,

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Table 1. Four lists of 25 words each used as a closed message set to measure speech discrimination in Spanish-speaking children

List 1 mala (sick female) boca (mouth) lloro (crying) ocho (eight) cama (bed) hueso (bone) casa (house) sac0 (coat) mano (hand) pel0 (hair) lodo (mud) cuna (crib) rata (rat) misa (mass) plato (plate) comer (eat) mata (plant) boda (wedding) pera (pear) baiio (bathtub) reza (to p y i y ) silla (chair) moto (motorcycle) cena (supper) seco (to dry)

List 2 pala (shovel) troca (truck) pozo (hole) ojo (eye) caja (box) queso (cheese) pasa (raisin) call0 (corn blister) s a w (frog) pecho (chest) rojo (red) sopa (soup) rama (branch) nifia (girl) pato (duck) correr (run) bata (bathrobe) bota (boot) bafia (to bathe) vaso (glass) vela (candle) tia (aunt) foco (light bulb) fecha (date) dedo (finger)

List 3 sala (living room) foca (seal)

YOYO

List 4 ala (bird's wing) coca (coke) tor0 (bull) or0 (gold) cara (face) beso (kiss) taza (cup) taco carro (car) wrro (dog) cod0 (elbow) soda raja (belt) risa (laughing) gat0 (cat) coser (sew) vaca (cow) bote (tin can) garra (rag) paiio (handerchief, cloth) mesa (table) chiva (goat) rot0 (torn) ceja (eyebrow) velo (veil)

oso (bear) caps (cape) peso (dollar) masa (flour) gallo (rooster) palo (stick) burro (donkey) pollo (chicken) luna (moon) papa (potato) piiia (pineapple) uno (one) llover (to rain) pata (foot) borra (erase) uiia (fingernail) brazo (arm) tela (screen) liga (rubber band) coco (coconut) mecha (match) heuvo ( w )

Figure 1 . Sample line drawings of 25 plates used to measure speech discrimination in Spanish-speakingchildren.

were used as subjects for experiment 2. Ages ranged from 3 to 8 Yr. Procedures Experiment 1 Pure-tone air-conduction thresholds at 500, 1O00, and 2000 Hz were obtained for the test ear using the method recommended by the American Speech-Language-Hearing Association.' The average of the three thresholds was taken and rounded to the nearest or next larger even number. This average was used as the reference level for word discrimination testing. A performance intensity function was performed by presenting all the lists at 0, 8, 16, 24, 32, and 40 dB above the pure-tone average. An open-message response form was used for experi-

ment I . All the lists were presented at one presentation level before the intensity was increased to the next higher level (i.e., the stimuli were presented at 0 dB first, 8 dB next, etc.). The order that the lists were presented was varied at each intensity and for each subject. At no time were the same lists presented in consecutive order. These precautions were necessary to prevent the subjects from learning the order of the lists. The subjects responded by writing each of the words they heard. At the end of the testing session. the answers were reviewed to find any words which were not intelligible or spelled correctly. Experiment 2 Air-conduction pure-tone information was obtained for the frequency range of 250 through 4000 Hz.When possible, these thresholds were obtained in the same manner described for experiment 1; however, the age of these children necessitated the use of play audiometric techniques to obtain the information required in some cases. When a difference was noted between ears, the better ear was used. All the speech stimuli were presented at 50 dB HL. After the completion of testing, the pictures of the items missed were shown to the subjects, who were then asked to name the pictures. Those which were not correctly identified were noted. Last, an acoustic immittance screening was performed bilaterally, which all subjects passed.
RESULTS

Experiment 1 The data collected for experiment 1 indicate that, for clinical purposes, the four word lists were essentially equivalent. That is, at 32 to 40 dB SL the lists varied in discriminability by less than 4%. This translates to a oneword difference in scores. A t-test was performed comparing the average means of each discrimination list at each sensation level. With few exceptions, the lists are equivalent at the 0.1 level of confidence. The only lists which are

A Childrens Spanish Word Discrimination Test

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100 significantly different at the 0.01 level include the following combinations: 8 Lists 1 and 3 at 40 dB SL 90 Lists 1 and 2 at 8 dB SL Lists 2 and 4 at 8 dB SL Lists 3 and 4 at 0 dB SL 80 Lists 3 and 4 at 8 dB SL. An inspection of the means as a function of lists and sensation levels suggests that list 3 is generally the most difficult, whereas list 4 is slightly easier than the others. 70 A study of the standard deviations and range of scores across intensities revealed an expected pattern. The scores vary most at the lower sensation levels, especially at 8 dB 60 above the pure-tone average. With an increase of intensity, a reduction in ranges and thus in standard deviations is 0 noted. At 40 dB SL the standard deviations span from 50 2.53 (list 1 ) to 4.399 (list 4). 0 Plotting the performance-intensity function for the sound levels against the speech discrimination score of each list showed that they were similar to the average 2 functions of established discrimination tests. The scores 8 increase at a rate of approximately 2.9%/dB over the linear 30 portion of the curve, which asymptotes when maximum discrimination is seen (Fig. 2). This is similar to the average x list 1 curve for PB-50 word lists which averages 2.5%/dB for o list 2 20 A list 3 the linear portion of the curve. 0 list 4 An item analysis of the appropriateness of responses was also tabulated. It was the intent to vary the level of 10 discriminability of the stimuli within each list. The item analysis revealed a continuum of discriminability; howA ever, there were a few words that proved to be particularly difficult. These words were spread among three of the lists 0 8 1 6 24 32 40 (cuna in list 1, foco in list 2, and foca in list 3). The stimuli determined to be particularly easy to understand Sensation Level (re: pure-tone average) fell within list 4 (cara, carro, and chiva). Figure 2. Performanceintensityfunctions for four lists of Spanish bisyl-

Experiment 2 An analysis of the data revealed a general increase in discrimination score with an increase in age. This trend was expected as it has been previously reported on a number of occasions.. Many of the missed words appeared to be the result of limited vocabulary. As with any speech discrimination assessment for children, a determination of vocabulary must be made for any missed words. Generally, the children from 3 to 8 yrs of age could perform the task of listening to the recorded stimuli and pointing to the appropriate pictures. Some of the younger children had to be reminded initially to look at all the illustrations. This was accomplished by holding the subjects hands as a signal to wait and then pantomiming with a sweep of the hand across the pictures as a signal to look at the entire page. This procedure was successful with the exception of one 3-yr-old child who continued to point haphazardly to the same picture on each card. The reliability of that childs scores was poor. A relationship between presentation order and discrimination scores was expected; however, this difference was not demonstrated. A tendency was noted, though, for low scores to be obtained on list 3 ( 1 3 of 20), and high scores to be obtained for list 1 ( 15 of 20). These differences often did not vary by more than one or two words.

labic words.

There was a relationship between missed items and unknown vocabulary for some of the words:
list 2 Pa= callo fecha

list 3 capa tela

list 4 ala

Whether these missed stimuli were a function of unknown vocabulary or unrecognizable pictures is not known. It is suspected that in isolation some of the illustrations were not readily recognizable. The pictures in which this may be applicable are ala (birds wing), pasa (raisin), paiio (handkerchief), roto (torn), and or0 (gold). Some confusion was also noted between burro (donkey) and perro (dog), both of which were presented on one plate. Tia (aunt) and risa (laughing) [illustrated with a girl giggling] on one plate also seemed to distort the results slightly.
CONCLUSIONS

Results of experiment 1 revealed that the Spanish discrimination lists described in this paper are clinically equivalent when presented as an open-message set. A statistically significant difference was noted between lists

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percent in the Spanish language spoken in Mexico City and formation of PB lists oftrochaic words. Int. Audiol. 6.21 1-216. 3. Cancel. C. A. 1965. Multiple choice intelligibility test for Spanish-speaking audiometry. Int. Audiol. 4, 91-93. 4. Cancel de Irizany. C. A. 1971. Verbal testing needs of bi-lingual societies. Acta Symbolica 2.48-53. 5. Cancel-Hardigree, C. A. 1957. Effects of selected phonetic aspects in the transmission of the Spanish language. Unpublished doctoral dissertation. Ohio State University. 6. Carhart. R. 1951. Basic principles of speech audiometry. Acta Oto-larlyngol. 40.62-7 I . 7. Egan, J. P. 1948. Articulation testing methods. Laryngoscope 58,955-991. 8. Ferrer. 0. 1960. Speech audiometry: A discrimination test for the Spanish language. Laryngoscope 70, 154I - 155 I. 9. Goldman, R.. M. Fristoe. and R. W. Woodcock. 1970. Goldman-FristoeWoodcock Tevl0fA~ditor.V Discriminution. American Guidance Service, Circle Pines. MN. 10. Haskins. H. 1949. A ohoneticallv balanced test of soeech discrimination for children. Unpublished masters thesis, Northwestern University. I 1 Haspiel. G.. and B. Siegenthaler. 1966. Evaluation of two measures of speech hearing for hearing impaired children. USOE Bureau of Research Project No. R6-I 159, The Pennsylvania State University. I2 Kroes. P. A. 1973. Comparison of the relative intelligibility of four Spanish speech audiometric tests. Unpublished doctoral dissertation, Ohio State University. 13 Lerman, J.. M. Ross. and R. M. McLaughlin. 1965. A picture-pointingtest for hearing impaired children. J. Aud. Res. 5,273-278. 14 Martin, F. N.. and D. B. Hart. 1978. Measurement of speech thresholds of Spanish-speaking children by non-Spanish speaking clinicians. J. Speech Hear. Disord. 43, 255-262. 15. Ornstein, J. (ed.) 1975. Three Essays on Linguistic Diversity in the SpanishSpeaking World The US. Southwest and the-River Plate Area. Mouton, The Hague. 16. Rosenblut. J. P. 1962. Listas de palabras en. espanol para pruebas de discriminacion. Rev. Otolaryngologia (Chile). 22, 37-49. cited in P. A. Kroes. 1973. Ciimpuri.son of the Rdative Inlc,//igihilityqf Four Spanish Speech Audiometric Tevrs. Unpublished doctoral dissertation, Ohio State University. 17. Ross. M., and J. Lerman. 1970. A picture identification test for hearing impaired children. J. Speech Hear. Res. 13.44-53. 18. Siegenthaler. 8. M. 1975. Reliability of the TIP and DIP speech and hearing tests for children. J. Commun. Disord. 8, 325-333. 19. Siegenthaler. B.. J. Pearson. R. Lezak. 1954. A speech reception threshold test for children. J. Speech Hear. Disord. 19, 360-366. 20. Spitzer. J. B. 1980. The development of a picture SRT test in Spanish for use with urban U.S. residents of Hispanic background. J. Commun. Disord. 13, 147-1 5 I. 21. Tosi. 0. 1969. Estudio experimental sobre la inteligibilidad de un tet de multiple eleccion en idioma Espanol. cited in P. A. Kroes. 1973. Comparison of thc Rclutivc~Intelligihiliiy Jbr Four Spanish Speech Audiomeiric Tests. Unpublished doctoral dissertation, Ohio State University. 22. Tosi. 0..C. A. Cancel. and J. W. Black. 1966. Test electivo de inteligibilibad en idioma Espanol. Comunicacion Presentada en el IV Congreso de la Asocicion Espanola de Logodedia y Foniatria, Badajoz, Espana. cited in P. A. Kroes. 1973. Ci~mpurison of ihc Rihtivc Inidhgibility o f Four Spanish Speech Audiomiwic Tevts. Unpublished doctoral dissertation. Ohio State University.

1 and 3 when presented at 40 db SL, a sensation level typically used for clinical evaluation. This one significant difference of 2.6796, however, translates to less than one word difference in speech discrimination scores, a difference that is not clinically meaningful. Results of the second experiment on the children whose dominant language is Spanish, demonstrate that this test is essentially a useful method for assessing speech discrimination ability using a closed-message paradigm, as long as vocabulary is taken into account. For the population tested in this study, reviewing the incorrect responses was only a problem with one 3-yr-old child. It was possible to have this child name the items through a system of pointing and gesturing. Ascertaining that the test items are within the childs vocabularies is also essential for the word intelligibility by picture identification (WIPI) test. It generally proved effective for the English-speaking clinician to administer this test to Spanish-speaking children without providing verbal instructions. Hearing only the recorded carrier phrase, Apunta con el dedo (point with your finger) for guidance, the subjects were able to perform the task with minimum practice. When this procedure is used clinically, careful attention must be paid to the childrens performance of the task, however. If they appear to be haphazardly pointing to the illustrations, despite repeated instructions to look at all the pictures, the results will not reflect true discrimination abilities. This appears to be more of a consideration with the younger children, a problem encountered with any picture-pointing test. Specific problems were previously noted with the vocabulary items and illustrations used in this study. Alterations in these stimuli may eliminate some of the unfamiliarity that was observed. The important conclusion that can be drawn from this study is that it is possible to construct a recorded word discrimination test which can be used with children whose language is not spoken by the examining clinician. Just how well this procedure estimates speech discrimination abilities in hearing-impaired subjects is presently under investigation.
References
1. American National Standards Institute. 1978. American National Standards

Institute Methods for Manual Pure-Tone Threshold Audiometry, New York. 2. Beurruecos. P. R.. and J. H. Rodriquez. 1967. Determination of the phonetic

Address reprint requests to Cathryn L. Comstock, M.A., West Texas Rehabilitation Center, 3001 South Jackson, San Angelo, TX 76904. Received July 11, 1983: accepted November 1,1983.