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Audiology Review: Preparing for the Praxis and Comprehensive Examinations
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132
3. Mr. Miller is a 34-year-old patient scheduled for a workers’ compensation examination. He is
a mechanic who reports hearing loss in his left ear following a tire exploding to that side when
he was working on a vehicle. The right ear had normal hearing thresholds, but the left ear
was consistent with a flat severe to profound hearing loss (unmasked and at levels exceeding
interaural attenuation). Mr. Miller had very few false-positive responses on the left ear and a
positive Stenger; speech reception threshold was not in agreement with the pure-tone average for
the left ear. What form of response bias did he likely demonstrate?
a.
Conservative
Hypoactive
b.
c.
Liberal
Neutral
d.
Explanation: Mr. Miller is likely exaggerating a hearing loss in the left ear, which can be assumed
given the amount of hearing loss exceeding interaural attenuation levels, SRT not agreeing with PTA,
and the positive Stenger. Other tests that could confirm malingering would include objective measures
such as middle ear muscle reflexes and otoacoustic emissions. Behaviorally, with the low false positives
and suprathreshold responses (misses), Mr. Miller likely demonstrated a conservative response bias by
waiting until the signal is above threshold to respond to the presented tones (equating to a miss), so a
is the correct answer.
4. A calibration company has contacted an audiologist reporting that they only had 6-cc couplers
available for use for an upcoming appointment. What devices could be sufficiently calibrated?
a. Insert earphones
b. Immittance probes
c. OAE probes
d. None of the above
Explanation: 2-cc couplers are used when the ear canal volume is expected to be reduced as opposed
to 6-cc couplers, which are used when the canal volume is expected to be larger (e.g., in the case of
supra-aural headphones). Probes for immittance and OAEs are inserted into the ear canal, reducing its
volume, so 2-cc couplers are appropriately used in those cases. Similarly, insert earphones reduce the
ear canal volume, which necessitate the use of a 2-cc coupler. Therefore, d is the correct answer.
5. A clinician runs a real ear aided response (REAR) and compares it to a real ear unaided response
(REUR) for a patient. The difference between those two values is referred to as:
a. Real ear insertion gain (REIG)
b. Real ear saturation response (RESR)
Real ear to coupler difference (RECD)
c.
d. Real ear occluded response (REOR)
Explanation: REIG is a measure of gain provided by amplification placed in the ear and turned on.
It is calculated by subtracting REUR from the REAR. Therefore, a is the correct answer.
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6. Assuming equal auditory sensitivity between the right and left ear, at which of the following
degrees are interaural phase/timing differences the greatest?
a. 45°
b.
90°
130°
c.
d.
180°
Explanation: Research has shown that the strongest IPDs/ITDs occur at 90° and 270°. Thus, b is the
correct answer.
7. An audiologist is conducting speech recognition in noise testing and wishes to use a masker
that provides a high degree of informational masking. Which of the following would meet the
audiologist’s need?
White noise
a.
b. Pink noise
c. 2-talker babble
d. 20-talker babble
Explanation: Recall that instances of informational masking contain meaningful content. White and
pink noise provide energetic masking due to a lack of meaningful content. While 20-talker babble is
composed of speech from 20 talkers and individually their productions would provide informational
masking, when combined, the effects of informational masking are lost due to a loss of intelligibility
of speech from any speaker. In the case of 2-talker babble, a significant amount of meaningful content
is perceptible. Thus, c is the best answer.
8. During a biological check, an audiologist notices that a signal presented through one channel of
the audiometer to the right headphone is heard in the left headphone, which is set to the second
channel. Which of the following potential calibration issues should the audiologist report to the
calibration company?
a. Crosstalk
b. Rise-fall time
c.
Ambient level
On-off ratio
d.
Explanation: Recall that crosstalk occurs when the presentation of a signal through one channel of
the audiometer is present (and often audible) in the transducer set to the other channel. The output
is measured in one earphone (test) and compared to the output of the other earphone (nontest).
Significant crosstalk is present if the difference between these two measurements is less than 70 dB.
Thus, a is the correct answer.
Audiology Review: Preparing for the Praxis and Comprehensive Examinations
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9. A new hearing aid has a sampling rate of 22 kHz. Using the Nyquist theorem, at which
frequency is distortion most likely to occur?
a. 4 kHz
b.
6 kHz
9 kHz
c.
d.
11 kHz
Explanation: The Nyquist theorem/frequency is a sampling rate that is double the highest frequency
of a signal that will be encoded. Thus, half the reported rate (22 kHz) would be 11 kHz. The closer
you get to the maximum frequency that is encoded, the more likely the signal is going to be distorted.
In this question, the frequency closest to that maximum frequency of 22 kHz is 11 kHz. Therefore, d
is the correct answer.
An audiologist is asked to perform sound-level measurements at a local factory. The company
10.
is concerned that a new piece of equipment is exposing an employee to excessive levels of noise.
The audiologist is at the site and setting the decibel scale for recordings. Which scale is the most
appropriate to use?
a. dBA
b. dBB
c. dBC
d. All of the above are equivalent
Explanation: Recall that the dBA weighting provides a measurement that weights the input similarly
to the response of the human auditory system. Thus, if the goal is to estimate sound levels experienced
by the worker, dBA would provide the most accurate estimate. Thus, a is the correct answer.
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Communication Across
the Lifespan:
Typical vs. Disordered
Angela Van Sickle and Brittany Hall
Chapter 4
Typical Language Development
“Communication is part of what makes us human” (Owens & Farinella, 2019, p. 2). Although humans
communicate in a variety of ways (e.g., speech, gestures, facial/body expressions), language and speech
are used to convey most messages. Communication and language begin to develop at birth, even
though the first words may not be spoken for 10 months.
Milestones for language development (i.e., receptive and expressive) provide information related to
skills that should be mastered within specified age ranges. It is important to understand language development milestones and age ranges for milestones to determine delays and disorders. Appendix4–A
outlines milestones for receptive and expressive language. Tables included in this section outline more
specific components of language, such as phonology, morphology, syntax, and pragmatics.
Owens and Farinella (2019) describe three main components that are part of all human languages:
content, form, and use.
n
Content: information to be communicated; includes the semantics or the meaning of the
message.
n
Form: involves the words used to convey a message and includes phonology, morphology,
and syntax.
Phonology: the sound system of a specific language (i.e., 43 sounds in English) that form words.
●
Phonemes are the smallest unit of speech sounds that change meaning (e.g., changing
one phoneme for “in” and “on” changes the meanings of the words).
●
Counting phonemes: for example, “kicks” contains four phonemes.
Morphology: the use of grammatical structures to form and vary words. Morphemes are the
smallest grammatical units that have meaning. There are free and bound morphemes.
●
Free morphemes: independent and cannot be partitioned into smaller units without
losing the meaning, such as “dog.”
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●
Bound morphemes: cannot be independent; they are attached to free morphemes and
change the meaning, such as “dogs.” “Dog” is a free morpheme, and “s” is a bound
morpheme that changes the meaning.
●
Counting morphemes: “Audiologists love studying the topics of speech.” There are 10
morphemes: Audiologist, -s, love, study, -ing, the, topic, -s, of, and speech.
Syntax: involves the rules for organizing and combining words to form sentences.
n
Use: involves pragmatics or different ways language is utilized.
KNOWLEDGE CHECKPOINT: Content, Form, and Use
1. A child says, “The ball wed.” The adult version is “The red ball.” This
example shows an error with syntax (i.e., the order of the words, ball and
red) and phonology (i.e., /w/ for /r/).
2. A child says, “Mommy cup.” The adult version is “Mommy’s cup.” This
example shows an error with morphology (i.e., exclusion of the bound
morpheme, ’s).
3. A child says, “Look at kitty.” The adult version is “Look at the dog.” This
example shows a semantic error (i.e., “kitty” for “dog”) and an error with
morphology (i.e., exclusion of “the”).
Phoneme Development
Each spoken language contains a unique set of sounds for creating words and for communication.
Infants and children produce a variety of sounds and eventually master the sounds and combinations
of sounds specific to the language spoken by individuals around them. Over time, meaning is attached
to these sounds and combinations of sounds (Owens, 2020). Table 4–1 summarizes development for
sounds in the English language.
Q & A
Question: You see a 5-year-old child who has not mastered /k/ or /g/. Would
you refer this child for a speech evaluation?
Answer: A 5-year-old child that has not mastered /k/ or /g/ should be referred
for speech services. These phonemes should be mastered between ages 2 and 4.
Phonological Processes
McLeod and Baker (2017) synthesized the work of several researchers to provide an overview of
the phonological processes or patterns that are evident in normal development of speech. They describe
phonological processes or patterns as error patterns that occur during the normal development of
CHAPTER 4 Communication Across the Lifespan: Typical vs. Disordered
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TABLE 4–1. Development of Phonemes
AGE RANGES PHONEME DEVELOPMENT EXAMPLES
137
Before 2 up to 3 years /p/, /m/, /h/, /n/, /w/
Before 2 up to 4 years /b/
2–4 years /k/, /g/, /d/, /t/, /
2.5–4 years /f/, /j/
3–6 years /r/, /l/
3–8 years /s/
3.5–7 years /
3.5–8 years /z/
4–7 years /
4–8 years /v/
4.5–7 years /
5–8 years /ð/
6–8+ years /
Source: Data obtained from Sander (1972); Lanza and Flahive (2008).
tʃ/, /ʃ/ chair, shoe
dʒ/ jacket
θ/ thumb
ʒ/ television
ŋ/ cat,
pot, mom, hot, not, we
ba
five,
ring, lamp
stop
zoo
vet
this
by
go, dog, truck, si
yellow
ng
speech. Table 4–2 includes normal phonological processes, examples, and ages they should diminish.
In addition, processes or patterns that are not typical in normal development are included in the table.
These do not include age ranges, since they are not part of normal development for speech.
Q & A
Your 5-year-old client says, “I throw a ba to my da” (i.e., he is describing that he
throws a ball to his dog).
Question:
What phonological process is this client demonstrating? Is this
normal development for this child?
Answer:
This client is demonstrating final consonant deletion (i.e., “ba” for
“ball” and “da” for “dog”). Since the likely age of elimination for final consonant deletion is around 3 years of age, this child should not be deleting final
consonants.
Vocabulary Development
Kaderavek (2011) stated that children typically begin producing words between 10 and 16 months
of age. Several resources have outlined vocabulary development from first words through over 50,000
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TABLE 4–2. Development of Phonological Processes or Patterns
LIKELY AGE OF
ELIMINATION
(YEARS) PROCESS/PATTERN DESCRIPTION EXAMPLE
3 Final consonant deletion Deletion of final consonant of a
word
3 Consonant assimilation A sound changes due to presence
of another sound in the word
3 Reduplication Repetition of the first syllable
(usually) in a multisyllabic word
4 Weak/unstressed syllable
Unstressed syllable deleted tato for potato
deletion
4 Velar fronting Velar sound replaced with a front
sound
/f, s/:
3
/z, v/: 4
ʃ, tʃ, dʒ, θ/: 5
/
Without -s:
With -s: 5
Stopping Fricative or affricate replaced with
a stop
4
Cluster reduction Consonant clusters simplified to
a single consonant
6–7 Gliding liquids replaced by glides lello for yello
Rare or atypical
processes/
patterns
• Initial consonant deletion
Backing
•
• Gliding of fricatives
• Denasalization
•
Delete initial consonant
Using a back sound for a front
•
sound
•
Using glide for a fricative
• Nonnasal consonant for a nasal
consonant
• Affrication
Using an affricate for a
•
nonaffricate
• Glottal insertion
• Consonant is substituted with
a glottal stop
ba for ball
gog for dog
wawa for water
take for cake
tay for say
go for grow
• up for cup
• key for tea
• woot for foot
• be for me
• chew for shoe
pɛʔɪŋ/ for petting
/
•
Source: Data obtained from ASHA (n.d.-c); Lanza and Flahive (2008); McLeod and Baker (2017).
words (e.g., Kaderavek, 2011). Using several resources (Child Development Institute, n.d.; Lanza &
Flahive, 2008), the following provides an overview of expressive vocabulary development for infants
through 12 years of age.
n
10–16 months: first words; one-word utterances — usually describe or name (e.g., mama,
dada, no, hot)
n
18 months (1.5 years): 50 to 150 words; beginning to combine words into two, three, or
more utterances
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n
24 months (2 years): 50 words consistently, producing 200 to 300 words
n
30 months (2.5 years): 450 words
n
36 months (3 years): 1,000 words
n
48 months (4 years): 1,600 words
n
60 months (5 years): 2,200 to 2,500 words
n
72 months (6 years): 2,600 to 7,000 words
n
12 years: 50,000 words
139
Data obtained from Lanza and Flahive (2008) and the Child Development Institute (https://child
developmentinfo.com/child-development/language_development/).
Q & A
Question: You see a 24-month-old child for a hearing evaluation. The child’s
mother states the child has 10 words in her vocabulary. Is this cause for concern?
Answer: Yes; this should be noted in your report. The child should be referred
for speech and language services.
Rationale: A 24-month-old child should consistently produce at least 50 words.
Morphological Development
Brown (1973) and Retherford (2000) outline morphological development. Once a child has approximately 50 words, which is around 24 to 27 months, it is possible to calculate a child’s mean length of
utterance (MLU) and examine the use of grammatical morphemes. MLU is calculated by counting the
number of morphemes in several utterances (e.g., 100 utterances) and dividing the total by the number
of utterances. This calculation is helpful in determining progress and development of language. Because
this number does not provide information regarding the various morphemes used by a child, analyzing
the morphemes provides additional information related to language development. SLPs begin analyzing grammatical morphemes at approximately 24 to 27 months. All grammatical morphemes should
be mastered by age 4 in the following order (Brown, 1973):
1. Present progressive -ing (e.g., singing)
2. In
3. On
4. Plural -s (e.g., cats)
5. Past irregular (e.g., went, ate)
6. Possessive ’s (e.g., cat’s)
7. Uncontractible copula (e.g., am, is, are, was, were)
8. Articles (e.g., a, an, the)
9. Past regular -ed (e.g., walked)
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10. Third person regular -s (e.g., she eats)
11.
Third person irregular (e.g., she has)
Uncontractible auxiliary: am, is, are, has (e.g., He was playing. The subject and verb cannot be
12.
contracted, “He’s playing,” without changing the meaning.)
13. Contractible copula: ’m, ’s, ’re (e.g., I am happy. “I” and “am” can be put into the contraction.)
14.
Contractible auxiliary: ’m, ’s with -ing, 're, 've (e.g., “She’s eating.” instead of “She is eating.”)
KNOWLEDGE CHECKPOINT
If you see a 4-year-old client that is not producing present progressive -ing,
possessive ’s, or articles, you may consider referring the child for a language
evaluation. All 14 grammatical morphemes should be acquired by age 4, and
these mentioned are three of the earlier grammatical morphemes to develop.
Speech Intelligibility Development
Hustad et al. (2021) examined intelligibility for single and multiword production by children between
the ages of 30 and 119 months to determine intelligibility growth for children by transcribing speech
samples rather than through parent reports. Speech samples were collected from typically developing
children; adult listeners transcribed the speech samples, and intelligibility was measured for single-word
and multiword utterances. The following results were reported:
n
Single-word intelligibility
31–47 months: 50% intelligible for single words
49–87 months: 75% intelligible for single words
83–119 months: 90% intelligible for single words
n
Multiword intelligibility
34–46 months: 50% intelligible
46–61 months: 75% intelligible
62–87 months: 90% intelligible
Q & A
Question: During a hearing assessment, you interact with your 5-year-old
patient. You are having significant difficulty understanding the majority (over
50%) of the child’s speech. Should you disregard this since the client is only
5years old?
Answer: No, you should note this in your report and refer for SLP evaluation.
Rationale: A 5-year-old should be 75% intelligible.
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Pragmatic Development
Pragmatics involves use of language in changing social situations and encompasses ways of understanding others’ intentions, in addition to making the speaker’s intentions understood. There are changes in
the way language is used during development. As outlined in Table 4–3, language is initially used to
gain attention and make requests and eventually develop complex abilities to tell stories and engage in
conversations, including abstract topics.
TABLE 4–3. Pragmatic Development
Birth–
6 months
6–12 months • Responds to “no” and name
1–2 years • Waves
• Responds and turns head to voice and sound
• Attends to speaker’s face
• Discriminates between familiar and unfamiliar individuals
• Stops crying and/or smiles when spoken to
Responses differ between individuals and between family members
•
• Has a social smile
• Babbles for attention and to make demands
• Establishes eye contact
• Pats image in mirror
• Points to objects to learn new words
• Vocalizes for attention
• Laughs
Uses actions and gestures to communicate
•
• Smiles at image of self in mirror
• Plays simple games, such as pat-a-cake
• Imitates simple actions
• Shouts for attention
• Indicates, such as when pants are wet
• Repeats an action that results in laughter by another person
• Parallel play
• Uses gestures with words to communicate wants
• Imitates adults during play
• Refers to self by name
Engages in turn-taking
•
• Engages in simple pretend play, such as cooking
• Uses social words, such as “hi” and “bye”
• Talks to self during play
• Uses intonation; imitates adult intonation at times
continues
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