Development and evaluation of the LittlEARS® Early Speech Production Questionnaire – LEESPQ
Introduction
Infant hearing loss in Germany is being discovered earlier than ever before, thanks to an increasing use of Universal Newborn Hearing Screening (UNHS) tests. While such early detection greatly increases access to the benefits of early intervention and subsequent speech and language therapy, it presents a challenge for therapist. In the pre-UNHS days, when hearing-impairment was discovered later, diagnostic and assessment tools for the speech production of hearing impaired children focused on comparatively high word and linguistic levels; age-appropriate in the past but not for today's younger, less physically and audiologically developed hearing-device users.
While many screening tools are available on the German-speaking market, all of them insufficiently assess the preverbal expressive development of children less than 10 months old. Screening questionnaires such as the ELFRA-1 [1] for 12 month olds and the FRAKIS and FRAKIS-K [2] for 18–30 month olds are helpful but, according to scientific standards, their prognostic validities are not significant. The screening questionnaire SBE-2KT [3] is for 21–24 month olds. Diagnostic instruments fulfilling the quality criteria are, unfortunately, only available for older children. The ELAN [4] is for children aged 16–26 months. The ELFRA-2 [1] is for children aged 21–24 months. Tests assessing receptive and expressive semantic-lexical and morphologic-syntactical levels are also only available for older children: the SETK-2 [5] is for children aged 2 years–2 years 11 months; and the SETK 3–5 [6] is for children aged 3–5 years. The LittlEARS® Auditory Questionnaire (LEAQ) [7] is for children under 24 months old, but it assesses receptive, not productive, auditory behavior. The Functioning After Pediatric Cochlear Implantation (FAPCI) [8] assesses the development of communication performance on a family-centered scale, but is for children aged 2–5 years. The Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS) [9] is a parental interview with 10 questions that evaluates the meaningful use of sound in everyday situations (vocal behavior, attachment with hearing instrument, ability to alert to sound, and ability to attach meaning to sound). The Production Infant Scale Evaluation (PRISE) [10] uses a parent questionnaire to access the vocal development of infants with cochlear implants. For the German language, efforts have been made to develop a diagnostic instrument for therapy based on the Stark Assessment of Early Vocal Development – Revised (SAEVD-R) [11], [12] which allows the classification of a child's utterances and the assessment of the developmental progress in his/her first 20 months of life and can be used to classify 3 main types of vocalization: vegetative sounds, fixed signals, and protophones. Thus far, results have only been preliminary [13].
We have been developing LEESPQ (LittlEARS® Early Speech Production Questionnaire) to meet the needs of children aged 0–18 months. It is our intention to use the LEESPQ within the LittlEARS® battery, alongside the LEAQ [14] and the My LittlEARS® Diary [15].
Based on a literature review and the clinical study data gathered in a longitudinal study on preverbal speech and language development [17], [18] the first questionnaire has been developed by an experienced group of professionals. The version with 24 age-dependent questions addressed reflexive behavior, crying, prelingual utterances, canonical babbling, jargon, and first words of children aged 0–18 months [16]. A small, independent sample of parents, therapists, and physicians then assessed this questionnaire for 1) understandability of the questions and examples, 2) usability, 3) quality, and 4) completeness. We incorporated their suggestions into a revised version of the questionnaire. The LEESPQ is primarily intended for parents to complete after observing their child's natural behavior while at home or in a familiar setting. It also aims to provide professionals with crucial information about children's earliest developmental milestones. In addition to being convenient for the parent and non-invasive for the child, parent-completed questionnaires are useful diagnostic tools to assess infants' and toddlers' communication abilities [19]; although when speech therapists and professionals evaluate the completed questionnaires, they should remember that parents are prone to over-estimating their children's abilities [20].
Our present purpose is to develop the LEESPQ and validate its ability to assess very early speech and language production development. Furthermore, we would like to determine the suitability of the LEESPQ (1) for documenting the speech and language development of normal-hearing children (2) as a general screening tool to support UNHS testing, (3) for use by pediatricians and ENT practices, and (4) as a test instrument for scientific studies.
Section snippets
Subject recruitment and inclusion criteria
600 pilot questionnaires of the LEESPQ (LittlEARS® Early Speech Production Questionnaire) were distributed to pediatricians and daycare centers in Mainz, Germany, and to daycare centers and parents in Innsbruck, Austria. The pediatricians and daycare centers functioned merely as distribution points wherefrom parents could pick up the questionnaire.
Parents were asked to complete the questionnaire based on their child's behavior. If they had seen the child exhibit the questioned behavior at least
Subjects
60.8% (365/600) of the questionnaires were returned, however 13 did not meet the inclusion criteria and were thus were excluded. 352 questionnaires were analyzed, yielding a study population of 161 male and 186 female children. 5 children were of unstated gender. The age ranged from 8 days (0 months) to 18 months old (see Table 1). Every child had, according to his/her parents, normal hearing and had been subject to a newborn hearing screening test. 72.2% (254/352) children were unilingual,
Discussion
The results of this study confirmed that the LEESPQ (LittlEARS® early speech production questionnaire) is a statistically validated, accurate, gender independent, and age dependent tool for the quick and easy assessment of milestones in early speech production in normal hearing German-language children, aged 0–18 months. This validation is an important preparatory step towards developing a validated assessment questionnaire for use with children aged 0–18 months with hearing loss, as their
Conclusion
The LittlEARS® Early Speech Production Questionnaire (LEESPQ) is a valid tool for assessing the most important milestones in very early development of speech and language production of German language normal hearing children aged 0–18 months old. It has good age-dependency, internal consistency, reliability, predictive accuracy, and is not influenced by gender. As it has an excellent correlation between age and total score, the LEESPQ is a potentially useful tool for long term follow-up testing
Conflicts of interest
Authors Joanna Brachmaier, Edda Amann and Vanessa Hoffmann are employed at MED-EL, as are Petra Kuss, Maria Wechselberger, and Michael Todd. Bianka Wachtlin and Annerose Keilmann received research funding from MED-EL.
Acknowledgments
We thank Petra Kuss and Maria Wechselberger for assisting in data collection and Michael Todd, who provided medical writing services, all on behalf of MED-EL, GmbH. Furthermore, many parents and teachers in various day nurseries in Innsbruck, Austria and Mainz, Germany actively supported this project in cooperation with MED-EL.
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