Behavioural Testing Part One PDF

Behavioural Testing Part One - **Assessment Philosophy and Approach** **The cross-check principle** - History: Behavioural test results in isolation led to misdiagnosis and mismanagement of children. - The advantage of immittance audiometry, auditory evoked potentials (AEPs), and o...

Behavioural Testing Part One - **Assessment Philosophy and Approach** **The cross-check principle** - History: Behavioural test results in isolation led to misdiagnosis and mismanagement of children. - The advantage of immittance audiometry, auditory evoked potentials (AEPs), and otoacoustic emissions (OAE) techniques is that they have significantly contributed to quantifying sensorineural hearing levels. Advantages of test battery approach: Gives us detailed information. - Avoids drawing conclusions from a single test. - Allows for identification of multiple pathologies. - Provides a comprehensive foundation for observation of auditory behaviours (Madell & Flexer, 2008) **Cross-check principle (Jerger & Hayes, 1976)** 1\. Key concept governing the assessment strategy 2\. No result will be accepted if an independent measure confirms it 3\. several appropriate behavioural and physiological tests must be used to determine the extent of a child's auditory function' (Stach 1998 in Madell and Flexer 2008) It has an effect on the accuracy with which one can identify and quantify hearing loss during the critical years of language learning. **Age group Different age groupings** **Procedural categories** Behavioural Physiological -------------------------------------- ---------------------------- Behavioural observational audiometry OAE VRA Auditory evoked potentials Sound field testing Immittance testing Conditioned play audiometry Conventional audiometry Speech audiometry **Checklist** **Expected outcome.** - Identification of hearing loss - Identification of auditory neuropathy or Central Auditory Processing/language disorder - Quantification of hearing status - Development of a report of historical, physical, and audiological findings and recommendations for treatment and management - Implementation of plan **Selection of test battery** - Dependant on: - Chronological Age/Maternal Age - Availability of equipment - Personnel - Test Environment **Personnel** - Number of individuals required. - Skill level of individuals **Equipment** - Screening/diagnostic - Calibrated - ANSI - Ancillary equipment (probe tips, electrodes, headphones, speakers) - Test material (age-appropriate, varied, standardised) **Setting** - Test room (sound-treated booth, size, distractions) - Infection Control - Positioning - Equipment - Positioning of child - Positioning of personnel **Clinical process** - Stimulus - Transducer - Reinforcer - Instructions - Procedure - Modification - Expected Response **Case history** **Reason for the interview** 1\. To obtain information regarding the child, the family and hearing function. 2\. The extent of information required is dependent on the reason for evaluation 3\. Enables one to observe the child and family interactions 4\. Information assists in planning evaluation and habilitation. 5\. Information reveals misconceptions that parents may have **Ways of collecting information** - Initial questionnaire provided to the family. - Corroborate information with significant members. - Collate reports: useful if primary caregivers are not present. - Questionnaire to fill out on arrival at the centre. - Interview **Topics to be covered.** - Reason for visit - Specific info (Madell & Flexer 2008) - Birth and prenatal history. - Health History - Developmental history - Amplification history - Social History - Educational History - Special services - Other evaluations **Birth and Prenatal history.** - Previous pregnancies - Illnesses during pregnancies (including the week it occurred) - RH incompatibilities - Medications during pregnancy (legal, illegal) - Complications during pregnancy - Length of pregnancy - Delivery --C-section (emergency, elective) or vaginal - Birth weight - Complications (anoxia, jaundice, APGARs, breech, ventilation, antibiotics) - Length of hospitalisation **Health history** - Colds, allergies, ear infections - High fevers - Immunizations, reactions - Meningitis - Other viruses (mumps, CMV) - Medications and reactions - Feeding and swallowing - Seizures - Head injury **Motor milestones** - Sitting, crawling, and walking - Age of visual response to parents - Is walking clumsy? Does the child fall? - Feeding and swallowing **Auditory** - Parents thoughts of hearing - Sounds to which the child responds. - Startle response present. - Does the child distinguish between sounds? - Does the child want sounds louder? - Does the hearing fluctuate? - Are sounds uncomfortable. **Communication milestones** - Age of babbling - Changes in babbling - Expressive - First words, phrases, sentences - Receptive - Does the child understand verbal requests without visual cues? - How does the child communicate needs (voice, gesture - Has there been a change in speech and language. - Did the child speak and then stop (did the child regress) **Amplification history** - Does the child wear a hearing aid and or CI, FM? - Who recommended the devices? - When were they acquired? - Name, SN and settings, unilateral /bilateral. - When does the child wear them? **Social history** - When did the child feed himself? - Dress himself? - Does he play with other children? - What toys or objects does the child like to play with? - Feeding and eating history - Age of toilet training - Does the child have any behavioural problems? - How does the child get along with other children? Adults? Family? - Have there been any changes in the child's behaviour? - Does the child respond to others? Make eye Contact? **Educational history** - Current School - Type of educational programme - Previous school placements - Reasons for change in school placements - Special services received in school. - Describe educational problems of concern. **Special services** - What special services does the child receive in school? Outside of school? - SL Therapy - Hearing/ Auditory Therapy - Occupational Therapy - Physiotherapy - Psychological Services - Educational tutoring - Other **Conducting the interview** - First 5 minutes - 'Calibrating' the interview - Questioning: Listening and observing - Diagnostic function -- Process and Content - Therapeutic tasks: Establishing a Helping relationship. - Facilitation Techniques **First five minutes** - Set the stage for active interaction. - Clear introductions - Communicate the clinician\'s respect for the patient/caregiver as a unique individual. - Anxiety common - Introduction establishes names, roles, purposes, and time of interview. **Calibrating the interview** - The first 5 minutes give an observant clinician information about the caregivers'/patient's communication style and behaviour and possible list of problems/concerns. - By recognising the caregiver/patient's state and by responding to it the clinician can conduct an effective interview **Questioning** Listen and observe. - Allow the caregiver to talk spontaneously rather than restricting and directing the flow with multiple questions. - Talking freely in the initial stages before initiating a more detailed enquiry what the patient says first may not be the only or even most important concern. - Encourage the caregiver to report all and any concerns by using. - Open-ended questions - Non-directive questions **Diagnostic function** Two categories of information are available. 1. What the caregiver says -- content 2. How it is said -- process Content\ written record - history. Process\ Observation both verbal and non-verbal provides information about the caregiver/patient as a person. **Therapeutic tasks: Establishing a Helping relationship.** - Cornerstone of care (Rogers 1961, In Lichstein 1990) - Interview: The most important avenue for establishing a relationship built on trust and commitment - Actively employ techniques to promote this relationship - Non-judgemental interest (active listening) - Empathy (communicating to the patient an accurate assessment of their emotional state) - Concern for patient/caregiver - Techniques strengthen the therapeutic bond and improve diagnostic power. - Caregiver's/patient's compliance and cooperation with future diagnostic and therapeutic plans often hinge on the clinician\'s skill. **Facilitation techniques** - Only exert as much control over the interview as is needed. - Keep the caregiver talking in a productive fashion. - Use facilitation techniques to encourage and guide caregivers\' spontaneous report. - Posture, gesture and words indicating interest. - Techniques reassure a caregiver that she should go on speaking. - Provide time for the caregiver to respond and reflect.  Review of common problems A white paper with black text Description automatically generated - Insisting that the interview be completed in one session. - Limiting the diagnostic hypotheses before adequate data has been collected. - Using questions that are too leading, complex, or unclear. - Failure to follow basic courtesies, lack of clear introductions. - Lack of clear instructions - Ignoring the patient\'s comfort - Failure to establish an atmosphere of trust and confidentiality. - Failure to elicit the patient\'s ideas about the problem. - Note-taking that interrupts the flow of conversation. \ **Developmental screening** **Childhood Motor Developmental Checklist** Modified - 'Rapid Developmental Checklist developed by the Committee on Children with Handicaps American Academy of Paediatrics, New York Chapter 3, District II Birth- 4yrs **Childhood Communication Developmental Checklist** Modification 'Your Child's Speech and Hearing " - American Speech and Hearing Foundation Birth- 4yrs **Functional auditory assessments** - Typically completed by teacher, student, parent - Questionnaires - Rating Scales - Before and or after the use of a hearing aid, CI FM, or sound field system - Enable one to monitor a child's auditory progress over time. See Functional Auditory Assessment Tools for Infants and Young Children (Madell, 2008)