Childhood listening and associated cognitive difficulties persist into adolescence

Abstract

AbstractObjectiveListening Difficulty (LiD) refers to the challenges individuals face when trying to hear and comprehend speech and other sounds. LiD can arise from various sources, such as hearing sensitivity, language comprehension, cognitive function, or auditory processing. Although some children with LiD have hearing loss, many have clinically normal audiometric thresholds. To determine the impact of hearing and cognitive factors on LiD in children with a clinically normal audiogram, we conducted a longitudinal study. The Evaluation of Children’s Listening & Processing Skills (ECLiPS), a validated and standardized caregiver evaluation tool, was used to group participants as either LiD or typically developing (TD). Our previous study aimed to characterize LiD in 6- to 13-year-old children during the project’s baseline, cross-sectional phase. We found that children with LiD needed a higher signal-to-noise ratio during speech-in-speech tests and scored lower on all assessed components of the NIH Cognition Toolbox than TD children. The primary goal of our current study was to examine if these differences between LiD and TD groups are temporary or enduring throughout childhood.DesignThis longitudinal study had three data collection waves for children with LiD and TD aged 6-13 years at Wave 1, followed by assessments at 2-year (Wave 2) and 4-year (Wave 3) intervals. The primary analysis focused on data from Waves 1 and 2, while a secondary analysis encompassed all three waves despite high attrition at Wave 3. Caregivers completed the ECLiPS, while participants underwent the Listening in Spatialized Noise Sentences test (LiSN-S) and the NIH Toolbox Cognition Battery during each wave. The analysis consisted of: 1) examining longitudinal differences between TD and LiD groups in demographics, listening, auditory, and cognitive function; 2) identifying the functional domains contributing to LiD longitudinally; and 3) evaluating the test-retest reliability of the measures across waves. Mixed-effect models were employed to analyze longitudinal data.ResultsThe study enrolled 169 participants, with 147, 100, and 31 children completing the required testing during Waves 1, 2, and 3 study visits, respectively. The mean ages at these waves were 9.5, 12.0, and 14.0 years old. Children with LiD consistently underperformed TD children in auditory and cognitive tasks across all waves. Maternal education, auditory and cognitive abilities independently predicted caregiver-reported listening skills. The measures exhibited significant correlations between Waves 1 and 2, displaying high reliability. Longitudinal analysis of Wave 3 participants corresponded with the primary analyses of Waves 1 and 2, reinforcing the enduring nature of listening difficulties.ConclusionChildren with LiD and clinically normal audiograms experience persistent auditory, listening, and cognitive challenges through at least adolescence. The degree of LiD can be independently predicted by maternal education, cognitive processing, and spatial listening skills. This study underscores the importance of early detection and intervention for childhood LiD and highlights the role of socioeconomic factors as contributors to these challenges.