Previous Award Number: R324A150029
Previous Awardee: Vanderbilt University

Purpose: This project will result in a validated measure to assess listening fatigue for children in grades 1–12 with hearing loss and other communication-based disabilities. Previous studies indicate that school-age children with hearing loss and specific language impairment are at increased risk for listening fatigue in their classes. Increased listening effort and the associated stress and fatigue can jeopardize the ability to learn, thus increasing the risk for problems in school. The development of a valid, sensitive measure of listening fatigue is critical to improving the understanding of fatigue in children with communication-based disabilities and is a prerequisite for the development and assessment of effective intervention strategies for students with communication disorders.

Project Activities: In Phase 1 of this project, researchers will gather qualitative data on fatigue outcomes through focus groups and cognitive interviews. Results will inform the development of the scale and experts will review the content at the end of this phase. In Phase 2, researchers will conduct a preliminary test of the developed fatigue scale to run psychometric analyses that inform revisions. In Phase 3, the fatigue scale will be field tested for further psychometric analyses to inform final revisions and complete the tool. Finally, a user manual will be written and made available, along with the measure, on the Internet.

Products: This project will result in a fully validated measure of listening fatigue and a companion user manual, as well as peer-reviewed publications and presentations.

Structured Abstract

Setting: This research project will be conducted with students from public and private elementary, middle, and high schools throughout Tennessee, as well as a local group of speech and hearing clinics in the state.

Sample: The sample will consist of three groups of children — children with moderate to profound hearing loss (CHL), children with specific language impairment (CSLI), and children with normal hearing (CNH). The CHL will be categorized into three subtypes, including CHL wearing hearing aids, CHL wearing cochlear implants, and CHL (wearing hearing aids or cochlear implants) exhibiting at least one additional handicapping condition (e.g., visual, physical, emotional/behavioral, learning). The Phase 1 sample includes approximately 126 students (7 per each of 18 focus groups) and 15 of their parents. The Phase 2 sample includes 300 students, and the Phase 3 sample includes 600 students. Students with CHL and CNH will range in age from 7–17 years; students with CSLI will range in age from 7–12 years.

Assessment: The resulting measure will be a reliable and valid child-centered measure of listening fatigue that is user-friendly, brief to complete, and self-administered online (children not yet at a basic reading level can complete this tool with assistance from the teacher). The measure assesses multiple domains of fatigue across age (e.g., listening-related, cognitive, physical, social-emotional). Finally, this assessment will provide information for the identification and management of fatigue in school-age children.

Research Design and Methods:  In Phase 1, researchers will gather qualitative data on fatigue outcomes through focus groups and cognitive interviews as well as through expert review.  These data will be used to generate items and construct a scale that measures children's experiences of fatigue related to hearing loss and language disorders. In Phase 2, researchers will run preliminary tests of the fatigue scale in a large sample of CHL, CSLI, and CNH. Thorough psychometric analyses will be conducted and items or domains will be revised to improve clarity and reduce the length of the scale. In Phase 3, the final test of the tool will be conducted through a large-scale survey (Internet and mailed questionnaires) with a representative sample of CHL, CSLI, and CNH. Finally, a detailed psychometric analysis of the tool will be conducted to refine and complete the fatigue scale.

Control Condition:  Although there is no control group due to the nature of the study, there will be a comparison group included for each test of the measure consisting of children without hearing impairment.

Key Measures: A fatigue scale will be developed that is specific to hearing/listening, will be acceptable to children, yields scores with small floor and ceiling effects, achieves internal-consistency reliability standards of 0.80 or greater, yields reproducibility, and demonstrates evidence of validity. For CHL, clinical validity will be assessed by relating degrees of hearing loss to the fatigue scale scores. For CSLI, clinical validity will be assessed by relating receptive language skills and listening comprehension to fatigue scale scores. 

Data Analytic Strategy: The test will be analyzed using classical test theory, factor analysis, and item response theory. Eight psychometric criteria will be evaluated: a) respondent burden, b) item variability, c) missing data, d) scaling assumptions, e) scaling success rates, f) score reliability, g) features of score distributions, and h) clinical validity.

Related IES Projects: Fatigue and Listening Effort in School-Age Children with Hearing Loss (R324A110266)

Products and Publications

Book chapter

Hornsby, B.W.Y. & Bess, F.H. (in press). Understanding Listening-Induced Fatigue in School-Age Children with Hearing Loss, in A.M. Tharpe (Ed.),A Sound Foundation Through Early Amplification.

Journal article, monograph, or newsletter

Hornsby, B.W.Y, Naylor, G., and Bess, F.H. (2016). A Taxonomy of Fatigue Concepts and Their Relation to Hearing Loss. Ear and Hearing, 37: 136S–144S. doi:10.1097/AUD.0000000000000289 Full text