Children's Ability to Identify and Describe Dysphonia: A Multimethod Study

Engaging children with voice therapy is a commonly reported clinical challenge. It is unknown whether this is because children cannot always perceive dysphonia, or whether clinicians do not explain it in age-appropriate terms.

This research aimed to analyse whether children can identify the presence of dysphonia in other children's voices and understand how they describe dysphonic and non-dysphonic voices.

The research was carried out using a multimethod design combining quantitative and qualitative approaches. Thirty children aged 6;4-10;6 (17 male, 13 female) listened to 5 dysphonic and 5 non-dysphonic paediatric voice samples. They were asked whether the voices sounded 'OK' or 'Not-OK'. The relationships between sex, age, and the percentage of correct responses were analysed using the Mann-Whitney U test and Spearman's correlation. Participants were asked to describe one non-dysphonic and one dysphonic voice sample in their own words. Descriptions were analysed using content analysis to thematically categorise responses.

Median correct answers for identifying dysphonia presence were 70% (IQR = 20). No statistically significant difference between sexes was found (p = 0.432, power = 0.53). Results showed no correlation between age and percentage of correct answers (p = 0.751, power = 0.83). Content analysis identified three categories: (a) Words describing voices, featuring adjectives related to voice quality, (b) Extra information, concerning speech and voice but not voice quality, (c) Unrelated information, irrelevant to communication.

Children are capable of correctly identifying dysphonia presence in other children's voices with a high degree of accuracy, unrelated to their sex or age. However, the lack of universal appreciation of dysphonia means that clinicians should examine children's perceptual abilities before commencing voice therapy. Children sometimes mistake voice quality for other concepts, both communication-related and not. The findings from this study provide age-appropriate descriptive terms that could facilitate education of paediatric clients about the concept of voice quality.

What is already known on the subject There is little knowledge about age-related understanding of paediatric dysphonia, and the barriers that weaken adherence to voice therapy are numerous, including children's awareness of their voice disorder and limited knowledge about how the voice is produced. Past studies have demonstrated that children with dysphonia are aware of their voice disorder and its impact on their daily lives. However, these findings were based on structured questionnaires that may have influenced the responses. We therefore wanted to investigate whether children can distinguish between dysphonic and non-dysphonic voices and understand how they describe dysphonic and non-dysphonic voices when asked an open-ended question. What this study adds to existing knowledge The results of the present study demonstrate that children can identify the presence of dysphonia in other children's voices with 70% accuracy. Accuracy is unaffected by sex or age. Children can express themselves about how voices sound, and the language is extremely varied, but they tend to mistake voice for other concepts. What are the potential or actual clinical implications of this work? Since children cannot consistently perceive dysphonia with absolute accuracy, improving their ability by training them, and consequently enhancing their awareness of the voice disorder, can potentially benefit voice therapy. Similarly, if clinicians teach children what voice and dysphonia are by using age-appropriate descriptive terms, some of which are suggested in the present findings, compliance, therapy adherence and consequently therapy efficacy could be positively impacted.