A Delphi-guided development and validation of a comprehensive auditory attention assessment tool (C-AAAT)

Efficient everyday communication depends on the ability to sustain, selectively allocate, and inhibit auditory attention, particularly in multi-talker environments. Despite its clinical importance, standardized tools that assess attention across multiple stimulus levels are limited, especially within the auditory domain and the Indian context. The study aimed to develop and validate a comprehensive auditory attention assessment tool (C-AAAT) in Malayalam using a Delphi-guided framework. In Phase I, expert consensus established the need for the tool and guided its conceptualization, resulting in five subsections: syllable, word, nonword, discourse, and nonverbal stimuli. Content validation demonstrated strong relevance and clarity, with all items exceeding accepted content validity index thresholds, and pilot testing confirmed feasibility and ease of administration. In Phase II, the C-AAAT was administered to 67 younger adults (18-25 years) and 57 older adults (55-70 years) with normal hearing and no cognitive impairment. Outcome measures included accuracy, impulsivity, inattention, and response time. Exploratory factor analysis confirmed the coherent internal structure. Mann-Whitney U, Friedman's test, logistic regression, and receiver operating characteristic analyses and intraclass-correlation demonstrated sensitivity to age-related and subsection-wise differences, along with good to excellent test-retest reliability. These findings provide preliminary evidence of tool's validity and potential utility in assessing auditory attention among Indian-context.