Listening Effort in Preschool Children With Hearing Loss: A Multidimensional Investigation

Listening effort may impact listeners' performance; however, existing methods for measuring this effort have not been thoroughly applied to preschool children. This study investigated the multidimensional nature of listening effort in preschool children with hearing loss (HL) compared to those with typical hearing (TH).

Fifty children ages 4-6 years (25 with HL and 25 with TH) participated in this study. Children with TH had a mean bilateral hearing threshold of 11.47 dB HL (SD = 3.98). Children with HL had mean bilateral hearing thresholds of 56.6 dB HL (SD = 3.9) and mean bilateral aided thresholds of 25.9 dB HL (SD = 4.5). Children with a history of premature birth, low birth weight, birth complications, medical disorders, or rare diseases were excluded. Auditory tasks included a speech identification test, a subjective listening effort questionnaire, and physiological measurements under three signal-to-noise ratio (SNR) conditions.

Children with HL showed significantly lower speech identification accuracy, F(1, 48) = 29.72, p < .001, η_p² = .38, and longer response times, with a significant post hoc difference between groups at the -5-dB SNR condition, F(2, 96) = 4.65, p = .012. Interestingly, children with TH reported higher subjective effort than HL children at 0 dB SNR, χ²(2) = 8.22, p = .02. Critically, the HL group exhibited significantly higher skin conductance response (SCR) across all conditions, F(2, 96) = 7.64, p < .001, η_p² = .14. Multiple regression analyses across the entire sample, controlling for language ability, demonstrated that SCR remained a significant predictor of performance across all SNR conditions (b = -45.95 to -58.62, all p < .025).

This study demonstrated the value of a multidimensional assessment of listening effort. SCR emerged as a sensitive and objective indicator, revealing significantly higher effort in the HL group. Notably, no significant correlation was found between SCR and subjective listening effort, highlighting the discrepancy between perceived and physiological effort. These findings support the integration of physiological measures, particularly SCR, with behavioral assessments to provide a comprehensive and reliable evaluation of listening effort in young children with HL.