The “Words in noise” test: an instrument for objective assessment of speech-in-noise difficulties in children

Difficulties in speech perception, particularly central auditory processing disorders (CAPD), are a common yet challenging-to-diagnose cause of learning problems in children. These deficits are most evident in noisy environments such as classrooms and frequently accompany developmental conditions, including autism spectrum disorders (ASD). Standard audiometry does not detect CAPD, and existing Russian-language speech-in-noise tests are either not normed or too demanding for young school-aged children due to reliance on working memory. This study aimed to develop and validate a pediatric speech-in-noise intelligibility test that overcomes these limitations. The “Words in Noise” test is based on 144 early-acquired disyllabic words used in our previous study, which demonstrated that such linguistic material minimizes the influence of cognitive abilities on test performance. The new version of the test was administered to 35 typically developing (TD) children and 52 verbal children with ASD aged 7–12 years. The goals were as follows. First, the existing word set was ranked by perceptual difficulty to ensure equivalence across conditions: stationary (ST) and amplitude-modulated (AM) noise, signal-to-noise ratios of −3 and −6 dB. Such balancing ensures comparability across conditions. Second, the internal validity of the test was evaluated by examining practice effects, fatigue effects, and within-session stability in TD and ASD groups. Third, we sought to replicate previous findings — reduced speech-in-noise intelligibility and diminished ability to benefit from pauses in modulated noise in children with ASD. The results revealed a strong correlation in perceptual difficulty ratings between TD and ASD groups (ICC > 0.9). Within-session stability and practice effects did not differ between groups, while no fatigue effect (performance decline toward the end of the test) was observed in either group. The benefit from amplitude modulation of the masking noise was reduced in children with ASD, and approximately 20% of them scored at least 2 standard deviations below age norms in both ST and AM conditions. Thus, this study replicated earlier findings and demonstrated that the “Words in Noise” test can be used to assess speech-in-noise difficulties in children with ASD and, potentially, in children with other developmental disorders.

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