Reported Listening-in-Noise Difficulties as a Gold Standard in Pediatric Auditory Processing Disorder

Purpose: This study examined the relationship between reported listening difficulties and behavioral auditory processing measures in children. Additionally, the role of reported listening difficulty was explored within pediatric auditory processing disorder diagnosis when a true biological gold standard is unavailable. Method: Diagnostic performance and reported listening difficulty were examined across three data sets: (a) 60 children aged 7–14 years referred to the Idaho State University Speech and Hearing Clinic for listening difficulties, (b) 51 children aged 8–9 years who participated in a separate factor analysis study, and (c) 717 children aged 7–14 years who participated in a national normative study. The sensitivity and specificity were calculated using behavioral tests as the index and parent/professional report as the gold standard. In addition, behavioral tests were then used as the gold standard and reported difficulty as the index. Target conditions of the diagnostic systems were speech-in-noise difficulty and more general listening difficulty. Results: Results did not produce both high sensitivity and specificity across measures and data sets. This was true whether the behavioral tests were the index or reported difficulty was the index. Conclusions: Reported difficulty and behavioral tests do not appear to show strong overlap when used in children. Despite this, evidence in the literature does support the utility of reported difficulty as an index test in the diagnostic process when combined with behavioral tests. Furthermore, when it is not possible to identify a good gold standard, it is possible to support diagnostic procedures when there is good standardization by demonstrating (a) good reliability, (b) good validity, (c) that treatment is possible, and (d) that treatment is beneficial.