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International Journal of Pediatric Otorhinolaryngology 110 (2018) 93–99

Contents lists available at ScienceDirect

International Journal of Pediatric Otorhinolaryngology


journal homepage: www.elsevier.com/locate/ijporl

The Persian version of auditory word discrimination test (P-AWDT) for T


children: Development, validity, and reliability
Nassim Hashemia, Ali Ghorbanib, Zahra Soleymania, Mohmmad Kamalic,
Zohreh Ziatabar Ahmadid,∗, Saeid Mahmoudiane,f
a
Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
b
Department of Speech Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
c
Department of Basic Sciences in Rehabilitation, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
d
Department of Speech Therapy, School of Rehabilitation, Babol University of Medical Sciences, Babol, I.R, Iran
e
Laboratory for Auditory Neuroscience, ENT and Head & Neck Research Center, Iran University of Medical Sciences, Tehran, Iran
f
Department of Otorhinolaryngology - Medical University of Hannover (MHH), Hannover, Germany

A R T I C LE I N FO A B S T R A C T

Keywords: Objective: Auditory discrimination of speech sounds is an important perceptual ability and a precursor to the
Auditory discrimination acquisition of language. Auditory information is at least partially necessary for the acquisition and organization
Test of phonological rules. There are few standardized behavioral tests to evaluate phonemic distinctive features in
Validity children with or without speech and language disorders. The main objective of the present study was the de-
Reliability
velopment, validity, and reliability of the Persian version of auditory word discrimination test (P-AWDT) for 4-8-
Speech sound disorder
year-old children.
Methods: A total of 120 typical children and 40 children with speech sound disorder (SSD) participated in the
present study. The test comprised of 160 monosyllabic paired-words distributed in the Forms A-1 and the Form
A-2 for the initial consonants (80 words) and the Forms B-1 and the Form B-2 for the final consonants (80
words). Moreover, the discrimination of vowels was randomly included in all forms. Content validity was cal-
culated and 50 children repeated the test twice with two weeks of interval (test–retest reliability). Further
analysis was also implemented including validity, intraclass correlation coefficient (ICC), Cronbach's alpha
(internal consistency), age groups, and gender.
Results: The content validity index (CVI) and the test-retest reliability of the P-AWDT were achieved 63%–86%
and 81%-96%, respectively. Moreover, the total Cronbach’s alpha for the internal consistency was estimated
relatively high (0.93). Comparison of the mean scores of the P-AWDT in the typical children and the children
with SSD revealed a significant difference. The results revealed that the group with SSD had greater severity of
deficit than the typical group in auditory word discrimination. In addition, the difference between the age groups
was statistically significant, especially in 4–4.11-year-old children. The performance of the two gender groups
was relatively same.
Conclusion: The comparison of the P-AWDT scores between the typical children and the children with SSD
demonstrated differences in the capabilities of auditory phonological discrimination in both initial and final
positions. It supposed that the P-AWDT meets the appropriate validity and reliability criteria. The P-AWDT test
can be utilized to measure the distinctive features of phonemes, the auditory discrimination of initial and final
consonants and middle vowels of words in 4-8-year-old typical children and children with SSD.

1. Introduction redundancy sounds” [1]. Auditory discrimination is commonly referred


to as the capacity to distinguish between phonemes or individual
The processes of the auditory discrimination include “location and speech sounds [2]. It is emphasized that the precise dissociation of
lateralization of sound, recognition of auditory patterns, temporal as- spoken sounds is the critical factor for the achievement of the articu-
pects of hearing (temporal integration, temporal discrimination, tem- latory proficiency and the language comprehension [3–5]. Six-month-
poral order, and marking), and perception of competitive and low- old infants are able to detect consonant contrasts and able to


Corresponding author. Department of Speech Therapy, School of Rehabilitation, Babol University of Medical Sciences, Ganj Afrooz Ave, Postal Code: 47745-47176, Babol, Iran.
E-mail addresses: z.ziatabar@mubabol.ac.ir, ziatabar.ahmadi@gmail.com (Z.Z. Ahmadi).

https://doi.org/10.1016/j.ijporl.2018.05.003
Received 19 January 2018; Received in revised form 30 April 2018; Accepted 3 May 2018
Available online 05 May 2018
0165-5876/ © 2018 Elsevier B.V. All rights reserved.
N. Hashemi et al. International Journal of Pediatric Otorhinolaryngology 110 (2018) 93–99

differentiate among the phonemes of language which they are exposed implementation of speech sound discrimination tests are commonly
[6–9]. According to the Maintenance theory, the auditory experience is heavy for young children [24]. One possible reason is that the pure
required to maintain perceptual sensitivities in the infants [10]. auditory tests provide the confined lingual information concerning to
Therefore, the discrimination ability may be improved through the the phonological discrimination [24]. Moreover, auditory discrimina-
language experiences, the developmental changes, and age [6–9]. It has tion tests are different from each other by multiple factors. These fac-
been hypothesized to be a hierarchical and maturational pattern of the tors contain the mode of presentation (auditory or visual), the position
phonetic distinction in infants and children [11]. For example, the re- of the phonemic contrasts (initial, middle, or final consonant), and the
searchers revealed that manner and voicing is the most important au- type of distinctive features (placement, voicing, and manner), the type
ditory dimensions which followed by the place of articulation [12]. of segment (consonants or vowels), syllabic context, age groups
Young children can separate the acoustic components of the manner [2,18,22,23]. On the other hand, a listener's correct identification of a
and the voicing better than the acoustic components of place of ar- single spoken word depends on the situation, dialects, and the mode of
ticulation [13]. Moreover, it can be inferred that vowel changes are presentation by examiner. Therefore, providing of a similar mode of
occurred earlier than the consonant changes [11]. presentation for all the participants, such as a recorded voice can ap-
In order to acquire the speech sounds, children are needed to have a proximately decrease biases in the research studies. Accordingly, it
typical oral, auditory, and central nervous systems [3]. A speech dis- seems a necessity to assess the skills of auditory phonological dis-
order is characterized by inadequate use of the phonological rules of crimination using minimal sets in other languages.
language (DSM-IV F80.0–315.39) [14,15]. Speech sound disorders The aim of the present study to develop a comprehensive list of
(SSD) may be accompanied by problems in the process of the phonemic recorded and Persian words with different vowels, as well as initial and
differentiation and comprehension [3,16,17]. Children with SSD have final consonants based on the distinctive features of phonemes.
difficulties to produce the speech sounds and the phonological re- Furthermore, the various age groups (4–8 years) are examined to follow
presentations, and to organize the lingual rules that are characterized the probable developmental trends of the auditory word discrimination
by errors such as phoneme substitution, omission, and distortion in the typical children and the children with SSD.
[3,16,17]. According to the theories concerning the speech sound
production and comprehension, the SSD can be generated by the central 2. Materials and methods
auditory processing problems, difficulties in the acquirement of the
phonological rules and the speech production [14,18]. Accordingly, the 2.1. Participants
precise observation of the speech performance in children with SSD can
partially contribute in understanding of their speech and language A total of 120 typical children, aged between 4 and 8 years
abilities. Although the relationship between speech-sound discrimina- (Mean = 5.62 ± 1.22), and 40 children with SSD, aged between 4 and
tion and the SSD are still unknown and controversial [19,20], it sus- 8 years (Mean = 5.57 ± 1.12), participated in the present study. All
pected that there is a reciprocal association between the articulation the children were monolingual and native speakers of Persian language
disorder and the auditory discrimination, as confirmed by Liberman's and were selected from Tehran kindergarten and Primary schools.
motor mediation theory [21]. According to the Liberman's theory [21], Typical children were healthy, socially well-functioning, and none had
“the phonetic information is perceived in a biologically distinct system, neither cognitive nor learning difficulties; children with SSD had only
a ‘module’ specialized to detect the intended gestures of the speaker speech sound errors as a disorder. The diagnosis was established in-
that are the basis for the phonetic categories”. As results, the lack of formally by a professional speech and language pathologist in a spe-
valid and reliable data, especially concerning the capabilities of Per- cialized clinic affiliated with the researchers' university based on client
sian-speaking children with SSD in the distinction of the auditory seg- articulation errors. The diagnostic criteria were based on (DSM-IV
mental units led to the need for a reliable instrument. F80.0–315.39) [14,15]. The criteria were persistent unintelligible
The instruments that are used to measure speech discrimination in speech consisting of phoneme addition, omission, distortion, or sub-
children have been relatively limited. The most widely used instru- stitution, which interferes with verbal communication. The two groups
ments were the Goldman-Fristoe-Woodcock Test of Auditory were matched for age, gender, and parental socio-economic status.
Discrimination [22], the Wepman Auditory Discrimination Test (ADT) Participants' characteristics are shown in Table 1. All children were
[2], and the Boston University Speech-Sound Discrimination Test [23]. evaluated in a private room with the experimenter present. The as-
The Wepman test includes a comparison of paired-words by auditory sessment for each participant took place in one session, as well.
presentation while the Goldman-Fristoe and Woodcock test contains a
language-context test [2]. This instrument utilizes a carrier phrase or 2.2. Ethical considerations
sentence context to present auditory stimuli and the child should select
a picture from a category [2]. In the Wepman's test, the child is asked to The study was approved by the Ethical Committee of the Tehran
response if two words presented by auditory method are the same or University of Medical Sciences. All parents enrolled in the study filled a
different [2]. This test provides precise information regarding a child's written informed consent which was designed according to the
speech-sound discrimination and is more difficult than the Goldman-
Fristoe-Woodcock test. On the other hand, the ADT consists of two al- Table 1
ternative forms (Form A1 and Form A2) [2]. This test is a very rapid Characteristics of the participants with age means (and standard deviations).
screening measure for the identification of children with auditory dis-
Group Gender N Chronological Age
crimination problems [2]. However, the ADT investigates distinctive
features of phonemes only in the initial position of words [2]. The Mean(SD)
Boston University Speech-Sound Discrimination Test is a picture-word
Typical F 64 5.68 (1.26)
discrimination test used for young children without considering dis-
M 56 5.55 (1.18)
tinctive features and specific phonological rules [23]. The tests of au- Total 120 5.62 (1.22)
ditory discrimination are generally old and often designed for English- SSD F 20 5.60 (1.19)
speaking children. Each language seems to have unique multifarious M 20 5.53 (1.08)
phonological and metalinguistic rules. Therefore, it is logical that au- Total 40 5.57 (1.12)
Total F 84 5.61 (1.25)
ditory discrimination tests should be designed based on the lingual and
M 76 5.47 (1.16)
the cultural characteristics. Total 160 5.61 (1.19)
To the best of our knowledge, the understanding and the

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N. Hashemi et al. International Journal of Pediatric Otorhinolaryngology 110 (2018) 93–99

Declaration of Helsinki. reliability of this test [26]. For test-retest reliability, 50 participants
were re-examined twice with two weeks of interval and the correlations
2.3. Persian version of auditory word discrimination test (P-AWDT) between the test-retest mean scores were compared. Reliable perfor-
mances on the tasks result in high scale correlations across the test-
In order to administer the P-AWDT, we used from a list of paired- retest interval. Intra-class correlation (ICC) higher than 70% was con-
words with consonant-vowel-consonant monosyllabic structures. The P- sidered as acceptable [27].
AWDT inspired by Wepman's Auditory Discrimination Test [2]. The
meaningful word list was prepared from a collection of story books
appropriate for the children. The difference between paired-words was 2.6. Statistical analyses
in initial or final consonants and middle vowels. Initial and final con-
sonants were different from each other in minimal sets (the voicing, the Kolmogrolov-Smirnov was used to ensure normal distribution of the
manner, and the place of articulation). Although meaningless pseudo- samples. Furthermore, the CVI was calculated to examine the content
words were substituted with meaningful words, they did not impact on validity of the P-AWDT and the ICC and the Pearson's correlation
performance and children didn't make errors on these items. To eval- coefficient were used to check the test-retest reliability. Besides, de-
uate ability in the distinction of different pairs and the diagnosis of the scriptive and analytic statistics were used. For descriptive analysis, the
same pairs, 25% of all the words were selected as same pairs that dis- mean scores and standard deviation values were used. Due to non-
tributed randomly through the four forms. Overall, 160 paired-words in normal distribution of samples, non-parametric Mann-Whitney U,
four forms (Form A-1, Form A-2, Form B-1, and Form B-2) were selected Kruskal-Wallis, and Chi square tests were used for the comparison of the
as the test items (e.g. 10 sample of paired-words from each category P-AWDT scores in the age groups and genders for the typical children
listed in Appendix 1). Each form is contributed from 40 items. Forms A- and the children with SSD. Data was analyzed using SPSS 19 (SPSS,
1 and Form A-2 were designed to survey the initial phonemes and Inc., Chicago, IL) and the statistical significance was set at p ≤ 0.05.
Forms B-1 and Form B-2 were developed to investigate the final pho-
nemes. The vowel changes (16 items) were also assessed and dis- 3. Results
tributed randomly through the four forms. The total P-AWDT scores
were in the range of 0 and 160. A native Persian male speaker produced The results of the present study are presented in three parts. In first
the final list of 160 words several times at a 44.1 kHz sampling rate and second parts, we reported the results of the content validity, the
with neutral intonation in a sound-proof studio. A microphone (Model: test-retest reliability, and the internal consistency of the P-AWDT. In
M-Audio Nova) was used set at 20 cm distance from the speaker's third part, the results of the correlation between the P-AWDT and
mouth. All the recorded words were transferred to a sound card (Model: gender were illustrated by a box plot. Finally, all children's perfor-
M-Audio Fast track pro II) and all the recordings were edited using mances including the descriptive and analytic values on individual
Behringer Mixer (Model: XeroX1002FX) and Cubase, Logic software. tasks in the four age groups (4–4.11, 5–5.11, 6–6.11, 7-8 year-old) are
The duration between the two words in one pair and the two paired- summarized in tables and a simple line chart.
words from each other were 500 ms and 3 s, respectively. The intensity
of sound was measured at the height of the listener's head using a Sound
Level Meter (Model: GM 1357-EN-00). Sound intensity level was set on 3.1. Content validity
70 dB SPL. All the stimuli were presented a 10 inch laptop (Aspire one
3665-D257) in a pseudorandom sequence to control for order/learning The CVI of each form is presented in Table 2. The CVIs for the Form
effects. Two high-quality headphones placed in the child's ear were A-1 and the Form A-2 were achieved 63% and 85%, respectively, and
used to present. A primary list of items (10 items) was available for the the CVIs for the Form B-1 and the Form B-2 were estimated 60% and
children to use prior to presenting main items. Children were asked to 86%, respectively. The results demonstrated that the P-AWDT has
verbally discriminate between each paired-word presented by re- strong and acceptable content validity in all the four forms.
sponding “yes” inferred to mean “same”) or “no” to indicate “different”.

2.4. Validity of the P-AWDT 3.2. Internal consistency and test-retest reliability

Content validity of the P-AWDT was evaluated by a panel of 14 Total Cronbach's alpha of the P-AWDT was 0.93. Table 2 presents
judges. For each question, a 0-2-point scale was used; (2 points for: the means, standard deviations, the ICC, and Pearson product moment
“very suitable”, 1 for: “somewhat suitable”, and 0 for: “totally un- correlations between the test and retest with two weeks of interval in 50
suitable” [25].The criteria were used to judge the suitability of each typical children. The ICC measures were observed between 84% and
item based on the types of selected consonants and vowels. Then, we 96% in the four forms. Furthermore, there was a significant correlation
computed the content validity index (CVI) for each item: only items between children's performances in first and second times. These data
scoring 2 were regarded as acceptable. Therefore, the CVI was calcu- reflected the Pearson product-moment correlations in all the forms
lated as following: the number of judges who scored 2 divided by the which were found very high (0.81 ≤ r ≥ 0.96).
total number of judges. Only items over 0.51 in the CVI, meaning that
Table 2
more than 51% of the experts regarded them as valid, were selected as
The results of the content validity and the test-retest reliability of the P-AWDT.
significant [25]. Other items with low score were eliminated.
P-AWDT Validity Test Retest Reliability
2.5. Reliability of the P-AWDT
CVI M SD M SD ICC Correlation
Coefficients
Reliability of the P-AWDT was determined in two ways: Internal
consistency and test-retest reliability. To evaluate the internal con- Form A-1 63% 38.85 1.14 39.02 0.99 94% 0.96
sistency, we examined inter-task agreement by Cronbach alpha. In this Form A-2 85% 39.25 0.80 39.25 0.77 96% 0.96
Form B-1 60% 39.12 1.01 39.12 0.96 84% 0.81
procedure, each task was essentially treated as a test item. When the Form B-2 86% 39.20 0.91 39.37 0.86 84% 0.82
different tasks reliably measure the same construct, Cronbach's alpha
will be high. When each word is individually deleted, alpha never drops CVI = Content validity index; M = mean; SD = Standard deviation, ICC =
below 0.70, suggesting that all the words are contributing equally to the Intraclass correlation.

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N. Hashemi et al. International Journal of Pediatric Otorhinolaryngology 110 (2018) 93–99

Table 4
The percentage of correct responses to vowels changes compared with con-
sonants in the typical children and the children with SSD.
P-AWDT Mean Rank Mann-Whitney Wilcoxon Z P-value

Typical SSD

Form A-1 90.60 50.14 1185.50 2005.50 −5.04 0.000*


Form A-2 89.63 53.13 1305.00 2125.00 −4.67 0.000*
Form B-1 91.66 47.03 1061.00 1881.00 −5.68 0.000*
Form B-2 91.00 48.99 1139.50 1139.50 −5.37 0.000*

Note. *P ≤ 0.05.

AWDT in the four age groups (4–4.11, 5–5.11, 6–6.11, and 7–8 years)
and in the typical children and in the children with SSD by a simple line
chart. The SEMs in all the age groups were larger in the children with
Fig. 1. The mean ranks of the scores of auditory word discrimination skills SSD than in the typical children. The mean scores of each age group
(Form A-1, Form A-2, Form B-1, and Form B-2) are reported in all the parti- showed that the capabilities of auditory word discrimination are line-
cipants in the two genders by the line chart. There was no significant difference arly increased when children grow. This indicates that the P-AWDT has
in the mean scores of the P-AWDT between the two gender groups.
the essential criteria of a developmental scale and is sensitive to ma-
turation. As can be seen by chart, the most increase in the auditory
3.3. Gender and the P-AWDT word discrimination took place between the ages of 6 and 8 years.

The comparison of gender differences in the P-AWDT using non-


3.5. The comparison of the vowels and the consonants
parametric Mann-Whitney U test were obtained for Form A-1
(z = −0.16; p = 0.86), Form A-2 (z = −0.12; p = 0.90), Form B-1
Table 5 presented the percentage of correct responses to the vowel
(z = −0.28; p = 0.77), and Form B-2 (z = −0.21 (p = 0.82). Besides,
changes which were compared with consonants in the typical children
Fig. 1 reflected the description of the mean ranks of the P-AWDT in all
and the children with SSD using Chi square test. The typical children
the girls and the boys in the four forms by a line chart. Overall, the
and the children with SSD were answered to the vowel changes better
comparisons between the boys and the girls on each form revealed any
than the consonant discriminations in all forms (p < 0.05).
significant differences (p > 0.05).

3.4. Age and the P-AWDT 4. Discussion

As expected, there was a robust correlation between the P-AWDT Undoubtedly, the distinction of speech-related auditory stimuli as
and age (Form A-1: r = 0.60, Form A-2: r = 0.52, Form B-1: r = 0.54, one of neurobiological pathways has directly been implied in auditory
and Form B-2: r = 0.52, p < 0.05). Tables 3 and 4 present the mean processing [28–30]. During the recent years, it has been a necessity to
scores, standard deviations, and the values of P-value in the four age consider the probable reasons, basic generators, and all the con-
groups in typical children and those with SSD by nonparametric Mann- sequences of a speech and/or language disorder. The present study was
Whitney U, Kruskal-Wallis, and Chi square tests. The correlation be- carried out in order to develop a Persian version of auditory word
tween the P-AWDT and age was most commonly significant in the discrimination test to measure phonemic distinctive features in typical
4–4.11-year-old group (p = 0.00). The difference between the typical children and children with SSD.
children and the group with SSD was statistically significant in all the The most important characteristics of a valuable tool are repeat-
four forms (p = 0.00). Furthermore, Fig. 2 shows the comparison of the ability, consistency, and validity of obtained scores [25,31]. In in-
mean scores and the standard errors of measurements (SEM) of the P- vestigation of content validity, Polit et al. [25] and Shi and et al. [32]

Table 3
The comparison of the means scores of the subtests in all age groups in the typical children and the children with SSD.
P-AWDT Age Typical SSD Chi-scores Mean Rank P-value

Mean (SD) Mean (SD) 4–4.11 5–5.11 6–6.11 7–8


Form A-1 4–4.11 36.90 (2.02) 33.40 (3.09) 58.04 35.45 1.00 0.00 0.00* 0.00*
5–5.11 39.40 (0.89) 37.70 (0.94) 87.43 0.00* 1.00 0.70 0.74
6–6.11 39.66 (0.54) 38.50(1.50) 100.03 0.00* 0.70 1.00 1.00
7–8 39.66 (0.54) 38.40 (1.26) 90.10 0.00* 0.74 1.00 1.00
Form A-2 4–4.11 37.90 (1.49) 34.50 (2.95) 63.44 35.86 1.00 0.00* 0.00* 0.00*
5–5.11 39.56 (0.67) 38.10 (1.37) 84.15 0.00* 1.00 0.25 0.62
6–6.11 39.86 (0.34) 38.10 (1.37) 106.00 0.00* 0.25 1.00 0.91
7–8 39.76 (0.43) 39.00 (0.81) 95.99 0.00* 0.62 0.91 1.00
Form B-1 4–4.11 37.56 (1.45) 34.90 (2.02) 60.60 35.46 1.00 0.00* 0.00* 0.00*
5–5.11 39.60 (0.72) 37.80 (1.22) 87.46 0.00* 1.00 0.56 0.50
6–6.11 39.76 (0.43) 38.80 (1.31) 98.58 0.00* 0.56 1.00 1.00
7–8 39.86 (0.34) 38.60 (1.07) 100.50 0.00* 0.50 1.00 1.00
Form B-2 4–4.11 37.86 (1.54) 35.10 (1.37) 55.67 37.40 1.00 0.00* 0.00* 0.00*
5–5.11 39.60 (0.62) 38.40 (1.07) 87.88 0.00* 1.00 0.74 0.88
6–6.11 39.83 (0.37) 38.80 (1.03) 99.49 0.00* 0.74 1.00 0.99
7–8 39.80 (0.40) 38.60 (1.26) 97.24 0.00* 0.88 0.99 1.00

Note. *P ≤ 0.05.

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N. Hashemi et al. International Journal of Pediatric Otorhinolaryngology 110 (2018) 93–99

lower in the Form A-1 and the Form B-1 than in the Form A-2 and the
Form B-2. These differences may be probably due to the type of selected
words and the opinion of experts. Our results suggested that the test-
retest reliability of the P-AWDT was relatively very high (≥0. 84). Like
the results of the current study, Wepman [2] reported a test-retest re-
liability of the ADT (0.91) for 4-8 year-old normal children. Besides, a
test-retest reliability of the ADT (0.88) with one to two weeks of in-
terval in children with ‘mild intellectual impairments’ was reported
[33]. Moreover, eventually, it became clear that the internal con-
sistency of the P-AWDT was very high (0.93). Internal consistency of
Goldman, Fristoe, and Woodcock's test [25] for Quit subtest was re-
ported between 0.51 and 0.88 and for Noise subtest between 0.63 and
0.68. Furthermore, Tafiadis et al. [34] demonstrated the reliability of
the Greek minimal pairs test by Cronbach's alpha which estimated
72.16%. It implies that the response of every item to the response of the
total items in the P-AWDT was matched. These findings suggest that the
P-AWDT is a reliable instrument of auditory discrimination for typical
developing children and children with SSD. In other hands, it can be
concluded that the instrument can have satisfactory application as part
of a clinical or education test battery in clinical/research environments.
In addition, the developmental difference, which observed in the
children's auditory discrimination ability, suggests a maturational and
developmental shift effect. This difference was especially displayed in
the 4–4.11-year-old age group. The overall magnitude of effect in other
groups was small. The performance of this group compared to other
groups was low in the discrimination of initial and final consonants and
vowel changes. The discrimination of vowel changes was partially
better than the consonant discrimination in all groups and all four
forms. It is probably due to the different acoustic cues which distinguish
these two classes of speech sounds. As a result, the findings of the
current study were in accordance with those reported by Wepman [2]
who showed a minimal effect of age on the auditory discrimination
skills. It is well recognized that the young children perform more poorly
than older children and adults on psychoacoustic tasks. Their poor
performance could to be due to both sensory and non-sensory compo-
nents [35].
Yet further analysis provides important insights into the relationship
between the gender differences on the P-AWDT scores. Like Wepman's
[2] findings, the performances of both genders on the P-AWDT were
same. Moreover, the evidence of the current study suggested that the
typically developing children obtained the maximal results, especially
Fig. 2. The mean scores of the P-AWDT in the four age groups (4–4.11, 5–5.11,
6–6.11, and 7–8 years) in the typical children (in the top) and the children with
in the initial and final consonants discrimination test. The children with
SSD (in the bottom). The SEMs are shown by the error bars. The mean scores of SSD were often encountered with problems in auditory analyses and
the P-AWDT are significantly lower in 4–4.11 year-old groups than in other age phonological representations and were completely unable to separate
groups in both the typical children and the children with SSD. The SEMs were the words with different phonemes from each other in while typical
larger in the children with SSD than in the typical children in all the age groups. developing children could carry out without problem. Consequently,
the participants have difficulties in retrieving the phonological re-
Table 5 presentations by the auditory feedback during speech production. We
The comparison of the mean ranks of the P-AWDT using nonparametric tests in found that the P-AWDT is able to discriminate between the typical
the typical children and the children with SSD. children and the children with speech articulation deficient. These re-
sults were homologous with those reported by Marquardt and Saxman
P-AWDT Typical SSD
[36] on the ADT.
Vowels Consonants P-value Vowels Consonants P-value Overall, it should be mentioned that problem in the acquisition of
phonological and auditory discrimination may result in an inability to
Form A-1 98.75 92.01 0.000* 94.37 87.35 0.000* decode and to organize the auditory stimuli. Due to the ambiguous
Form A-2 99.37 96.00 0.000* 100.00 94.00 0.000*
Form B-1 98.12 95.38 0.000* 97.50 93.40 0.000*
nature of neurophysiologic bases related to speech-sound discrimina-
Form B-2 99.16 97.05 0.000* 97.50 93.95 0.000* tion and numerous questions posed against the critical role of the dis-
crimination in the articulation disorders, the evaluations of phonemic
Note. *P ≤ 0.05. discrimination should be carried out in the typical developing children
and children with speech disorders for more accurate diagnosis and
advocated that the CVI is a simple validity method. Content validity of early intervention. The P-AWDT, as a valid and reliable auditory dis-
the P-AWDT was assessed acceptable. Unlike our study, the content crimination test, can be used to measure fine phonological differences
validity was not clearly demonstrated in many previous studies such as in 4-8-year-old Persian-speaking children. However, the researchers
Goldman, Fristoe and Woodcock's test [22]. Perhaps, the reason is that should be informed about the wide variety of the procedures provided
the most used words were selected on the basis of high familiarity and by the available auditory discrimination tests to select the relevant tool
meaningfulness for young children. However, the CVI was partially instrument according to the clinical and research requirements and

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N. Hashemi et al. International Journal of Pediatric Otorhinolaryngology 110 (2018) 93–99

applications. with age. This test can make a distinction between normal children and
In the current study, there were some limitations that should be children with SSD. The children with SSD in comparison to the typical
taken into account when popularize the findings. Auditory dis- children had greater difficulty in cognitive-linguistic processing (orga-
crimination skills should be considered in other population, as well. nization of phonological rules), auditory processing, and/or speech
Some factors could affect on the speech discrimination scores including production. There was no significant correlation between auditory
educational level, fatigue, confusion, self-confidence, linguistic cap- discrimination and gender. The test can be practically used to measure
abilities, and attention, etc. Furthermore, the examiner's ability to and to diagnosis the phonological auditory discrimination difficulties in
correctly score participants' responses could have influenced the results. Persian-speaking and typical children, children with SSD, and probably
Although the P-AWDT can be used as a valid and reliable test for other children with various auditory processing disorders.
Persian-speaking typical children and children with SSD, the standar-
dization of the test should be carried out on larger sample sizes and on Funding
other speech and language disorders. Finally, it is substantial to in-
vestigate other types of the validity and the reliability including the This research received no specific grant from any funding agency in
construct and the concurrent validity, and the inter-rater reliability. the public, commercial, or not-for-profit sectors.

5. Conclusions
Conflicts of interest
The inexpensive, confidential and brief nature of dimensional rating
scales makes these instruments attractive tools for research [37]. The The authors declare that there is no conflict of interests.
findings of the present research have shown that the P-AWDT appears
to be acceptable for validity and reliability. Moreover, a strong re- Acknowledgment
lationship was observed, especially between the mean scores of 4–4.11-
year-old group and the P-AWDT. It suggests that there is a develop- We would like to express our sincere thanks to all the parents and
mental change in the acquisition of phonological distinctive features children who have participated in the present study.

Appendix 1

The samples of paired-words in each form are listed in the appendix 1.

Form A-1 Form A-2 Form B-1 Form B-2

čay-jay čin-jin kot-kod sut-sud


tar-kar tam-kam baz-bar suz-sur
gel-gul kel-kul gel-gol qel-qol
gom-gom gom-gom šæb-šæb šæb-šæb
sir-zir sud-zud gav-gaz nav-naz
gaz-qaz gom-qom sæq-sæg tæq-tæg
niš-niš niš-niš tæk-tæk tæk-tæk
niz-riz niš-riš sæd-sag ræd-ræg
kæm-xæm kam-xam maš-mah kaš-kah
baz-boz bar-bor tær-tir dær-dir

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