研究目的：本研究欲了解華語聽損幼兒在不同聽覺作業下的聆聽費力度，藉由測量幼兒在不同訊噪比的聽覺作業過程中的聆聽費力度主觀感受及客觀生理指標，探討聽損幼兒在不同訊噪比的聽覺作業中，其正確率、反應時間、費力度主觀感受及客觀生理指標的變化是否受到訊噪比的影響，並檢視聽損幼兒各項反應是否與聽常同儕相當，以更全面評估聽損幼兒的聽能表現。
研究背景：聽力檢查能測得聽損幼兒的聽察覺反應及語音聽辨分數，評估聽損幼兒輔具效益的第一步為評估其聲場聽力圖，然而即使是學齡兒童，由於專注力較短暫，在完成聽力圖評估後，再進行語音測驗來交互比對實為困難；但若單純以正確率來評估，亦容易錯估學生的聽能表現，且不同作業難度會使幼兒的聆聽費力度改變，因而影響學生聆聽時的表現。然而目前臨床及聽語復健並未針對幼兒之聆聽費力度進行量測，無法得知聽損幼兒在進行評估或復健時的表現是否受到聆聽費力度的影響。故本研究探討學齡前聽損及聽常幼兒在進行聽覺作業時的聆聽費力度，並分析聆聽費力度的主觀感受及客觀生理指標之間的相關性及預測力，希望及早偵測學齡前聽損幼兒在聽覺作業下的主觀及客觀聆聽費力度，以利臨床人員將其與聽力圖及其他表現整合，更全面地評估聽損幼兒之聽能表現。
研究方法：十名4~6歲之學齡前聽常幼兒參與預試，另外25名聽常及25名聽損幼兒參加正式測驗，以配對方式控制兩組之語言、年齡等人口學變項。測試內容包含純音聽力檢查、三種訊噪比之下（安靜、SNR 0、SNR-5）兩項聽覺作業的表現（區辨正確率、辨識正確率、區辨反應速度、辨識反應速度）、聆聽費力度主觀感受尸（問卷）、聆聽費力度客觀生理指標（膚電、膚溫、心率），以了解兩組幼兒在進行聽覺作業時之主客觀聆聽費力度為何，並探討費力度主觀感受、客觀生理指標及聽覺作業表現之間的相關性及預測性。
研究結果：聽損幼兒在區辨及辨識作業中的正確率均顯著較聽常幼兒低，且反應時間較慢，顯示聽損幼兒雖然與聽常同儕有相當的語言理解能力且配戴合適的輔具，其聽覺表現仍不如聽常同儕。雖然兩組幼兒在聽覺作業的表現有顯著差異，但兩組幼兒的費力度主觀感受卻無顯著差異；兩組幼兒在區辨作業中的三個訊噪比之主觀費力度兩兩相比，主觀費力度感受無顯著差異，表示兩組幼兒在進行區辨作業時，對於不同訊噪比的主觀感受雷同。在辨識作業中，聽損組在三個訊噪比之主觀費力度兩兩相比，均有顯著差異，聽常幼兒僅在安靜環境與SNR-5相比的情況下，主觀費力度感受有顯著差異，其他情境則無顯著差異，結果顯示出兩組幼兒對於不同訊噪比的主觀感受不同。而本研究中的客觀生理指標則顯示出聽損幼兒在區辨及辨識作業中的三種訊噪比的「膚電反應」顯著較聽常幼兒高，說明聽損幼兒雖然主觀感受與聽常幼兒相似，但其聽覺作業表現較差，且客觀生理回饋指標也呈現出較高的聆聽費力度。另外，兩組幼兒的心率與膚溫均無顯著組間差異，顯示心率與膚溫在評估幼兒在區辨及辨識作業之下的聆聽費力度較不敏感。斯皮爾曼相關係數結果顯示，「膚電與區辨正確率」之間的相關性在區辨作業的安靜環境及SNR0都達顯著水準；而「膚電與辨識正確率」之間的相關性則在辨識作業的所有訊噪比中達顯著水準。迴歸結果顯示，區辨及辨識作業中，均無可以預測主觀費力度感受之指標。此結果再次強調欲評估幼兒的聆聽費力度，應同時評估主觀費力度及費力度客觀生理指標。最後，多元迴歸結果顯示，「反應時間」可預測區辨正確率，而「膚電反應」可以預測辨識正確率，然而由於本研究結果顯示之預測力較低，故仍建議在進行聽覺作業時，仍需記錄幼兒之正確率。
結論：本研究結果呈現聽損幼兒無論在何種訊噪比之下的聽覺反應正確率均顯著較聽常幼兒低、反應時間較長，且膚電反應顯著高於聽常幼兒，說明聽損幼兒雖具備與聽常幼兒相當的語言理解能力，且配戴合適的輔具，其聽覺表現仍較聽常同儕差，且客觀的聆聽費力度生理反應亦較聽常幼兒高。區辨及辨識作業中，均無可以預測主觀費力度感受之指標。多元迴歸結果顯示，「反應時間」可預測區辨正確率，而「膚電反應」可以預測辨識正確率。在區辨及辦識作業中，主觀費力度量表結果顯示兩組無顯著差異。本研究結果顯示，欲評估學齡前幼兒之聆聽費力度，宜測量聽覺作業正確率、反應時間及膚電反應，再加上主觀聆聽費力度測量，以更全面評估學齡前聽損幼兒的聆聽費力度及聽能表現。

Purpose：The present study aimed to examine the listening effort in different listening tasks for preschool children with hearing loss. By measuring the subjective listening effort and objective biofeedback of listening tasks, the present study investigated whether the signal-to-noise ratio (SNR) affects the percent correct, response time, subjective listening effort and objective biofeedback for children with hearing loss and typical hearing.
Background：Audiometry examination could evaluate the detection threshold and speech recognition score of children with hearing loss. However, the short span of concentration of children makes it difficult to complete the pure tone audiometry and the speech test in a one-time assessment. Using the percent corrects of listening tasks to assume the auditory ability of children with hearing loss may under-or over-estimate the performance of children. Recent studies indicated that the task difficulty alters the listening effort and influences the listening performance. However, routine auditory examination and auditory rehabilitation clinics did not include the measurement of listening effort. Therefore, the present study aimed to investigate the listening effort of preschool children with hearing loss and typical hearing, and further analyzing the correlation and predictive power between subjective listening effort and objective biofeedback, in order to detect the listening effort elicited by different listening tasks for preschool children. The results of the present study would help the clinicians to integrate the audiogram, speech perception score and listening effort to evaluate the auditory performance of children with hearing loss more comprehensively.
Methods：Ten children with typical hearing and ages between 4 to 6 participated in the piloting test. Another 25 children with typical hearing and 25 children with hearing loss participated in the formal test. Children in two groups were matched by the chorongical age and language comprehension ability. Formal test included the puretone audiometry test, speech discrimination and identification test, subjective listening effort questionnaire, and objective biofeedback measurement of listening effort in the listening condition with three levels of SNRs (quiet, SNR 0, SNR-5). The subjective listening effort and objective biofeedback between two groups were analyzed by two-way mixed designed ANOVA and Chi-Square Test. Spearman’s correlation, multiple logistic regression and multiple linear regression were conducted for analyzing the correlation and predictive power between subjective listening effort and objective measurements.
Results：The results indicated that after controlling the language comprehensive score, children with hearing loss performed lower scores and slower response time in listening tasks than that of children with typical hearing, but the subjective listening effort between two groups are similar. Comparing the subjective effort of the three SNRs between the two groups of children in the discrimination task, there was no significant difference in the perception of subjective effort. In the identification task, children with hearing loss had a significant difference in the subjective effort of the three SNRs. Children with typical children only experienced the significant difference of subjective effort between the SNR-5 and in quiet environment, no significant difference in other situations. The results emphasized that the two groups of children have different subjective perceptions of listening efforts in the different SNRs. The objective biofeedback indicators measured in this study showed that the skin conductance response of the three SNRs in the speech discrimination and identification tasks of children with hearing loss is significantly higher than that of children with typical hearing. In addition, heart rate and skin temperature had no significant difference between the two groups of children, indicating that heart rate and skin temperature were less sensitive in assessing children's listening effort under discrimination and identification tasks. The results of Spearman's correlation coefficients showed that the skin conductance response and percent correct were significantly correlated in the conditions of quiet environment and SNR0 of the discrimination task; while the correlation between skin conductance response and percent correct were correlated in all the SNR conditions in the identification task. The multiple logistic regression results showed that there were no indicators that could predict individuals’ subjective effort in the discrimination and identification tasks. The multiple linear regression results indicated that the reaction time can predict the percent correct of speech discrimination ability, and the skin conductance response can predict the percent correct of speech identification.
Conclusions：The lower accuracy score, longer response time and higher skin conductance response were observed in children with hearing loss when comparing to the age-matched typical children. In discrimination and identification tasks, there was no significant difference between the subjective listening effort for the two groups. And there is no variable that can predict the subjective listening effort. On the other hand, reaction time can predict the percent correct of discrimination task, and skin conductance response can predict the percent correct of identification task. This study suggests that to assess the listening effort of preschool children, measuring the percent correct, reaction time, and skin conductance response, as well as the subjective listening effort are recommended to conduct a more comprehensive evaluation of the listening effort in preschool children with hearing loss.

王南梅、費珮妮、黃珣、陳靜文（1984）：三歲至六歲學齡前兒童華語語音發展結構。聽語會刊，1，12-17。
吳敏而、魏金財、趙鏡中（1998）：國民小學兒童常用字詞彙資料庫之建立與初步分析(III)。臺北市：臺灣省國民學校教師研習會研究室。
邢敏華、黃士賓（1999）：聽覺障礙學生教室音響環境之調查研究。國立彰化師範大學特殊教育學報，13，221-238。
林桂如、林郡儀（2017）：聽力圖上沒說的事—聽覺障礙學童的聽能表現。特殊教育季刊，145，1-7。
林寶貴（2003）：語言障礙與矯治。臺北：五南圖書。
林寶貴、林美秀（1993）：學前兒童語言障礙評量表指導手冊。國立臺灣師範大學特殊教育研究所。
林寶貴、黃玉枝、黃桂君、宣崇慧（2008）：修訂學前兒童語言障礙評量表。國立臺灣師範大學特殊教育研究所。
張正芬、鍾玉梅（1986）：學前兒童語言發展之修訂及其相關研究。特殊教育季刊，2(2)，37-52。
張秀雯（2019）：聽障兒童圖片式語音辨識能力測驗指導手冊（附施測光碟）。臺北：華騰文化。
張顯達（2000）：三至四歲兒童對國語輔音的聽辨與發音。語言暨語言學，1(2)，19-38。
教育部（2013）：身心障礙及資賦優異學生鑑定辦法（2013年9月2日）。
陳小娟、利文鳳（1999）：學齡前兒童國語語音閾語詞之編製。特殊教育與復健學報，(7)，183-217。
鄭靜宜（2017）：華語學前兒童語音的習得。華語文教學研究，14(3)，109–136。
鄭靜宜（2003）：兒童國語構音測驗。國立台南大學特殊教育系。
Akeroyd, M.A. (2008). Are individual differences in speech reception related to individual differences in cognitive ability? A survey of twenty experimental studies with normal and hearing–impaired adults. International Journal of Audiology, 47(Suppl 2), S53–S71.
Alhanbali, S., Dawes, P., Lloyd, S., & Munro, K.J. (2017). Self–reported listening–related effort and fatigue in hearing impaired adults. Ear & Hearing, 38(1), e39–e48.
Alhanbali, S., Dawes, P., Lloyd, S., & Munro, K.J. (2018). Hearing handicap and speech recognition correlate with self–reported listening effort and fatigue. Ear & Hearing, 39(3), 470–474.
Alhanbali, S., Dawes, P., Millman, R.E., & Munro, K.J. (2019). Measures of listening effort are multidimensional. Ear and Hearing, 40(5), 1084.
Alvarez, R.P., Johnson, L., & Grillon, C. (2007). Contextual–specificity of short–delay extinction in humans: Renewal of fear–potentiated startle in a virtual environment. Learning & Memory, 14(4), 247–253.
American National Standards Institute. (2010). Acoustical performance criteria, design requirements, and guidelines for schools, part 1: Permanent schools (ANSI S12. 60–2010).
American Speech–Language–Hearing Association. (2008). Guidelines for audiologists providing informational and adjustment counseling to families of infants and young children with hearing loss birth to 5years of age. Retrieve from https://www.asha.org/content.aspx?id=10737450069
American Speec–Language–Hearing Assosiation. (2015). Effets of hearing loss on development, Audiology information Series. Retrieve from https://www.asha.org/uploadedFiles/AIS–Hearing–Loss–Development–Effects.pdf
Andreassi, J.L. (2013). Psychophysiology: Human Behavior & Physiological Response. London, LD: Psychology Press.
Appelhans, B.M., & Luecken, L.J. (2006). Heart rate variability as an index of regulated emotional responding. Review of General Psychology, 10(3), 229–240.
Baldwin, C.L., & Ash, I.K. (2011). Impact of sensory acuity on auditory working memory span in young and older adults. Psychology and Aging, 26(1), 85-91.
Ben‐Shakhar, G. (1985). Standardization within individuals: A simple method to neutralize individual differences in skin conductance. Psychophysiology, 22(3), 292–299.
Bentler, S. E., Hartz, A. J., & Kuhn, E. M. (2005). Prospective observational study of treatments for unexplained chronic fatigue. The Journal of Clinical Psychiatry, 66(5), 625–632.
Bess, F.H., & Hornsby, B.W. (2014). Commentary: Listening can be exhausting — Fatigue in children and adults with hearing loss. Ear and Hearing, 35(6), 592-599.
Bess, F. H., & Hornsby, B. W. (2014). The complexities of fatigue in children with hearing loss. Perspectives on Hearing and Hearing Disorders in Childhood, 24(2), 25–39.
Bess, F. H., Gustafson, S. J., & Hornsby, B. W. (2014). How Hard Can It Be to Listen? Fatigue in School–Age Children with Hearing Loss. Grantee Submission, 20, 1–14.
Best, C. T., McRoberts, G. W., & Sithole, N. M. (1988). Examination of perceptual reorganization for nonnative speech contrasts: Zulu click discrimination by English–speaking adults and infants. Journal of Experimental Psychology: Human Perception and Performance, 14(3), 345-360.
Bialystok, E., Craik, F. I., & Luk, G. (2012). Bilingualism: consequences for mind and brain. Trends in Cognitive Sciences, 16(4), 240–250.
Bianchi, F., Santurette, S., Wendt, D., & Dau, T. (2016). Pitch discrimination in musicians and non–musicians: Effects of harmonic resolvability and processing effort. Journal of the Association for Research in Otolaryngology, 17(1), 69–79.
Bishop, D. V. M., Hardiman, M. J., & Barry, J. G. (2012). Auditory deficit as a consequence rather than endophenotype of specific language impairment: electrophysiological evidence. PLoS One, 7(5), 1-11.
Blackman, G.A., & Hall, D.A. (2011). Reducing the effects of background noise during auditory functional magnetic resonance imaging of speech processing: qualitative and quantitative comparisons between two image acquisition schemes and noise cancellation. Journal of Speech, Language, and Hearing Research, 54(2), 693–704.
Boucsein, W. (1992). Electrodermal activity. New York, NY: Plenum Press.
Boucsein, W. (2012). Methods of electrodermal recording. In Electrodermal activity (pp. 87–258). Boston, MA: SpringerLink.
Braithwaite, J. J., Watson, D. G., Jones, R., & Rowe, M. (2013). A guide for analysing electrodermal activity (EDA) & skin conductance responses (SCRs) for psychological experiments. Psychophysiology, 49(1), 1017–1034.
Brännström, K. J., Lyberg–Åhlander, V., & Sahlén, B. (2020). Perceived listening effort in children with hearing loss: listening to a dysphonic voice in quiet and in noise. Logopedics Phoniatrics Vocology, 1–9.
Brumbaugh M. and Harveth B. (2010). Articulation development of children with a hearing loss: results from an Auditory–Oral program. EHDI Conference 2010. Retrieve from https://www.infanthearing.org/ meeting/ehdi2010/ehdi_2010_presentations/Articulation%20Development.pdf
Ching, T. Y., Dillon, H., Marnane, V., Hou, S., Day, J., Seeto, M., Crown, K., Street, L., Thomson, J., Van Buynder, P., Zhang, V., Wong, A., Burns, L., Flynn, C., Cupples, L., Cowan, R.S.C., Leigh, G., Sjahalam-King, J., & Yeh, A. (2013). Outcomes of early–and late–identified children at 3 years of age: Findings from a prospective population–based study. Ear and Hearing, 34(5), 535-552.
Ciocca, V., Francis, A.L., Aisha, R., & Wong, L. (2002). The perception of Cantonese lexical tones by early–deafened cochlear implantees, Journal of Acoustic Society of America, 111(5), 2250–2256.
Cohen, L.B. (1969). Observing responses, visual preferences, and habituation to visual stimuli in infants. Journal of Experimental Child Psychology, 7(3), 419–433.
Crandell, C. (1993). Speech recognition in noise by children with minimal degrees of sensorineural hearing loss. Ear and Hearing, 14(3), 210–216.
De Vries, J., Van der Steeg, A. F., & Roukema, J. A. (2010). Psychometric properties of the Fatigue Assessment Scale (FAS) in women with breast problems. InternationalJournal of Clinical and Health Psychology, 10(1), 125–139.
Downs, D. W. (1982). Effects of hearing aid use on speech discrimination and listening effort. Journal of Speech and Hearing Disorders, 47(2), 189–193.
Erber, N. (1982). Auditory Training. Wachington, DC: Alexander Graham Bell Association for the Deaf Inc.
Feilner, M., Rich, S., & Jones, C. (2016). Automatic and directional for kids – Scientific background and implementation of pediatric optimized automatic functions. Phonak Insight. Retrieve from https://www.phonak.com/content/dam/phonakpro/gc_hu/hu/products_solutions/hearing_aid/Sky_M/documents/Brochure_BtB_Sky_Marvel_210x280_HU_V2.00_028–2016–13.pdf
Finitzo–Hieber, T., & Tillman, T. W. (1978). Room acoustics effects on monosyllabic word discrimination ability for normal and hearing–impaired children. Journal of Speech and Hearing Research, 21(3), 440–458.
Francis, A. L., MacPherson, M. K., Chandrasekaran, B., & Alvar, A. M. (2016). Autonomic nervous system responses during perception of masked speech may reflect constructs other than subjective listening effort. Frontiers in Psychology, 7, Article 263, 1-15.
Fu, Q.–J., Zhu, M. & Wang, X. (2011). Development and validation of the Mandarin speech perception test, Journal of Acoustic Society of America. 129(6): EL267–273.
Gagne, J. P., Besser, J., & Lemke, U. (2017). Behavioral assessment of listening effort using a dual–task paradigm: A review. Trends in Hearing, 21, 1-25.
Garrett, N., & Seeman PhD, S. E. (2018). Costs of Hearing Loss Relating to Listening Effort, Fatigue, and Stress. AuD Capstone Projects - Communication Sciences and Disorders. 10. 1-27.
Gatehouse, S., & Noble, W. (2004). The speech, spatial and qualities of hearing scale (SSQ). InternationalJournal of Audiology, 43(2), 85–99.
Giuliani, N. P. (2017). Comparisons of physiologic and psychophysical measures of listening effort in normal–hearing adults. [unpublished doctoral dissertation thesis] The University of Iowa.
Giuliani, N.P., Brown, C.J., & Wu, Y.H. (2021). Comparisons of the Sensitivity and Reliability of Multiple Measures of Listening Effort. Ear and Hearing, 42(2), 465–474.
Goldsworthy, R.L. , & Markle, K.L. (2019). Pediatric hearing loss and speech recognition in quiet and in different types of background noise. Journal of Speech, Language, and Hearing Research, 62(3), 758–767.
Gatehouse, S., & Gordon, J. (1990). Response times to speech stimuli as measures of benefit from amplification, British Journal of Audiology, 24(1), 63–68.
Gates, G. A., & Mills, J. H. (2005). Presbycusis. Lancet, 366(9491), 1111–1120.
Gathercole, S.E., Pickering, S.J., Ambridge, B., & Wearing, H. (2004). The structure of working memory from 4–15 years of age. Developmental Psychology, 40(2), 177-190.
Gianluca, T. (2018). Signal–to –noise explained. Retrieve from http://getsuperhumanhearing.com/signal–noise–ratio–explained/
Gosselin, P. A., & Gagné, J. P. (2011). Older adults expend more listening effort than young adults recognizing audiovisual speech in noise. International Journal of Audiology, 50(11), 786–792.
Grieco–Calub, T. M., Ward, K. M., & Brehm, L. (2017). Multitasking during degraded speech recognition in school–age children. Trends in Hearing, 21, 1-14.
Green, K. B., Pasternack, B. S., & Shore, R. E. (1982). Effects of aircraft noise on reading ability of school–age children. Archives of Environmental Health: An International Journal, 37(5), 284-289.
Gustafson, S., McCreery, R., Hoover, B., Kopun, J. G., & Stelmachowicz, P. (2014). Listening effort and perceived clarity for normal hearing children with the use of digital noise reduction. Ear and Hearing, 35(2), 183-194.
Hart, S.G. and Staveland L.E. (1988). Development of NASA-TLX (Task Load Index): Results of empirical and theoretical research. Human Mental Work Load. Advances in Psychology, 52, 139-183.
Harvey, D. (2012). Hearing aids, 2nd Edition. Thieme Medical Publishers Inc.
Heinrich, A., and Schneider, B. A. (2011). Elucidating the effects of ageing on remembering perceptually distorted word pairs. The Quarterly Journal of Experimental Psychology, 64, 186–205.
Heinrich, A., Schneider, B. A., & Craik, F. I. (2008). Investigating the influence of continuous babble on auditory short–term memory performance. The Quarterly Journal of Experimental Psychology, 61(5), 735–751.
Hicks, C. B., & Tharpe, A. M. (2002). Listening effort and fatigue in school–age children with and without hearing loss. Journal of Speech, Language, and Hearing Research, 45(3), 573–584.
Hinds, P. S., Hockenberry, M., Tong, X., Rai, S. N., Gattuso, J. S., McCarthy, K., Pui, C.-H., & Srivastava, D.K. (2007). Validity and reliability of a new instrument to measure cancer–related fatigue in adolescents. Journal of Pain and Symptom Management, 34(6), 607–618.
Hockenberry, M. J., Hinds, P. S., Barrera, P., Bryant, R., Adams–McNeill, J., Hooke, C., Rasco-Baggott, C., Patterson-Kelly, K., Gattuso, J.S., & Manteuffel, B. (2003). Three instruments to assess fatigue in children with cancer: the child, parent and staff perspectives. Journal of Pain and Symptom Management, 25(4), 319–328.
Holube, I., Haeder, K., Imbery, C., & Weber, R. (2016). Subjective listening effort and electrodermal activity in listening situations with reverberation and noise. Trends in Hearing, 20, 1–15.
Hornsby, B. W. (2013). The effects of hearing aid use on listening effort and mental fatigue associated with sustained speech processing demands. Ear and Hearing, 34(5), 523–534.
Hornsby, B. W., Werfel, K., Camarata, S., & Bess, F. H. (2014). Subjective fatigue in children with hearing loss: Some preliminary findings. American Journal of Audiology, 23(1), 129–134.
Hornsby, B., Gustafson, S., Lancaster, H., Cho, S., Camarata, S., Bess, F., & Bess, F. (2017). Subjective Fatigue in Children with Hearing Loss Assessed Using Self– and Parent–Proxy Report. American Journal of Audiology, 26, 393–407.
Howard, C. S., Munro, K. J., & Plack, C. J. (2010). Listening effort at signal–to–noise ratios that are typical of the school classroom. International Journal of Audiology, 49(12), 928–932.
Hygge, S., Kjellberg, A., & Nöstl, A. (2015). Speech intelligibility and recall of first and second language words heard at different signal–to–noise ratios, Frontiers in Psychology, 14(6), 1–7.
Ishikawa, K., Boyce, S., Kelchner, L., Powell, M. G., Schieve, H., de Alarcon, A., & Khosla, S. (2017). The effect of background noise on intelligibility of dysphonic speech. Journal of Speech, Language, and Hearing Research, 60(7), 1919–1929.
Jeng. H. (1979). The acquisition of Chinese phonology in relation to Jakobson’s Laws’ of Irreversible Solidarity. Proceedings of the 9th International Congress of Phonetic Sciences, 155–161. Copenhagen: University of Copenhagen, USA.
Killion, M. C. (1997). Hearing aids: Past, present, future: Moving toward normal conversations in noise. British Journal of Audiology, 31(3), 141–148.
Klimesch, W., Sauseng, P., & Hanslmayr, S. (2007). EEG alpha oscillations: the inhibition–timing hypothesis. Brain Research Reviews, 53(1), 63–88.
Ko, N. (1979). Response of teachers to aircraft noise. Journal of Sound and Vibration, 62(2), 277–292.
Koelewijn, T., Zekveld, A. A., Festen, J. M., & Kramer, S. E. (2012). Pupil dilation uncovers extra listening effort in the presence of a single–talker masker. Ear and Hearing, 33(2), 291–300.
Kramer, S. E., Kapteyn, T. S., Kuik, D. J., & Deeg, D. J. (2002). The association of hearing impairment and chronic diseases with psychosocial health status in older age. Journal of Aging and Health, 14(1), 122–137.
Kuhl, P. K., Stevens, E., Hayashi, A., Deguchi, T., Kiritani, S., & Iverson, P. (2006). Infants show a facilitation effect for native language phonetic perception between 6 and 12 months. Developmental Science, 9(2), F13–F21.
Lane, K. A. (2012). Visual attention in children: theories and activities. (1st Edition). New Jersey, NJ: Slack Incorporated.
Larsby, B., Hällgren, M., Lyxell, B., & Arlinger, S. (2005). Cognitive performance and perceived effort in speech processing tasks: effects of different noise backgrounds in normal–hearing and hearing–impaired subjects. International Journal of Audiology, 44(3), 131–143.
Lau, M. K., Hicks, C., Kroll, T., & Zupancic, S. (2019). Effect of auditory task type on physiological and subjective measures of listening effort in individuals with normal hearing. Journal of Speech, Language, and Hearing Research, 62(5), 1549–1560.
Lehman, A., & Gratiot, A. (1983). Effets du bruit sur les enfants a l'ecole. In Proceedings of the 4th Congress on Noise as a Public Health Problem (pp. 859–862).
Lewis, D., Schmid, K., O'Leary, S., Spalding, J., Heinrichs–Graham, E., & High, R. (2016). Effects of noise on speech recognition and listening effort in children with normal hearing and children with mild bilateral or unilateral hearing loss. Journal of Speech, Language, and Hearing Research, 59(5), 1218–1232.
Lewis, D., Schmid, K., O'Leary, S., Spalding, J., Heinrichs–Graham, E., High, R. (206). Effects of noise on speech recognition and listening effort in children with normal hearing and children with mild bilateral or unilateral hearing loss. Journal of Speech Language and Hearing Research, 59(5), 1218–1232.
Lunner, T., Gustafsson, F., Graversen, C., & Alickovic, E. (2019). Hearing assistance system comprising an EEG–recording and analysis system. U.S. Patent No. 10,362,414. Patent and Trademark Office. Retrieve from https://patentimages.storage.googleapis.com/49/22/04/1c1ff8142d3bdc/US10362414.pdf
Lunner, T., Rudner, M., & Rönnberg, J. (2009). Cognition and hearing aids. Scandinavian Journal of Psychology, 50(5), 395–403.
Lyberg–Åhlander, V., Holm, L., Kastberg, T., Haake, M., Brännström, K. J., & Sahlén, B. (2015). Are children with stronger cognitive capacity more or less disturbed by classroom noise and dysphonic teachers?. International Journal of Speech–Language Pathology, 17(6), 577–588.
Mackersie, C. L., & Calderon–Moultrie, N. (2016). Autonomic nervous system reactivity during speech repetition tasks: Heart rate variability and skin conductance. Ear and Hearing, 37(Suppl 1), 118S–125S.
Mackersie, C. L., & Cones, H. (2011). Subjective and psychophysiological indexes of listening effort in a competing–talker task. Journal of the American Academy of Audiology, 22(2), 113–122.
Mackersie, C. L., MacPhee, I. X., & Heldt, E. W. (2015). Effects of hearing loss on heart–rate variability and skin conductance measured during sentence recognition in noise. Ear and Hearing, 36(1), 145-154.
McGarrigle, R., Munro, K. J., Dawes, P., Stewart, A. J., Moore, D. R., Barry, J. G., & Amitay, S. (2014). Listening effort and fatigue: What exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group ‘white paper’. International Journal of Audiology, 53(7), 433-445.
Major, R. C., Fitzmaurice, S. F., Bunta, F., & Balasubramanian, C. (2002). The effects of nonnative accents on listening comprehension: Implications for ESL assessment. TESOL Quarterly, 36(2), 173–190.
Marcus, S. B., Strople, J. A., Neighbors, K., Weissberg–Benchell, J., Nelson, S. P., Limbers, C., Varni, J.W., & Alonso, E.M. (2009). Fatigue and health–related quality of life in pediatric inflammatory bowel disease. Clinical Gastroenterology and Hepatology, 7(5), 554–561.
Mattys, S. L., Davis, M. H., Bradlow, A. R., & Scott, S. K. (2012). Speech recognition in adverse conditions: A review. Language and Cognitive Processes, 27(7–8), 953–978.
McArdle, W. D., Katch, F. I., & Katch, V. L. (2006). Essentials of exercise physiology. (3rd Edition). Lippincott Williams & Wilkins (LWW).
McCarthy, P. & Rollow, J. (2005). Poor Acoustics. Retrieve from https:// suzannedemallie. com /poor-acoustics
McCoy, S. L., Tun, P. A., Cox, L. C., Colangelo, M., Stewart, R. A., & Wingfield, A. (2005). Hearing loss and perceptual effort: Downstream effects on older adults’ memory for speech. The Quarterly Journal of Experimental Psychology Section A, 58(1), 22–33.
McCreery, R.W., Walker, E.A., Spratford, M., Lewis, D., & Brennan, M. (2019). Auditory, cognitive, and linguistic factors predict speech recognition in adverse listening conditions for children with hearing loss. Frontiers in Neuroscience, 13, Article 1093, 1-11.
McGarrigle, R., Dawes, P., Stewart, A. J., Kuchinsky, S. E., & Munro, K. J. (2017). Measuring listening–related effort and fatigue in school–aged children using pupillometry. Journal of Experimental Child Psychology, 161, 95–112.
McGarrigle, R., Munro, K. J., Dawes, P., Stewart, A. J., Moore, D. R., Barry, J. G., & Amitay, S. (2014). Listening effort and fatigue: What exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group ‘white paper’. International Journal of Audiology, 53(7), 433–440.
Miles, K., McMahon, C., Boisvert, I., Ibrahim, R., de Lissa, P., Graham, P., & Lyxell, B. (2017). Objective assessment of listening effort: Coregistration of pupillometry and EEG. Trends in Hearing, 21, 1-13.
Miller, C. L. (1983). Developmental changes in male/female voice classification by infants. Infant Behavior and Development, 6(2-3), 313-330.
Moore, B. C. (2003). Speech processing for the hearing–impaired: successes, failures, and implications for speech mechanisms. Speech Communication, 41(1), 81–91.
Murata, A., Uetake, A., & Takasawa, Y. (2005). Evaluation of mental fatigue using feature parameter extracted from event–related potential. International Journal of Industrial Ergonomics, 35(8), 761–770.
Munro, M. J., and Derwing, T. M. (1995). Foreign accent, comprehensibility, and intelligibility in the speech of second language learners. Language Learning, 49(s1), 285-310.
Neuman, A. C., Wroblewski, M., Hajicek, J., & Rubinstein, A. (2012). Measuring speech recognition in children with cochlear implants in a virtual classroom. Journal of Speech,Langauge, and Hearing Research, 55(2), 532–540.
Nittrouer, S., Caldwell–Tarr, A., Tarr, E., Lowenstein, J. H., Rice, C., & Moberly, A. C. (2013). Improving speech–in–noise recognition for children with hearing loss: Potential effects of language abilities, binaural summation, and head shadow. International Journal of Audiology, 52(8), 513–525.
Noble, W., & Gatehouse, S. (2006). Effects of bilateral versus unilateral hearing aid fitting on abilities measured by the Speech, Spatial, and Qualities of Hearing scale (SSQ). International Journal of Audiology, 45(3), 172–181.
Nott, P., Cowan, R., Brown, P. M., & Wigglesworth, G. (2009). Early language development in children with profound hearing loss fitted with a device at a young age: Part I—The time period taken to acquire first words and first word combinations. Ear and Hearing, 30(5), 526–540.
Obleser, J., & Kotz, S. A. (2011). Multiple brain signatures of integration in the comprehension of degraded speech. Neuroimage, 55(2), 713–723.
Obleser, J., & Weisz, N. (2012). Suppressed alpha oscillations predict intelligibility of speech and its acoustic details. Cerebral Cortex, 22(11), 2466–2477.
Obleser, J., Wöstmann, M., Hellbernd, N., Wilsch, A., & Maess, B. (2012). Adverse listening conditions and memory load drive a common alpha oscillatory network. Journal of Neuroscience, 32(36), 12376–12383.
Ohlenforst, B., Zekveld, A. A., Lunner, T., Wendt, D., Naylor, G., Wang, Y., ... & Kramer, S. E. (2017). Impact of stimulus–related factors and hearing impairment on listening effort as indicated by pupil dilation. Hearing Research, 351, 68–79.
Peelle, J. E. (2017). Listening effort: How the cognitive consequences of acoustic challenge are reflected in brain and behavior. Ear and Hearing, 39(2), 204-214.
Pekkarinen, E., Salmivalli, A., & Suonpää, J. (1990). Effect of noise on word discrimination by subjects with impaired hearing, compared with those with normal hearing. Scandinavian Audiology, 19(1), 31–36.
Petersen, E. B., Wöstmann, M., Obleser, J., Stenfelt, S., & Lunner, T. (2015). Hearing loss impacts neural alpha oscillations under adverse listening conditions. Frontiers in Psychology, 6, Article 177, 1-11.
Peterson, C. C., O’Reilly, K., & Wellman, H. M. (2016). Deaf and hearing children’s development of theory of mind, peer popularity, and leadership during middle childhood. Journal of Experimental Child Psychology, 149, 146–158.
Peterson, C. C., Slaughter, V., & Wellman, H. M. (2018). Nimble negotiators: How theory of mind (ToM) interconnects with persuasion skills in children with and without ToM delay. Developmental Psychology, 54(3), 494-509.
Pichora–Fuller, M. K. (2003). Processing speed and timing in aging adults: psychoacoustics, speech perception, and comprehension. International Journal of Audiology, 42(suppl 1), s59–67.
Pichora–Fuller, M. K., Kramer, S. E., Eckert, M. A., Edwards, B., Hornsby, B. W., Humes, L. E., ... & Naylor, G. (2016). Hearing impairment and cognitive energy: The framework for understanding effortful listening (FUEL). Ear and Hearing, 37(suppl 1), 5S–27S.
Pichora‐Fuller, M. K., Schneider, B. A., & Daneman, M. (1995). How young and old adults listen to and remember speech in noise. The Journal of the Acoustical Society of America, 97(1), 593–608.
Primus, M. A. (1992). The role of localization in visual reinforcement audiometry. Journal of Speech, Language, and Hearing Research, 35(5), 1137–1141.
Rabbitt, P., & Abson, V. (1990). ‘Lost and Found’: Some logical and methodological limitations of self‐report uestionnaires as tools to study cognitive ageing. British Journal of Psychology, 81(1), 1–16.
Rennies, J., Schepker, H., Holube, I., & Kollmeier, B. (2014). Listening effort and speech intelligibility in listening situations affected by noise and reverberation. The Journal of the Acoustical Society of America, 136(5), 2642–2653.
Rönnberg, J., Lunner, T., Zekveld, A., Sörqvist, P., Danielsson, H., Lyxell, B., Dahlström, O., Signoret, C., Stenfelt, S., Pichora-Fuller, M.K., & Rudner, M. (2013). The Ease of Language Understanding (ELU) model: theoretical, empirical, and clinical advances. Frontiers in Systems Neuroscience, 7, Article 31, 1-17.
https://doi.org/10.3389/fnsys.2013.00031
Rönnberg, J., Rudner, M., Foo, C., & Lunner, T. (2008). Cognition counts: A working memory system for ease of language understanding (ELU). International Journal of Audiology, 47(Suppl 2), S99–S105.
Sahlén, B., Hansson, K., Lyberg–Åhlander, V., & Brännström, J. (2018). Spoken Language and Language Impairment in Deaf and Hard–of–Hearing Children: Fostering Classroom Environments for Mainstreamed Children. In H. Knoors, & M. Marshark (Eds.), Evidence-Based Practices in Deaf Education (pp. 1-21). Oxford University Press.
Sandgren, O., Hansson, K., & Sahlén, B. (2015). Working memory and referential communication—multimodal aspects of interaction between children with sensorineural hearing impairment and normal hearing peers. Frontiers in Psychology, 6, Article 242, 1-4.
Sauro, J. (2019). 10 things to know about the NASA TLX. Retrieve from https://humansystems.arc.nasa.gov/groups/TLX/tlxpaperpencil.php
Sauseng, P., & Klimesch, W. (2008). What does phase information of oscillatory brain activity tell us about cognitive processes?. Neuroscience & Biobehavioral Reviews, 32(5), 1001–1013.
Schiller, D., Cain, C. K., Curley, N. G., Schwartz, J. S., Stern, S. A., LeDoux, J. E., & Phelps, E. A. (2008). Evidence for recovery of fear following immediate extinction in rats and humans. Learning & Memory, 15(6), 394–402.
Seeman, S., & Sims, R. (2015). Comparison of psychophysiological and dual–task measures of listening effort. Journal of Speech, Language, and Hearing Research, 58(6), 1781–1792.
Segal, O., Hejli–Assi, S., & Kishon–Rabin, L. (2016). The effect of listening experience on the discrimination of /ba/ and /pa/ in Hebrew–learning and Arabic–learning infants. Infant Behavior and Development, 42, 86–99.
Segerstrom, S. C., & Nes, L. S. (2007). Heart rate variability reflects self–regulatory strength, effort, and fatigue. Psychological Science, 18(3), 275–281.
Semel, E., Wiig, E. H., & Secord, W. A. (2003). Clinical evaluation of language fundamentals, 4th Edition, (CELF–4). San Antonio, TX: The Psychological Corporation/A Harcourt Assessment Company.
Shiu, H. (1990). The Phonological Acquisition by Mandarin–speaking Children: A Longitudinal Case Study on Children from Nine Months through Three Years Old. [Unpublished Mater thesis]. Taiwan Normal University.
Shohet, J. A., & Bent, T. (1998). Hearing loss: The invisible disability: Helping patients overcome a stigma of old age. Postgraduate Medicine, 104(3), 81–90.
Shojaei, E., Ashayeri, H., Jafari, Z., Dast, M. R. Z., & Kamali, K. (2016). Effect of signal to noise ratio on the speech perception ability of older adults. Medical Journal of the Islamic Republic of Iran, 30(1), 1-7.
Scientific Committee on Emerging and Newly Identified Health Risks. (2008). Potential health risks of exposure to noise from personal music players and mobile phones including a music playing function: Preliminary report. Retrieve from https://ec.europa.eu/health/ph_risk/committees/04_scenihr/docs/scenihr_o_017.pdf
Smriga, D. (2016). Clinical verfificationi of ear level FM systems: Classroom & personal use applications. Retrieve from https://www.audiologyonline.com/articles/clinical-verification-ear-level-fm-17322
Sohoglu, E., Peelle, J. E., Carlyon, R. P., and Davis, M. H. (2012). Predictive top–down integration of prior knowledge during speech perception. Journal of Neuroscience, 32(25), 8443–8453.
Styles, E. (2006). The psychology of attention: 2nd edition. Psychology Press.
Tun, P. A., Benichov, J., and Wingield, A. (2010). Response latencies in auditory sentence comprehension: Effects of linguistic versus perceptual challenge. Psychology and Aging, 25(3), 730–735.
van Esch, T.E, Kollmeier, B., Vormann, M., Lyzenga, J., Houtgast, T., Hällgren, M., Larsby, B., Athalye, S.P., Lutman, M.E., & Dreschler, W.A. (2013). Evaluation of the preliminary auditory profile test battery in an international multi–centre study. International Journal of Audiology, 52(5), 305 – 321.
Venables, P.H., Christie, M.J. (1980). Electrodermal activity. In Techniques in Psychophysiology, ed. I Martin, PH Venables, pp. 2–67, New York, NY: John Wiley.
Wagner, A. E., Toffanin, P., & Başkent, D. (2016). The timing and effort of lexical access in natural and degraded speech. Frontiers in Psychology, 7, Article 398, 1-14.
Wagner, A., Pals, C., de Blecourt, C. M., Sarampalis, A., & Başkent, D. (2016). Does signal degradation affect top–down processing of speech?. In Physiology, Psychoacoustics and Cognition in Normal and Impaired Hearing (pp. 297–306). Cham, Switzerland: Springer.
Weaver, J. (2015). Single–sided deafness: causes, and solutions, take many forms. The Hearing Journal, 68(3), 20–22.
Werker, J.F., Shi, R., Desjardins, R., Pegg, J.E., Polka, L., & Patterson, M. (1998). Three methods for testing infant speech perception. In A. Slater (Ed.), Perceptual Development: Visual, Auditory, and Speech Perception in Infancy (pp. 389–420). London, LD: Psychology Press.
Wild, C. J., Yusuf, A., Wilson, D. E., Peelle, J. E., Davis, M. H., & Johnsrude, I. S. (2012). Effortful listening: the processing of degraded speech depends critically on attention. Journal of Neuroscience, 32(40), 14010–14021.
Winn, M. B., Edwards, J. R., & Litovsky, R. Y. (2015). The impact of auditory spectral resolution on listening effort revealed by pupil dilation. Ear and Hearing, 36(4), e153-e165.
Yeh, C. H., Chiang, Y. C., Lin, L., Yang, C. P., Chien, L. C., Weaver, M. A., & Chuang, H. L. (2008). Clinical factors associated with fatigue over time in paediatric oncology patients receiving chemotherapy. British Journal of Cancer, 99(1), 23–29.
Zekveld, A.A., Kramer, S.E., & Festen, J.M. (2010). Pupil response as an indication of effortful listening: The influence of sentence intelligibility. Ear and Hearing, 31(4), 480–490.
Zekveld, A. A., Kramer, S. E., & Festen, J. M. (2011). Cognitive load during speech perception in noise: The influence of age, hearing loss, and cognition on the pupil response. Ear and Hearing, 32(4), 498–510.
Zhang, Y. X., Moore, D. R., Guiraud, J., Molloy, K., Yan, T. T., & Amitay, S. (2016). Auditory discrimination learning: Role of working memory. PloS one, 11(1), 1–18.
Zhou, N., Huang, J., Chen, X., and Xu, L. (2013). Relationship between tone perception and production in prelingually deafened children with cochlear implants. Otology & Neurotology, 34(3), 499–506.