## 1 Introduction  
The presence of a dysphonic, or altered, vocal quality can have a significant negative impact on a child [1; 2; 3]. The most common cause of dysphonia in children is vocal fold nodules, benign, collous-like lesions on the vocal folds [4; 5; 6; 7; 8; 9; 10; 11]. Vocal fold nodules are suggested to be related to vocal use, vocal misuse, and/or vocal hyperfunction [6; 12; 13; 14; 15; 16; 17]. Voice therapy is considered the best practice for the treatment of vocal fold nodules in children [18; 19; 20; 21; 22], yet it yields varied success rates [23; 24]. This is likely due to multiple factors, including: Lack of transparency with regard to therapy, differing outcome measures, lack of understanding of the exact etiology of vocal fold nodules' development, and an overall shortage of pediatric-focused research within the greater field of voice disorders [25; 26; 27]. A recent study has provided a more comprehensive view of pediatric-focused voice therapy by conducting a randomized clinical trial with children with vocal fold nodules (CwVN) ages 6-10 [28]. Authors selected two therapy approaches to compare: (1) 'Indirect' therapy, focusing on vocal hygiene and discussion of desired vocal productions, and (2) 'direct' therapy, focusing on motor learning tasks. Results indicated that both therapy approaches resulted in improvement of the primary outcome measure, the Pediatric Voice-Related Quality of Life (PVRQQL) [29]. Improvements of secondary outcome measures, including auditory-perceptual evaluation of voice, vocal fold nodule size, acoustic measures, and aerodynamic measures were also shown. Although no significant differences were found between the two therapy types, _post hoc_ analyses indicated that older children (8-10 years) had a larger improvement in their PVRQOL scores for the 'direct' therapy, as compared to 'indirect' therapy. Authors suggested that these older children may be more cognitively able to learn the new motor patterns during the 'direct' therapy sessions and, thus, displayed greater improvements [28]. An alternate (or perhaps, extended) hypothesis for differences seen between older and younger children [28] may be that older children have more developed auditory-perceptual abilities, thus allowing them to better detect, learn, and implement vocal changes. Explicit examination of auditory-perceptual discrimination has not been examined in CwVN, yet previous works suggest that CwVN may have perceptual differences as compared to children without voice disorders [30; 31]. Historically, methods of voice therapy for children suggested spending extensive time in therapy on attention and awareness (e.g., [32]), as the supposition was these children were not noticing their own vocal characteristics. More recently, a study examining the parental perception of personality traits suggested that CwVN may have difficulties using detection of small changes as a self-regulation tool, as compared to children without diagnosed speech disorders and children who stutter [31]. Finally, emerging evidence in adults with dysphonic voices indicates that they have poorer pitch discrimination than vocally healthy controls [33]. Overall, these previous studies suggest that explicit examination of auditory-perceptual abilities in CwVN is needed to determine if there are perceptual differences in this population. Studies examining auditory-perceptual discrimination, typically using pure tones, show that most children do not reach adult-like maturity until at least eight years of age [34; 35; 36; 37; 38; 39; 40]. Yet it remains unknown whether mature auditory discrimination is required to efficiently learn and apply new therapy tasks and strategies. Additionally, the ecological validity of evaluating auditory discrimination abilities of pure tones is low, making it difficult to translate these findings to auditory discrimination of changes in the voice.