Auditory Processing in Spanish-English Bilinguals: Is Performance Better When Tested in Spanish or English?

Study Overview
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Brief Summary
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The purpose of this study is to learn more about how bilingual individuals process sound in challenging listening environments and how testing language may impact results on auditory processing assessments. Auditory processing evaluations assess specific auditory skills necessary to hear and understand complex auditory signals, but many of these tests rely heavily on language. This poses an issue for individuals with native languages other than English because the test results may not clearly identify whether performance is due to an auditory processing problem or to the language used in the test materials. This study aims to identify whether auditory processing performance differs in Spanish-English bilinguals based on the language of the test materials used (English vs. Spanish). Ultimately, the results of this study may aid in more accurate diagnoses and treatment of auditory processing disorders in bilingual individuals.

Detailed Description
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Auditory processing disorder (APD) is a disorder caused by a disruption within the central auditory pathway that impairs processing of complex or degraded auditory inputs. Patients with this condition often present with normal hearing but still report problems understanding speech. This commonly manifests as individuals having difficulty understanding speech in challenging listening environments (e.g., noisy backgrounds, reverberant environments, rapid speech), localizing sounds, and following complex auditory directions. An underlying auditory skill vital to these processes is binaural processing, or the ability to utilize auditory cues from both ears. Binaural processing aids in identifying a talker in the midst of background noise and allows us to better separate relevant from irrelevant inputs. While auditory processing evaluations assess specific auditory skills (like binaural processing) necessary for efficient processing and understanding of complex auditory signals, many of the tests rely heavily on language. This poses an issue for individuals for whom English is not their native language. Because the tests are linguistically loaded, the obtained results do not clearly identify whether an issue should be attributed to a central auditory problem or to the language used in the test materials. Thus, audiologists are often hesitant to test bilingual patients who demonstrate features of APD. It is possible that bilingual individuals would perform more favorably when tested in their native language (L1). Indeed, differences in complex auditory task performance have been seen in Spanish-English bilinguals when materials were presented in Spanish versus English. Recent studies have evaluated test-language effects in bilingual education and described significant improvements in performance when bilinguals were instructed and tested in their native language (L1) compared to performance in their later acquired language (L2). Numerous studies have also assessed monolingual vs. bilingual performance in complex auditory tasks including listening in noise, auditory memory, and competing speech. While much research in auditory processing of bilingual speakers compares performance between monolinguals and bilinguals, evidence to inform best clinical practice in the assessment of APD in bilinguals is lacking. To date, relatively few studies investigate performance within the same participant with testing language being the differential factor. Therefore, the purpose of this study is to compare binaural processing performance in Spanish-English bilingual participants when tested in Spanish (L1) versus in English (L2). Based on prior literature, we suspect that bilingual participants will perform better when they are instructed and presented with assessments in their native language versus when they are assessed in their later acquired language (L2). However, it is possible that our participants, who will be proficient in both L1 and L2, will show no difference in task performance. Regardless, by comparing binaural processing performance in bilingual participants, we will clarify whether testing bilingual individuals in a secondary language (when proficient in that language) results in valid and reliable measures of their auditory processing abilities. Thus, our results will provide evidence to establish best clinical practice when evaluating bilingual listeners for auditory processing deficits. This will enable clinicians to more confidently evaluate and diagnose auditory processing disorders in bilingual populations.

Official Title
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Comparing Central Auditory Processing Performance in Bilinguals Using L1 vs. L2 Materials

Conditions
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Auditory Processing Disorder

Intervention / Treatment
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* Diagnostic Test: English APD assessment
* Diagnostic Test: Spanish APD assessment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Bilingual Spanish-English speakers Must have learned Spanish first followed by English Proficiency in both languages Normal hearing Exclusion Criteria: Hearing loss History of traumatic brain injuries (TBI) Neurological issues Auditory processing concerns

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Interventional Model Description: This study is a repeated measures experimental design in which participants will complete auditory processing tests in both English (L2) and Spanish (L1). The presentation of Spanish and English test materials will be counterbalanced across participants to minimize fatigue and practice effects.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Auditory Processing Disorder (APD) Assessment<br>All participants will receive both experimental conditions (i.e., test materials in English, test materials in Spanish) in a counterbalanced order. | Diagnostic Test: English APD assessment<br>* Materials presented in English<br>Diagnostic Test: Spanish APD assessment<br>* Materials presented in Spanish<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean difference in scores for APD assessment using English vs. Spanish materials | The APD assessment will include sub-tests (dichotic digits, dichotic word listening test, synthetic sentence identification test). Participants' performance will be scored as percent correct for each sub-test. | 90 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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bilingual, Spanish