THE FUNCTIONAL HEARING INVENTORY: CRITERION-RELATED VALIDITY AND INTERRATER RELIABILITY by PAMELA M. BROADSTON, B.S., M.A. A DISSERTATION IN SPECIAL EDUCATION Submitted to the Graduate Faculty of Texas Tech University in Partial Fulfillment of the Requirements for the Degree of DOCTOR OF EDUCATION Approved December, 2003 Copyright 2003, Pamela M. Broadston ACKNOWLEDGEMENTS First and foremost, I thank my Lord, Jesus Christ for opening the door that provided the opportunity for me to obtain this degree. Without His almighty love and endless grace, I would never have achieved this milestone. This milestone could also never have been achieved without the love and support of my family. I cannot proceed without first acknowledging them: to my parents who provided constant love and support throughout this entire endeavor; to my brother Bob, without his financial support I would probably still be working on my master's degrees one class at a time; to my sister, who allowed me to vent and provided sound advice during trying times; to my baby brother, Jeff, thanks for believing in me. I most gratefully thank my dissertation committee for their wisdom, support, and constructive criticism. Their dedication and skilled instruction were vital to the completion of this project. They include: Dr. Carol Layton who provided me with her expertise and guidance in diagnostics and assessment, Dr. Nora Griffm-Shirley who got me hooked on O&M, and Dr. Robert Kennedy who patiently explained and re-explained statistics, time and time again. Last but not least, I want to thank my chair. Dr. Roseanna Davidson, for providing the resources and opportunities that enhanced my doctoral studies and for her expertise and guidance into the field of deafblindness. I sincerely thank Gillis Ward, my second rater, who allowed me to totally control her life for four weeks. Without her willingness to drop everything and show up when and where I asked her, I would never have completed the data collection. Thank you Gillis, you are the best. I also want to thank the many professionals who assisted me at various stages of the FHI development and this dissertation research. Some of these professionals include: John Macias for his professional input and constant support and encouragement, Marcella Dalla Rosa for allowing me access to her staff and students (Cheers), Theresa Mays for contacting parents, all of the teachers and staff at the residential school for allowing me free access to your classrooms and school activities, Candace Bums and Jim Vander Putten for editing my proposal, my colleagues and friends at UALR for their constant words of support and encouragement, Paul Pagliano, Pat Kelley, Jim Durkle, Suzanne House, Hansel Burley and NTAC for their input when this project was in its infancy. And a very special thanks to Margaret Robinson, my friend and colleague, for teaching me PowerPoint and table formatting, and for walking around for days with a sound level meter attached to her hip. A special thanks is extended to the parents and students who participated in this research project. Without you this research could not have been completed. Ill TABLE OF CONTENTS ACKNOWLEDGEMENTS ii ABSTRACT viii LIST OF TABLES x CHAPTER I. OVERVIEW OF THE STUDY 1 Introduction 1 Significance of the Study 7 Statement of the Problem 7 Purpose of the Study 8 Research Questions 8 Null Hypotheses 9 Definition of Terms 9 Delimitations 11 Assumption 12 Organization of the Study 12 H: REVIEW OF THE RELATED LITERATURE 13 Role of Hearing 13 Primitive Level 13 Signal Warning 14 Spoken Communication 14 IV Impact of Hearing Loss 15 In Adult Lives 15 In Infant's and Young Children's Lives 16 Hearing Impairment 18 Age of Onset 18 Severity or Degree of Hearing Loss 19 Types of Hearing Loss 20 Assessment of Hearing in Infants and Children 22 Basic Audiometric Assessments 22 Physiological Tests 25 Limitations of Traditional Audiological Testing 27 Infants and Young Children 27 Children with Multiple Disabilities 28 Functional Hearing Screenings/Assessments with Limitations of Each 29 Infants and Young Children 29 Children with Multiple Disabilities 30 Summary 33 m. METHOD 35 Introduction 35 Setting 36 Participants 36 Participant Selection 36 Purposeful Sample 37 Demographic Data 37 Informed Consent 37 Research Design 3g Instrument Development 38 Validity 40 Criterion-Related Validity 43 Interrater Reliability 44 Data Collection 46 Data Analysis 46 Materials 49 Summary 49 IV. RESULTS 51 Introduction 51 Research Questions 52 Null Hypotheses 52 Demographics 52 Criterion-Related Validity 57 Interrater Reliability 61 Summary 64 V. SUMMARY, CONCLUSIONS, RECOMMENDATIONS, AND IMPLICATIONS 66 Summary 66 VI Limitations of the Study 67 Conclusions 68 Recommendations 71 Implications 73 BIBLIOGRAPHY 76 APPENDIX A: PARTICIPATION LETTER, INFORMED CONSENT FORMS, AND INSTITUTIONAL REVIEW BOARD EXEMPTION 83 B: FHI TEACHER QUESTIONNAIRE AND FHI PARENT QUESTIONNAIRE 88 Vll ABSTRACT The Functional Hearing Inventory (FHI), an observational instrument for functional hearing, provides information about how a deafblind child uses his/her residual hearing within his/her natural environment. This study obtained evidence of the validity and reliability of the FHI. In particular, criterion-related validity for the FHI was investigated by correlating it with teachers' and parents' ratings of functional hearing, and the traditional measure of hearing, the audiogram. Interrater reliability for the FHI was studied through correlating the FHI ratings of deafblind subjects by two trained evaluators using point-by-point and consensus methods. The two raters included the researcher and one other rater who was trained by the researcher. The raters observed students in their natural settings and recorded the information on the FHI observation form. The subjects for this study were a purposeful sample of students between the ages of three and twenty-one who were reported on the Federal Deafblind Census. There were 14 participants for whom there was complete information, comprising 6 females (43%) and 8 males (57%). The demographic section indicated that 57% of the participants were male, and 57% were Caucasian. The majority of the participants are in their teens with 21% being in the 7* grade. Over 42% of the participants had a primary disability of deafblindness and four of the participants had a secondary disability of either hearing or visual impairment. vui Cohen' s kappa was used to measure agreement for criterion validity as well as to determine interrater reliability. Null hypotheses of no relationship between the FHI and teachers' ratings, and between thd^HI and parents' ratings were rejected, with a moderate relationship in the former case (K = 0.46, p = 0.0043), and with a somewhat weaker relationship in the latter case (K = 0.22, p = 0.01 ). The null hypothesis between the FHI and the audiogram could not be rejected (K = 0.13, p = 0.26). The null hypothesis for interrater reliability was rejected for environmental conditions/background noise, signal, and response levels. The respective kappas were 0.96 (p < 0.0000001), 0.85 (p < 0.0000001), and 0.81 (p < 0.0000001), all considered to be high levels of association. IX LIST OF TABLES 1 Levels of Hearing Loss with Implications 20 2 Levels of Response with Descriptions 39 3 Criterion Validity by histrument. Source, Scale, and Technique 48 4 Frequency Distribution by Gender 53 5 Frequency Distribution by Age 54 6 Frequency Distribution by Grade 55 7 Frequency Distribution by Ethnicity 55 8 Frequency Distribution by Primary Disability 56 9 Frequency Distribution by Secondary Disability 56 10 Frequency Distribution of Students wearing Hearing Aids During FHI Observations 57 11 Cohen' s Kappa between FHI Ratings and Teachers' Ratings of Hearing Functioning 58 12 Cohen' s Kappa between FHI Ratings and Parents' Ratings of Hearing Functioning 59 13 Cohen' s Kappa between FHI Ratings and Audiogram 61 14 Cohen' s Kappa between Trained Evaluators' FHI Environmental Conditions/Background Noise Measurements 62 15 Cohen' s Kappa between Trained Evaluators' FHI Intensity of Signals Measurements 63 16 Cohen' s Kappa between Trained Evaluators' FHI Levels of Response 63 CHAPTER I OVERVIEW OF THE STUDY Introduction Deafblindness is a multifaceted disability that impacts an individual in compound and complex ways. "The deaf-blind child is not a deaf child who cannot see or a blind child who cannot hear. The problem is not an additive one of deafness plus blindness" (Mclnnes & Treffery, 1982, p. 2). Deafblindness impacts the use of the distance senses of vision and hearing, as well as the development of communication and perception. Because of the impact that this dual-sensory impairment has on children with deafblindness it is necessary to provide educational instruction in the use of residual hearing and vision for these children, and to provide appropriate access to the environment in which they live. Intervention can significantly expand the learning potential of children who are deafblind (Miles & Riggio, 1999). The development of goals and objectives for intervention should be based on the needs of each individual child as revealed through appropriate educational assessment. Information about access to the environment also needs to be obtained as part of the assessment process for children who are deafblind. (Olson, Miles, & Riggio, 1999, pp. 78-93). "The primary purpose of assessment is to provide information that can serve as the basis for intervention" (Flexer, 1999, p. 27). Therefore, quality program planning for students with deafblindness must begin with assessment. Eyre (2000) says, "Assessment goes hand in hand with curriculum" (p. 127). "Our assessments will reveal the stages they (children with deafblindness) have reached in each of the areas within curriculum and from there, we can plan next steps to take with them. In most schools, long-term aims or goals and short-term objectives or steps are used to plan this future work with the child" (p.