Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type

Capstone Project

Degree Name





Brett A. Martin

Subject Categories

Speech and Hearing Science | Speech Pathology and Audiology


infant speech perception, visual reinforcement, hearing loss in infancy, auditory development


Objective: The purpose of this capstone project was to conduct a systematic review of literature relating to two behavioral infant speech discrimination procedures to evaluate their potential clinical utility. The two procedures examined were the Observer-based Psychoacoustic Procedure (OPP) and the Visual Reinforcement of Infant Speech Discrimination (VRISD) method. The methodology utilized and the results obtained are examined for normal hearing infants and infants with hearing loss. The procedures are compared and contrasted in terms of potential clinical feasibility and modifications for potential clinical use are considered.

Methods: A comprehensive search was performed using Pubmed and EBSCO Academic Search Complete databases accessible through the City University of New York (CUNY) Graduate Center library to identify studies utilizing OPP or VRISD in infants under the age of 36 months. Inclusion criteria consisted subject age (under 36 months), use of speech stimuli or assessment of auditory abilities closely relating to speech perception, such as frequency and intensity discrimination, gap detection, and localization.

Results: Twenty-four studies met the inclusion criteria for this systematic review. Findings indicated that VRISD studies generally required fewer trials than OPP studies to obtain discrimination results; however, OPP allows for testing of younger infants. The amount of time required for testers to be adequately trained was longer for OPP compared to VRISD. Sample sizes differed for the 2 procedures. Both procedures controlled for observer and response bias; however, this was more consistent for OPP studies. Some differences in discrimination ability between infants with normal hearing compared to infants with hearing loss were noted, as would be expected. VRISD studies consistently used phonemic stimuli and produced repeatable results in infants with and without hearing loss. OPP studies utilized speech stimuli and other psychoacoustic stimuli and assessed abilities related to speech perception.

Discussion: While more research is warranted, both procedures have obtained repeatable results and an evaluation of the speech discrimination abilities of infants for a variety of speech contrasts can be performed. More studies employing larger sample sizes are needed for infants with hearing loss. VRISD may be easier to implement clinically as the procedures are more familiar to audiologists, requires less tester training, can be adapted to 1- and 2-tester conditions, and more quickly and easily provides discrimination results for different speech contrasts; however, OPP has an advantage in that it can be used with younger infants and the procedure incorporates more controls. Modifications must be made to procedures prior to clinical use, including standardization of stimuli and established shaping and training protocols. A proposed modification of the VRISD procedure is included for potential clinical use. These procedures, if used clinically, can potentially serve to monitor changes in speech discrimination with development, amplification and/or training.