Speech Perception In Children Research Articles

The Not-So-Slight Perceptual Consequences of Slight Hearing Loss in School-Age Children: A Scoping Review.

This study aimed to conduct a scoping review of research exploring the effects of slight hearing loss on auditory and speech perception in children. A comprehensive search conducted in August 2023 identified a total of 402 potential articles sourced from eight prominent bibliographic databases. These articles were subjected to rigorous evaluation for inclusion criteria, specifically focusing on their reporting of speech or auditory perception using psychoacoustic tasks. The selected studies exclusively examined school-age children, encompassing those between 5 and 18 years of age. Following rigorous evaluation, 10 articles meeting these criteria were selected for inclusion in the review. The analysis of included articles consistently shows that even slight hearing loss in school-age children significantly affects their speech and auditory perception. Notably, most of the included articles highlighted a common trend, demonstrating that perceptual deficits originating due to slight hearing loss in children are particularly observable under challenging experimental conditions and/or in cognitively demanding listening tasks. Recent evidence further underscores that the negative impacts of slight hearing loss in school-age children cannot be solely predicted by their pure-tone thresholds alone. However, there is limited evidence concerning the effect of slight hearing loss on the segregation of competing speech, which may be a better representation of listening in the classroom. This scoping review discusses the perceptual consequences of slight hearing loss in school-age children and provides insights into an array of methodological issues associated with studying perceptual skills in school-age children with slight hearing losses, offering guidance for future research endeavors.

The effect of otitis media with effusion on phonological performance of preschool children

ObjectivesPhonological development is dependent on the integrity of the auditory system. Otitis media with effusion (OME) may affect speech perception in children and therefore phonological development. The aim of this study was to investigate the impact of persistent OME on the phonological performance of preschool children.MethodsSixty children with persistent OME who were candidates for myringotomy and ventilation tube insertion were included in this prospective observational study. We assessed their phonological skills before and after surgery (3 and 6 months) by phonological production tasks that included calculation of percentage of consonants correct (PCC) and process density index (PDI).ResultsWe detected preoperative poor phonological performance in 91.7% of children. We found statistically significant differences in PCC and PDI between the three time periods. Also, there was a significant improvement after 6 months compared to 3 months.ConclusionsOME has an adverse consequence on the phonological performance of preschool children, it can affect different domains such as PCC and PDI. The findings of this study revealed that myringotomy with ventilation tube insertion for children with persistent OME could aid in the development of intact phonological skills.

Development of the Children's English and Spanish Speech Recognition Test: Psychometric Properties, Feasibility, Reliability, and Normative Data.

The Children's English and Spanish Speech Recognition (ChEgSS) test is a computer-based tool for assessing closed-set word recognition in English and in Spanish, with a masker that is either speech-shaped noise or competing speech. The present study was conducted to (1) characterize the psychometric properties of the ChEgSS test, (2) evaluate feasibility and reliability for a large cohort of Spanish/English bilingual children with normal hearing, and (3) establish normative data. Three experiments were conducted to evaluate speech perception in children (4-17 years) and adults (19-40 years) with normal hearing using the ChEgSS test. In Experiment 1, data were collected from Spanish/English bilingual and English monolingual adults at multiple, fixed signal-to-noise ratios. Psychometric functions were fitted to the word-level data to characterize variability across target words in each language and in each masker condition. In Experiment 2, Spanish/English bilingual adults were tested using an adaptive tracking procedure to evaluate the influence of different target-word normalization approaches on the reliability of estimates of masked-speech recognition thresholds corresponding to 70.7% correct word recognition and to determine the optimal number of reversals needed to obtain reliable estimates. In Experiment 3, Spanish/English bilingual and English monolingual children completed speech perception testing using the ChEgSS test to (1) characterize feasibility across age and language group, (2) evaluate test-retest reliability, and (3) establish normative data. Experiments 1 and 2 yielded data that are essential for stimulus normalization, optimizing threshold estimation procedures, and interpreting threshold data across test language and masker type. Findings obtained from Spanish/English bilingual and English monolingual children with normal hearing in Experiment 3 support feasibility and demonstrate reliability for use with children as young as 4 years of age. Equivalent results for testing in English and Spanish were observed for Spanish/English bilingual children, contingent on adequate proficiency in the target language. Regression-based threshold norms were established for Spanish/English bilingual and English monolingual children between 4 and 17 years of age. The present findings indicate the ChEgSS test is appropriate for testing a wide age range of children with normal hearing in either Spanish, English, or both languages. The ChEgSS test is currently being evaluated in a large cohort of patients with hearing loss at pediatric audiology clinics across the United States. Results will be compared with normative data established in the present study and with established clinical measures used to evaluate English- and Spanish-speaking children. Questionnaire data from parents and clinician feedback will be used to further improve test procedures.

Neural correlates of audiovisual narrative speech perception in children and adults on the autism spectrum: A functional magnetic resonance imaging study.

Autistic individuals show substantially reduced benefit from observing visual articulations during audiovisual speech perception, a multisensory integration deficit that is particularly relevant to social communication. This has mostly been studied using simple syllabic or word-level stimuli and it remains unclear how altered lower-level multisensory integration translates to the processing of more complex natural multisensory stimulus environments in autism. Here, functional neuroimaging was used to examine neural correlates of audiovisual gain (AV-gain) in 41 autistic individuals to those of 41 age-matched non-autistic controls when presented with a complex audiovisual narrative. Participants were presented with continuous narration of a story in auditory-alone, visual-alone, and both synchronous and asynchronous audiovisual speech conditions. We hypothesized that previously identified differences in audiovisual speech processing in autism would be characterized by activation differences in brain regions well known to be associated with audiovisual enhancement in neurotypicals. However, our results did not provide evidence for altered processing of auditory alone, visual alone, audiovisual conditions or AV- gain in regions associated with the respective task when comparing activation patterns between groups. Instead, we found that autistic individuals responded with higher activations in mostly frontal regions where the activation to the experimental conditions was below baseline (de-activations) in the control group. These frontal effects were observed in both unisensory and audiovisual conditions, suggesting that these altered activations were not specific to multisensory processing but reflective of more general mechanisms such as an altered disengagement of Default Mode Network processes during the observation of the language stimulus across conditions.

Do children better understand adults or themselves? An acoustic and perceptual study of the complex sibilant system of Polish

This paper reports a developmental production-perception study of the three-way Polish sibilant contrast /s, ʂ, ɕ/ in typically developing children (N = 76). Children aged 2;11–7;11 produced words with sibilants in word-medial and initial position. They then identified the same words they produced, and the words as produced by an unknown adult female. Results show higher identification accuracy for adult productions across all ages. Production and perception data suggest that the alveolo-palatal /ɕ/ is acquired first, and that it is differentiated mainly by formant patterns. In the perceptual discrimination task, most errors were found for child-produced /ʂ/, and this persisted into the oldest ages. Early acquisition of /ɕ/ has been observed in other languages and may reflect motoric considerations as well as a focus on formant information in child speech perception. Cue weighting appears to change over age in sibilant-specific ways. While all children weight formants highest for /ɕ/, spectral cues appear to be more important for /s/ and /ʂ/, and reliance on formants may decrease with age. This work contributes to the study of cross-language differences in acquisition, provides an acoustic characterization of child-produced Polish sibilants, and elucidates the acoustic characteristics that children use in perceptual judgments of sibilants.

Children with developmental dyslexia have equivalent audiovisual speech perception performance but their perceptual weights differ.

As reading is inherently a multisensory, audiovisual (AV) process where visual symbols (i.e., letters) are connected to speech sounds, the question has been raised whether individuals with reading difficulties, like children with developmental dyslexia (DD), have broader impairments in multisensory processing. This question has been posed before, yet it remains unanswered due to (a) the complexity and contentious etiology of DD along with (b) lack of consensus on developmentally appropriate AV processing tasks. We created an ecologically valid task for measuring multisensory AV processing by leveraging the natural phenomenon that speech perception improves when listeners are provided visual information from mouth movements (particularly when the auditory signal is degraded). We designed this AV processing task with low cognitive and linguistic demands such that children with and without DD would have equal unimodal (auditory and visual) performance. We then collected data in a group of 135 children (age 6.5-15) with an AV speech perception task to answer the following questions: (1) How do AV speech perception benefits manifest in children, with and without DD? (2) Do children all use the same perceptual weights to create AV speech perception benefits, and (3) what is the role of phonological processing in AV speech perception? We show that children with and without DD have equal AV speech perception benefits on this task, but that children with DD rely less on auditory processing in more difficult listening situations to create these benefits and weigh both incoming information streams differently. Lastly, any reported differences in speech perception in children with DD might be better explained by differences in phonological processing than differences in reading skills. RESEARCH HIGHLIGHTS: Children with versus without developmental dyslexia have equal audiovisual speech perception benefits, regardless of their phonological awareness or reading skills. Children with developmental dyslexia rely less on auditory performance to create audiovisual speech perception benefits. Individual differences in speech perception in children might be better explained by differences in phonological processing than differences in reading skills.

Neural and Behavioral Differences in Speech Perception for Children With Autism Spectrum Disorders Within an Audiovisual Context.

Reduced use of visible articulatory information on a speaker's face has been implicated as a possible contributor to language deficits in autism spectrum disorders (ASD). We employ an audiovisual (AV) phonemic restoration paradigm to measure behavioral performance (button press) and event-related potentials (ERPs) of visual speech perception in children with ASD and their neurotypical peers to assess potential neural substrates that contribute to group differences. Two sets of speech stimuli, /ba/-"/a/" ("/a/" was created from the /ba/ token by a reducing the initial consonant) and /ba/-/pa/, were presented within an auditory oddball paradigm to children aged 6-13 years with ASD (n = 17) and typical development (TD; n = 33) within two conditions. The AV condition contained a fully visible speaking face; the pixelated (PX) condition included a face, but the mouth and jaw were PX, removing all articulatory information. When articulatory features were present for the /ba/-"/a/" contrast, it was expected that the influence of the visual articulators would facilitate a phonemic restoration effect in which "/a/" would be perceived as /ba/. ERPs were recorded during the experiment while children were required to press a button for the deviant sound for both sets of speech contrasts within both conditions. Button press data revealed that TD children were more accurate in discriminating between /ba/-"/a/" and /ba/-/pa/ contrasts in the PX condition relative to the ASD group. ERPs in response to the /ba/-/pa/ contrast within both AV and PX conditions differed between children with ASD and TD children (earlier P300 responses for children with ASD). Children with ASD differ in the underlying neural mechanisms responsible for speech processing compared with TD peers within an AV context.

Erratum: Assessing Speech Perception in Children with Hearing Loss: What Conventional Clinical Tools May Miss: Erratum.

Erratum: Assessing Speech Perception in Children with Hearing Loss: What Conventional Clinical Tools May Miss: Erratum.

Speech rehabilitation in children with cochlear implants using a multisensory (French Cued Speech) or a hearing-focused (Auditory Verbal Therapy) approach.

Early exposure to a rich linguistic environment is essential as soon as the diagnosis of deafness is made. Cochlear implantation (CI) allows children to have access to speech perception in their early years. However, it provides only partial acoustic information, which can lead to difficulties in perceiving some phonetic contrasts. This study investigates the contribution of two spoken speech and language rehabilitation approaches to speech perception in children with CI using a lexicality judgment task from the EULALIES battery. Auditory Verbal Therapy (AVT) is an early intervention program that relies on auditory learning to enhance hearing skills in deaf children with CI. French Cued Speech, also called Cued French (CF), is a multisensory communication tool that disambiguates lip reading by adding a manual gesture. In this study, 124 children aged from 60 to 140 months were included: 90 children with typical hearing skills (TH), 9 deaf children with CI who had participated in an AVT program (AVT), 6 deaf children with CI with high Cued French reading skills (CF+), and 19 deaf children with CI with low Cued French reading skills (CF-). Speech perception was assessed using sensitivity (d') using both the hit and false alarm rates, as defined in signal-detection theory. The results show that children with cochlear implants from the CF- and CF+ groups have significantly lower performance compared to children with typical hearing (TH) (p < 0.001 and p = 0.033, respectively). Additionally, children in the AVT group also tended to have lower scores compared to TH children (p = 0.07). However, exposition to AVT and CF seems to improve speech perception. The scores of the children in the AVT and CF+ groups are closer to typical scores than those of children in the CF- group, as evidenced by a distance measure. Overall, the findings of this study provide evidence for the effectiveness of these two speech and language rehabilitation approaches, and highlight the importance of using a specific approach in addition to a cochlear implant to improve speech perception in children with cochlear implants.

Acceptance and Benefit of Electroacoustic Stimulation in Children.

Children with high-frequency severe-to-profound hearing loss and low-frequency residual hearing who do not derive significant benefit from hearing aids are now being considered for cochlear implantation. Previous research shows that hearing preservation is possible and may be desirable for the use of electroacoustic stimulation (EAS) in adults, but this topic remains underexplored in children. The goal of this study was to explore factors relating to hearing preservation, acceptance, and benefits of EAS for children. Retrospective review. Tertiary academic medical center. Forty children (48 ears) with preoperative low-frequency pure-tone averages of 75 dB HL or less at 250 and 500 Hz (n = 48). All patients underwent cochlear implantation with a standard-length electrode. Low-frequency audiometric thresholds, speech perception, and EAS usage were measured at initial stimulation, and 3 and 12 months postoperatively. Outcomes were compared between children with and without hearing preservation, and between EAS users and nonusers. Hearing was preserved at similar rates as adults but worse for children with an enlarged vestibular aqueduct. Fewer than half of children who qualified to use EAS chose to do so, citing a variety of audiologic and nonaudiologic reasons. No differences were detected in speech perception scores across the groups for words, sentences, or sentences in noise tests. Neither hearing preservation nor EAS use resulted in superior speech perception in children with preoperative residual hearing; rather, all children performed well after implantation.

Speech perception and children with speech sound disorder: An assessment of non-errored speech sounds

Previous studies assessing speech perception in children with speech sound disorder (SSD) suggest inconsistent, if any, differences from typically-developing peers (TD). However, others suggest that children with SSD perceive inaccurate productions as acceptable variants of a sound. Currently, limited research explores speech perception of non-errored sounds in children with SSD compared to TD peers. This study assesses how distributional characteristics of naturally produced child speech stimuli, collected from six 2–3-year-old English-speaking children, might impact listening behavior of children with SSD for non-errored sounds. Stimuli included six exemplars per speaker and VOT categories of short-lag /b d/, short-lag /p t/, long-lag /b d/, long-lag /p t/. For each POA and VOT group, /b d/ and /p t/ VOTs were bimodally distributed (shorter for voiced targets), separated by a minimum 5 ms gap. We will compare perception results for TD children and children with SSD (ages 6;0–10;11). Earlier findings showed high accuracy in adults and TD children for targets with appropriate VOT values with adults slightly outperforming children. We hypothesize that children with SSD will demonstrate similar accuracy levels between groups when VOT values are appropriate for the target, and slightly greater response variability and group differences for inappropriate VOTs.

Effects of acoustic-phonetic access on audiovisual speech perception in children

Visual speech helps compensate for degraded acoustic input, especially when redundancy between the accessible acoustic and visual cues is low. Recent findings indicate that children who are hard of hearing benefit more from visual speech than their peers with normal hearing, yet the two groups demonstrate similar speechreading ability. It is unclear whether this increased benefit reflects differences in auditory and multisensory development or differences in redundancy between the visual and acoustic cues available to each group. This study examines the extent to which acoustic-phonetic access (acoustic frequency content) influences auditory and audiovisual word recognition in children with normal hearing. Isolated word and word-in-sentence recognition accuracy are measured for auditory-only and audiovisual speech that were high-pass filtered and low-pass filtered with a 2 kHz cutoff frequency. Data collection is ongoing. We hypothesize that children will demonstrate greater audiovisual benefit when acoustic speech is low-pass filtered than when it is high-pass filtered, because low-frequency acoustic content is less redundant with visual speech cues than high-frequency acoustic content. These findings will elucidate whether acoustic-phonetic access can explain differences in audiovisual benefit between children with normal hearing and children who are hard of hearing. [Work supported by NIH R21DC020544.]

The Children’s English/Spanish Speech Recognition Test (ChEgSS): Feasibility, Reliability, and Normative data

The Children’s English/Spanish Speech Recognition Test (ChEgSS) is a computer-based tool for assessing closed-set word recognition in either speech-shaped noise or two-talker speech. Instructions and stimuli are recorded in both languages, and listeners respond by pointing to the picture depicting the word that they heard. Preliminary clinical feasibility and reliability data will be presented, along with age norms for children (4.1–17.0 yrs) who are either English monolinguals (n = 89) or Spanish/English bilinguals (n = 83). Results obtained with the two maskers will be evaluated with respect to age, language group, and receptive vocabulary. SRTs in English were higher in two-talker speech than speech-shaped noise and were 1.7dB lower for monolinguals than bilinguals for both maskers. SRTs were lower in English than Spanish for bilinguals in noise but not significantly different in speech. Consistent with prior research, SRTs in both languages improved with age; effects of age were more pronounced and prolonged in two-talker speech than in speech-shaped noise. The mean discrepancy between replicate estimates of SRT in English were 1.8 dB in noise and 3.1 in two-talker speech. Overall, these results suggest ChEgSS may be a valuable tool for clinical assessment of masked speech perception in children.

Effects of binaural classroom noise scenarios on primary school children's speech perception and listening comprehension

When it comes to learning in school, perception of speech and listening comprehension are crucial. The ability to listen effectively under the conditions of background noise and reverberation in a classroom involves the ability to continuously filter out background noise and fill in missing pieces in the speech communicated by teachers or classmates. A large number of experimental tasks have demonstrated that children's speech perception is significantly more sensitive to unfavorable listening settings than adults' (Buss et al., 2017; Klatte et al. 2013). Despite this, there are just a few studies that have looked at the impact of real-world classroom noise on children's performance in listening tasks that take into account the demands of school-based education. Rather, the increased listening effort appeared to lower the amount of resources available for storing and processing information in working memory, as demonstrated by Klatte and colleagues (2010). The goal of this study is to compare children's performance on word identification and listening comprehension tasks in realistic classroom scenarios, which include monaural and binaural reproductions of complex background noises such as typical classroom sounds and non-native children's speech. Conclusions on the acoustic design of learning environments and the development of speech-in-noise perception in primary school students can be drawn.

Hearing Preservation and Spatial Hearing Outcomes After Cochlear Implantation in Children With TMPRSS3 Mutations.

Investigate hearing preservation and spatial hearing outcomes in children with TMPRSS3 mutations who received bilateral cochlear implantation. Longitudinal case series report. Two siblings (ages, 7 and 4 yr) with TMPRSS3 mutations with down-sloping audiograms received sequential bilateral cochlear implantation with hearing preservation with low-frequency acoustic amplification and high-frequency electrical stimulation. Spatial hearing, including speech perception and localization, was assessed at three time points: preoperative, postoperative of first and second cochlear implant (CI). Both children showed low-frequency hearing preservation in unaided, acoustic-only audiograms. Both children demonstrated improvements in speech perception in both quiet and noise after CI activations. The emergence of spatial hearing was observed. Each child's overall speech perception and spatial hearing when listening with bilateral CIs were within the range or better than published group data from children with bilateral CIs of other etiology. Bilateral cochlear implantation with hearing preservation is a viable option for managing hearing loss for pediatric patients with TMPRSS3 mutations.

The Impact of Singing on Visual and Multisensory Speech Perception in Children on the Autism Spectrum.

Autistic children show reduced multisensory integration of audiovisual speech stimuli in response to the McGurk illusion. Previously, it has been shown that adults can integrate sung McGurk tokens. These sung speech tokens offer more salient visual and auditory cues, in comparison to the spoken tokens, which may increase the identification and integration of visual speech cues in autistic children. Forty participants (20 autism, 20 non-autistic peers) aged 7-14 completed the study. Participants were presented with speech tokens in four modalities: auditory-only, visual-only, congruent audiovisual, and incongruent audiovisual (i.e., McGurk; auditory 'ba' and visual 'ga'). Tokens were also presented in two formats: spoken and sung. Participants indicated what they perceived via a four-button response box (i.e., 'ba', 'ga', 'da', or 'tha'). Accuracies and perception of the McGurk illusion were calculated for each modality and format. Analysis of visual-only identification indicated a significant main effect of format, whereby participants were more accurate in sung versus spoken trials, but no significant main effect of group or interaction effect. Analysis of the McGurk trials indicated no significant main effect of format or group and no significant interaction effect. Sung speech tokens improved identification of visual speech cues, but did not boost the integration of visual cues with heard speech across groups. Additional work is needed to determine what properties of spoken speech contributed to the observed improvement in visual accuracy and to evaluate whether more prolonged exposure to sung speech may yield effects on multisensory integration.

Sensory Inhibition and Speech Perception-in-Noise Performance in Children With Normal Hearing.

This study investigated whether sensory inhibition in children may be associated with speech perception-in-noise performance. Additionally, gating networks associated with sensory inhibition were identified via standardized low-resolution brain electromagnetic tomography (sLORETA), and the detectability of the cortical auditory evoked potential (CAEP) N1 response was enhanced using a 4- to 30-Hz bandpass filter. CAEP gating responses, reflective of inhibition, were evoked via click pairs and recorded using high-density electroencephalography in neurotypical 5- to 8-year-olds and 22- to 24-year-olds. Amplitude gating indices were calculated and correlated with speech perception in noise. Gating generators were estimated using sLORETA. A 4- to 30-Hz filter was applied to detect the N1 gating component. Preliminary findings indicate children showed reduced gating, but there was a correlational trend between better speech perception and decreased N2 gating. Commensurate with decreased gating, children presented with incomplete compensatory gating networks. The 4- to 30-Hz filter identified the N1 response in a subset of children. There was a tenuous relationship between children's speech perception and sensory inhibition. This may suggest that sensory inhibition is only implicated in atypically poor speech perception. Finally, the 4- to 30-Hz filter settings are critical in N1 detectability. Gating may help evaluate reduced sensory inhibition in children with clinically poor speech perception using the appropriate methodology. Cortical gating generators in typically developing children are also newly identified.

The Impact of Hearing Aids on Speech Perception in Mandarin-Speaking Children.

Background Severe hearing loss can affect speech perception in children, and hearing aids as a medical device may help improve speech perception in children. Objective To explore the effects of fitting hearing aids (HAs) on speech perception in children with severe hearing loss (60–70 dB HL). Methods Ninety-five children with bilateral severe hearing loss who were fitted bilaterally with HAs before the age of 3 years were followed up. The subjects were grouped according to their age at the time of fitting, i.e., <1, 1–2 , and 2–3 years groups. The Mandarin Early Speech Perception test was used to evaluate speech perception of Mandarin monosyllabic words at 12, 24, and 36 months after fitting. Results There were significant improvements in vowel, consonant, and tone perception scores from 12 to 36 months after fitting HAs in the three age groups, and the mean score at 36 months after fitting was significantly improved at >85%. The mean speech pattern and spondee perception scores averaged at >90% at 12 months after fitting and were comparable to the scores of 2-year-old children with normal hearing. Conclusions HA helps with speech perception in children with severe hearing loss.

Efficacy of an integrated intervention with vocabulary and phonetic training for Mandarin-speaking children with developmental language disorders

Background: Children with developmental language disorder (DLD) demonstrate deficits in vocabulary development and novel word learning processes, which have been proposed to stem from their speech perception deficits. Aims: This study had two aims. The first was to evaluate the efficacy of an intervention incorporating a computer-based phonetic training programme with rich and explicit vocabulary instruction. The second aim was to investigate the adjuvant treatment effect of phonetic training on word learning performance. Methods and procedures: The experimental group comprised 34 children with DLD aged 5–7 years, and the control group comprised another 15 children with DLD. All participants in the experimental group attended 1-h direct vocabulary instruction classes weekly for 9 weeks. They were also asked to play computer-based phonetic training games individually at home or school. Pre-post differences between groups in word definition and speech perception tasks were examined. The relationship between the experimental group's vocabulary learning performance and scores on the phonetic training games was examined using correlation analysis. Results: Between-group comparisons revealed that children in the experimental group exhibited significantly greater pre-post gains in word definition task than did the control group. Children in the experimental group performed better in the lexical tone posttest No improvement in the speech discrimination tasks was detected in the control group. Finally, correlation analyses indicated a positive relationship between the total number of phonetic games played and the pre-post gain in the word definition production task. The children's response accuracy in the lexical tone discrimination games was significantly correlated with the performance of the posttest tone discrimination task and the pre-post gain in the word definition task. Conclusions: The results of this study suggest that vocabulary intervention programmes incorporating speech perception training promote children's vocabulary and speech perception abilities. These findings can serve as evidence to support future school-based studies.

Classroom acoustics and the inclusion of hard of hearing children, helping the data be heard

Data on speech perception in children have led to acoustic accommodations in built schools for children with typical hearing but, despite compelling data, not for children who are hard of hearing. The ways to meet the acoustic needs of hard of hearing children are well researched and established in standards. After many years, however, the message is still not disseminating to architects, school districts, and building officials, and thus rarely makes its way into classroom construction. To help bring classroom accessibility to hard of hearing children, a team from the fields of acoustical engineering, architecture, and audiology is using speech perception data and computer simulations to promote inclusion in school design. This multi-year, multi-disciplinary effort began with earlier federal and foundation fundings for research on speech perception in hard of hearing children, which led to development of a new voluntary acoustic standard for schools by the American National Standards Institute. The goal of this work now is to get this standard into the hands of architects and school districts, and ultimately into building codes to have classroom acoustics designed for all students including those hard of hearing.