The current study was intended to look at the effectiveness of using TSI: Focused Attention with adults whose main complaint was difficulty hearing and understanding when there is background noise.

Method

Fifteen participants completed the study. NACD client families were contacted about the study, so participants were either parents or grandparents of children involved with NACD. Criteria for inclusion into the study included:

• Age 40 or older
• Complaint of figure-ground processing problems, with or without a documented hearing loss

Figure-ground processing problems were explained to potential candidates as concerns related to processing, hearing or listening when there is background noise.

Participants were provided with a TSI: Focused Attention program and headphones. They were instructed to listen twice per day, 5 days/week, for a total of 24 weeks. Pre- and post-testing included a speech-in-noise test and rating scales.

Participants were divided into two groups:

• Hearing loss—either documented or suspected but never tested (N=9)
• No hearing loss (N=6)

Regardless of grouping, all participants used the program the same way and received the same instruction and testing.  The speech-in-noise test administered was an informal assessment created by NACD. It consisted of a CD of 20 words spoken in quiet (to serve as a comparison), randomly alternated with 20 words spoken in noise. Listeners were asked to repeat each word they heard.  In addition, participants were asked to rate eight listening/processing skills 0-10, with 0 meaning they had no difficulty with that task and 10 meaning they had the greatest difficulty. Skills on the rating scale are listed in Table 1.

Results

Results are reported in Tables 2 and 3 and are reported separately for the Hearing Loss group and No Hearing Loss group. Results are shown as percentages correct for the speech-in-noise test. For the rating scales, results are shown as the mean score for each question.

On the speech-in-noise test, percentage of accuracy increased after the program, although the increase was much greater for the No Hearing Loss group than the Hearing Loss group. On the functional rating questionnaire, most ratings by the listeners in the Hearing Loss group decreased after the program, indicating a perceived improvement in function. For the few questions that showed a higher post-rating (implying worse function), some possible factors can be found in the Discussion section.

As part of the post-program interview, participants were asked about if they felt they benefited from the program, their enjoyment of the program, and whether they’d recommend it to someone else. Results are reported in Table 4.

Discussion

Results suggest that the normal hearing adults who experience difficulty with figure-ground processing may benefit from auditory training using TSI: Focused Attention. Adults who have issues with figure-ground processing due to hearing loss may be less likely candidates for the program.

One factor that the scores of the speech-in-noise noise test do not reflect is the accuracy—or, more aptly, the degree of inaccuracy—of incorrect responses. In many cases, some responses on the post-test were incorrect, yet closer to the correct answer than they were on the pre-test. If scores could reflect improvement in the accuracy of incorrect responses, the results would have reflected more change than they did only looking at correct vs. incorrect.
Although the numerical values in the tables in the Results section are interesting, perhaps even more significant are the comments made by the listeners about their perception of functional change with use of the program (see Appendix 1). Even listeners with hearing loss commented on how they felt their listening skills had improved. So test scores should be interpreted with caution, as the scores on the tests could be influenced by a number of factors. Some participants admitted that on the functional rating questionnaire they may have been thinking about the questions differently on the post-test compared to the pre-test. Others felt certain that for both the speech-in-noise test and the post functional questionnaire, they were more aware of their own skills and efforts and may have tried harder. A complete list of quotes and comments can be found in Appendix 1.

Besides the scores and listeners’ comments about change, other outcomes were also worth mentioning. Two of the participants reported that family members wanted to do the program because of the change they noticed in the listener. In addition, because of their positive experience with TSI: Focused Attention, 14 of the 15 participants wanted to go on to participate in the second research study, which looked at the effectiveness of TSI: FA2 for adults, a language-based figure-ground program. The one participant who declined participation in the second study said she only did so due to the logistics of her current schedule. Additionally, 100% of participants who responded to the question said they enjoyed doing the program; most felt they benefited from doing it; and most would recommend it to someone else.

Conclusion

It is often the case that efficacy studies such as this raise more questions than they answer. For this reason, almost all “conclusion” sections include the statement, “More research is needed…” And we concur with that thought, especially in light of the small number tested in the current trial. At the same time, understanding the limitations of the current study, we suggest that the results imply that TSI: Focused Attention can benefit adults who experience difficulties with auditory figure-ground processing, and that adults with normal hearing are better candidates for the program than those with hearing loss.

Appendix 1

54 y.o. male with hearing loss: “[It] helped me concentrate on what I was listening to, even though it didn’t help my hearing. I learned to focus, although my hearing problem still seems to be getting worse.”
52 y.o. female: “…I feel like I’m better able to focus.”
71 y.o. female: “As to whether or not it will help in everyday life, I’m not sure yet. But I definitely felt it was worth doing.”
61 y.o. female with hearing loss: “I get nervous going places with friends where I think there will be background nose. The last time I went, it was better than I thought it would be [post-program].” “[The program] helped me work harder at paying attention in conversations.”
41 y.o. female with suspected hearing loss: She reported that after the program she no longer became agitated and frustrated when all of her kids were talking. “It’s been great! My husband wants to do it.”
41 y.o. female who had some rating scores increase on the post-test: “It’s not worse; I’m just paying attention to it more.”
42 y.o. female: In regard to ratings that increased, she felt it was due to being more tuned in and aware of what she’s hearing and what she’s missing. Other comments: “I can turn the volume on things down now.” “I have my kids repeat less.” “I’m still distracted by other people’s conversations, but it’s a little better.”
42 y.o. female: “[After the program] I find it easier to listen in public when someone’s talking to me and there’s others around. I think I’m more focused on who I’m with.”
63 y.o. male with hearing loss: In regard to a functional skill he rated as higher (i.e. worse) after the program: “I don’t think I’m actually any worse than before. I may be doing better; I may be more aware now.”
68 y.o. female: Reported she was able to concentrate better and had less frustration with background sounds after the program. “My focusing has improved.”
64 y.o. female with hearing loss: “[My] awareness has changed. I’m more aware of what I’m missing now.”

Reprinted from the Journal of The NACD Foundation (formerly The National Academy for Child Development)

Reprinted by permission of The NACD Foundation, Volume 27 No. 3, 2014 ©NACD

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I am the mother of a lovely 12-year old boy, Usaid. He was diagnosed with Autism when he was 3 1/2 years old. We went through all the regular denials, nightmares, helplessness, and frustrations that all parents of newly diagnosed ASD children go through. As his language started developing with speech therapy, we discovered he was advanced at reading and high-functioning, and so he got admission in mainstream school. The school was very cooperative, and academics were never an issue; but his tantrums, perseveration, and behaviors were becoming huge problems in school. Every day from the time I would drop him off at school until I picked him up, I would be looking at the phone as if it were a sword hanging over my head. Each time the phone rang my heart would miss a few beats. I would dread the calls from school telling me they could not handle his tantrum and requesting me to come to school as soon as possible. This had become a routine at least 2-3 times a week and has been going on for the last 8 years.

In August 2011 I came to know about Simply Smarter online from a friend. I decided to try it for Usaid. I was not very sure if this would work when nothing else had worked for the last 8 years. But I started noticing the positive changes in him from the 2nd week. He was speaking in sentences, had lots of spontaneous speech, started asking a lot of questions and initiating discussions and JOKING too! His violent tantrums at home, which had been a daily affair, were reduced to once a week. By the 3rd week I was convinced that all these changes had to be due to Simply Smarter and there could not be so many coincidences.

I decided to go in for the Targeted Developmental Intervention program for him at NACD. By the next week I had set up an appointment with Prachi Sinha in Gurgaon, India. Prachi set up a very detailed and impressive program for him. (Prachi Sinha is no longer associated with NACD.)

In the following 2 months the changes in my child have been immense. His TANTRUMS have completely gone. PERSEVERATIONS are gone. He has become much more social and friendly. As his digits in sequential processing went on increasing every week, so did his awareness of people, their feelings, his surroundings, and his logical reasoning, understanding and thinking skills.

We are currently in the 3rd week of the TSI program, and his sound sensitivity to noises has reduced considerably, and his listening skills have also improved a great deal.

In the last 2 months I have not received any phone calls from his school. In fact it has been the other way round. I have approached his teachers to ask if there are any issues and they have said–NONE! He has started helping me in household chores and has become much more independent in his skills at school. If 2 1/2 months of NACD has bought such huge changes in my child, then my heart sings and wants to believe that my son will be SYMPTOM FREE very soon!!

Thank you Bob, Prachi & NACD!!!

Regards,
Fatima

Reprinted by permission of The NACD Foundation, Volume 24 No. 5 2011 ©NACD

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