Keywords
attention - hearing - child - rating
Palavras-chave
atenção - audição - criança - avaliação
Introduction
Attention is a multimodal process, essential for development and learning[1] and the acquisition of language, not only on aspects relating to the field of linguistic
structures, but also in the development of communication skills that allow the child
to participate in a conversation, talk about a topic or tell a story[2].
The literature has shown that sustained attention and vigilance are the processes
that characterize the attention abilities. Mediated by the prefrontal cortex in sustained
attention is voluntary and controlled by the subject[3]
[4]. It is defined as the ability to maintain an efficient level of response to a target
during a given period of time[1]
[5]
[6], the organization of appropriate responses to signs and inhibition of inappropriate
responses. The failure to detect the target stimulus (omission errors) reflects a
lack of attention[7]
[8]
[9] as well as the presence of responses to a non-target stimulus, reflects the lack
of inhibition[9]. Children who have problems in sustaining attention, often have difficulty in inhibiting
inappropriate responses to stimuli[10]
[11].
Research has shown that the effects of age are greater than gender in sustained attention[12]
[13]
[14]. However, the specific literature shows that when the ability to sustain attention
has been studied, time of day is a factor that has been very little explored. Thus,
some authors have reported data on sustained attention emphasizing school hours[11]
[12]. Another study[15] found that the period of the day may be a possible source of variation in the child's
ability to sustain attention.
Other variables such as socioeconomic status and type of school the child attends,
whether from public or private schools, which could directly impact on the skills
of attention, because children with low socioeconomic and studying in public schools
have worse performance in tasks that require these skills[16]
[17].
For professionals in health and education is essential to understand the effects of
these variables in the skills of attention, since the sustained attention and vigilance,
when altered, cause difficulty concentrating on the task at the expense of development
and learning[2]
[18]
[19]
[20]
[21]
[22]. Given this context, the objectives of this study were to assess the effect of length
of day and type of school attended by children in their ability to sustained auditory
attention.
Method
The prospective study was undertaken after approval by the Ethics in Human Research
in the opinion paragraph. 011/2007, in 2007.
To compose the series, was conducted random contact with the public schools and particularly
the city of Bauru (SP), and with officials and professionals from the Faculty of Dentistry
of Bauru (FOB-USP), to invite their children belonging to aged 7 years to 7 years
and 11 months to participate in this study.
After reading and signing the consent form the parents or guardians for the child
underwent a directed interview in order to obtain personal data from children, information
on hearing health, as regards the presence of a history of otitis , and hearing complaints
of inattention, as well as academic and behavioral aspects.
Participants from this study 50 volunteer children of genders, 23 males and 27 females,
aged from 7 years to 7 years and 11 months, enrolled in first grade of elementary
school. For inclusion in the children should not complain school and/or behavioral
difficulties or historical attention, comprehension problems, as well as complaints
and/or hearing impairment.
To exclude the presence of any modification hearing and middle ear changes in the
status of appraisal, visual inspection was made of the external ear canal with an
otoscope Missouri brand, model TK007, specific interview, pure tone audiometry and
tympanometry.
Pure tone audiometry was performed in a soundproof booth, using the Siemens SD 50 audiometer with TDH-39. Was investigated air hearing thresholds in the frequencies
between 250, 500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz The results of audiometry
were analyzed according to the classification proposed by Northern and Downs (1991)[23], in which children who have hearing thresholds better than or equal to 15 dB HL,
have normal hearing. Immittanciometry was made by the apparatus Tympstar GSI. Were included in the study subjects with type A tympanometric curve, according to
the classification proposed by Jerger (1970)[24].
Participants were divided into two groups (group M and group T). Each group was composed
of 25 children, taking into account the time of day that was performed to evaluate
the proposal. The Group M was composed of children who underwent evaluation in the
morning, between 09:00 and 11:30, and Group T in children who underwent evaluation
in the afternoon, between 15:00 and 17:30.
[Table 1] shows the distribution of children sampled.
Table 1.
Distribution of children in the study of the type of school and gender in groups.
|
Type of school
|
Period of the day
|
Total
|
|
Morning
|
Afternoon
|
|
|
Male
|
Female
|
Male
|
Female
|
|
|
Public
|
7
|
6
|
7
|
10
|
30
|
|
Private
|
5
|
7
|
4
|
4
|
20
|
|
Total
|
12
|
13
|
11
|
14
|
50
|
The whole sample group was submitted to Test the Ability of Sustained Auditory Attention
- SAAAT[13]
[14]. The SAAAT is used to assess sustained auditory attention, in which the child should
respond only to a specific auditory stimulus (target word), maintaining attention
and concentration on the task for a period of time. Consists of the presentation and
binaural diotic through earphones from a list of 100 monosyllabic words (containing
20 instances of the target word “not”). That list (recorded on CD standard) was presented
six times without interruption. To be heard the target word; the child should raise
a hand. The test was conducted in a soundproof booth with the aid of a CD player attached
to a two-channel audiometer (Siemens SD 50) at an intensity of 50 dBNS, considering the average air hearing thresholds
of the frequencies of 500, 1000 and 2000Hz, for each ear. The test lasts approximately
10 minutes. As for the result set by regulatory SAAAT, it is expected that a child
of seven years to submit a score of 24.7 (SD = 11.0) for the total score and a decrease
of vigilance ≤8.0 (14).
Statistical analysis was performed using analysis of variance (ANOVA) model with three
fixed criteria. Adopted was 5% (p ≤0.05) value for rejection of the null hypothesis
(Ho).
Results
Based on the results obtained in SAAAT, was elaborated in [Table 2] showing the distribution of mean values and standard deviations for the children
sampled in different periods.
Table 2.
Mean values (X) and standard deviation (SD) errors of inattention, impulsivity, total
score of errors and decreased vigilance, considering the different periods.
|
Period of evaluation
|
Listlessness
|
Impulsivity
|
Total of errors
|
Decrease of Vigilance
|
|
X (SD)
|
X (SD)
|
X (SD)
|
X (SD)
|
|
Group M
|
11.32 (7.31)
|
4.08 (3.03)
|
15.44 (8.34)
|
0.92 (1.58)
|
|
Group T
|
19.00 (13.42)
|
5.64 (5.31)
|
24.64 (16.45)
|
2.04 (3.49)
|
[Table 3] shows mean values and standard deviations for the results achieved in implementing
the SAAAT in different types of schools (public and private) attended by children.
Table 3.
Mean values (X) and standard deviation (SD) errors of inattention, impulsivity, and
total score of errors and decreased vigilance, considering the different types of
schools.
|
Type of school
|
Listlessness
|
Impulsivity
|
Total of errors
|
Decrease of Vigilance
|
|
X (SD)
|
X (SD)
|
X (SD)
|
X (SD)
|
|
Public
|
18,37 (11,77)
|
5,60 (3,07)
|
24,00 (12,31)
|
1,20 (2,31)
|
|
Private
|
10,35 (9,06)
|
3,75 (5,68)
|
14,10 (13,86)
|
1,90 (3,31)
|
Based on the values described in [Table 4], analysis of variance (ANOVA) with significance level of 5% (p ≤0.05) showed a statistically
significant difference for the errors of inattention (p = 0.041 and p = 0.027) and
total error score (p = 0.033 and p = 0.024) in different periods of evaluation and
types of schools, respectively. Given this evidence, it is noted that the children
assessed in the afternoon and the children studying in public schools, had a poorer
performance on auditory attention sustained.
Table 4.
Results of analysis of variance (ANOVA) according to gender, type of school and the
evaluation period.
|
Variable
|
Listlessness
|
Impulsivity
|
Total of errors
|
Decrease of Vigilance
|
|
|
(p)
|
(p)
|
(p)
|
|
Gender
|
0,591
|
0,816
|
0,721
|
0,125
|
|
Type of school
|
0,027
|
0,241
|
0,024
|
0,327
|
|
Period of evaluation
|
0,041
|
0,190
|
0,033
|
0,067
|
Discussion
The auditory attention is a cognitive process that allows the listener to focus selectively
on the stimulus of interest, a stimulus while ignoring irrelevant competing, so the
listener consciously selects the stimulus which he will watch and process its response[1]
[5].
The auditory attention of students can be influenced by hearing impairment, causing
impairment in attention and comprehension skills and thus compromising the performance
and learning of these children. Thus, it became essential to realization of audiometry
and impedance prior to application of SAAAT[19].
By comparing the results of this study, described in [Table 4], referred to specific literature[13]
[14]
[20]
[25]
[26], no statistically significant difference observed in the comparison between the
genders is consistent. However, these data contradict other study[27], in which the genre has proved to be an important variable in the skills of attention.
Regarding the type of school (public or private), children who attend public school
had a score value increased to a total score of errors. The statistically significant
difference found when comparing public and private schools is evident in other studies[16]
[17], it was found lower performance of attention abilities in children who were studying
in public schools, since they live in environments of communication less encouraging.
As described in [Tables 2] and [3], it is possible to observe a greater number of errors of inattention compared to
impulsivity, both during the day, as the type of school. These data corroborate findings
in other studies[20]
[25]. The observation of this data is important for planning therapeutic intervention,
since the compensatory strategy used for intervention should be dependent on the type
of error made by the child.
The skill of attention, according to our data, appears to be influenced by time of
day because the children studied in the afternoon (Group T) had a score above the
expected result for the total score of errors. As for the decrease in vigilance, the
score obtained is within normal parameters for both groups[20]. Thus, these children showed inferior performance, becoming more careless when compared
those evaluated in the morning. Inattention is displayed by children who have difficulty
decoding lexical, which often take in processing the stimulus and completely lose
the word or show a delayed response[5].
The hearing process is a series of processes involved in listening skills, including
attention, memory, sound detection, location, figure-ground, among others[28]. The literature[21]
[29] reports that children with learning difficulties, have poorer performance on alertness,
suggesting delayed maturation of auditory processing skills.
The association between the ability of attention and learning raised by some authors[1]
[2]
[18]
[21]
[29], shows that academic performance is strongly affected when the child has no ability
to concentrate to a target stimulus, for a given period of time. This attention deficit
will affect these children in the communication skills necessary for the acquisition
of oral language as well as in written language acquisition[2]
[22].
Importantly, the identification of difficulties in processing auditory verbal and
nonverbal children in preschool and school has affirmed its importance in academic
foundations, maturational, psychological, and economic. Early identification of children
with serious skills auditory information processing reduces time and costs of intervention[30].
Thus, considering that one of the leading causes of school failure among children
is the lack of attention[20], as this is essential for learning new skills, oral and written communication, and
learning as described above, to assess the sustained auditory attention ability is
of utmost importance.
In this study, the comparative assessment of different periods of the day allows the
speech therapist to determine the period that the child has a higher level of sustained
auditory attention, enabling a study of the therapeutic plan for the rehabilitation
process is enhanced. In this context, it is still the professional guidance to parents
and guardians about the school term attended by their children, because it may encourage
the academic performance of children with this skill.
The audiologist also should note the type of school attended by children, public or
private, as this variable may also influence the ability of sustained auditory attention.
They need to be carried out guidelines for teachers and educators on the auditory
attention, as well as activities that can stimulate the development and maintenance
of this ability during the class period in order to favor the development of oral
language, writing and learning of these students.
Conclusion
The children assessed in the afternoon and those who study in public schools had a
poorer performance on sustained auditory attention, suggesting that the length of
day and type of school may be a possible source of variation in the child's ability
to sustain attention hearing.
