Exploring the Relationships Between Auditory Processing, Language, Cognitive, and Speech-in-Noise Abilities in School-Aged Children

OBJECTIVES: Understanding speech in noise and reverberation requires the integration of auditory, language, and cognitive abilities. Many children experience listening difficulties in such environments which, if persistent, can affect long-term academic outcomes. However, relative contributions of underlying processes remain poorly understood. This study investigated how nonspeech auditory processing, language and cognitive abilities contribute to phoneme identification and sentence understanding in noise in a representative sample of school-aged children. DESIGN: The study included 221 primary school children aged 6 to 11 yr (88 boys, 133 girls), all with normal peripheral hearing. Participants completed measures of nonspeech auditory processing, phoneme identification, and sentence understanding in noise and reverberation, as well as language ability, attention, nonverbal intelligence, and memory. Using structural equation modeling enabled us to consider the influence of multiple predictors simultaneously. RESULTS: A complex pattern of relationships emerged. Bottom-up nonspeech auditory processing supported phoneme identification, which in turn supported sentence understanding in noise. Language ability had a direct top-down influence on sentence understanding. Memory and intelligence contributed indirectly through their influence on language. Minimal associations were observed between cognition and nonspeech auditory processing, supporting a conceptual distinction between auditory and higher-level processes. CONCLUSIONS: The results show that bottom-up and top-down abilities make distinct contributions to listening and identify direct and indirect pathways underlying children's listening in adverse conditions. Auditory processing contributed to phoneme perception, which in turn supported sentence understanding in noise. Language abilities exerted a strong independent influence to sentence understanding in noise, while nonverbal intelligence and memory affected performance only indirectly through language.