Paediatric Audiology —
Training activity: 4

Details

Select, perform and interpret the following diagnostic tests on  school-age children with complex needs, and document the results:

• Behavioural observation assessment
• Distraction testing
• Visual reinforcement audiometry
• Performance/play audiometry
• Otoscopy
• Tympanometry
• Speech testing
• Diagnostic otoacoustic emissions

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Considerations

• Complex needs, including, but not limited to, Down’s syndrome, autism spectrum disorder and non-organic hearing loss
• Principles of patient-centred care and support
• Testing dependent on clinical question
• Previous results
• Test selection and modification for the development of the child
• Safeguarding procedures
• Local, national and international guidelines and best practice

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What does success look like?
  • What are the key indicators of selecting, performing, and interpreting these tests effectively for school-age children with complex needs?
  • Have you discussed expectations with your training officer?
• What is your prior experience of this activity?
  • Have you performed this range of tests on school-age children with complex needs before?
  • What do you already know about tailoring assessment techniques for different types of complex needs?
  • What specific challenges related to communication, understanding abilities, or managing behaviour during testing with complex needs might you face? How might you plan to handle them?
  • What is the scope of your own practice for testing school-age children with complex needs? When must you recognise that something is beyond your scope and seek advice or escalate?
  • How do you feel about undertaking assessments on school-age children with complex needs?
• What do you anticipate you will learn from the experience?
  • What specific adaptations to standard testing procedures for school-age children with complex needs do you want to focus on developing?
  • What specific insights into assessing hearing in this diverse population and synthesising test results do you hope to gain?
• What additional considerations do you need to make?
  • Have you reviewed any actions identified from your previous reflections on testing children with complex needs or adapting assessment methods?
  • Do you need to research the specific needs of the child beforehand or consider strategies for interagency support/communication if relevant (e.g., involving an interpreter)?

In action

• During the activity, is anything unexpected occurring?
  • Are you noticing anything surprising or different from what you anticipate during the assessment of school-age children with complex needs? Are you encountering situations such as:
    • Audiometric findings that suggest non-organic hearing loss, conflicting significantly with the child’s behaviour or history?
    • Significant difficulty performing necessary tests (e.g., Performance/Play Audiometry) due to the child’s complex needs, such as a physical disability or dual sensory impairment?
    • The child or family expressing high levels of frustration or anxiety due to the need for multiple test adaptations?
  • How is this experience comparing with previous experiences of similar activities?
• How are you reacting to the unexpected development?
  • How is the unexpected development being resolved as you progress during the activity? Are you successfully managing the situation yourself (e.g., switching the test environment, confirming results using a different modality), or do you need support because the child’s specific communication needs or the complexity of the non-organic presentation is beyond your current scope?
  • What are you learning in this moment as a result of the unexpected development? For example, are you learning more nuanced communication styles to reassure the child with complex needs, or a clearer way to verify unexpected results when adaptation is necessary?
  • How is this impacting your actions?
    • Are you responding to the situation appropriately? Are you adapting or changing your assessment approach immediately to ensure the behavioural test techniques are tailored to the individual’s needs?
    • Is this unexpected event affecting your ability to undertake the activity independently?
    • Specifically, are you immediately using active listening and validation techniques to address child/family frustration, or are you adjusting the complexity of the test procedure based on the awareness of the child’s specific additional needs?
  • How are you feeling in this moment?
• What is the conclusion or outcome?
  • How are you working within your scope of practice? E.g. Are you practising within your scope by managing the presentation of non-organic hearing loss appropriately, potentially confirming results using objective measures and ensuring referral when necessary? Are you successfully performing paediatric assessments by tailoring behavioural test techniques to the individual needs and limitations imposed by complex conditions (e.g., dual sensory impairment or physical disabilities)?
  • What are you learning as a result of the unexpected development? E.g. Are you learning more nuanced communication styles (e.g., active listening and validation techniques) to reassure a child and family experiencing frustration due to multiple test adaptations? Are you deepening your understanding of how to adjust the complexity of the test procedure based on awareness of the child’s specific additional needs?

On action

• What happened?
  • Begin by summarising the key points of the assessment with the school-age child with complex needs (e.g., a child with Down’s Syndrome or Autism Spectrum Disorder).
  • Consider specific events or actions that felt important, such as setting up adapted testing equipment or communicating results effectively to a parent/carer. What feelings were present while navigating these complexities?
  • Include any ‘reflect-in-action’ moments, where you adapted your approach, perhaps modifying the Pure Tone Audiometry procedure due to sensory sensitivities or making an immediate decision to seek supervision due to unexpected findings.
• How has this experience contributed to your developing practice?
  • Identify what learning you can take from this experience regarding assessing children with complex needs. What strengths did you demonstrate (e.g., patience, creative adaptation of techniques)? What skills and/or knowledge gaps were evident (e.g., specific knowledge of communication challenges related to the child’s specific condition, interpreting results in the context of their additional needs)?
  • Compare this experience against previous similar activities. Has your practice in adapting tests for complexity improved?
  • Identify any challenges (e.g., difficulty obtaining otoscopy on a child with physical disabilities, technical difficulties using specialised probes) and how you reacted.
  • Identify anything significant, such as needing to seek advice or clarification on the appropriate test battery for a specific syndromic hearing loss.
• What will you take from the experience moving forward?
  • Identify the actions or ‘next steps’ you will take to support assimilation.
  • What will you do differently next time? Do you need to practise any aspect of adapting communication or ensuring you are working within your scope of practice when dealing with significant complexity? E.g.
    • Reviewing clinical guidance on communication and behavioural adaptations specific to children with complex needs (e.g., Down’s Syndrome or Autism Spectrum Disorder) prior to their appointments.
    • Practising adapting Pure Tone Audiometry procedures to accommodate sensory sensitivities, ensuring patient comfort and reliable thresholds.
    • Working within your scope of practice and promptly seek supervision or advice upon encountering difficulties, such as obtaining otoscopy due to physical disabilities or unexpected findings.

Beyond action

• Have you revisited the experiences?
• • Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (selecting, performing, and interpreting diagnostic tests on school-age children with complex needs)?
  • When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to adapting behavioural methods for children with significant cognitive or physical disabilities, managing time constraints effectively, or accurately interpreting complex results?
  • Have you completed these previously identified actions? If not, what are the barriers? If so, how did completing them impact your subsequent performance of this activity? Are you ready to demonstrate this new learning confidently and consistently when performing this task?
  • Have you engaged in professional storytelling or discussed your experiences of testing school-age children with complex needs with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of interagency communication requirements, ethical considerations in testing this population, or handling unexpected developments during complex testing?
• How have these experiences impacted upon current practice?
  • Considering your cumulative experiences and reflections on this activity, how will the learning you have gained support you in preparing for relevant observed ‘in-person’ assessments for the module? For example, your improved understanding and skill in PPA preparation is vital for working within your scope of practice when dealing with this population.
  • How has your practice related to selecting, performing, and interpreting diagnostic tests on school-age children with complex needs developed and evolved over time across multiple instances of undertaking this training activity? Can you identify specific examples of improvement or increased confidence in utilising specialist testing equipment, liaising with carers/parents during the session, or formulating a preliminary diagnosis based on adapted findings?
  • Based on your experiences, how has your ability to recognise when something related to testing children with complex needs is beyond your scope of practice improved? Do you have a clearer understanding of when and from whom (e.g., paediatric clinical lead, relevant specialist teacher/therapist, medical specialist) you need to seek advice or clarification regarding highly complex cases (e.g., dual sensory impairment), profound testing difficulties, or where assessment requires multidisciplinary consensus?

Relevant learning outcomes

#	Outcome
# 2	Outcome Perform paediatric assessments adapting the test approach to suit the needs of the child.
# 3	Outcome Perform a hearing tests on children of all ages.