Optimisation of visual reinforcement audiometry: a scoping review.

Objective: Visual reinforcement audiometry (VRA) is a well-established behavioural test used to assess hearing in infants and young children. This scoping review aimed to summarise the evidence for different approaches to optimising and improving the effectiveness of VRA for clinical practice. Design: A pre-registered scoping review was conducted. Study sample: Fifty-nine original articles were included in the review. Results: The review identified a number of factors which improved response behaviour, such as increased variety and complexity of visual reinforcers, short reinforcer durations, and providing breaks. Intermittent conditioning, where as few as 50% of conditioning trials were rewarded, did not have an impact on response behaviour, and neither did the (suprathreshold) presentation level used during conditioning. More responses were achieved for younger (around 12 months) than older (around 18–24 months) infants. Once infants were developmentally ready to condition to play audiometry, this allowed for a more comprehensive hearing evaluation. Conclusions: VRA is a successful behavioural hearing test for most infants of developmental age around 7–24 months, with well-established protocols describing its clinical implementation. Further evidence is needed to assess potential benefits of different reinforcers, different auditory stimuli (e.g. filtered familiar sounds), and technologies to assist response detection.