J Am Acad Audiol 2019; 30(05): 363-369
DOI: 10.3766/jaaa.17125
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparison of Children’s Double Dichotic Digits and SCAN-3 Competing Words Free Recall Scores

Kairn Stetler Kelley
*   Program in Clinical and Translational Science, University of Vermont, Burlington, VT
Benjamin Littenberg
*   Program in Clinical and Translational Science, University of Vermont, Burlington, VT
†   Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT
› Author Affiliations
Further Information

Publication History

06 October 2018

10 October 2018

Publication Date:
26 May 2020 (online)



Practice guidelines do not specify which test recordings are best for assessing dichotic deficit or interaural asymmetry. Dichotic Digits and SCAN-3 Competing Words Free Recall are among the most widely used dichotic tests, but it is not known if the choice of test results in important differences in the identification of children with deficits or if they can be used interchangeably.


To determine whether two commonly used dichotic tests, SCAN-3 Competing Words Free Recall (CW) and Musiek’s Dichotic Digits (DD), agree on interaural asymmetry and dichotic deficit in children.

Research Design:

CW and DD tests were administered to all participants. Each participant had a single study visit.

Study Sample:

Sixty volunteers aged 7–14 years with normal hearing sensitivity participated in the study.

Data Collection and Analysis:

Hearing sensitivity, CW, and DD performance were measured at a single study visit. We used Spearman’s rho (ρ) to assess associations between rank ordering of participants by each test and the kappa statistic (κ) to assess decision consistency between tests.


Participants were rank-ordered similarly by CW and DD for the right ear (ρ = 0.58), left ear (ρ = 0.51), and total (ρ = 0.73) scores, but not for interaural asymmetry (ρ =0.18). They agreed no better than chance on direction of ear advantage (κ = 0.01, p = 0.93) and had poor agreement on which children scored below cut-scores (κ = 0.22, p < 0.01). DD identified significantly more participants with deficits (n = 18) than CW (n = 3) (p < 0.001).


Although children with high scores on one test tend to have high scores on the other, CW and DD do not agree on ear advantage or the presence of deficit. They are not interchangeable for clinical use. Additional research is needed to determine whether either is appropriate for identifying children who would benefit from treatment for dichotic listening deficits.

A preliminary analysis of these data was presented to the 2015 Scientific and Technology Meeting of American Auditory Society in Scottsdale, AZ, March 5.


  • Abigail ER, Johnson EG. 1976; Ear and hand dominance and their relationship with reading retardation. Percept Mot Skills 43 (03) 1031-1036
  • Agnew J. 2004; Effect of intensive training on auditory processing and reading skills. Brain Lang 88 (01) 21-25
  • American Academy of Audiology 2010 Guidelines for the Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder
  • American Speech-Language Hearing Association 2005. (Central) auditory processing disorders [Technical Report] Rockville, MD: American Speech-Language-Hearing Association;
  • American National Standards Institute (ANSI) 1996. American Standard Specifications for Audiometers. ANSI S3.6-1996 New York, NY: ANSI;
  • American National Standards Institute (ANSI) 1999. Maximum Permissible Ambient Noise Levels for Audiometric Test Rooms. ANSI S3.1 - 1999 R2013 New York, NY: ANSI;
  • Bellis TJ. 2002. Assessment & Management of Central Auditory Processing Disorders in the Educational Setting: From Science to Practice. 2nd ed. Clifton Park, NY: Singular;
  • Carhart R, Jerger JF. 1959; Preferred method for clinical determination of pure-tone thresholds. J Speech Hear Disord 24 (04) 330-345
  • Chermak GD, Silva ME, Nye J, Hasbrouck J, Musiek FE. 2007; An update on professional education and clinical practices in central auditory processing. J Am Acad Audiol 18 (05) 428-452
  • Cullen JK, Thompson CL, Hughes LF, Berlín CI, Samson DS. 1974; The effects of varied acoustic parameters on performance in dichotic speech perception tasks. Brain Lang 1 (04) 307-322
  • DeBonis DA. 2015; It is time to rethink CAPD protocols for school-aged children. Am J Audiol 24 (02) 124-136
  • Dlouha O, Novak A, Vokral J. 2007; Central auditory processing disorder (CAPD) in children with specific language impairment (SLI). Central auditory tests. Int J Pediatr Otorhinolaryngol 71 (06) 903-907
  • Emanuel DC. 2002; The auditory processing battery: survey of common practices. J Am Acad Audiol 13 (02) 93-117
  • Emanuel DC, Ficca KN, Korczak P. 2011; Survey of the diagnosis and management of auditory processing disorder. Am J Audiol 20 (01) 48-60
  • Harshman RA, Lundy ME. 1988. Can dichotic listening measure “degree of lateralization”?. In: Hugdahl K. Handbook of Dichotic Listening: Theory, Methods, and Research. New York, NY: John Wiley & Sons; 215-282
  • Hugdahl K. 2011; Fifty years of dichotic listening research–still going and going and…. Brain Cogn 76 (02) 211-213
  • Hurley RM, Musiek FE. 1997; Effectiveness of three central auditory processing (CAP) tests in identifying cerebral lesions. J Am Acad Audiol 8 (04) 257-262
  • Jerger JF, Hayes D. 1976; The cross-check principle in pediatric audiometry. Arch Otolaryngol 102 (10) 614-620
  • Keith RW. 1986. Screening Test for Auditory Processing Disoders (SCAN). San Antonio, TX: Psychological Corportation and Harcourt Brace Jovanovich;
  • Keith RW. 2009. a SCAN-3 for Adolescents and Adults Tests for Auditory Processing Disorders Manual. Pearson;
  • Keith RW. 2009. b SCAN-3 for Children Tests for Auditory Processing Disorders Manual. Pearson;
  • Kelley KS, Littenberg B. 2018; Structured review of dichotic tests of binaural integration: clinical performance in children. Am J Audiol 27 (01) 156-166
  • Kelley KS, Littenberg B. 2019; Dichotic listening test-retest reliability in children. J Speech Lang Hear Res 62 (01) 169-176
  • Kimura D. 1961; Some effects of temporal-lobe damage on auditory perception. Can J Exp Psychol 15: 156-165
  • Moncrieff D, Black JR. 2008; Dichotic listening deficits in children with dyslexia. Dyslexia 14 (01) 54-75
  • Moncrieff D, Musiek FE. 2002; Interaural asymmetries revealed by dichotic listening tests in normal and dyslexic children. J Am Acad Audiol 13 (08) 428-437
  • Musiek FE. 1983; a Assessment of central auditory dysfunction: the dichotic digit test revisited. Ear Hear 4 (02) 79-83
  • Musiek FE. 1983; b Results of three dichotic speech tests on subjects with intracranial lesions. Ear Hear 4 (06) 318-323
  • Musiek FE, Gollegly KM, Kibbe KS, Verkest-Lenz SB. 1991; Proposed screening test for central auditory disorders: follow-up on the dichotic digits test. Am J Otol 12 (02) 109-113
  • Noffsinger D, Martinez CD, Andrews M. 1996; Dichotic listening to speech: VA-CD data from elderly subjects. J Am Acad Audiol 7 (01) 49-56
  • Noffsinger D, Martinez CD, Wilson RH. 1994; Dichotic listening to speech: background and preliminary data for digits, sentences, and nonsense syllables. J Am Acad Audiol 5 (04) 248-254
  • Rosenberg G. 2011; Development of local child norms for the dichotic digits test. J Educ Audiol 17: 6-10
  • Turner RG. 2003; Double checking the cross-check principle. J Am Acad Audiol 14 (05) 269-277
  • Vermiglio AJ. 2014; On the clinical entity in audiology: (central) auditory processing and speech recognition in noise disorders. J Am Acad Audiol 25 (09) 904-917
  • Viera AJ, Garrett JM. 2005; Understanding interobserver agreement: the kappa statistic. Fam Med 37 (05) 360-363
  • Wilson RH, Jaffe MS. 1996; Interactions of age, ear, and stimulus complexity on dichotic digit recognition. J Am Acad Audiol 7 (05) 358-364
  • Wilson RH, Leigh ED. 1996; Identification performance by right- and left-handed listeners on dichotic CV materials. J Am Acad Audiol 7 (01) 1-6
  • Wilson WJ, Arnott W. 2013; Using different criteria to diagnose (C)APD: how big a difference does it make?. J Speech Lang Hear Res 56: 63-70