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Behavioural audiometry in children: BOA, VRA, play audiometry and corrected age
The behavioural method is chosen by the child's developmental age, not age from birth: watching responses in a young infant, visual reinforcement from about six months, play from about two and a half to three, and conventional testing from school age. In a preterm baby, responses are read by corrected age.
Why it matters in the exam
The bank asks when each method is used. In behavioural observation (BOA, from birth to about 6 months) the tester watches for responses such as stopping sucking, eye widening or a startle; it gives a minimum response level, not a threshold, and the levels drop as the infant grows. A sideways head turn toward sound begins at about 3–4 months and matures by about 6–7 months; a baby who always turns to the same side, wherever the sound comes from, is not localising. VRA suits a developmental age of about 6 months (head control) up to about 2–2.5 years: a head turn to sound is rewarded with a lit display. Conditioned play audiometry (CPA) suits about 2.5–3 years onward: each sound becomes a cue for a small game move — a block into a bucket, a ring onto a stick.
Corrected age is used for babies born before week 37: chronological age minus the weeks born early, usually up to age two. A baby born at week 30 and tested at 7 months behaves like a baby of about 4.5 months; a baby born at week 38 counts as term and gets no correction. In the sound field pure tones are not used because of standing waves; warble tones, narrowband noise and speech are used instead — and the result reflects only the better ear. A typically developing 6-year-old being tested before a hearing-aid fitting is tested ear by ear and frequency by frequency under earphones, and in a cooperative adult behavioural pure-tone audiometry is the most accurate test. The cross-check principle: every behavioural result in a child is confirmed by an independent test (tympanometry, OAE, ABR).
Key points
- BOA up to about 6 months; VRA from about 6 months; CPA from about 2.5–3 years.
- Horizontal head turn to sound from about 3–4 months.
- Preterm: corrected age; born at week 38 — no correction.
- Sound field: warble tones and narrowband noise; better ear only.
- Cross-check: every behavioural finding is confirmed objectively.
Summary table
| Method | Developmental age | What it gives |
|---|---|---|
| BOA | Birth to about 6 months | A minimum response level, not a threshold; depends on corrected age |
| VRA | About 6 months to 2–2.5 years | Thresholds in sound field or under earphones with visual reward |
| CPA | About 2.5 to 5 years | Ear- and frequency-specific thresholds through play |
| Conventional audiometry | From about 5–6 years | Full thresholds; the basis for fitting aids |
| Localisation development | Horizontal turn from about 3–4 months, mature by 6–7 months | Always turning to one side — no localisation |
| Sound-field stimuli | Warble tone, narrowband noise, speech | No pure tones; reflects only the better ear |
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Sources
- Madell, Flexer, Wolfe & Schafer (eds.), Pediatric Audiology, 3rd edition (2019) — Behavioural assessment by age
- Jerger & Hayes, Archives of Otolaryngology, 1976 — The cross-check principle in pediatric audiometry
- American Academy of Audiology, 2020 — Clinical Guidance Document: Assessment of Hearing in Infants and Young Children
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.