Validation of the Second Version of the LittlEARS^® Early Speech Production Questionnaire (LEESPQ) in Romanian-Speaking Children with Normal Hearing

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Nil

Comments for author File: Comments.pdf

Comments on the Quality of English Language

Needs improvement 

Author Response

Comments 1:
Abstract In the result section, What author inferred with “A number of 232 questionnaires were analyzed”??. Does that mean the data collected from 232 participants were analyzed? If yes, rephrase the sentence for better clarity. 
Response 1:
The Result section from Abstract was rewritten.

Comments 2:
Page 2, line no. 51-52, the Author can avoid writing single-sentence paragraphs. Author/s should be consistent in using the term LittleEars/Littlears consistently throughout the manuscript whichever is appropriate.
Respones 2:
We have ensured that the manuscript contains no single-sentence paragraphs. Additionally, we have standardized the terminology by exclusively using the term LittlEARS® consistently throughout the text.

Comments 3:
Line no. 69-78, the Author should justify better for the need to adapt the Romanian version of the LEESPQ from the English version.
Response 4:
We believe we have thoroughly explained the necessity of translating the questionnaire into other languages, including Romanian, as highlighted on page 2, line 23. Additionally, we have provided detailed information about the translation process in both the Introduction and Methods sections, ensuring clarity and comprehensiveness.

Comments 4:
Line no. 102, How did the author arrive at 232 participants? Did they perform sample size calculations? Or, it is just based on the availability of the participants.
Response 4:
In the Subjects section we explained better how the subjects were recruited.

Comments 5:
Line no. 103-04, there is a difference in a number of girls and boys mentioned in the method (girls n=94; boys n=104; undeclared gender n=5) and result section (Female: n=106 & male: n=121). The author can review the same
Response 5:
We identified and corrected the error in the reported number of girls and boys in the Methods section to ensure the accuracy and reliability of the data presented.

 Comments 6:
Line no. 107-08, What were the pass criteria used for OAE test? Was TEOAE/DPOAE done? The author should specify the same. What was the rationale for considering only OAE test for inclusion criteria?

Response 6:
The inclusion of only OAE testing as a criterion was based on the fact that all newborns in Romania undergo OAE testing as part of the national newborn hearing screening program. This standardized procedure ensures uniformity in assessing hearing function for all participants.

 

Comments 7:
Line 193, Typo error “Bellow” instead of ‘below’.
Response 7:
We corrected the typo error.

Comments 8: Results
In the abstract and method, it is mentioned that 129 patients' medical records are reviewed whereas in the result section it is mentioned that 128 patients' medical records were reviewed. Which one is correct- 128/129? Line 69-70 & 79-80, Author mentioned that “the largest ethnic group was Malay (91.4%) followed by Chinese (7.8%). How does this information have significance in the prevalence study? This could be because the study is conducted in that locality or, does that mean Malay population are more vulnerable to TH than other population? Line 87-88, What about the 2 patients' audiometry report (as it is mentioned 126 out of 128) Line 88, Which 4FA was considered. Was it 500, 1k, 2k, & 4k Hz? Author should mention the same. Line 91, the Author should mention the percentage of unilateral and bilateral hearing loss. Line 123-124, the Author mentioned that most patients with hyperacusis (37.5%) had mild tinnitus followed by very mild tinnitus (31.2%). What is the difference between mild and very mild tinnitus? I guess the operational definition of these terminologies will help the prospective reader to understand better. Further, 37.5% should not be mentioned as the most patients. 
Response 8:
The comments for the Results seems to be for other study.

Comments 9:
The correlation of different questions with age and its clinical significance should be discussed with supporting literature.
Response 9:
We added clinical significance of the correlation in Results page 5, line 19 and in Discussion page 7 line 16

Comments 10:
The regression curve with age and its understanding clinically with supporting literature could add value to the discussion.
Response 10:
We added details for regression curve on page 7 line 16.

Comments 11:
The overall discussion is very weak and needs strengthening. Authors should explain the rationale of values obtained across different age groups and their clinical significance with relevant literature support.
Response 11:
We removed 1-3-6 model from the study

Reviewer 2 Report

Comments and Suggestions for Authors

Thank you for this interesting study, which I read with great interest! I am convinced that the text will clearly improve in quality if more content-related information about the questionnaire itself and about the development of early language skills is integrated into the text. At the moment, the text is very much limited to the “technical”, namely the translation and validation of the tool, which is not really new and seems difficult to access for readers who are not familiar with the contents of the LEESPQ. What exactly can it be used for, and how come that development is similar in other languages? It would be important and nice to put this into a larger context.

Besides, I have some other comments.

P 1, line 24/25:

“The data analysis shows that the LEESPQ is reliable, accurate, and consistent…”

This is not a result, but a conclusion. In the result section you should present statistical results.

P 1, line 34/35:

“The statistical data from Romania, from the year 2022, show that, of the 21,556 people with hearing disabilities, 1985 were represented by children (1).“

This is a very wordy sentence. Please reformulate. You could give percentages instead of absolute numbers. “Hearing disabilities” is old-fashioned, besides you also use hearing impairment, whereby the difference is not entirely clear. Please change to “peripheral hearing disorder”, if that is what you want to say. “Impairment” could also mean CAPD. Please have a look at the whole text to ensure that you changed everything.

P1, line 37:

“Diagnosis as early as possible and early auditory rehabilitation“

Please add „hearing care“, „provision with hearing aids“. Use “early intervention” instead of early auditory rehabilitation, which is a bit old-fashioned.

P2, line 51/52:

„the LittlEars test battery developed by Coninx and collaborators“

Only the LittlEARS® (LEAQ) auditory questionnaire was developed by Coninx and collaborators, the whole test battery consists of other tools developed by others.

You should also use the Copyright symbol ® for the LEAQ®. You should check if you are obliged to use this for LEESPQ® too. Maybe you should also add the name of the person who developed it? (I don't know who it is, sorry - and it would be interesting to know why you validated the "second version" (heading of your text). What happened to the first version?).

After reading the whole paper, I start to wonder if you could give more information about the questionnaire and about early speech production. What exactly does the questionnaire ask for, what can parents observe, what should they be attuned to?

P2, line 55:

“LEESPQ, the short auditory questionnaire“

A sentence before you wrote “LittlEars Early Speech Production auditory questionnaire”, why is it only a short auditory questionnaire now?

P2, line 62-64:

“Due to the cultural differences between different languages, the authors recommended the translation and validation of the questionnaire in each new language (Weichbold et.al., 2005).”

This was referred to the LEAQ, not to LEESPQ. So this is not “the questionnaire” of your study you refer to.

P2, line 69:

„The English version was adapted into Romanian“

The Canadian version? Please clarify.

P2, line 79:

„are compared to evaluate the quality of the translation“

Could you please add how exactly they are compared? Does a person only look at the results or is there a statistical proof necessary?

P2, line 83/84:

“complete the auditory questionnaire LittlEars Early Speech Production (LEESPQ)”

In line 53/54 it was the Early Speech Production auditory questionnaire, now it is the auditory questionnaire Speech Production. Please stick to the original name and don’t switch.

P2, line 88/89:

“parents/guardians can describe the 88 children's auditory responses in real situations.”

But the LEESPQ does not ask about auditory responses, it is about early Speech Production. Please reformulate.

P3, 95-10:

“The LittlEars Early Speech Production auditory questionnaire (LEESPQ) was initially developed in German. The version, later translated into English, was the basis for the adaptation of the questionnaire in other languages. The English version was adapted into Romanian using the translation/reverse translation procedure recommended by the International Testing Commission (ITC). In this way, the aim is to preserve the variable meanings of the test items in the questionnaire and to ensure a linguistically correct version.”

You already said everything in the introduction about using the English version for translation/back-transation, adaptation and so on. This is a repetition. Please move your explanations from the introduction to the methods section. You could add more information about the questionnaires LEAQ and LEESPQ in the introduction instead.

P 3, 101

“Subjects”

Could you add where you recruited your parents? Where did it all take place? Were parents in a clinic? (Because you did OAE). Why did parents come to you? Only for the questionnaire or was there something else?

P 3, line 115:

“interviewer”

You talk about an interviewer/a researcher here: Did the person accompany the parents in any way while they were filling out the questionnaire? The questionnaire is normally very easy to understand and you won’t need any assistance if you are literate. What exactly did the interviewer do?

P 5, line 175-185

I am not sure why you are referring to the 1-3-6 model which is basically a guideline for hearing device provision and not for milestones of development. You should make clear in your paper what kind of connection you see from diagnosis and time of provision of hearing aids to the questionnaire LEESPQ; Honestly I don’t see any connection to the questionnaire, in which development is continuously recorded. I don't see any particular or foundational change in your table at 1, 3 and 6 months which could point to the guideline.

P 5, table 1

Legend: You should add: age in months

Results: Is it percent?... Please add that to your legend.

P 6, table 2:

Could you please add your motivation for calculating the response rate with a ration of “yes” above/below 50%? What information did you gain with this?

P 7, line 196-197:

“A regression analysis was conducted to create a normative curve for auditory behavior development in children aged 0 to 2 years.”

The LEESPQ is not a questionnaire for auditory behavior, but for early speech production. Please reformulate.

P 9, Conclusion

There are many aspects in the conclusion that you just repeat from the discussion; could you please rather give more of an outlook into the future what you would like to do with this questionnaire? (You already did this, but you could intensify).  

Author Response

Comment 1:
Thank you for this interesting study, which I read with great interest! I am convinced that the text will clearly improve in quality if more content-related information about the questionnaire itself and about the development of early language skills is integrated into the text. At the moment, the text is very much limited to the “technical”, namely the translation and validation of the tool, which is not really new and seems difficult to access for readers who are not familiar with the contents of the LEESPQ. What exactly can it be used for, and how come that development is similar in other languages? It would be important and nice to put this into a larger context.
Response 1:
We appreciate your suggestion to provide more content-related information about the questionnaire and early language development. In response, we have enriched the text with additional details about the LEESPQ’s purpose, its practical applications, and how it aligns with early language development milestones. Furthermore, we have included a discussion on the similarities in developmental patterns across languages and placed the study in a broader context to make it more accessible and engaging for a diverse readership.

Comment 2:
P 1, line 24/25:
“The data analysis shows that the LEESPQ is reliable, accurate, and consistent…”
This is not a result, but a conclusion. In the result section you should present statistical results.
Response 2:
We agree with this comment. Therefore, we changed the Result from Abstract presenting statistical results, page 1 line 22.

Comment 3:
P 1, line 34/35:
“The statistical data from Romania, from the year 2022, show that, of the 21,556 people with hearing disabilities, 1985 were represented by children (1).“This is a very wordy sentence. Please reformulate. You could give percentages instead of absolute numbers. “Hearing disabilities” is old-fashioned, besides you also use hearing impairment, whereby the difference is not entirely clear. Please change to “peripheral hearing disorder”, if that is what you want to say. “Impairment” could also mean CAPD. Please have a look at the whole text to ensure that you changed everything.
Response 3:
We agree with this comment. Therefore, we changed the paragraph that starts on page 2 line 13

Comment 4:
P1, line 37:
“Diagnosis as early as possible and early auditory rehabilitation“
Please add „hearing care“, „provision with hearing aids“. Use “early intervention” instead of early auditory rehabilitation, which is a bit old-fashioned.
Response 4:
We agree with this comment. Therefore, we changed the sentence on page 2 line 15

Comment 5:
P2, line 51/52:
„the LittlEars test battery developed by Coninx and collaborators“
Only the LittlEARS® (LEAQ) auditory questionnaire was developed by Coninx and collaborators, the whole test battery consists of other tools developed by others.
You should also use the Copyright symbol ® for the LEAQ®. You should check if you are obliged to use this for LEESPQ® too. Maybe you should also add the name of the person who developed it? (I don't know who it is, sorry - and it would be interesting to know why you validated the "second version" (heading of your text). What happened to the first version?).
After reading the whole paper, I start to wonder if you could give more information about the questionnaire and about early speech production. What exactly does the questionnaire ask for, what can parents observe, what should they be attuned to?
Response 5:
We have revised the phrase related to the LittlEARS® Auditory Questionnaire (LEAQ) on page 1, line 40, to improve clarity and accuracy. Additionally, we have ensured the inclusion of the copyright symbol where appropriate throughout the document.
On page 2, line 3, we have explicitly stated who developed the questionnaire, providing appropriate references to support this clarification.
Regarding the questionnaire versions, we clarified that the initial version is designed for children aged 0–24 months, while the second version is intended for children aged 0–18 months. Our study focuses on children aged 0–18 months, as this version aligns with our interest in assessing auditory and speech development in the context of cochlear implants.
We have expanded the information on early speech production on page 1, lines 31–34, to provide a more comprehensive overview. While we believe the explanation of the questionnaire was detailed, we recognize the need for greater clarity. Therefore, we have added more specific details on page 2, line 8, to outline what the questionnaire assesses.

Comment 6:
P2, line 55:
“LEESPQ, the short auditory questionnaire“
A sentence before you wrote “LittlEars Early Speech Production auditory questionnaire”, why is it only a short auditory questionnaire now?
Response 7:
We have resolved the issue by ensuring consistent use of the correct name, LittlEARS® Early Speech Production Questionnaire, throughout the text.

Comment 8:
P2, line 62-64:
“Due to the cultural differences between different languages, the authors recommended the translation and validation of the questionnaire in each new language (Weichbold et.al., 2005).”
This was referred to the LEAQ, not to LEESPQ. So this is not “the questionnaire” of your study you refer to.
Response 8:
We have fixed the issue on page 2 line 9

Comments 9:
P2, line 69:
„The English version was adapted into Romanian“
The Canadian version? Please clarify.
Response 9:
We removed reference to Canadian version.

Comments 10:
P2, line 79:
„are compared to evaluate the quality of the translation“
Could you please add how exactly they are compared? Does a person only look at the results or is there a statistical proof necessary?
Response 10:
We have provided details how translated versions are compared on page 2, line 50

Comments 11:
P2, line 83/84:
“complete the auditory questionnaire LittlEars Early Speech Production (LEESPQ)”
In line 53/54 it was the Early Speech Production auditory questionnaire, now it is the auditory questionnaire Speech Production. Please stick to the original name and don’t switch.
Response 11:
We have resolved the issue by ensuring consistent use of the correct name.

Comments 12:
P2, line 88/89:
“parents/guardians can describe the 88 children's auditory responses in real situations.”
But the LEESPQ does not ask about auditory responses, it is about early Speech Production.
Response 12:
We reformulate the sentence.

Comments 13:
P3, 95-10:
“The LittlEars Early Speech Production auditory questionnaire (LEESPQ) was initially developed in German. The version, later translated into English, was the basis for the adaptation of the questionnaire in other languages. The English version was adapted into Romanian using the translation/reverse translation procedure recommended by the International Testing Commission (ITC). In this way, the aim is to preserve the variable meanings of the test items in the questionnaire and to ensure a linguistically correct version.”
You already said everything in the introduction about using the English version for translation/back-transation, adaptation and so on. This is a repetition. Please move your explanations from the introduction to the methods section. You could add more information about the questionnaires LEAQ and LEESPQ in the introduction instead.
Response 13:
We moved this paragraph in the Introduction, page 2 line 40

Comments 14:
P 3, 101
“Subjects”
Could you add where you recruited your parents? Where did it all take place? Were parents in a clinic? (Because you did OAE). Why did parents come to you? Only for the questionnaire or was there something else?
Response 14:
We added more details about subjects on page 3 line 9.

Comments 15:
P 3, line 115:
“interviewer”
You talk about an interviewer/a researcher here: Did the person accompany the parents in any way while they were filling out the questionnaire? The questionnaire is normally very easy to understand and you won’t need any assistance if you are literate. What exactly did the interviewer do?
Response 15:
We added more information about interviewer and what he did on page 3, line 9.

Comments 16:
P 5, line 175-185
I am not sure why you are referring to the 1-3-6 model which is basically a guideline for hearing device provision and not for milestones of development. You should make clear in your paper what kind of connection you see from diagnosis and time of provision of hearing aids to the questionnaire LEESPQ; Honestly I don’t see any connection to the questionnaire, in which development is continuously recorded. I don't see any particular or foundational change in your table at 1, 3 and 6 months which could point to the guideline.
Response 16:
Thank you for your insightful observation. We agree that the 1-3-6 model is not directly relevant to the scope of our study as it pertains to guidelines for hearing device provision rather than developmental milestones recorded by the LEESPQ. In light of this, we have removed all references to the 1-3-6 model from our study.

Comments 17:
P 5, table 1
Legend: You should add: age in months
Results: Is it percent?... Please add that to your legend.
Response 17:
We really didn't understand the comment. We suppose you were referring to figure 1 instead table 1.
We changed for clarity the name of the axes of figure 1.

Comments 18:
P 6, table 2:
Could you please add your motivation for calculating the response rate with a ration of “yes” above/below 50%? What information did you gain with this?
Response 18:
This table is from to 1-3-6 model that we removed.

Comments 19:
P 7, line 196-197:
“A regression analysis was conducted to create a normative curve for auditory behavior development in children aged 0 to 2 years.”
The LEESPQ is not a questionnaire for auditory behavior, but for early speech production. Please reformulate.
Response 19:
We reformulate the sentence, page 5, line 2

Comments 20:
P 9, Conclusion
There are many aspects in the conclusion that you just repeat from the discussion; could you please rather give more of an outlook into the future what you would like to do with this questionnaire? (You already did this, but you could intensify).
Response 20:
We have revised the conclusion to minimize repetition from the discussion and provide a more forward-looking perspective. The updated conclusion now includes specific details about future directions and potential applications of the questionnaire.