Digit-in-Noise Test as a Hearing Screening Test for Individuals With Intellectual Disability.
DIN(2) gives valid hearing thresholds in adults with mild-moderate ID in under two minutes.
01Research in Context
What this study did
Shmerler et al. (2025) tried a two-digit hearing test on adults with mild-moderate intellectual disability. The test is called DIN(2). People listen to numbers played with noise and repeat what they hear.
The team wanted to know if adults with ID could finish the test and if their hearing scores looked like those of neurotypical adults.
What they found
Every adult with ID finished the DIN(2). Their hearing thresholds were almost the same as adults without ID.
The result shows the test works on-site and gives quick, valid hearing data for this group.
How this fits with other research
Tarasova et al. (2024) also validated a tool for adults with ID, but for dementia, not hearing. Both studies show that short, structured tasks can give clear cut-off scores clinicians can trust.
Nevin et al. (2005) used a long chart review to find new diagnoses in adults with moderate-profound ID. Noa’s five-minute DIN(2) gives faster answers for a milder group, showing how ID assessment keeps moving toward brief, practical tools.
Greenlee et al. (2024) argue we need better data tracking for all ID health issues. Adding DIN(2) to routine screens answers that call by giving a quick number we can log and compare over time.
Why it matters
You can now screen hearing in-house before therapy starts. No special booth, no long test, no refusal because the task is too hard. If a client fails DIN(2), refer for full audiology. If they pass, you know hearing is not why they ignore instructions. One minute of screening saves months of guesswork.
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02At a glance
03Original abstract
BACKGROUND: Diagnosis of intellectual disability (ID) may overshadow, or co-occur with, hearing impairment, but screening is frequently inaccessible due to various factors that prevent successful test execution. There is a pressing need for easily, locally administered hearing tests. This study aimed to assess the efficacy of the digit-in-noise (DIN) test, as well as three variations of it, as a hearing screening for individuals with mild to moderate ID. Additionally, we explored correlations between participant characteristics and cognitive-linguistic abilities, with DIN test performance. METHOD: Forty participants with ID aged 21-40 were recruited from two supported employment centres, 31 of whom met full inclusion criteria. Controls were 20 typically developed (TD) participants, aged 21-40. The original DIN test (DIN(3)) was administered, and those unable to recall the three digits were administered a version with two digits (DIN(2)). Participants unable to successfully complete DIN(3) or DIN(2) were administered versions with added visual and verbal performance feedback. RESULTS: A significant difference in speech receptive threshold in noise (SRTn) between DIN(2) and DIN(3) was only present for the ID group. A moderate negative relationship between DIN(2) SRTn and vocabulary and a positive relationship with age was found for the ID group; no correlation was found with digit span or matrices. The DIN(2) SRTn was correlated with the average hearing level of pure tones measured by audiometry. CONCLUSIONS: Our findings highlight the DIN(2) as the most effective version, as its signal-to-noise ratio (SRTn) threshold was closest to the typically developed (TD) control group. This study is the first step towards developing a hearing screening test for individuals with ID who are at elevated risk of impairment and who have insufficient evaluation access. Our findings suggest that adults with mild to moderate ID can sufficiently perform the adapted DIN(2) as a hearing screening test.
Journal of intellectual disability research : JIDR, 2025 · doi:10.1111/jir.13205