It is often difficult to test the hearing of children who are multiply impaired, visually impaired or deafblind. Hearing tests can be a challenge to perform and valid results are often difficult to obtain.

Even when valid results are obtained from audiological assessment, a child's performance in the clinical setting does not reveal how the child uses her/his hearing in a familiar setting such as the classroom or home environment (Goodrich & Kinney, 1985).