Effects of Age and Cognition on a Cross-Cultural Paediatric Adaptation of the Sniffin' Sticks Identification Test

Abstract

ObjectivesTo study the effects of age and cognition on the performance of children aged 3 to 18 years on a culturally adapted version of the 16 item smell identification test from Sniffin' Sticks (SS16).MethodsA series of pilots were conducted on 29 children aged 3 to 18 years old and 23 adults to produce an adapted version of the SS16 suitable for Brazilian children (SS16-Child). A final version was applied to 51 children alongside a picture identification test (PIT-SS16-Child) to access cognitive abilities involved in the smell identification task. In addition 20 adults performed the same tasks as a comparison group.ResultsThe final adapted SS16-Child was applied to 51 children with a mean age of 9.9 years (range 3-18 years, SD=4.25 years), of which 68.3% were girls. There was an independent effect of age (p<0.05) and PIT-SS16-Child (p<0.001) on the performance on the SS16-Child, and older children reached the ceiling for scoring in the cognitive and olfactory test. Pre-school children had difficulties identifying items of the test.Discussion/ConclusionsA cross-culturally adapted version of the SS16 can be used to test olfaction in children but interpretation of the results must take age and cognitive abilities into consideration.

Development of an International Odor Identification Test for Children: The Universal Sniff Test

“…To avoid the bias of age-dependent odor learning, we included young children who were old enough to understand and perform an odor identification task. Recently, Cavazzana and colleagues reported that odor identification tasks in children younger than 5 years of age to be unreliable 48 , considering previous studies 39,46 . Although some studies have claimed that children as young as 3-4 years are able to perform an odor identification task [28][29][30] , results must be evaluated with caution.…”

“…To increase the number of anosmic children in our test validation, the age range of this population was 6-17 years. Previous studies have reported an increase in odor identification score with age 27,28,39,52 . Such an increase is not expected in children with ICA.…”

“…Today several country-specific, modified versions of the UPSIT and the "Sniffin' Sticks" odor identification test are used, e.g. in Brazil, China, South Korea, Turkey and Egypt [38][39][40][41][42] . Due to the child's development in odor learning, it is plausible that especially for children, the cultural background has substantial impact on odor identification tasks.…”

Olfactory assessment in the Chinese pediatric population

“…Within each group, testing scores were not affected by the factor “age.” Several factors may contribute to the positive result, which includes verbal abilities, familiarity with odors, and cognitive capacity to identify certain odors. [ 28 , 30 ] These factors are associated with cognitive level and seem to develop with age. Cognition is known as a significant determinant of olfactory performance other than age.…”

Serum vitamin D level is associated with smell dysfunction independently of aeroallergen sensitization, nasal obstruction, and the presence of allergic rhinitis in children

“…13 This test has been used for adults and children and adolescents, including studies providing normative data for children and adolescents that can be used in clinical settings. [14][15][16] The olfactory threshold test for n-butanol was conducted by presenting a participant with 16 numbered triplets of felt-tip pens, using a single-staircase and 3 alternative forced-choice procedures. Three pens were placed in a random order, 1 with the odorant and 2 others with the solvent alone.…”