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The TDT test is a two-alternative, forced-choice, staircase procedure that uses strict rules to meet criteria than prior methods12, thus ensuring a more stable outcome measure. Using criteria established at the Monell-Jefferson Chemosensory Clinical Research Center2, the TDT is a reliable swish-and-spit method that measures the lowest concentration of sucrose, NaCl, or MSG in solution that can be detected by taste among individuals as young as 6 years. If completed as described, including enforcing participants rinsing their mouths before and after each tasting, the results are reliable and quick and provide insight into an important dimension of taste that is independent of hedonics8.
Although the application of psychophysical tools to measure this dimension of taste is well established in the field, many methods have not been validated for use in children14. There are several critical steps in the protocol, some of which apply particularly to children [see also reference15]. First, criteria for attaining threshold should not rely solely on the occurrence of any four reversals or vary due to the age of the participant. Rather, there should be a maximum of two dilution steps between two successive reversals, and the series of reversals should not form an ascending pattern, which may be the case when the participant is simply guessing or not attending to the task. These additional criteria, which were established based on clinical experience2, allow for the evaluation of the functioning of the taste system of the individual, in part because they control for false positives, especially when the participant is simply guessing16.
Second, the procedure is forced-choice, so if participants respond that "neither" or "both" solutions have a taste, that answer is not accepted. Rather, they are told to "guess." During TDT, participants often feel like they are guessing, but that should not be accepted as evidence that they are completely unaware of the taste stimuli17. Moreover, individuals may vary in their internal criteria for what constitutes a taste sensation and hence, their willingness to say that a solution does or does not have a taste. Third, because the recency of eating affects taste perception18, standardizing the time since the participant last ate or drank anything but water is important to reduce intersubject variability caused by sensory adaptation or enhancement. Fourth, the tastants used herein are palatable and presented in solution, not in a food matrix. When a food matrix is used, longer interstimulus intervals might be required for foods to clear the palate. While this method has been used to measure detection thresholds for sour or bitter tastants among adults2,11, its use to measure detection thresholds for unpalatable tastants among some young children may be problematic due to their heightened sensitivity to some bitter tastants and their potential unwillingness to continue participation19.
A forced-choice procedure of presenting up to four pairs of ascending concentrations of bitter-tasting solutions and dH2O has been successful for pediatric populations19,20. Fifth, embedded in the context of a game, the method is sensitive to the cognitive and language limitations of children, and requires only that the participant point to the cup that contains the taste. In a recent study, 80% of the children provided sustained attention for, on average, 15 min and reached criteria8. Such information on completion of the tasks should be reported, particularly when pediatric populations are studied.
The present method has real-world relevance and has been used for assessing detection thresholds for the other basic tastes of sour (citric acid) and bitter (quinine)2 and in adults of varying ages8. Because the method does not require verbal responses, the instructions should easily be translated to other languages21, making it a valuable psychophysical tool for scientists worldwide. However, like any other psychophysical methods, there will likely be limitations in its use, particularly with younger children. The procedure may be more difficult to attain criteria for children than for adults. In one study, 20% of children did not reach criteria, compared to 5% of adults8. Reasons for non-completion included unfocused behavior, failure to understand the task, or becoming fatigued and unable to continue.
Findings from studies that used this taste TDT have contributed extensively to the diagnosis of taste ageusia in the clinic and have furthered the understanding of how taste sensitivity changes with age and health status. Clinical evaluation of patients revealed that sucrose detection thresholds ≥ 0.025 M for both sexes and NaCl detection thresholds ≥ 0.012 M for men or ≥ 0.010 M for women are considered abnormal2. Among adults, there is a gradual decline in taste sensitivity for sweet, salty, sour, and bitter tastes that continues into the eighth decade22. Younger adults typically have lower taste detection thresholds (are more sensitive) than are older adults22,23,24,25. However, children and adolescents have taste thresholds for sucrose that are higher (less sensitive)8 and that are lower (more sensitive) than those of adults for the bitter taste of propylthiouracil, with the adult pattern emerging during adolescence19,26.
Taste detection thresholds have been shown to be related to indicators of health. For example, salt taste detection thresholds positively correlated with systolic blood pressure among children who were normal weight7, whereas children with central obesity had lower detection thresholds for sucrose (more sensitive) than those without central obesity4, with similar findings among adolescents27. However, the relationship between obesity and sucrose detection thresholds was not observed in adult women, and adult women with obesity had higher detection thresholds (were less sensitive) to the savory taste of MSG9.
While research on the differences in detection thresholds between children and adults are limited, it is known that sucrose taste detection thresholds do not predict sweet taste preferences or suprathreshold intensity ratings from childhood to adulthood8,28,29, providing further evidence that taste sensitivity represents a distinct dimension of taste that is independent of preferences and thus suggesting different underlying mechanisms. Greater understanding of the complex interplay among age, dietary habits, health status, and the sensitivity of the taste system, and whether such interactions differs among the primary tastants, is an important area for future research.