Spoken Language and Literacy Development for Today`s Children

Spoken Language and Literacy
Development for Today’s Children
with Hearing Loss
Denise Wray, Ph.D., CCC-SLP, LSLS
Cert. AVT
The University of Akron
School of Speech Pathology & Audiology
dwray@uakron.edu
The University of Akron’s Auditory-Verbal Clinic:
Training Parents as Language Facilitators
www.auditoryoptions.org
Diagnostic Audiology Services for
Children
Carol Flexer, Ph.D., CCC-A, LSLS Cert. AVT
Changing Demographics
Gallaudet Research Institute
(2008)

“For the 17-year-olds and the 18year-olds in the deaf and hard of
hearing students norming sample, the
median Reading Comprehension
subtest score corresponds to about a
4.0 grade level for hearing students.”
Project Hope
Results (1999)
Progress Achieved, but
Challenges Exist…(Lyons, 2011)
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Early Hearing Detection and Intervention
(EHDI) Act of 2010 reauthorized
About half of those referred for a diagnosis
following a failed screening are lost to the
system (Joint Com. on Infant Hearing sets the “Gold Standard”)
One-third of infants in the system do not
receive a diagnostic eval. by 3 mos. of age
More than half diagnosed are not enrolled in
intervention programs by 6 mos. of age
Parental Choices Changing
Dramatically…

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In 1995: 40% of families chose spoken
language options compared to those who
chose sign/visually-based communication
modes.
In 2005: 85% chose spoken language
options compared to 15% who chose
sign. (Brown, 2006)
Early Intervention Outcomes

Data from the Colorado Project are showing that
children born with a profound hearing loss who obtain
a cochlear implant before they are 2, have a high
chance of obtaining intelligible speech (YoshinagoItano, Sedey, Coulter, & Mehl, 1998).
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This outcome is based on having the cochlear implant
mapped appropriately and worn consistently.
Direct, repetitive auditory skill instruction as part of
an effective early intervention program.
Niparko, J., Journal of the American
Medical Association (2011)

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Children receiving cochlear implants before 18
months are achieving age-appropriate spoken
language outcomes.
“Babies are primed to learn language, but if
not exposed to spoken language early, the
window begins to close and by 5 years of age,
it is substantially shut.”
Effects of Early Auditory Experience on
Spoken Language at 3 Years
(Nicholas & Geers, 2006-Ear & Hearing)
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Longer use of a cochlear implant in infancy
and very early childhood (i.e., before age 3)
dramatically affects the amount of spoken
language exhibited by 3.5 year old children
with profound hearing loss, even more so than
a greater amount of pre-implant intervention
given to children wearing hearing aids
Key factor: early cochlear implantation
optimizes spoken language
Hierarchy of Listening Skills
(Erber, 1977)
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Detection: ability to respond to presence or absence
of sound
Discrimination: ability to perceive similarities &
differences among 2 or more speech stimuli
Identification/Recognition: ability to reproduce a
speech stimulus by pointing at a picture, writing, or
by repeating the speech heard
Comprehension: ability to understand the meaning
of speech by answering questions, following
directions, paraphrasing or engaging in conversation
Detection
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Awareness of sound…we’re growing the BRAIN, BRAIN, BRAIN!
Teach conditioned play response and spontaneous alerting responses
However….First obtain a BASELINE…
MED-EL: Auditory Checklist Questionnaire (one for parents and one for
professionals-www.medel.com-out of Innsbruck, Austria) to establish auditory
goals and objectives for treatment plan
 IT-MAIS (Osberger, McKonky-Robbins, Zimmerman-Phillips)
 Infant-Toddler Meaningful Auditory Integration Scale
 Interview style with 10 probes
 Assesses
 Vocalization behavior
 Alerting to sounds
 Deriving meaning from sounds
 Available from ADVANCED BIONICS
(800) 678-2572 or www.bionicear.com
Detection…Environmental Sounds
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Listening Walks- “I Hear That!”
Set the Stage for an Auditory Lifestyle:
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Top 10 Strategies for Parents by Jill Bader
 jbaderconsultant@aol.com
 303-841-7987
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Jabber Journal: kept by the parent
Parent reports sounds the child detects
 Parent reports sounds the child makes
 Listening is Fun! A Guide for Parents &
Families- CD with training manual by Med-El
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Detection…Speech Sounds
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Child’s Name…The Calling Game
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Start Listening: A guide to pediatric rehabilitation
 FREE DVD from COCHLEAR AMERICAS
 (303) 790-9010 or www.cochlear.com
The Ling 6 Sound Test-free pictures from Med-El and Advanced Bionics
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Adaptable to any age
Can be paired with “Learning to Listen” sounds as bridge to identification and
sound/object association (Pollack, 1985; 1997); Dave Sindrey’s explanation:
 www.hearingjourney.com/userfiles/file/ling6screeninstr.pdf
 Suprasegmentals of speech
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Pitch, duration, intensity, timing, and stress
Learning to Listen Sounds/Objects-”Tools for Schools” (Advanced Bionics)
 Ooh = ghost
 Aah = airplane
 Eee = slide, vacuum, Chinese yo-yo
 Sss = snake
 Shh = baby
 Mmm = ice cream cone, any food
Factors Influencing Spoken Language
Outcomes in Children following Early
Cochlear Implantation
(Geers, 2006)
•
Auditory Processing Abilities
–
•
Auditory memory, verbal rehearsal, and serial scanning abilities
were revealed to be important predictors of speech and language
proficiency in children with cochlear implants
Mainstreaming in Education
–
–
If access to auditory information via a cochlear implant is
acquired at an early age, the need for special education may be
decreased which allows for earlier entry into a regular education
classroom with hearing children
“Earlier educational mainstreaming following cochlear
implantation is associated with higher speech intelligibility and
better reading scores.”
Factors Cont’d
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Overall Language Achievements of Early Implanted
Children
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“…achievements of profoundly deaf children following cochlear implantation
indicates a dramatic shift towards spoken language skills that closely
approximate those of hearing children.”
A national study of 181 children in early elementary school who had been
implanted before the age of 5 revealed that half of the children were at least
80% intelligible to unfamiliar listeners and 47% had age-appropriate spoken
language skills.
Children using new cochlear implant technology have provided evidence of
accelerated language development after implantation
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Children who are congenitally deaf might only demonstrate an insignificant delay in language
development if they receive their implant early enough
The child’s learning capacity and motivation, the implant’s contribution, and
the child’s rehabilitation program are all factors that influence the benefit of a
cochlear implant
Reading, Writing, and Phonological Processing Skills of
Adolescents With 10 or More Years of Cochlear Implant
Experience
(Geers & Hayes, 2010)
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112 of the 181 students with cochlear implants from the
previous study were assessed again in high school in the areas
of reading, spelling, expository writing, and phonological
processing
47- 66% performed within or above average range for hearing
peers on reading tests
Those identified as good readers in elementary were good
readers in high school, and the majority maintained their
reading levels since elementary compared with hearing peers
Written expression and phonological processing were the most
problematic areas
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The high schoolers with cochlear implants performed lower than
hearing age-mates in spelling, expository writing, and phonological
knowledge
Phonological processing skills were a critical predictor of high
school literacy skills
Reading, Writing, and Phonological
Processing Skills, Con’t
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Conclusions
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Children who receive cochlear implants as
preschoolers, or younger, can frequently achieve
age-appropriate literacy skills
Significant delays in spelling and written
expression compared to hearing peers
Development of phonological processing skills is
essential for literacy success later on
Outcomes of an Auditory-Verbal Therapy Program for
Children with Hearing Loss
- A Comparative Study with a Matched Group of Children
with Normal Hearing
(Dornan, Hickson, Murdoch, and Houston, 2007)
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Results suggested that children in an AVT program would
make significant progress in language development and
speech production over a nine-month period that would
be similar to progress made by typically hearing peers
72.4% of the AVT group fell into the age-appropriate
range for total language scores at the post-test
High levels of parent involvement and child-directed
speech are two desired outcomes of AVT

High levels of parent involvement has been suggested to lead to
positive language outcomes in children with hearing loss while
child directed speech leads to larger vocabularies with faster
vocabulary growth
The Importance of Vocabulary
(Geers and Hayes, 2010)
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Vocabulary knowledge- formal instruction and
exposure leads to a child learning and remembering
word meanings

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The more severe the hearing loss, the larger the delay in
vocabulary development (Boothroyd, Geers & Moog, 1991)
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Vocabulary knowledge is critical for reading
comprehension and expository writing
Vocabulary development speeds up after a child receives a
cochlear implant, especially if implantation occurs during
or before preschool age
Vocabulary knowledge continuously expands
throughout development

Implantation early on, combined with improved
phonological decoding, assists with reading and compre.,
leads to literacy skills comparable to hearing peers
Receptive Vocabulary
(Dornan, Hickson, Murdoch & Houston, 2009)

Second stage of a longitudinal study of children in an
auditory verbal program included reassessment 21 months
after initial assessment
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Revealed a significant advantage for typically hearing peers in
the area of receptive vocabulary, but children in the AV program
scored within typical range
The typically hearing group had a significantly higher change in
PPVT-3 scores than the AV group
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Typically hearing group: progressed 33.68 months in 21 months
AV group: progressed 23.8 months in 21 months
The PPVT-3 scores for the AV group were still in average range
Acquisition of receptive vocabulary progressed steadily for the
AV group

84% achieved age appropriate scores
Receptive Vocabulary Cont’d
(Dornan, Hickson, Murdoch & Houston)
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Results measured at 38 months showed similar
results to previous assessments
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There was no significant difference between the
mean age equivalent for the AV group and the
typically hearing group for receptive vocabulary as
measured by the PPVT-3
The typically hearing group showed greater
improvement in receptive vocabulary, but 61% of
the AV group scored within normal range
Vocabulary is one of the biggest
predictors of kindergarten
success…therefore, early
intervention is not about the child, it
is about the family learning about
vocabulary development.
Think of early intervention as “adult
education”.
Number of Words Understood by
Children who are Typical
Gard, Gilman & Gorman (1980)
Age
2
2.5
3
4
5
6
7
# of Words
300 words
500 words
900 words
1,500 words
2,500 words
13,000 words
20,000 words
Key Study by HART AND
RISLEY (1995): The Lines of
Demarcation are Drawn
Early On…
“Meaningful Differences in the
Everyday Experience of Young
American Children”
Words in Millions
Cumulative Words
Addressed to a Child in
the First Four Years
60
40
20
0
45
26
13
Hart and Risley 1995
Professional
Family
Working Class
Family
Poverty Family
Factors Predicting Reading Success:
(Strickland & Shanahan, Educational Leadership, March ’04, Nat’l Early
Literacy Panel-NELP)
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Alphabetic Knowledge
Environmental Print/Print Knowledge
Invented Spelling
Listening Comprehension
Oral Language/Vocabulary Knowledge
Phonemic Awareness
Phonological Short-Term Memory
Rapid Naming Recall
Visual Memory & Visual Perceptual Skills
Why Focus on Reading?
•
Children fail and drop out of school
because they cannot read. Reading
affects the entire report card
•
Reading is the tide that
lifts all the boats of the curriculum
(Trelease, 2001)
Put Reading First:
The Research Building Blocks for
Teaching to Read
National Reading Panel (NRP)
Report in 2000-FREE Copies
•Charged with reviewing literature in reading
instruction
•Reviewed 100,000 studies
•Condensed findings into a guide designed for
teachers on how to successfully teach children to
read based on 5 areas of instruction:
Phonemic Awareness
Phonics
Fluency
Vocabulary
Text Comprehension
Vocabulary
•
Words we must know to
communicate.
•
Beginning readers have a difficult
time reading words that are not part
of their oral vocabulary.
•
The more exposure to oral
language children have the more
word meanings they will learn.
•
Most vocabulary is learned
indirectly in 3 ways:
1)
Engaging daily in oral language.
2)
Listening to adults read to them
3)
Reading on their own.
Phonemic Awareness
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Ability to notice, think about, and work with the individual sounds of
spoken words (understanding that words are made of sounds)
Phonemic Awareness instruction will improve a child’s ability to read
words, increase reading comprehension, and spelling.
Development Activities:
*identify and categorize phonemes
*blend phonemes to form words
*segment words into phonemes
*delete, add, substitute phonemes to
make new words
National Institute for Literacy at ED Pubs
PO BOX 1398
Jessup, MD 20794-1398
To download go to the National Institute
for Literacy website at www.nifl.gov
Reading Outcomes for the Deaf and
Hard of Hearing
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Deaf or hard of hearing 17 and 18- year- old
students in a normative sample for research done
by Gallaudet Research Institute demonstrated
literacy skills that were equivalent to a 4th grade
level
In a study of 181 elementary students who
received a cochlear implant before age 5, over
half (52%) had age-appropriate reading scores
(Geers, 2006)
In high school, 47-66% obtained reading scores at
or above average range compared to hearing peers
It’s a new generation of
children who are deaf/hard of
hearing...because it is all
about the BRAIN.
Hearing loss is not about the ears; it’s
about the brain!
Hearing aids, FM systems and
cochlear implants are not about the
ears; they are about the brain!
(Flexer, 2008)
Critical Keys to a Successful Spoken
Language Outcome:
*Access the Auditory Centers
of the Brain as Early
and Completely as Possible;
*Then, Practice, Practice, Practice Listening
and Talking…
*Approach it as a “Neurodevelopmental
Emergency” (Flexer, 2008)
Parents as Partners
The Art of Reading Aloud
Single-Most Important Activity
Building a Knowledge-Base Required for Reading Success
Becoming a Nation of Readers (1985)
Commission on Reading funded by U.S. Dept. of Ed.
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“It is a practice that should continue
throughout the grades.”
Not only in the home but also in the classroom
on a daily basis
Reading aloud is more important than work
sheets, homework, assessments, book reports,
and flash cards.” (Trelease, 2006, p.3)
The cheapest, simplest and oldest tools of
teaching: the more you read, the better you get.
Surprising Findings…
•
Only 20% of parents
read to their children
daily
•
In both poverty and
university-level
families, fathers read to
children only 15% of
time while mothers
read 76% of time
Children are made readers on the
laps of their parents. (Emilie Buchwald)

Laptops don’t have laps…
Percent of Text Consisting of
Compound or Complex
Sentences
Percent of
Compound
or Complex
Sentences
80
60
40
28
20
0
67
79
Favorite Teen TV
Shows
Make Way For
Duckings
The Tale of Peter
Rabbit
Tips for Reading Aloud…
Read aloud to your child—it’s never too early
to begin and never too late to start
• Continue to read aloud after your child learns
to read alone—best to read to child slightly
above their own reading level
• Read aloud every day, even several times a
day
• Establish a regular time to read
•
Tips for Reading Aloud…
•
Show enthusiasm about what you are reading
Choose a story, poem, news story to grab the child’s
interest
Cut the session short if interest lags
•
Link the story to life and other books
•
Ask the child to predict the outcome through the
reading of the story
•
•
Tips for Reading Aloud…
•
•
•
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Start with picture books, build to
storybooks and novels
Vary the length and subject matter of your
readings
Go on a “book walk” prior to reading the
book
-point out the title, author, illustrator
-talk about front/back of book
-discuss illustration on cover
-predict what the story will be about
6th edition Penguin (2006)
www.trelease-on-reading.com
Factors Influencing Spoken
Language: Summary

Monitoring the functioning of the equipment
 Expanding receptive vocabulary growth
 Expanding phonemic awareness skills
 Expanding daily read aloud experiences with the
child-note the excellent S/N ratio
RESOURCES
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April 2003 and Vol. 27, #3, 2006: Ear and Hearing
Archives of Otolaryngology – Head and Neck Surgery. May
2004.
The Volta Review, Vol. 106, Spring 2006; & Summer 2010
Flexer, C. (1999). Facilitating Hearing and Listening in
Young Children, 2nd ed. San Diego: Singular Publishing
Group. Go to: www.carolflexer.com
Robertson. L. (2009). Literacy and Deafness: Listening and
Spoken Language. Plural Publishing
Ellen Rhoades’ website: www.auditoryverbaltraining.com
& www.listen-up.org.
RESOURCES (cont.)
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Children with Hearing Loss Developing Listening &
Talking, Birth to Six—E. Cole & C. Flexer, (2011),
2nd. Ed., Plural Publishing.
Speech Perception Instructional Curriculum and
Evaluation (SPICE)—J. Moog, J. Biedenstein, &
L. Davidson (1995). Central Institute of the Deaf.
Developmental Approach to Successful Listening
II—G. Stout & J. Windle (1992). Houston School
for the Deaf.
Word Associations for Syllable Perception (WASP)--M. Koch (1999). Advanced Bionics at
www.bionicear.com.
Additional Resources
The Volta Review (Vols. 110, Number 2). Wash., D.C.: AG Bell
Professional Preparation for Listening and Spoken Language Practitioners (2010)
By K.T. Houston & C. B. Perigoe
Listen to This- Volume 1 (2004) – Book and DVD
By Warren Estabrooks, Karen MacIver-Lux, Lisa Katz, and Maria Emilia De Melo
Listen to This- Volume 2 (2006) – Book and DVD
By Warren Estabrooks, Karen MacIver-Lux, Lisa Katz and Maria Emilia De Melo
The Baby is Listening (2003) – Book and DVD
By Warren Estabrooks, M.Ed., Dip. Ed. Deaf, LSLS Cert. AVT, and Judith Marlowe, Ph.D., FAAA
Pediatric Audiology Casebook (2011)
By Jane Madell and Carol Flexer
Ed. Aud. for the Limited-Hrg Infant & Preschooler: An Auditory-Verbal Prog- 3rd Ed. (1997)
By Doreen Pollack, Donald Goldberg, and Nancy Caleffe-Schenck
Children with Hearing Loss: Developing Listening and Talking Birth to Six (2008)
2nd Edition, By Elizabeth Cole and Carol Flexer
Speech and the Hearing-Impaired Child: Theory and Practice- 2nd Edition (2002)
By Daniel Ling
Auditory-Verbal Practice: Towards a Family Centered Approach
By AG Bell members Ellen Rhoades, Ed.S., LSLS Cert. AVT, and Jill Duncan, Ph.D., LSLS Cert. AVT
ABCs of AVT: Analyzing Auditory-Verbal Therapy
By Warren Estabrooks, M.Ed., Dip. Ed. Deaf, LSLS Cert. AVT, and Rhonda Schwartz, M.A., S-LP(C)
Auditory-Verbal Therapy and Practice (2006)
By Warren Estabrooks
**For a list of additional research articles: email: dwray@uakron.edu
“The best way to predict the future
is to create it.”
Peter Drucker
(Management Consultant, writer, social ecologist)