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Teaching reading to students who are deaf and hard of hearing

Teaching reading to students who are deaf and hard of hearing

Dr Kerry Hempenstall, Senior Industry Fellow, School of Education, RMIT University, Melbourne, Australia.

Each of my articles can be downloaded as a PDF file at https://tinyurl.com/y6vat4ut


 

Deaf and hard of hearing students (DHH) are a heterogeneous group. Is their loss mild/moderate/severe/profound? Are they pre-lingually deaf (e.g., rubella) or was their loss acquired later (e.g, ototoxic medications, meningitis)? What was the age at diagnosis? Is it sensorineural or conductive? Did they learn a sign language from birth? Do they have a cochlear implant? At what age? Are they aided, and if so, when? How effective for them has been their hearing aid technology? What was the degree and salience of parental and educational support? Did they receive evidence-based early intervention? In what type of education setting (mainstream, special facility) are they enrolled? Do they receive evidence-based reading instruction?

Each of these variations, among others, may play a part on how readily DHH students develop literacy skills.

In the hearing population, there has been much literacy research completed in recent years, enabling a consensus to be reached about the factors that lead to skilful reading. Do the same principles apply to other populations, such as ELL, autism, intellectual disability? For example, there are those who argue that an initial reading program with a phonics emphasis is ineffective with students with autism, because they are “visual learners”. This claim has been strongly contested by numerous researchers in recent years. However, there is often concern that students who differ in some significant way from most of their peers are not best served by a regular program with suitable modifications, but a unique program designed to match their unusual learning needs. We know that every child is unique, but an important issue is whether our similarities outweigh our differences when considering the content and style of reading instruction.

There has been an upsurge in research into teaching reading to deaf and hearing impaired students. What are some its findings?

Who are these children?

“It continues that approximately two to three out of every 1000 children in the United States are born with a detectable level of permanent hearing loss in one or both ears, and close to 95% percent of those children are born to hearing parents [6]. Fifteen percent of all American school-age children (aged between 6 and 19) have some degree of permanent or transient hearing loss, and more than half of those children have what is termed an educationally significant hearing loss in that it affects how they learn and influences academic achievement [6]. d/Dhh children are ethnically and socioeconomically diverse, although children of low-income families remain at a disproportionate risk for hearing-related disabilities [7]. The population of children with hearing loss has become increasingly diverse in terms of concurrent disabilities, as the number of children born at very early gestational ages are now surviving, but presenting with complex needs in addition to their hearing loss. It is now reported that 40% to 50% of the children who were deaf or hard of hearing have additional disabilities [7,8]. Currently, almost 98% of all babies born in the United States are screened for hearing loss, as opposed to fewer than 3% in the early 1990s [9]. The establishment of universal newborn hearing screening, new screening technologies, as well as procedures for assessing hearing in newborns, has led to a reduction in the average age of hearing loss identification to the age of six months in 2007 from 30 months just two decades ago [9]. This timely identification of hearing loss in infants provides the opportunity for earlier access to visual or spoken language, hearing assistive technology, and early intervention services. Although some challenges in state tracking systems remain, particularly those related to failures to follow up from referrals to audiologic evaluations, over 5000 infants are identified very early in life each year [9]. Along with early identification, techniques for fitting amplification on newborns continue to improve. Digital hearing aids, cochlear implants, and remote microphone systems provide better access to higher quality sound at younger ages than ever before. Infants can be fit with hearing aids during the first weeks of life, and research has evidenced that when children with severe to profound hearing loss begin using hearing assistive technology between six and 18 months of age, listening, language, and speech development improve [10,11].” (p.2)

Hartman, M.C., Nicolarakis, O.D., & Wang, Y. (2019). Language and literacy: Issues and considerations. Education Sciences, 9(3), 180.


How well do students who are DHH usually fare in reading?

“Learning to read at age-appropriate levels is a problem for many, but not all, students who are born deaf. Regardless of whether they speak or sign, the median reading level of deaf students indicates subpar achievement. Approximately 10% of deaf students read beyond an eighth grade level (Traxler, 2000). This statistic indicates that there are many skilled readers in the deaf population. The challenge is to discover what factors distinguish them from unskilled readers (Belanger, Baum, & Mayberry, 2010; Chamberlain & Mayberry, 2008). Only then can effective diagnostic and educational programs be devised to ameliorate the problem. Moreover, understanding the nature of proficient reading in individuals who are deaf promises to elucidate theoretical models of reading development and disabilities.”

Mayberry, R.I., del Giudice, A.A., & Lieberman, A.M. (2011). Reading achievement in relation to phonological coding and awareness in deaf readers: A meta-analysis. Journal of Deaf Studies and Deaf Education, 16(2), 164-188.


 

“Research on reading outcomes of children with mild to moderate hearing loss (CMMHL) has long shown potential weaknesses in these students (e.g., Davis, Elfenbein, Schum, & Bentler, 1986), and despite advances in hearing aid technology and medical management (e.g., improved hearing aid technology, cochlear implants), CMMHL continue to have widely variable outcomes in regard to reading abilities, especially phonological awareness and language abilities (Nittrouer & Caldwell- Tarr, 2016; Park, Lombardino, & Ritter, 2013). Moreover, there continues to be a significant risk for poor reading outcomes in all children with hearing loss, including those with mild to moderate hearing loss (see Cupples, Ching, Crowe, Day, & Seeto, 2013; Wake, Hughes, Poulakis, Collins, & Richards, 2004; Werfel, 2017).” (p.420)

Camarata, S., Werfel, K., Davis, T., Hornsby, B.W.Y., & Bess, F.H. (2018). Language abilities, phonological awareness, reading skills, and subjective fatigue in school-age children with mild to moderate hearing loss. Exceptional Children, 84(4), 420-436.


“This study [Geers & Hayes, 2011] also reported relatively poor levels of reading among secondary school pupils in comparison to performance in primary school and the authors suggest that the gap between deaf children and hearing peers continues to widen with age. This conclusion is in line with the outcomes of a study of reading among adolescents in the UK (Harris & Terlektsi, 2011), which found an average reading delay of over 3 years in a group of 12- to 16-year-olds.” (p.234) 

Harris, M., Terlektsi, E., & Kyle, F.E. (2017). Concurrent and longitudinal predictors of reading for deaf and hearing children in primary school. The Journal of Deaf Studies and Deaf Education, 22(2), 233–242. https://doi.org/10.1093/deafed/enw101


 

“Hearing loss reduces audibility, impacts the perception of temporal fine structure cues, and degrades the spectral characteristics of auditory signals (Moore, 2008; Souza, Wright, Blackburn, Tatman, & Gallun, 2015). Whether receiving amplified acoustic signals through hearing aids (HAs) or electrical signals through cochlear implants (CIs), complete restoration of the original auditory signal is not achieved with the use of amplification devices (Nittrouer et al., 2012; Sininger, Grimes, & Christensen, 2010). Thus, children with hearing loss do not have the same access to spoken language as children without hearing loss and, as a result, may experience perceptual processing deficits (Nittrouer & Burton, 2001; Tomblin, Oleson, Ambrose, Walker, & Moeller, 2014).” (p.17)

Runnion, E., & Gray, S. (2019). What clinicians need to know about early literacy development in children with hearing loss. Language, Speech, and Hearing Services in Schools, 50, 16–33.


Thirty-three young people with cochlear implants, aged between 9 and 16 years, were assessed for use of their implant system, cognitive abilities, vocabulary, reading, and writing skills. The group came from throughout England and included 26 born deaf, six deafened by meningitis, one with auditory neuropathy, and five with additional needs. Nineteen had bilateral implants with a mean age at first implantation of three years six months. The majority were educated in mainstream, with 85 per cent using oral communication in school. The group was cognitively able, all scoring within or above the normal range. In terms of receptive and expressive vocabulary, 75 per cent and 67 per cent scored within the average range respectively. Using the Single Word Reading Test, 55 per cent were within the average range, and 21 per cent above. As measured by the York Assessment of Reading Comprehension, 72 per cent were commensurate with hearing peers, and 9 per cent above on reading rate, and 75 per cent within the average range, and 13 per cent above on comprehension. Free writing samples indicated that 25 per cent were performing at the expected level for their age, 19 per cent above, and 56 per cent below. Influences on outcomes were age at implantation, bilateral implantation, and age at testing. Overall this group demonstrated good use of their technology, and much stronger outcomes in vocabulary and reading than evidenced in the deaf population prior to implantation. Writing outcomes were not as strong as in reading, but were not showing the use of non-standard English as in the past, and were showing writing strategies such as invented spelling, common in hearing children.” (p.71)

Mayer, C., Watson, L., Archbold,S., Ng, Z.Y., & Mulla, I. (2016). Reading and writing skills of deaf pupils with cochlear implants. Deafness & Education International, 18(2), 71-86. DOI: 10.1080/14643154.2016.1155346


Do DHH students learn to read in the same way as hearing students? Is phonology important for their progress?

First of all, it should be acknowledged that, for children who are DHH, perception of the acousticphonetic details of language is poorer compared with TH peers (Brown & Bacon, 2010; Pisoni et al., 2008; Tomblin et al., 2015). This deficit, in turn, leads to poorer phonological skills (Lyxell et al., 2008; Pisoni et al., 2008), and according to a large number of research studies on TH children, weaknesses in phonological skills should be expected to result in poorer phonological decoding skills (e.g., Goswami et al., 2010; Hulme et al., 2012). A number of studies have indeed demonstrated poorer reading skills in children who are DHH (e.g., Geers, 2003; Geers & Hayes, 2011; Harris & Terlektsi, 2010; Johnson & Goswami, 2010; Kyle & Harris, 2006; Moeller et al., 2007).Overall, the children who are DHH in the current study performed below the level of peers with typical hearing and typical reading development on most of the measures of reading used in this study. Their performance was also below TH peers on the spelling measure but not on the recognition measure of orthographic learning, which suggests that children who are DHH are able to acquire orthographic representations from a brief exposure to words, although these representations may, at least initially, be weaker than for TH children. Based on the current results, it is likely that problems with orthographic learning in children who are DHH are a consequence of poor phonological decoding. It is further likely that these difficulties may result in the previously reported drop in reading development as children who are DHH grow older (Geers & Hayes, 2011; Harris & Terlektsi, 2010), and this issue should be further investigated in future research. The cognitive variables associated with orthographic learning in this study were relatively similar to those for children with typical hearing, including orthographic knowledge and PAL. The results from the current study suggest that phonological decoding may be the key to fluent reading also in children who are DHH. Thus, efforts should be made to give educational support, specifically aimed at improving phonological decoding in this group of children. The finding that children who are DHH do develop orthographic representations that are sufficiently distinct for recognition tasks but not for spelling further suggests that they may need more practice for successful orthographic learning to occur.” (p.101, 109)

Wass, M., Ching, T.Y.C., Cupples, L., Wang, H-C., Lyxell, B., Martin, L., Gunnourie, M., Button, L., Boisvert, I., McMahon, C., & Castles, A. (2019). Orthographic learning in children who are deaf or hard of hearing. Language, Speech, and Hearing Services in Schools, 50, 99–112. http://LSHSS.pubs.asha.org/article.aspx?doi=10.1044/2018_LSHSS-17-0146


 

“Deaf learners have historically faced challenges in achieving reading outcomes commensurate with their hearing peers. Specifically, outcome data have consistently indicated significant delays in achievement among this population of students, with a reported median fourth-grade reading level for high school graduates [1]. Over the years, these persistently low achievement levels have led scholars to question whether reading skill development is different for deaf readers (see [2,3] for discussions). In a seminal discussion of this topic, Hanson [4] directly explored the question, “Is reading different for deaf individuals?” (p. 85). Based on the evidence available at the time, rather than a yes or no answer, a dual response to this question was offered. Hanson suggested that even though deaf learners often bring a different set of language experiences to the task of reading, the fundamental task of reading remains the same. Like their hearing peers, they need to rely on an understanding and application of both English language and phonology when reading (see also [5]). A contemporary interpretation of Hanson’s [4] dual response is reflected in the qualitative similarity hypothesis (QSH) proffered by Paul and colleagues [6,7,8,9,10]. According to the QSH, deaf children follow a qualitatively similar developmental learning trajectory to that of hearing students, even though the development of skills may be quantitatively delayed. Furthermore, becoming a proficient reader depends upon mastering the same fundamental abilities that are well established for hearing learners, regardless of the degree of hearing loss or communication modality used (e.g., spoken or signed). In discussing conventional literacy skills specifically, Paul, Wang, and Williams [10] recognized the importance of the ability “to decode and encode written language to attain or construct meaning” (p. 90) as well as apply strategies to both comprehend and create text. … Beginning in 1974 and continuing through 2003, five large-scale studies were conducted using the SAT-HI [Stanford Achievement Test for Hearing Impaired], with normative data regarding student performance developed as a result of each investigation. Data from nearly 7000 students ages 8 through 18 comprised the special norming sample in 1974, whereas the normative data from 2003 represented approximately 3500 students. Considering the data for the reading comprehension subtest across 11 cohorts of students over time (i.e., students age 8 through 18 from 1974 to 2003), performance levels were shown to increase slightly as a function of age. However, the median grade equivalent never exceeded the fourth grade level for any given cohort. These findings led Qi and Mitchell [1] to conclude, “there has been little or no change in the central tendency of academic achievement among the deaf and hearing student population over the last three decades” (p. 7). … Considering the aforementioned skills, [10] we see this perspective closely aligned with the Simple View of Reading (SVR) [11], which establishes the critical role that both language and phonological skills play in the development of reading comprehension abilities. … Given the strong theoretical and empirical base for the SVR, coupled with the insights garnered regarding students with reading disabilities as part of its development, we contend that the SVR provides a model for understanding the reading process among a wide-range of students, including those who are deaf, and serves as an appropriate framework for explaining development within the context of the QSH.” (p.1, 5)

Trezek, B., & Mayer, C. (2019). Reading and deafness: State of the evidence and implications for research and practice. Education Sciences, 9, 216.


“A large number of studies have highlighted the significant difficulties that many children with severe-profound prelingual hearing loss experience in learning to read and write (Kronenberger, Colson, Henning, & Pisoni, 2014; Marschark & Harris, 1996). Although there is general agreement about the extent of these difficulties, there is rather less agreement about their underlying cause, with a major area of disagreement being the importance or otherwise of phonological skills (Bochner & Kelstone, 2016; Harris, 2016; Mayberry, del Giudice, & Lieberman, 2011). For example, a meta-analysis by Mayberry et al. (2011) suggested that phonological skills play only a minor role in deaf children's reading, whereas other authors have argued that these skills are key to success (Bochner & Kelstone, 2016; Kyle & Harris, 2010, 2011; Miller, Lederberg, & Easterbrooks, 2013). … Forty-one children with severe-profound prelingual hearing loss were assessed on single word reading, reading comprehension, English vocabulary, phonological awareness and speechreading at three time points, 1 year apart (T1–T3). Their progress was compared with that of a group of hearing children of similar nonverbal IQ, initially reading at the same level. Single word reading improved at each assessment point for the deaf children but there was no growth in reading comprehension from T2 to T3. There were no differences between children with cochlear implants and those with hearing aids on either reading measure but orally educated children had higher scores than children who signed in the classroom. English vocabulary and speechreading were the most consistent longitudinal predictors of reading for the deaf children. Phonological awareness was the most consistent longitudinal predictor for the hearing group and also a concurrent predictor of reading at T3 for both groups. There were many more significant correlations among the various measures for the deaf children than the hearing at both T1 and T3, suggesting that skills underpinning reading, including phonological awareness and vocabulary, are more closely related for deaf children.” (p.1)

Harris, M., Terlektsi, E., & Kyle, F.E. (2017). Concurrent and longitudinal predictors of reading for deaf and hearing children in primary school. The Journal of Deaf Studies and Deaf Education, 22(2), 233–242. https://doi.org/10.1093/deafed/enw101


“There is some debate about the way in which DHH children acquire literacy skills and whether it is qualitatively or quantitatively different from children with typical hearing. Proponents of the Qualitative Similarity Hypothesis propose that DHH children acquire skills in a manner that is qualitatively similar to hearing children suggesting, “there are certain fundamentals (e.g., skills) that are necessary for the acquisition process for all individuals” ( Paul & Lee, 2010, p. 456). On this view, phonological ability, and PA more specifically, will play an important role in reading development for all DHH children. Furthermore, they will proceed through the same stages of literacy acquisition as their hearing peers, although potentially at a different rate, and may benefit from different instructional methods for developing their PA skills.

However, it is possible that children’s level of functional hearing, defined by Miller, Lederberg, and Easterbrooks (2013, p. 206) as the “ability to access spoken language through hearing,” might influence the way in which reading develops. Easterbrooks and colleagues (2015) have suggested that variability in children’s access to the spoken language (in which PA and alphabetic writing systems are grounded) could have consequences for the development of phonological abilities, including PA, and also go some way to explain conflicting reports in the literature about the DHH children’s PA and literacy development. Under this view, it may be possible that for some DHH children with very low levels of functional hearing (poor ability to produce or perceive speech), forming the necessary phonological representations for PA development may be so difficult that they acquire literacy in a manner that is qualitatively different from their hearing peers, with a subsequently different relationship between PA and reading development. However, for DHH children with greater levels of functional hearing, the role of spoken PA could closely mirror that of children without hearing difficulties, again supporting the importance of PA development, for this group (Kyle & Harris, 2011; Lederberg, Schick, & Spencer, 2013).

Thus, regardless of perspective, it appears likely that many, if not all DHH children, are likely to require appropriate PA skills in order to achieve literacy success. With this in mind, research findings showing that DHH children generally display difficulty in acquiring PA are of deep concern because poor performance on such tasks would in turn be associated with difficulties in subsequent reading development (e.g., Colin, Magnan, Ecalle, & Leybaert, 2007; Harris & Beech, 1998; Johnson & Goswami, 2010; Most, Aram, & Andorn, 2006; Nakeva von Mentzer et al., 2013). …Despite this ready access to early pediatric hearing services, Australian DHH children continue to show poorer performance on many aspects of language development than their peers without hearing loss (Ching & Dillon, 2013). A recent study examining 101 bilaterally fitted children showed that at 5 years of age, more than half of these participants who used spoken language scored below the 25th percentile on standardized measures of PA (Cupples, Ching, Crowe, Day, & Seeto, 2014). This outcome is of particular concern when considered in combination with other findings from the same study showing that PA made a significant, specific, contribution to early reading development, even after controlling for vocabulary, cognitive ability, hearing loss, and other factors. The overall pattern of results reinforces the importance of PA skills for early reading growth, while simultaneously highlighting the need to find ways to support PA development in these children. In this regard, it is encouraging to note further that Cupples et al. reported no significant association between PA and degree of hearing loss, thus suggesting that PA intervention may hold benefit for children with losses across the range from mild to profound.” (p.269, 270)

Gilliver, M., Cupples, L., Ching, T.Y.C., Leigh, G., & Gunnourie, M. (2016). Developing sound skills for reading: Teaching phonological awareness to preschoolers with hearing loss. The Journal of Deaf Studies and Deaf Education, 21(3), 268–279. https://doi.org/10.1093/deafed/enw004


 What should be the focus and style for instruction?

“Traditional reading instruction in the education of children who are DHH has focused on the development of language and vocabulary (Spencer, Tomblin, & Gantz, 1997) rather than on instruction of the alphabetic principle because of the children’s lack of spoken word knowledge (Schirmer, 2001). For example, in a 1997 survey, more than 70% of teachers who work with children who are DHH stated that they used special basal readers and language experience approaches to teach reading (LaSasso & Mobely, 1997). Perfetti and Sandak (2000) posited that lack of phonological representation of words was a factor in the lower literacy levels among students with severe to profound hearing losses: “[there is a] fundamental discrepancy between their incomplete spoken language system and the demands of reading a speech-based system” (p. 47). … Phonics during preschool will build a foundation for instruction of reading programs, such as Reading Mastery (2008) in elementary school (see Trezek & Wang, 2006). … While traditionally alphabetic knowledge is not taught until kindergarten, even for children with typical hearing, recent research suggests such instruction in prekindergarten can have long-term positive effects on later reading skills, including reading achievement and spelling (Kirk & Gillon, 2007; Korkman & Peltomaa, 1993). The current study suggests that children who are DHH, even those who have delays in language, are able to learn the foundation for the alphabetic principle during prekindergarten.” (p.113, 114)

Bergeron, J.P., Lederberg, A.R., Easterbrooks, S.R., Miller, E.M., & Connor, C. (2009). Building the alphabetic principle in young children who are deaf or hard of hearing. The Volta Review, 109(2–3), 87–119. Retrieved from http://clad.education.gsu.edu/files/2016/05/Bergeron-et-al-2009-Alphabetic-Principle.pdf


“While the language delays and deficits of deaf learners have been widely accepted and are well documented in the literature (e.g., [41]), the role of phonological decoding in reading for deaf learners is one of the most fiercely debated topics in the field (see [2,3,5]). In fact, criticisms of the QSH have focused “mostly on the role of phonology in the development of reading, particularly in the learning to read period” ([10] p. 17). From the perspective of the SVR, “reading comprehension increases linearly with increases in either decoding or linguistic comprehension except where skill in one component is nil.” [13] (p. 308). The notion that an absence of skill in the decoding domain, or a lack of instructional focus on this component, largely contributes to the difficulties deaf learners experience in attaining age-appropriate reading outcomes has been the focus of many discussions in reading and deafness in recent years (see [5,39,40] for discussions).” (p.6-7)

Trezek, B., & Mayer, C. (2019). Reading and deafness: State of the evidence and implications for research and practice. Education Sciences, 9, 216.


“DHH children are able to gain knowledge about speech sounds through combining auditory information with information gained through speechreading (Kyle & Harris, 2010). Encouraging children to look at the way sounds are made on the lips - perhaps with the additional information that can be provided by visual phonics (Narr, 2008; Trezek, Wang, Woods, Gampp, & Paul, 2007) - can support the development of more robust phonological coding skills. The finding that letter-sound knowledge was associated with phonological awareness in the present study suggests that training in grapheme-phoneme correspondences might also be helpful as has been shown in a recent computer-based training study carried out in Sweden (Nakeva von Mentzer et al., 2013); and also in an extensive phonological training intervention carried out in the US (Miller, Lederberg, & Easterbrooks, 2013).” (p.706)

Harris, M., Terlektsi, E., & Kyle, F.E. (2017). Literacy outcomes for primary school children who are deaf and hard of hearing: A cohort comparison study. Journal of Speech, Language, and Hearing Research, 60(3), 701-711.


“Many deaf and hard-of-hearing (DHH) children struggle to learn to read, while others develop age-appropriate skills (Lederberg, Schick, & Spencer, 2013). Understanding the factors that relate to individual differences in reading is critical to designing better interventions and improving reading for all DHH children. One fiercely debated but unanswered question is how much reading relies on children’s knowledge of spoken language (Paul & Lee, 2010; Petitto et al., 2016). Because written language encodes spoken language, many claim that DHH children need to acquire spoken language through auditory or visual means. For example, Paul and colleagues (Paul & Lee, 2010; Wang, Trezek, Luckner, & Paul, 2008) posited that all DHH children must use qualitatively-similar processes to learn to read as hearing children. If this is true, reading interventions for DHH children should resemble those for hearing readers with an additional emphasis on increasing children’s knowledge of the phonological, semantic, and syntactical features of spoken language. Others propose that DHH children use different processes to read (Hoffmeister & Caldwell-Harris, 2014; Petitto et al., 2016). This view implies that interventions should differ in substantial ways from those developed for hearing children. There is a third possibility: both hypotheses may be true, but for different DHH children, depending on their acquisition of spoken and signed language (Lederberg et al., 2013; Miller, 2002). Indeed, research suggests that reading processes differ depending on deaf adults’ primary mode of communication (spoken vs. signed language) (Hirshorn, Dye, Hauser, Supalla, & Bavelier, 2015; Miller, 2002). We do not know which of these three hypotheses best explains how young DHH children learn to read. Based on both reading theory and previous research, we hypothesized that DHH children’s early reading abilities would be closely related to phonological awareness and language abilities, but the nature of this relation might differ for children acquiring signed and/or spoken language.” (p. 1)

Lederberg, A.R., Branum-Martin, L., Webb, M-Y., Schick, B., Antia, S., Easterbrooks, S.A, & McDonald Connor, C. (2019). Modality and interrelations among language, reading, spoken phonological awareness, and fingerspelling. Journal of Deaf Studies and Deaf Education, 1–16. Retrieved from https://escholarship.org/content/qt61j2f2tx/qt61j2f2tx.pdf


“There has been a surge in research with young deaf children using Visual Phonics and Direct Instruction. The results to date have been promising, but with the caution that most of the work has been done with children who are second graders or younger” (p.101).

Moores, D. F. (2013). One size does not fit all: Individualized instruction in a standardized educational system. American Annals of the Deaf, 158(1), 98-103.


“Like earlier research, more recent studies demonstrate that d/Deaf children learn best through explicit and direct instruction (Cannon, Fredrick, & Easterbrooks, 2010; Davenport, Alber-Morgan, Clancy, & Kranak, 2017; Dimling, 2010; Lund & Schuele, 2013; Lund, Douglas, & Schuele, 2015) in meaningful contexts (Lederberg, Miller, Easterbrooks, & Connor, 2014), rather than through incidental exposure. … As has been recommended by others (Ayantoye & Luckner, 2016; Luckner, 2017; Luckner & Cooke, 2010; Luckner et al., 2005; Webb et al., 2015; Williams, 2012; Trezek & Wang, 2017), research-based practices and guidelines identified for hearing children should be employed with d/Deaf children. They should be extended to include the evidence-based interventions for teaching academic language that have been validated with hearing children to teaching d/Deaf children, at least until rigorous research can be conducted specifically with d/Deaf students.” (p. 517, 528-529)

Strassman, B.K., Marashian, K., & Memon, Z. (2019). Teaching academic language to d/deaf students: Does research offer evidence for practice? American Annals of the Deaf, 163(5), 501-533.


“Based on a previous investigation implementing remedial phonics-based reading instruction for DHH students at the middle school level (Trezek & Malmgren, 2005), this study also utilized the first 20 lessons of the Direct Instruction Corrective Reading-Decoding A curriculum (Engelmann, Carnine, & Johnson, 2008) for instruction. This remedial reading curriculum, the first in a series of four levels, focuses on teaching the fundamental code-related skills necessary to develop the alphabetic principle. Research findings have documented the effectiveness of the Corrective Reading Decoding series for a variety of remedial readers, including noncategorical poor readers and special education students (see Przychodzin-Havis, Marchand Martella, & Martella, 2005, for review)” (p.394)

“The purpose of this study was to examine the results of implementing remedial instruction in the alphabetic principle with DHH students in the 2nd grade or higher and educated in a setting employing a sign bilingual model. More specifically, the goal of this inquiry was to explore participants’ acquisition and generalization of skills as a result of remedial instruction. As hypothesized, the intervention of the Decoding A curriculum supplemented by Visual Phonics resulted in growth in identifying phonemes in isolation, phoneme blending, and word reading. Results of the analysis indicated that there was statistically significant difference between pre- and posttest scores and Cohen’s d estimates revealed effect sizes of 1.75, 2.18, and 2.39 for the three dependent measures, respectively. … These results are supported by the findings indicating that a direct, explicit, and systematic phonics instructional approach, which includes teaching phoneme blending and segmenting, produces more favorable results than curricula that do not include these features, benefitting even older students experiencing difficulty learning to read (National Reading Panel, 2000; Scammacca et al., 2007).” (p.403-4)

“It is time to bring to an end the reading wars that are polarizing researchers and practitioners in the field of deafness. Although we contend that code related skills are a necessary element of the reading instruction, we also recognize that the development of these skills alone is not sufficient to support overall reading achievement. As members of a field, we must resolve the either/or dichotomy, acknowledge the importance of developing skills in both the language- and code-related domains, and collaborate to explore and evaluate pedagogical practices that support the development of overall reading proficiency among DHH learners. (p.406)

Trezek, B. J., & Hancock, G. R. (2013). Implementing instruction in the alphabetic principle within a sign bilingual setting. Journal of Deaf Studies and Deaf Education, 18(3), 391–408. Retrieved from https://www.researchgate.net/publication/236252529_Implementing_Instruction_in_the_Alphabetic_Principle_Within_a_Sign_Bilingual_Setting


“All children, regardless of hearing status, are biologically predisposed to acquire language (Gee & Goodheart, 1988; Goldin-Meadow & Mylander, 1990; Klima & Bellugi, 1979; Lenneberg, 1967; Marler, 1990; Pettito & Marentette, 1991). Hearing children in all parts of the world, regardless of the complexity or nature (e.g., alphabetic, tonal) of their home language, acquire that language naturally at the same rates and in the same ways related to the phonological contrasts of the language and the rules concerning its morphology, syntax, semantics, and pragmatics when two conditions are present: (a) early, clear, complete sensory access to the "continuous phoneme stream" of the language and (b) sufficient opportunities, in play-based situations, to interact with fluent language models (Lenneberg, 1967; Liberman, 1995). Deaf children of Deaf parents, whose home language is a natural signed language, such as ASL, have also been observed to acquire that home language naturally, in ways and processes similar to those used by hearing children of hearing parents (see Schick, 2003, for a review).”

“Supporting the view that the reading process and development of reading might be qualitatively and/or quantitatively different for deaf and hearing peers are numerous studies conducted over the past 50 years showing superior performance of hearing students compared to deaf peers (mainly from oral-aural and/or signing communication backgrounds) on tests of speech perception, vocabulary, figurative language, morphosyntax, cognitive abilities, metacognitive abilities, phonemic awareness, phonics, working memory, fluency, and reading comprehension (see Marschark & Wauters, 2008; Trezak, Wang, & Paul, 2010).

In contrast to those findings, there is a substantial body of research supporting the efficacious effect of Cued Speech and cued language on deaf cuers' speech perception (Alegría, 2010; Alegría, Charlier, & Mattys, 1999; Alegría & Lechat, 2005; Leybaert, Colin, & Hage, 2010; Nicholls & Ling, 1982; Périer, Charlier, Hage, & Alegría, 1990; Rees & Bladel, 2013; Torres, MorenoTorres, & Santana, 2006); the natural acquisition of English and other traditionally spoken languages (Crain, 2010; Kyllo, 2010; Rees & Bladel, 2013; Torres et al., 2006); phonemic awareness (Alegría et al., 1999; Charlier & Leybaert, 2000; D'Hondt & Leybaert, 2003; Leybaert, 1998; Leybaert, Alegría, & Fonk, 1983; Rees & Bladel, 2013); phonics (Alegría, Aurouer, & Hage, 1997; Alegría, Dejean, Capouillez, & Leybaert, 1990; Charlier & Leybaert, 2000; Colin, Leybaert, Ecalle, & Magnan, 2013; Colin, Magnan, Ecalle, & Leybaert, 2007; Rees & Bladel, 2013); working memory (Ketchum, 2001; Leybaert & Lechat, 2001; Wandel, 1989); spelling (Leybaert, 2000; Leybaert & Lechat, 2001; Rees & Bladel, 2013); vocabulary (Cornett, 1973; Nash, 1973; Rees & Bladel, 2013); morphosyntax, (Hage, Alegría, & Périer, 1991; Hage & Leybaert, 2006; Hawes, 2004; Koo & Supalla, 2010; Le Normand, 2003; Leybaert & Alegría, 1995; Leybaert & Charlier, 1996; Nouelle, 2005); fluency (Koo, Crain, LaSasso, & Eden, 2008); and reading comprehension (Rees & Bladel, 2013; Wandel, 1989). (See Leybaert, Colin, & LaSasso, 2010, and Rees & Bladel, 2013, for a review of this research). Findings from these studies, taken collectively, document clear benefits of exposure to cued language on measures of speech perception, phonemic awareness, phonics, working memory, spelling, vocabulary, morphosyntax, fluency, and reading comprehension.”

LaSasso, C. J., & Crain, K. L. (2015). Reading for deaf and hearing readers: Qualitatively and/or quantitatively similar or different? A nature versus nurture issue. American Annals of the Deaf, 159(5), 447-467. Retrieved from http://search.proquest.com/docview/1665182637?accountid=13552


"The present results are fully consistent with the educational approach of teaching deaf students overt strategies to learn to recognize words. Automatic word recognition is essential to the development of proficient reading, which is why the question of how individuals who are deaf achieve this feat is of enormous educational and theoretical importance. The present results indicate that recognizing written words solely via spoken phonology is moderately associated with reading achievement in the deaf population, as is the case for the hearing population. This means that reading instruction of deaf children requires an educational focus on linguistic as well as word recognition skills. The findings supporting this conclusion are that much variance in reading achievement is unexplained by PCA skills and that other factors, most notably language skill, are highly associated with reading achievement in this population.” (p. 166)

Mayberry, R.I., del Giudice, A.A., & Lieberman, A.M. (2011). Reading achievement in relation to phonological coding and awareness in deaf readers: A meta-analysis. Journal of Deaf Studies and Deaf Education, 16(2), 164-188.


Three conclusions can be drawn from these experiments. First, in the case of teenagers with PCHL [permanent childhood hearing loss] who communicate using oral language, the combination of reduced/degraded auditory cues and visual cues from lip-reading during speech perception are sufficient to allow pre-lexical phonological recoding during silent sentence reading. Second, during processing of directly fixated stimuli, phonological processing is slightly delayed in teenagers with PCHL relative to their hearing peers. Third, the well-documented reading difficulties associated with hearing loss are likely to be primarily attributable to other aspects of reading, and not to such a minor impairment in phonological processing.”

Blythe, H.I., Dickins, J.H., Kennedy, C.R., Liversedge, S.P. (2018). Phonological processing during silent reading in teenagers who are deaf/hard of hearing: An eye movement investigation. Developmental Science.


“These findings reveal that phonological encoding is available to deaf readers from the early stages of visual word recognition. Finally, the pattern of correlations of phonological priming with reading ability suggested that the amount of sub-lexical use of phonological information could be a main contributor to reading ability for hearing but not for deaf readers.” (p.261)

Gutierrez-Sigut, E., Vergara-Martínez, M., & Perea, M. (2017). Early use of phonological codes in deaf readers: An ERP study. Neuropsychologia, 106, 261-279.


“In this invited article, we addressed the question of whether reading for deaf and hearing readers is qualitatively and/or quantitatively similar or different. We interpreted that question in two ways: (a) whether the covert reading process is similar or different for deaf and hearing readers, and (b) whether the formal development of reading, including reading assessment, is a qualitatively and/or quantitatively different process for deaf and hearing readers. Acknowledging up front the extreme variability that exists in same-age members of either group (deaf, hearing) in regard to any of the variables related to reading, including linguistic knowledge, cognitive abilities, background knowledge, and sociocultural variables, we supported our view that the reading process for any reader, regardless of hearing status, is instance specific and depends on a reader's questions, or uncertainty, during reading about the language, content, or code (and, where applicable, the reading test). We challenged the view that deaf children cannot acquire phonological abilities, including phonics, in ways and at rates similar to those of hearing peers with conventional reading materials. We argued that a reader's questions about what is being read are less related to hearing status (deaf, hearing) and more related to environmental factors, including a rich linguistic home environment that provides clear, complete sensory access to the home language and, if different, the language encoded in print. We compared cued English and ASL, both visual languages, which function completely, both receptively and expressively, in the absence of either speech or hearing. We stressed the importance of teachers of deaf students providing clear, complete visual access to the instructional language, regardless of whether it is ASL, English, or Spanish, and regardless of whether reading instruction is accomplished via conventional or ELL methods and materials. Noting that English is the instructional language for almost 90% of deaf students (GRI, 2013, p. 11), we compared Cued Speech, oral-aural methods, and MCE sign systems in terms of their structural capability to convey English clearly and completely, and concluded that only Cued Speech is structurally capable of providing clear, complete visual access to English.” (p. 463)

LaSasso, C. J., & Crain, K. L. (2015). Reading for deaf and hearing readers: Qualitatively and/or quantitatively similar or different? A nature versus nurture issue. American Annals of the Deaf, 159(5), 447-467. Retrieved from http://search.proquest.com/docview/1665182637?accountid=13552


Vocabulary is important, too

“This research examined the effectiveness of using repeated storybook reading paired with explicit teacher instruction to teach novel vocabulary to young children with hearing loss who were receiving instruction with an oral approach. Data from a multiple baseline design across 4 children demonstrated that all children acquired the instructional vocabulary words, demonstrated generalization of the words in a novel situation, and maintained vocabulary for 2–4 weeks following intervention. Vocabulary that had not been explicitly taught was learned at a low rate across the 5 books.” (p.262)

Bobzien, J.L., Richels, C., Schwartz, K., Raver, S.A., Hester, P., & Morin, L. (2015). Using repeated reading and explicit instruction to teach vocabulary to preschoolers with hearing loss. Infants & Young Children, 28(3), 262-280.


“Reading comprehension and vocabulary strategies should be taught to individuals with hearing impairments in the same way as with their hearing peers (Charlesworth et al., 2006; Kyle et al., 2016; Schirmer and Woolsey, 1997; Walker et al., 1998). However, more activities, repetition and revision strategies should be conducted and employed along with the combined usage of direct and indirect vocabulary instruction strategies (Karasu and Girgin, 2007; Luckner and Cooke, 2010; Paul, 1996; Schirmer and McGough, 2005). Nevertheless, individuals with hearing impairments acquire only a small amount of the vocabulary knowledge when indirect instruction strategies are used (Beck et al., 1983; Paul, 2001). For this reason, it is emphasized that direct vocabulary developing strategies should be used more than indirect vocabulary developing strategies in order to develop the vocabulary of individuals with hearing impairments (Beck et al., 1983; Kelly, 1996; Luckner and Cooke, 2010; Taylor et al., 2009).” (p. 1403-1404)

Karasu, G., Girgin, U., Uzuner, Y., & Kaya, Z. (2016). Vocabulary developing strategies applied to individuals with hearing impairments. Educational Research and Reviews, 11(15), 1402-1414.


“The current results show that vocabulary knowledge of children with severe–profound hearing loss has improved over time, but there has not been a commensurate improvement in phonological skills or reading. They suggest that children with severe–profound hearing loss will require continued support to develop robust phonological coding skills to underpin reading.” (p.701)

Harris, M., Terlektsi, E., & Kyle, F.E. (2017). Literacy outcomes for primary school children who are deaf and hard of hearing: A cohort comparison study. Journal of Speech, Language, and Hearing Research, 60(3), 701-711.


What about writing research?

“With respect to writing and deaf learners, the state of the research is wanting, lacking in almost every respect. There is a scant evidence base upon which to advocate for any pedagogical practice or intervention, if the litmus test is that a positive change in outcomes has been achieved. It is also not clear that the evidence we do have is being interpreted in ways that meaningfully inform practice. The only group identified in this overview, that is performing at or close to age-appropriate levels, is the cohort who has enhanced access to spoken language (e.g., those with cochlear implants). Arguably this access affords these learners the opportunity to develop the discourse level oral language, that allows for more fluent ideation (i.e., text generation) as per the SVW, thus making it possible for them to more clearly say what they mean as they engage in the act of composing. It would seem useful to take this into account in thinking about the implications for the future, especially in a climate where meaningful access to spoken language is possible for so many. Having this control of the language in which they are writing would afford many more deaf individuals access to the power of the written word in a digital age when communication has become increasingly text dependent. Moving forward, attention needs to be paid not only to the teaching of writing and those approaches and strategies that are supportive of better outcomes, but to the reasons why so many deaf students have struggled. On the basis of the available theoretical and empirical evidence, deficits in language seem to be at the root of these challenges. Until this issue is addressed, it is likely that achievement for deaf learners will continue to lag behind that of their hearing peers. No writing intervention or approach, however well designed, will solve this language problem. In future, it would be important to design studies that test this proposition in order to establish the extent to which language impacts writing performance, and then consider how this can be addressed in the context of teaching deaf students to write.” (p.11-12)

Mayer, C., & Trezek, B. (2019). Writing and deafness: State of the evidence and implications for research and practice. Education Sciences, 9(3), 185.


Thirty-three young people with cochlear implants, aged between 9 and 16 years, were assessed for use of their implant system, cognitive abilities, vocabulary, reading, and writing skills. The group came from throughout England and included 26 born deaf, six deafened by meningitis, one with auditory neuropathy, and five with additional needs. Nineteen had bilateral implants with a mean age at first implantation of three years six months. The majority were educated in mainstream, with 85 per cent using oral communication in school. The group was cognitively able, all scoring within or above the normal range. In terms of receptive and expressive vocabulary, 75 per cent and 67 per cent scored within the average range respectively. Using the Single Word Reading Test, 55 per cent were within the average range, and 21 per cent above. As measured by the York Assessment of Reading Comprehension, 72 per cent were commensurate with hearing peers, and 9 per cent above on reading rate, and 75 per cent within the average range, and 13 per cent above on comprehension. Free writing samples indicated that 25 per cent were performing at the expected level for their age, 19 per cent above, and 56 per cent below. Influences on outcomes were age at implantation, bilateral implantation, and age at testing. Overall this group demonstrated good use of their technology, and much stronger outcomes in vocabulary and reading than evidenced in the deaf population prior to implantation. Writing outcomes were not as strong as in reading, but were not showing the use of non-standard English as in the past, and were showing writing strategies such as invented spelling, common in hearing children.” (p.71)

Mayer, C., Watson, L., Archbold, S., Ng, Z.Y., & Mulla, I. (2016). Reading and writing skills of deaf pupils with cochlear implants. Deafness & Education International, 18(2), 71-86. DOI: 10.1080/14643154.2016.1155346


Mainstream or special facility?

“Statistical information from the US Department of Education [4] indicate that approximately 19.4% of d/Deaf and hard of hearing (d/Dhh) students receive 40% to 70% of their education in general education classrooms and about 61.8% of those students receive 80% or more of their education in general education classrooms. In addition, it has been reported that about 13.8% of students with hearing loss receive less than 40% of their education in general education classrooms, and about 2.9% are in special schools for d/Dhh students. About 2.1% of those students are placed in separate residential facilities or regular private schools, such as homebound/hospital placements, and correctional facilities.” (p.1)

Alasim, K.N. (2019). Reading development of students who are deaf and hard of hearing in inclusive education classrooms. Education Sciences, 9, 201.


Assessment Issues?

“There is not general consensus on best practice for assessment and intervention of phonological awareness (PA) for children who are D/deaf or hard of hearing (D/dhh). The current study surveyed the PA practices of teachers of the deaf and speech-language pathologists to explore perceptions of PA importance, familiarity, and helpfulness related to assessment and intervention approaches used when working with children who are D/dhh. Survey responses from speech-language pathologists (n = 80) and teachers of the deaf (n = 94) indicated that the majority of respondents perceive PA to be important to literacy instruction with children who are deaf or hard of hearing. Notably there was a significantly higher average PA importance rating for literacy instruction with children with typical hearing than the PA importance rating for children who were D/dhh. There was wide variability in reported PA assessment and intervention practices. Participants reported using some assessments that included explicit items or subtests for PA including the following: Clinical Evaluation of Language Fundamentals, Comprehensive Test of Phonological Processing, and the Dynamic Indicators of Basic Early Literacy Skills. There was not general consensus on a particular instructional method or approach to support literacy development.” (p.1)

Puhlman, J. E., & Wood, C. L. (2019). Phonological awareness assessment and intervention practices for children who are d/deaf or hard of hearing. Communication Disorders Quarterly. OnlineFirst. https://doi.org/10.1177/1525740119853244


“Rose and McAnally (2008) published an additional, more recent study indicating that CBM maze passages using AIMSweb (aimsweb.com) for reading comprehension could be successfully used with students who are deaf or hard of hearing. The same 2008 study revealed that DIBELS (dibels.uoregon. edu) was a valid and reliable CBM procedure to use with students who are deaf or hard of hearing for oral reading fluency of letter naming and word identification, and that the Test of Silent Contextual Reading Fluency or TOSCRF (Hammill, Wiederholt, & Allen, 2006) was a valid and reliable measure with deaf and hard of hearing students. … As reported in Gibbons and Miller (2013), school psychologists reported a number of general challenges in assessing deaf and hard of hearing students, including an inadequate number of norm-referenced measures that may be administered in combination to demonstrate concordance of results. …. School psychologists with familiarity considered information obtained through CBA/CBM to be extremely valuable for progress monitoring, identifying areas of academic need, informing IEP goal development, preventing learning problems, and reducing the number of referrals for comprehensive evaluations.” (p.3, 8)

Miller, B.D. (2018). Utility of curriculum-based approaches for students with hearing loss Communication Disorders Quarterly, 1–10. On-Line First.


“Alphabet knowledge outcomes in children with hearing loss. Preschool and kindergarten children with hearing loss may learn alphabet knowledge skills at a similar pace as children without hearing loss (Easterbrooks, Lederberg, Miller, Bergeron, & Connor, 2008; Werfel, 2017). For example, Werfel (2017) found that 4-year-old children with hearing loss and 4-year-old children without hearing loss did not differ significantly on letter naming skills and knowledge of soundletter correspondences and improved on these skills at the same rate over a 6-month period. Children with hearing loss knew approximately 15 letter names and seven letter sounds at the first testing point and 19 letter names and 10 letter sounds at the second testing point. Although alphabet knowledge outcomes in children with hearing loss are encouraging, there are some children who may exhibit deficits (Cupples et al., 2014; Easterbrooks et al., 2008). Easterbrooks et al. (2008) reported that the standard deviation on a soundletter correspondence assessment was approximately 10 for a group of young children with hearing loss who achieved an average score of 10 in the beginning of an academic school year. This indicates that there may be children with hearing loss who need more intensive intervention in soundletter correspondences than others.” (p. 19)

Runnion, E., & Gray, S. (2019). What clinicians need to know about early literacy development in children with hearing loss. Language, Speech, and Hearing Services in Schools, 50, 16–33.


Early intervention

“Currently, almost 98% of all babies born in the United States are screened for hearing loss, as opposed to fewer than 3% in the early 1990s [9]. The establishment of universal newborn hearing screening, new screening technologies, as well as procedures for assessing hearing in newborns, has led to a reduction in the average age of hearing loss identification to the age of six months in 2007 from 30 months just two decades ago [9]. This timely identification of hearing loss in infants provides the opportunity for earlier access to visual or spoken language, hearing assistive technology, and early intervention services. Although some challenges in state tracking systems remain, particularly those related to failures to follow up from referrals to audiologic evaluations, over 5000 infants are identified very early in life each year [9]. Along with early identification, techniques for fitting amplification on newborns continue to improve. Digital hearing aids, cochlear implants, and remote microphone systems provide better access to higher quality sound at younger ages than ever before. Infants can be fit with hearing aids during the first weeks of life, and research has evidenced that when children with severe to profound hearing loss begin using hearing assistive technology between six and 18 months of age, listening, language, and speech development improve [10,11]. Early intervention services have also become available for increasing numbers of children between birth and age three. These services, funded through Part C of the Individuals With Disabilities Education Act (IDEA), provide family-centered intervention, which includes counseling, parent education, and services to support early signed and/or spoken communication development [12,13]. Substantial work remains in the area of counseling and reliability associated with early intervention services for caregivers and their d/Dhh children, but the services do much to meet the unique family support that is required. This shift in policy and practice has changed the demographics of the deaf population entering the educational system. Currently, 85% of all d/Dhh students in the United States are educated in public school programs, with 43% spending most of the school day in general education classrooms [14]. Most of these students receive support from an itinerant teacher of d/Dhh and/or an educational interpreter. Others spend part of their school day in the general education classroom, and the remainder in resource room settings receiving instruction from a teacher of d/Dhh.” (p.2)

Hartman, M.C., Nicolarakis, O.D., & Wang, Y. (2019). Language and literacy: Issues and considerations. Education Sciences, 9(3), 180.


“While traditionally alphabetic knowledge is not taught until kindergarten, even for children with typical hearing, recent research suggests such instruction in prekindergarten can have long-term positive effects on later reading skills, including reading achievement and spelling (Kirk & Gillon, 2007; Korkman & Peltomaa, 1993). The current study suggests that children who are DHH, even those who have delays in language, are able to learn the foundation for the alphabetic principle during prekindergarten. Although the longterm consequences of early instruction on the alphabetic principle need to be explored, such a finding holds promise for improving literacy skills of children who are DHH.” (p. 115)

Bergeron, J.P., Lederberg, A.R., Easterbrooks, S.R., Miller, E.M., & Connor, C. (2009). Building the alphabetic principle in young children who are deaf or hard of hearing. The Volta Review, 109(2–3), 87–119. Retrieved from http://clad.education.gsu.edu/files/2016/05/Bergeron-et-al-2009-Alphabetic-Principle.pdf


“In regards to communication options, there continues to be debate around whether deaf children should learn sign language, a sign system, or use listening to learn spoken language [18–20]. Gravel and O’Gara [19] as well as Fitzpatrick et al. [21] stressed in their work that at the current time, there is no solid evidence that one communication option is optimal for all young children who are d/Dhh, and that regardless of the mode chosen, language development is dependent on regular, consistent, and accessible input. d/Dhh children of deaf parents, with access to a natural sign language from birth, and those who have greater access to spoken language generally demonstrate somewhat better academic outcomes than d/Dhh children without those characteristics. Nevertheless, neither group as a whole achieves at the level of their hearing age peers [22–25]. This situation affects not only language development but also cognitive development, knowledge of the world, and social functioning, all of which influence each other cumulatively over time [26].” (p. 2-3)

Hartman, M.C., Nicolarakis, O.D., & Wang, Y. (2019). Language and literacy: Issues and considerations. Education Sciences, 9(3), 180.


“Already well documented for hearing children, schooling’s effects on early literacy skills for young students who are deaf or hard of hearing (DHH) were examined for the first time in the present study. Piecewise growth curve modeling was used to describe 3-, 4-, and 5-year-old students’ growth in phonological awareness, letter-word identification, and vocabulary during 2 years of schooling and the intervening summer (N = 56). Amplification mode was cochlear implants for 45% of the sample and hearing aids for 54%. Classroom communication mode was spoken language only (for 61%) or sign language (39%). Across all skills, significant growth occurred during the 2 years of schooling but not during the summer. These findings underscore early education’s importance in promoting DHH children’s critical early skills. Universal preschool intervention, including during summer, may be important in ensuring that DHH children have an adequate foundation when schooling begins. … The present study underscores that for young DHH children, even those as young as 3 years, schooling matters. The significant effect of schooling on children’s early literacy skills may indicate a need to establish early educational opportunities during the summer, or perhaps provide support for parents as they incorporate language and literacy experiences into the child’s home environment. Our findings indicated that 3-year-olds demonstrated significant rates of growth in all three areas while in school; therefore, beginning school at a younger age may play a critical role in supporting DHH children’s development.” (p.596, 615)

Scott, J. A., Goldberg, H., Connor, C. M., & Lederberg, A. R. (2019). Schooling effects on early literacy skills of young deaf and hard of hearing children. American Annals of the Deaf, 163(5), 596–618.


“However, when considered in their entirety, the results from this study provide strong support for implementing early intervention programs targeting PA skills in DHH children prior to commencing school.” (p.277)

Gilliver, M., Cupples, L., Ching, T.Y.C., Leigh, G., & Gunnourie, M. (2016). Developing sound skills for reading: Teaching phonological awareness to preschoolers with hearing loss. The Journal of Deaf Studies and Deaf Education, 21(3), 268–279. https://doi.org/10.1093/deafed/enw004


“Meanwhile, Allen et al. [84] agreed with the validity of the qualitative similarity hypothesis regarding the role of phonology in reading. However, they suggested a visual sign phonology instead of a sound-based English phonology as consequential for d/Dhh readers. In a review of research on the impact of early visual language exposure on a variety of developmental outcomes, including literacy, cognition, and social adjustment, they came to the conclusion that young deaf children of signing parents were able to recognize language patterns in segmented sign streams, which is a skill that is critical for early reading acquisition. They hypothesized that this skill would allow the brain and its memory processes to retain more words and facilitate the reading process. By having a visual sign phonology foundation, d/Dhh children would be able to map the sign phonological unit to print, especially during early emergent literacy (e.g., ABC letter writing or letter shape recognition). Allen et al. also found that American Sign Language (ASL) exposure had an independent effect on the participants’ letter knowledge and print concepts. An analysis of a parent rating scale given to over 100 children in this study showed that d/Dhh children from d/Dhh signing parents were more likely to demonstrate language and reading skills, whereas the results for d/Dhh children from hearing parents varied based on signing ability. Collectively, the authors supported the qualitative similarity hypothesis only if it was modality independent. Other studies [85,86] have also proposed using ASL phonology to teach reading, although the impact of ASL phonology knowledge on English reading is still questionable [87].” (p.7)

Hartman, M.C., Nicolarakis, O.D., & Wang, Y. (2019). Language and literacy: Issues and considerations. Education Sciences, 9(3), 180.


“Age-at-implant  is a well-established predictor of effectiveness in that children who receive early intervention are most likely to show benefits (Archbold et al., 2008; Kronenberger et al., 2014; Reading, 2012).” (p.704)

Harris, M., Terlektsi, E., & Kyle, F.E. (2017). Literacy outcomes for primary school children who are deaf and hard of hearing: A cohort comparison study. Journal of Speech, Language, and Hearing Research, 60(3), 701-711.


“Overall, children’s achievement in reading relies upon the strength of their early literacy skills. Intervention aimed at increasing the slope of children’s alphabet knowledge, phonological awareness, and oral language outcomes during the preschool and kindergarten years has the potential to prepare children for reading instruction once they begin elementary school. … As with alphabet knowledge, providing phonological awareness instruction benefits young children with hearing loss (Miller et al., 2013; Werfel, Douglas, & Ackal, 2016; Werfel & Schuele, 2014). Strategies that incorporate components from interventions designed for children without hearing loss, but are adapted for children with hearing loss, can be effective at teaching phonological awareness skills.” (p.21, 24)

Runnion, E., & Gray, S. (2019). What clinicians need to know about early literacy development in children with hearing loss. Language, Speech, and Hearing Services in Schools, 50, 16–33.


Kerry TeachingDeaf


“Direct Instruction programs in comprehension, spelling, and writing have been shown to produce considerable test-score gains for deaf and hard-of hearing high school students in selfcontained classrooms. To make these programs work efficiently with deaf and hard-of-hearing students, adaptations must be made in how the programs are taught and how to most effectively combine usage of ASL and CASE. Teacher training and widespread consistent usage of the programs are necessary to obtain the greatest impact. Although the high school student gains reported in this study are impressive, earlier and more consistent use of these programs and techniques has the potential of producing students who can attain much higher levels of performance.” (p.29)

Kraemer, J., Kramer, S., Koch, H., Madigan, K., & Steely, D. (2001). Using Direct Instruction programs to teach comprehension and language skills to deaf and hard-of hearing students: A six-year study. Direct Instruction News, 1, 23–31. Retrieved from http://files.eric.ed.gov/fulltext/ED467298.pdf


 “When beginning the present study, the researchers hypothesized that a deaf first-grade struggling reader would increase his phonological decoding skills by means of instruction from the Direct Instruction reading curriculum Teach Your Child to Read in 100 Easy Lessons. The results support this hypothesis. The participant was essentially a nonreader at the onset of the intervention. On a curriculum-based measure of oral reading from the story in Lesson 24 of the Teach Your Child to Read in 100 Easy Lessons curriculum, he was able to correctly read only the words a and in. In addition, he was able to identify only one nonsense word, nazz. At the end of the 8 weeks of the intervention, the participant correctly read short stories and 9 of 10 nonsense words. The present study was the first investigation to use Teach Your Child to Read in 100 Easy Lessons with a deaf student. Findings from this case study align with previous research investigating other use of the Direct Instruction curricula with deaf or hard of hearing students—that is, the studies by Trezek and Malmgren (2005) and Trezek and Wang (2006). Both of these previous studies, like the present study, emphasized the need to accompany phonological instruction with accommodations such visual cues.” (p.386)

Syverud, S.M., Guardino, C., & Selznick, D.N. (2009). Teaching phonological skills to a deaf first grader: A promising strategy. American Annals of the Deaf, 154(4), 382-388.


“After receiving instruction from the Reading Mastery I curriculum supplemented by Visual Phonics, the mean score of each cohort of students was higher at posttest when compared to pretest measures. In addition, the results of a paired-sample t test revealed that the findings obtained on the Word Reading subtest were considered statistically significant and the effect size was large.” (p. 211)

Trezek, B. J., & Wang, Y. (2006). Implications of utilizing a phonics-based reading curriculum with children who are deaf or hard of hearing. Journal of Deaf Studies and Deaf Education, 11(2), 202-213.


Morphology?

“Due to the need to improve reading achievement of students who are deaf or hard-of-hearing (DHH; Easterbrooks & BealAlvarez, 2012), researchers have documented the evidence surrounding the components of reading (see reviews for vocabulary, Luckner & Cooke, 2010; reading comprehension, Luckner & Handley, 2008; reading fluency, Luckner & Urbach, 2012; and decoding, Tucci, Trussell, & Easterbrooks, 2014). These reviews can be used by practitioners to guide instruction and researchers to guide research agendas.” (p.67). The view of morphology as a critical piece of the literacy pie is gaining momentum (Carlisle, 2003; Hurry et al., 2005); researchers are beginning to conduct morphological intervention research with various populations (hearing, Apel, Brimo, Diehm, & Apel, 2013; Carlisle, McBrideChang, Nagy, & Nunes, 2010; disabilities, Berninger, Lee, Abbott, & Breznitz, 2013; Harris, Schumaker, & Deshler, 2011; deaf, Bennett et al., 2014; Bow et al., 2004; Trussell & Easterbrooks, 2015). Situating the morphology evidence base in deaf education within the context of morphological research for general and special education leads us to believe that morphological intervention research in deaf education may be following a similar pattern. … Instruction that follows the principles of Direct Instruction (e.g., achievement-based groupings, small group instruction, fast-paced lessons, frequent choral responding, and vigilant monitoring of each student’s progress; Carnine, Silbert, Kame’enui, & Tarver, 2004) is promising for teaching morphology skills (Bennett et al., 2014; Trussell & Easterbrooks, 2015). Furthermore, Direct Instruction incorporates explicit instruction, communication between the teacher and the students, and scaffolding. Also, pairing phonological and morphological instruction may be a promising practice. Instructing both skills rather that one skill alone may be beneficial because students who are DHH need both skills to become literate (van Hoogmoed, Knoors, Schreuder, & Verhoeven, 2013).”” (p.74-5)

Trussell, J.W., & Easterbrooks, S.R. (2017). Morphological knowledge and students who are deaf or hard-of-hearing: A review of the literature. Communication Disorders Quarterly, 38(2), 67-77.


“Alternately, other studies have not shown clear use of phonological processing in deaf readers [78–81]. As a result, some researchers believe phonology might be bypassed by focusing on morphemes in the orthography of text. According to Gaustad [82], orthographic processing, or the visual processing of whole words or parts of words, may be a viable approach to decoding for deaf readers. The proposed morphographic approach to word identification with its emphasis on morphographic elements replaces an emphasis on phonemic elements as the focal element for analyzing print. This has implications for classroom practice; however, Gaustad noted that morphographic processing has not been extensively researched, particularly in relation to deaf participants.” (p. 7)

Hartman, M.C., Nicolarakis, O.D., & Wang, Y. (2019). Language and literacy: Issues and considerations. Education Sciences, 9(3), 180.


“Elements from the Spelling through Morphographs curriculum were chosen to develop lesson plans for the present study because DI curriculums have been effective for teaching discrete literacy skills to DHH students (Trezek & Malmgren, 2005; Trezek, Wang, Woods, Gampp, & Paul, 2007) in the past. (p.231) … What effect does morphographic instruction have on the morphographic analysis skills of DHH students who are reading below grade level? We answered this question through repeated assessment of morphographic analysis skill. We found that morphographic instruction does positively change the student participants’ morphographic analysis skills. … A functional relation between the morphographic intervention and the students’ morphographic analysis skills was established. These findings support previous findings that DHH students can improve literacy skills through DI programs (Trezek & Hancock, 2013; Trezek & Malmgren, 2005; Trezek & Wang, 2006) paired with a visual organizer (Easterbrooks & Stoner, 2006).” (p.237-8)

Trussell, J.W., & Easterbrooks, S.R. (2015). Effects of morphographic instruction on the morphographic analysis skills of deaf and hard-of-hearing students. The Journal of Deaf Studies and Deaf Education, 20(3), 229–241.


Otitis Media

The poor readers, therefore, show a broad pattern of weaknesses on linguistic tasks, with particular impairments on the metalinguistic tasks investigating morphological and phonological awareness. They consistently required more prompts to successfully complete the dynamic morphological and phonological tasks. In contrast, children with OM [Otitis Media ] show a circumscribed difficulty with phonological tasks that required segmenting and blending, and no difficulties in metalinguistic processing.” (p. 10)

Carroll, J.M., & Breadmore, H.L. (2018). Not all phonological awareness deficits are created equal: evidence from a comparison between children with Otitis Media and poor readers. Developmental Science, 21(3), 1-12.


Fatigue among children with hearing loss?

“Although reading outcomes for children with hearing loss are improving, too many of these children continue to display persistent reading difficulties. Because of these difficulties, there is an ongoing need to understand the nature of the relationships among decoding abilities, language skills, and reading achievement in this population more fully. Coincidentally, there has also been an emerging literature on the subjective fatigue in children with hearing loss, which could be directly or indirectly linked to reading ability. The purpose of this study was to examine associations among language abilities, reading skills, and subjective fatigue in 56 children with mild to moderate hearing loss (CMMHL). The results indicated that both phonological awareness and receptive language ability predicted reading achievement in CMMHL, which replicates findings for children without hearing loss. The results also indicated that CMMHL who had poor reading skills reported significantly higher levels of subjective fatigue relative to the other children with mild to moderate hearing loss in the sample.” (p. 420)

Camarata, S., Werfel, K., Davis, T., Hornsby, B.W.Y., & Bess, F.H. (2018). Language abilities, phonological awareness, reading skills, and subjective fatigue in school-age children with mild to moderate hearing loss. Exceptional Children, 84(4), 420-436.


Interesting areas for more research: Eye movement studies and brain circuitry analysis

“To conclude, the present research reveals several important similarities in eye movement characteristics and information processing between hearing and deaf readers, but also fascinating differences, such as the lack of (or weak) activation of phonological codes, the efficiency in gathering orthographic information in the parafovea and, for the skilled deaf readers, the increased amount of information processed within a single fixation relative to skilled hearing readers. The important point to be made here, however, is not whether deaf readers use phonological codes or not. The focus should rather be placed on proper assessment of reading level and on the similarities and differences between skilled and less skilled deaf readers. Crucially, using a very sensitive measure of information processing, both SKD and LSKD readers showed no clear evidence of phonological code activation, replicating previous research (Bélanger et al., 2012a) conducted in a different language and in a different population. These results support the growing evidence that the use of phonological codes in reading is not a determinant of reading skills in the deaf population and that another, more lingering factor, might be at play in determining reading skill in deaf readers. In light of the pervasiveness of reading difficulties in the deaf population, the present results shed an important light on issues that would need to be addressed in educational settings for reading acquisition by deaf children.” (p.10-11)

Bélanger, N.N., Mayberry, R.I., & Rayner, K. (2013). Orthographic and phonological preview benefits: Parafoveal processing in skilled and less-skilled deaf readers. Quarterly Journal of Experimental Psychology, 66(11), 2237-2252.


“We examined word-level reading circuits in skilled deaf readers whose primary language is American Sign Language, and hearing readers matched for reading ability (college level). During fMRI scanning, participants performed a semantic decision (concrete concept?), a phonological decision (two syllables?), and a false-font control task (string underlined?). The groups performed equally well on the semantic task, but hearing readers performed better on the phonological task. Semantic processing engaged similar left frontotemporal language circuits in deaf and hearing readers. However, phonological processing elicited increased neural activity in deaf, relative to hearing readers, in the left precentral gyrus, suggesting greater reliance on articulatory phonological codes, and in bilateral parietal cortex, suggesting increased phonological processing effort. Deaf readers also showed stronger anterior-posterior functional segregation between semantic and phonological processes in left inferior prefrontal cortex. Finally, weaker phonological decoding ability did not alter activation in the visual word form area for deaf readers.” (p. 169)

Emmorey, K., Weisberg, J., McCullough, S., & Petrich, J.A.F. (2013). Mapping the reading circuitry for skilled deaf readers: an fMRI study of semantic and phonological processing. Brain Language, 126(2), 169-180.


So, research seems to be coming closer to the nub of what’s important, and technology is making an increasingly important contribution. Acknowledging that there is still room for new discoveries, what’s the takeway in 2019?

“[Dehane] claimed that the brains of all readers are universally structured with the same brain mechanisms, and that reading always requires specialization of the visual system for the shape of letters and connecting them to speech sounds, regardless of the language being read [145]. The premise of the qualitative similarity hypothesis is that all learners, deaf and hearing, learn similarly through similar strategies, but perhaps at different stages or ages, depending on their circumstances and that the acquisition of English by any individual as a first or second language will be developmentally similar, whether they are d/Deaf, hard-of-hearing, or hearing, to others in similar first or second language learning circumstances. Teaching the correspondences between sounds and letters is essential, and is the most efficient way to acquire reading comprehension [2]. Numerous national reports [57, 91] have suggested the usefulness of systematic, explicit phonics instruction based on word structure along with wide reading of quality literature for supporting development in early reading instruction. However, other studies have indicated that many in-service teachers are not knowledgeable in the basic concepts of the English language or how to address the basic building blocks of language and reading. One of the reasons for this situation is that many teacher preparation programs that are responsible for training future elementary teachers are not providing sufficient coursework regarding the concepts of literacy pedagogy. … Accordingly, the curricula in teacher preparation programs in deaf education should include (1) the diversity of individuals who are d/Dhh, including those with multiple disabilities; (2) understanding of an individual’s type and degree of bilingualism or multilingualism; (3) language and literacy development theories, as well as assessment frameworks for consistent progress monitoring; and (4) evidence-based practice in facilitating the language and literacy development of individuals who are d/Dhh, particularly the strategies in providing rich and varied language experience. Meanwhile, the discussion of language and literacy development for d/Dhh continues as more research data is collected and instructional practice evolves.” (p.14)

Hartman, M.C., Nicolarakis, O.D., & Wang, Y. (2019). Language and literacy: Issues and considerations. Education Sciences, 9(3), 180.


Some other refs

  • Messier, J., & Jackson, C. W. (2014). A comparison of phonemic and phonological awareness in educators working with children who are d/deaf or hard of hearing. American Annals of the Deaf, 158(5), 522-38.

  • Friedman Narr (2006). Teaching phonological awareness with deaf and hard of hearing students. Teaching Exceptional Children, 38, 53-58.
  • Kids World Deaf Net: Published article by Bettie Wadd

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