ABSTRACT

Some children with hearing loss show delays in developing spoken language and in acquiring preliteracy skills. The purpose of this single subject study was to evaluate whether initial sound segmentation training increased initial sound segmentation ability in preschool children with hearing loss. Two preschool children with hearing loss participated in this multiple probe design single subject study. The children participated in individual initial sound segmentation training (37-39 half-hour sessions). Assessment of children’s initial sound segmentation skill occurred at the beginning of each session. Results indicated that initial sound segmentation training increased initial sound segmentation skill in the children with hearing loss. The children exhibited some maintenance of skill, but maintenance was not complete. Generalization to sounds not taught was generally not observed. Educational implications will be discussed.

INTRODUCTION

Approximately 12,000 infants are born each year with hearing loss, making hearing loss the most common of all birth defects (NCHAM, 2001; NIDCD, 2003).

Children with hearing loss show delays in developing spoken language and in acquiring preliteracy skills (Paul, 2009).The average 18- to 19-year-old with severe hearing loss reads on a fourth grade level (Stewart & Clarke, 2003). Only 3% of 18-year-olds who are deaf achieve the same reading level as the typical 18-year-old with normal hearing (Marschark, Lang, & Albertini, 2002). Despite technological advances in amplification for children with hearing loss (e.g., cochlear implants), the average reading level for this population has not increased in the past several decades (Trybus & Karchmer, 1977; Paul, 2009).

In children with typical hearing, phonological processing is an important precursor to early literacy skills (see Adams, 1990). Phonological processing deficits, including phonological awareness, in children with hearing loss may contribute to poor reading outcomes.

Phonological awareness is defined as an individual’s ability to analyze the sounds of spoken language (Wagner & Torgesen, 1987). To demonstrate phonological awareness, a child must attend to the speech sound structure of words, separate from a focus on word meaning (Snow, Burns, & Griffin, 1998).

It is generally agreed that children with hearing loss can develop phonological awareness, regardless of type of amplification or mode of communication. However, the development of phonological awareness in children with hearing loss lags behind their peers with typical hearing and does not appear to be sufficiently developed to support proficient reading (Harris & Beech, 1998; Miller, 1997; Paul, 2009; Sterne & Goswami, 2000).

No published studies of the response of children with hearing loss to phonological awareness intervention exist in the literature.

DISCUSSION

REFERENCES Adams, M. (1990). Beginning to read: Thinking and learning about print. Cambridge, MA: MIT Press. Harris, M., & Beech, J. (1998). Implicit phonological awareness and early reading development in prelingually deaf children. Journal of Deaf Studies and Deaf Education, 3, 205-216. Marschark, M., Lang, H., & Albertini, J. (2002). Educating deaf students. Oxford: University Press. Miller, P. (1997). The effect of communication mode on the development of phonemic awareness in prelingually deaf students, Journal of Speech, Language, and Hearing Research, 40, 1151-1163. National Center for Hearing Assessment and Management (NCHAM). (2001). The genetics of infant hearing loss. Sound ideas. Retrieved April 20, 2006, from http://www.infanthearing.org/newsletter/v3n3/genetics.html National Institute on Deafness and Other Communication Disorders (NIDCD). (2003). When a newborn doesn’t pass the hearing screening: How health professionals can encourage follow- up hearing evaluations for newborns. Retrieved April 20, 2006, from http://www.nidcd.nih.gov/health/hearing/professionals.htm Paul, P. (2009). Language and deafness (4th ed.). San Diego, CA: Singular Publishing Group. Schuele, C. M., & Dayton, N. D. (2004). Intensive phonological awareness program. Nashville, TN. Snow, C. E., Burns, M. S., & Griffin, P. (Eds.). (1998). Preventing reading difficulties in young children. Washington, DC: National Academy Press. Sterne, A., & Goswami, U. (2000). Phonological awareness of syllables, rhymes, and phonemes in deaf children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 41, 609-625. Stewart, D,, & Clarke, B. (2003). Literacy and your deaf child: What every parent should know. Washington, D.C.: Gallaudet University Press. Trybus, R., & Karchmer, M. (1977). School achievement scores of hearing-impaired children: National data on achievement status and growth patterns. American Annals of the Deaf, 122, 62-69. Wagner R. K., & Torgesen, J. K. (1987). The nature of phonological processing and its causal role in the acquisition of reading skills. Psychological Bulletin, 101, 192-212.

Author Contact: krystal.l.werfel@vanderbilt.edu

www.mc.vanderbilt.edu/languagelab

This study was supported by an Early Childhood Language Development Student Research Grant awarded to the first author by the American Speech-Language-Hearing Foundation and by a Preparation of Leadership Personnel grant (H325D080075; PI: Schuele), US Department of Education.

FUTURE RESEARCH •  Does phonological awareness training increase

phonological awareness skill for all children with hearing loss?

•  Can children with hearing loss be taught to successfully complete more complex tasks of phonological awareness (i.e., segmentation of entire words)?

•  Does phonological awareness training for children with hearing loss improve later reading outcomes?

PURPOSE

Phonological Awareness Training with Children with Hearing Loss

Krystal L. Werfel and C. Melanie Schuele ♦ Vanderbilt University School of Medicine

The purpose of this single subject study was to evaluate whether initial sound segmentation training increased initial sound segmentation skill in preschool children with hearing loss. This study was the first step toward a group phonological awareness intervention study for this population.

Participants

Procedures The intervention was adapted from the initial sounds lessons of Schuele and Dayton (2004), a 12-week phonological awareness curriculum. The lessons were modified in three ways:

(a)  The intervention targeted one sound at a time (/m/, /b/, /d/). Three sets of target words were developed.

(b)  An activity was added in the first lesson that introduced the target sound for each intervention wave.

(c)  The lessons were repeated three times (once with each target phoneme). Each wave of intervention included 9 lessons (3 weeks), unless children reached criterion to move to the next target sound.

(a) 

Following the order of development of phonological awareness skills, the first lessons targeted initial sound judgment, then lessons targeted initial sound matching, then initial sound segmentation, and finally initial sound generation.

The lesson target phoneme advanced when either (a) the child achieved 80% correct on the target phoneme for two consecutive daily assessments, or (b) the child completed three weeks targeting the same phoneme without reaching criterion.

EACH SESSION

Activity Time

Letter Activity 5 minutes

Initial Sound Activity 10 minutes

Initial Sound Activity 10 minutes

Assessment 5 minutes

ICRAW JCANT Performance on Initial Sound Segmentation Measure Performance on Initial Sound Segmentation Measure

Per

cent

Cor

rect

Per

cent

Cor

rect

Session Session

ICRAW JCANT Age 4;6 4;9 Type of HL Bilateral

Moderately Severe to Severe SNHL

Bilateral Profound SNHL

Age at ID 1;9 2;3 Amplification Hearing Aids Cochlear Implants

Education Auditory Oral Auditory Oral S-L Tmt. per week 1 hour 2 hours Leiter-R 113 107 CELF-P 67 67 PPVT-III 70 79 EOWPVT 82 84 GFTA-2 78 -- Arizona-3 -- 90 PALS-K Rhyme 3/10 5/10 PALS-K Initial Sounds 2/10 5/10 PALS-K Letter Sounds 8/26 10/26 MLU 2.83 3.12

Increase in Phonological Awareness Skill Individual phonological awareness intervention was associated with an increase in phonological awareness skill for these two children with hearing loss. Both participants made gains during each wave of intervention.

Less Instruction Needed for Subsequent Sounds Children were able to apply the general skill of initial sound segmentation to newly taught sounds with relative ease. However, children needed instruction for each sound to demonstrate proficiency with segmenting words that began with each target sound.

Some Maintenance, But Not Completely Sustained In addition to demonstrating learning of the skills taught in this study, the two participants demonstrated maintenance of skills learned. However, this maintenance of skills was not complete.

Little Generalization to Nontaught Sounds Generalization to proficient performance with sounds that were not taught generally was not observed. For children with hearing loss, it may be necessary to explicitly teach many sounds individually before children are able to generalize from phoneme-specific awareness to general awareness of initial sounds.

Use of a Hierarchy of Sounds in Instruction When teaching initial sound segmentation to children with hearing loss, interventionists may need to carefully consider the properties of the target phonemes. The target phonemes in this study were selected based on acoustic and visual properties of the sounds. Children with hearing loss may not have access to sounds that are high in frequency (e.g., /s/ or /f/) and/or low in amplitude (e.g., /s/ or /z/), as well as sounds that are produced with few visual cues (e.g., velar sounds such as /k/ and /g/). Intervention should begin with sounds that are easier for children to successfully segment.

Errors Give Insight to Children’s Skill It may not be sufficient to simply classify children’s errors as right or wrong. The types errors of the children in this study changed over time as skill developed and varied across the two children.

Note: Solid lines indicate introduction of intervention. Dashed lines indicated conclusion of intervention. NT = sounds not taught in intervention.

/m/

/d/

/b/

NT

/m/

/d/

/b/

NT

Note: Solid lines indicate introduction of intervention. Dashed lines indicated conclusion of intervention. NT = sounds not taught in intervention.

0

25

50

75

100

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

Session

Per

cent /m/

Error Analysis

0

25

50

75

100

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37

Session

Per

cent /m/

Error Analysis

METHOD RESULTS

Code Explanation Example 1 target initial sound /d/ for “dog” 2 initial sound; not target; /m/, /d/, or /b/ /m/ for “dog” 3 initial sound; not target; /n/, /t/, or /p/ /n/ for “dog” 4 initial sound; not target; other phoneme /k/ for “dog” 5 group of sounds; not whole word /da/ for “dog” 6 letter name “d” for “dog” 7 repeat target word “dog” for “dog” 8 whole word; not target word “black” for “dog” 9 phrase “it’s scary” for “dog”

10 no response/I don’t know

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