Listen Up

The essentials: glasses, iPhone, CIs.

I said before that I have been impressed with the way Laynie has used her CIs all day everyday since getting them (February and August). It's especially impressive considering that she hasn't really benefitted from them since June.

In May, Laynie began having problems with her first CI, the one on the left side. She had pain during a mapping, and it caused problems after that with tingling, discomfort, and sometimes jabs of pain. Not really knowing what the problem was but assuming it was related to the amount of stimulation, her audiologist turned her down. When I say "stimulation" and "turned her down," I'm talking about electricity running through her cochlea, in close proximity to sensitive nerve endings. People are bound to run into problems with this sometimes.

The audiologist kept turning her down more and more, hoping that would solve the problem. It didn't. But things got quieter and quieter for Laynie. She was missing many speech and environmental sounds. She could no longer hear birds or bugs. She lost S, F, TH, and more. We stopped doing therapy in August, because it was just an exercise in frustration. And then, about two weeks ago, the tingling and discomfort stopped, pretty much overnight. A day or two after that, Laynie had a mapping session, her one-month mapping for her new CI. Her new CI was also quiet, because the audiologist wanted to keep them equal. It turned out that she had been hearing at about 60-65 dB. No wonder she was missing so many sounds!

At that mapping (about two weeks ago), she asked for more sound. She missed all the things she was able to hear a few months ago but had not heard all summer. She got her wish, with hearing levels at about 30 dB. But she feels like she started hearing even better a few days ago (funny that things will change a week or so after mapping). She still wants to hear MORE, especially on the right side. Her next mapping will be the first week in December.

See? Better.

Just for kicks, this is what fun, colored coils look like. I love that she chose blue for the left and red for the right. An audiologist's dream come true.

Now you see them...

Now you don't!

She definitely is hearing better since this past mapping. I can use a normal voice and she turns to me. And she hates my cough again, ha. Yesterday, she was asking why I-695 is so much quieter than I-795. I had honestly never even noticed. As we drove to Target this morning, I realized that she is absolutely right. The only thing I could think of was that it might be because I-795 is made of concrete, while I-695 is paved with asphalt. Her speech is improving again, as well. She's using more final consonants, making nicer vowels, and her /s/ blends are sounding quite good. She told me to STop today, which was dah or dop preimplant. It's so nice to see her making progress and hearing new things again, after her four-month plateau. I guess it's time to get back on the horse with listening therapy.

Yesterday, I saw Laynie checking out the Phonak website, comparing the different FM transmitters. She liked the ZoomLink:

Of course, she wouldn't wear that, so I don't know why she cares about the transmitter. That's for the person speaking to her. She would use the little plug in MicroMLxS or MLxi or whatever. I've been thinking about FM systems since playing around with one with Laynie a few days ago. It seems like it would be perfect for her, because she doesn't need to hear a lot of people at home, just me. It would be nice to have one while out, so that she would be able to hear despite wind, crowds of people, noisy traffic, etc. The world is just full of challenging listening environments.

Too bad those things are so stinking expensive!

Please

Parents, please sign with your deaf children.

Deaf children with strong signing skills have stronger English literacy skills (yes, compared with deaf children who speak).

Deaf children who sign have a more positive self-concept. That's psychobabble for feeling good about themselves.

Deaf children who sign are no worse at spoken language than their deaf peers who do not sign--in fact, they have better spoken language skills. FYI, language is where it's at in education. If children can't say their /r/ correctly, their education will probably not be affected. In my school district, we frequently do not pick up hearing children with /r/ problems, due to lack of educational impact. Language and the concepts learned through language will have a direct impact on every child's education. Why is it that parents are willing to buy the story that children can be bilingual in any combination of languages except ASL and English? Oh, right, because if they learn ASL, they won't be motivated to learn English. Foolishness. Engage your common sense and do not believe everything you hear just because a person with abbreviations following their name said it.

Deaf children who sign have better relationships with their parents and experience fewer communication breakdowns with their families.

Deaf children who sign can develop their brains from birth (or at least from identification of their deafness), instead of waiting until they are old enough to receive a cochlear implant. No, it will not make their brain develop in a way that will prevent them from learning spoken language. This is hogwash. This idea is propagated by those who stand to benefit monetarily from parents buying into it. There is zero research to back it. There is, however, research to back the idea that with the brain, if you don't use it, you lose it. A child deprived of language input (and don't tell me that hearing aids and lipreading provide adequate language input for an infant, because I will laugh in your face) will slowly lose their intellectual capacity. The brain is the most plastic and most rapidly developing during the first year of life. Unused neural connections are dying every day during the first year of life. The very year wasted waiting for a cochlear implant.

Deaf children who sign are able to acquire language in an age-appropriate manner. Deaf children do not have full access to spoken language, even with cochlear implants. That's why they need therapy to learn language, rather than acquiring language naturally. They do have full access to sign language.

Deaf children who sign are able to listen and understand spoken language using a cochlear implant or hearing aid.

Deaf children who sign are able to behave appropriately just as hearing children do. Just a quick story: a family I knew was told by a teacher of the deaf (who herself was deaf and raised orally) that they needed to stop signing with their four-year-old child, so that he would learn to hear and speak using his cochlear implant. The mother trusted this teacher and followed her advice. Within a few weeks, the child's behavior had seriously deteriorated, and his mother was at wits end with him. The oral program referred her to a behavior specialist. They worked on behavior modification. The situation dragged on for months as they visited with the behavior specialist often and even tried a pediatric psychiatrist. His mother finally followed her instincts and allowed him to communicate freely again. He was back to normal by the end of the week, and they were able to get rid of the rewards charts, tracking sheets, and time out chair.

Deaf children who sign are able to acquire age-appropriate social skills. Many professionals take it as a given that deaf children will need social skills training. It doesn't have to be that way.

Deaf children who sign are able to do everything hearing children can do. Think, learn, speak, listen, and achieve. Sign with your deaf children. They will thank you later.

I will step down from my soapbox now.

Literacy Research in Deaf Education

Summary and thoughts:

Luckner, J., Sebald, A., Cooney, J., Young, J., & Muir, S. (2005/2006). An examination of the evidence-based literacy research in deaf education. American Annals of the Deaf, 150, 443-456.

"People who struggle to read and write are much more likely than literate people to drop out of school, go to prison, or struggle to find and keep meaningful, satisfying work." Yikes!

This article was a meta-analysis of the research over the past 25 years or so that studied deaf literacy learning.

There are some deaf and hard of hearing students who read at grade level. Some become successful writers. But most have a hard time learning literacy. Here are some problems that people often say are the reasons deaf students struggle with literacy:

1. Less access to the phonological code. This relates to the Goldin-Meadow and Mayberry (2001) article. ASL has its own vocabulary, which does not relate to English phonology. Auditory/oral deaf children do not hear well enough to access English phonology.

2. Limited language fluency. Many deaf children are not fluent in a spoken or signed language when they begin school. Reading and writing depend on a language foundation (spoken or signed). Many deaf children have to learn to read and write while learning their first language at the same time.

3. Not enough literacy experiences in early childhood. Deaf children do not have books read to them as often as hearing children. Parents do not feel comfortable signing, have a limited sign vocabulary, or have trouble finding a way to position the child and the book and still make eye contact.

4. Delayed vocabulary acquisition. Vocabulary is a major key to reading comprehension.

5. Problems with lower-level skills. Many deaf students struggle with word recognition, syntax, and vocabulary comprehension. Because of this, they do not develop the independent reading strategies that they need, such as self-questions, activating prior knowledge, etc. They need to a foundation of lower-level skills before they can learn higher-level literacy skills.

So what can we do?

1. Explicit vocabulary instruction and practice with short passages. Tell them the definition of a word, show them a sentence using the word, and use computer programs to practice the vocabulary words.

2. High-interest literature. This study used "adapted classics," meaning classic books like Treasure Island that have been changed in grammar and vocabulary to fit different (lower) reading levels.

3. Instruction in ASL grammar and how to translate ASL into written English. Exactly what it looks like. Teach ASL grammar just as hearing students learn English grammar. Practice translating ASL into written English.

4. Teacher discussion of stories. The teacher discusses the story and teaches students to summarize, question, clarify, and predict.

5. Instruction in reading comprehension strategies. For example, teach story grammar (characters, plot, etc.) and locating details in the text.

6. Interaction. Communicate and play games using English. Real interactions are better than analyzing grammar. You can use email, chat rooms, and the internet.

7. Reading to young students. Evening group storybook reading had a positive effect on independent reading and interest in books.

8. Use of captions. Watching videos with captioning improved comprehension of visual information.

9. Intensified instruction. The teachers were given plenty of materials and space to teach just a few students each.

10. Use of word processing. Let students use Word (or another program) so that they can use spell checker.

12. Use of simple stories and word recognition practice with young readers. Exactly what is says.

13. Use of the general education curriculum. Teach them what the hearing children are learning.

14. Direct teaching of sight words and teaching of morphological rules. Again, this is exactly what it says. And morphological basically means word endings, like going, takes, walked.

Now go get them!

Acquisition of English as a Second Language

This is a textbook chapter written by Jim Cummins. His work on language learning has applications to ESL, deaf education, and even to language disorders and normal language/literacy development. Love him.

Cummins, J. (1994). The acquisition of English as a second language. In Spangenberg-Urbschat, K. & Pritchard, R. (Eds.) Kids come in all languages: Reading instruction for ESL students (pp. 36-62). Newark, DE: International Reading Association.

Why do some children develop proficiency in a second language easily and others struggle? And what exactly does proficiency mean? How long should we expect for children to reach different levels of proficiency in English as a second language. What influences the rate of English acquisition and how far children can go in their English learning?

There are two kinds of English proficiency: conversational language and academic language. People assume that these two are closely related, but they are not. Academic language is more cognitively demanding. That means it requires more brain power. There are two continua (that would be "continuums") that combine, and it's best shown in a chart. So here you go.

I like this chart, because it has examples. So left to right you have cognitive undemanding (easier) to cognitively demanding (harder). Top to bottom you have context embedded (easier) to context reduced (harder). Context embedded means that you have clues to the meaning of the words right in the situation. Most conversations at home are context embedded. Vocabulary is predictable. Concepts are familiar. Most instruction at school is context reduced, although there certainly is a push toward more context embedded instruction (more visuals, especially). When the context is reduced, the child has to figure out what the teacher is saying based on language alone. I hope this makes sense.

Language in the home (conversational language) is usually in square A of the chart, sometimes square C, less often squares B or D. Language at school (academic language) is usually in square D of the chart, sometimes square B. It is rarely in squares C or A. You can see Cummins' point, that conversational language and academic language are different, even if both are English.

When a child begins learning a second language, where do they start on this chart? You guessed it: square A. It's not that the child deliberately decides to start in square A. It's just easier to develop that kind of language, since it's not cognitively demanding and has plenty of context clues to help construct meaning from language. When a child is able to have a conversation in English, should we assume that they can comprehend classroom instruction in English? Let's check the chart... nope.

Cummins invented vocabulary to describe this. Basic interpersonal communicative skills (BICS) is achieved first. Cognitive academic language proficiency (CALP) comes later. But how much later?

It takes two years or less to develop BICS. It takes five to seven years to develop CALP. While the child is learning English, their native English-speaking peers are learning through English. If an ESL child is in an immersion setting (in an English-speaking classroom), he will remain behind the native speakers for many years. By the time he attains CALP, those native speakers have already learned more than he has. So he has to catch up. In large scale studies, it took an average of seven years to catch up. We all know what an average means, right? A lot of the kids took longer than seven years.

Stopping ESL support when the child gains BICS in English is dangerous. It might seriously harm the child's academic development, especially if the child is in a very "square D" classroom.

Now, what makes a difference in the rate of second language acquisition?

-Quantity of language exposure (length of time, how much the child is paying attention)

-Quality of language exposure

-Child's age

-Cognitive abilities

-L1 literacy (literacy skills in the first language)

-Personality

-Personal confidence (are they willing to put themselves out there and be brave, trying to communicate in the second language?)

-Motivation

Alright, so let's talk application to deaf language/literacy development. My concern is "quality of language exposure." Hearing aids and cochlear implants provide poor exposure to spoken language. If the child is in a literacy-poor home environment, English print exposure may also be poor. Classrooms for deaf children MUST have plenty of English print exposure. This is totally accessible to all children with normal vision. "Cognitive abilities" is another factor that concerns me with deaf children. So many deaf children do not begin developing their cognitive abilities at birth, as hearing children do. This is because they do not have comprehensible language input until their hearing loss is identified and they either receive a cochlear implant or receive ASL exposure. Language exposure during infancy is the way to develop cognition. "L1 literacy" is obviously a huge concern, if a child receives poor signed input for several years before entering school. This reminds me of the Strong & Prinz (1997) study, which examined the relationship between ASL and English skills.

Now let's talk application to hearing literacy development. Some children struggle with reading in kindergarten (I don't know about your school district, but our kids read in kindergarten), and it suddenly clicks in a year or two later. My brother was one of those children. Could this be because the child hasn't yet developed CALP? After all, it takes five to seven years to develop CALP for ESL kids... is there evidence that it develops sooner in the native language? Just a thought.

How Do Profoundly Deaf Children Learn to Read?

This is the first of what I would like to make a series of summaries/commentaries on journal articles relating to speech, language, and literacy. My professional interests are deafness, phonology, and autism, so expect to see those topics show up. I guess I will call this Research Is for Everyone, Volume 1.

Here's the citation:

Goldin-Meadow, S., & Mayberry, R. (2001). How do profoundly deaf children learn to read? Learning Disabilities Research and Practice, 16, 222-229.

Most hearing children learn how to speak pretty easily, but many hearing children struggle with learning how to read. They must learn how the spoken language they already know relates to the printed words on a page. They use the sounds of the language (phonology) to figure out the printed words. Of course, they already know the meanings of the words. For example, they know that the sounds "mmm," "ah," "mmm" mean that wonderful woman who gives them juice and lets them watch cartoons. It's just a matter of figuring out that "mmm"=M, "ah"=O, "mmm"=M. So they need to know the spoken language (here, English). And they need to know the phonology (sounds) of the spoken language relates to the printed letters/words.

Deaf children have limited access to English phonology, because they don't hear it well. This includes with hearing aids and cochlear implants. If they need extensive therapy in order to learn a language, they obviously do not have full access to it. Deaf children also have limited access to English language concepts (mainly because of the whole phonology problem).

Only 15% of white deaf high school graduates read above a sixth grade level. The numbers are lower for black and Hispanic deaf high school graduates. Hard of hearing children, even with mild to moderate hearing losses, also read below the level of hearing children. Most deaf children with hearing aids and cochlear implants are in that mild to moderate hearing loss group, even worse if they have unilateral hearing (just one ear). We are not talking about ASL-using children, either. These numbers were consistent throughout the years of oral-only deaf education.

Again, deaf children do not have full access to the phonology (sounds) and language (structure and meaning) of spoken English. It doesn't matter what technology they use to hear.

Deaf children born to deaf parents tend to read at a higher level than deaf children born to hearing parents. Why? They have a native language. They are able to develop competence in their native language (which they have full access to), and they are able to apply their language learning skills to written English. But how? ASL and English do not share a phonological system. ASL and English are totally different languages.

Deaf children born to hearing parents typically are not exposed to ASL. If they are exposed to any sign language, it is usually a form Manually Coded English (MCE), such as Signed English or SEE. The problem with this is that exposure to the language is usually poor quality. Parents will typically sign only when directly communicating with the child, so the child misses out on all of the language that a hearing child overhears. That's a lot of language. Also, parents will often mess up their signs if they try to talk and sign at the same time. Another issue is that children may not be exposed to language early enough. Sometimes their parents wait to introduce signing until they "give them a chance" to be learn to speak. If they wait until the child fails to learn to hear well enough to learn spoken English through listening, the child has lost time that really cannot be made up. That child would not attain native proficiency in any language, meaning neither ASL nor English. All of this adds up to a group of children who often do not have the language skills necessary to learn to read.

So... if deaf children do not have enough access to the phonological code of spoken English, and they do not have a firm foundation in the English language, how can they learn to read? How do deaf children with deaf parents do so well, with much fewer interventions?

The first question to ask is: Do deaf children need to learn the phonological code in order to read English? The answer turns out to be no. Counterintuitive, isn't it? Orally trained deaf children in the sixth grade and up were studied (this article quotes at least eight other articles for these data), and the researchers found that they did not actually use phonological information for reading. And here's a kicker: ASL-using deaf college students used English phonological information for rhyming tasks! Some deaf high school students did use English phonology while reading; others did not. And we're talking about good readers. Who did not use or (apparently) need English phonological knowledge.

OK, so phonology may help some kids, but more deaf children learn to read without using phonology. What about the other problem, that deaf children do not typically have age-appropriate spoken English skills? And why would ASL-using deaf children with ASL-using deaf parents read better than deaf children with hearing parents?

One study examined deaf children ages 7 to 15, who were educated using simultaneous communication, meaning an MCE and spoken English at the same time. The deaf children with deaf parents signed ASL at home. The deaf children with hearing parents used spoken language at home. There were no differences between the two groups (deaf of hearing, deaf of deaf) in nonverbal intelligence and speech production. The researchers presented the children with stories and questions about the stories, three different ways: ASL, MCE, and written English. The children could answer the questions any way they wanted (so they could watch an ASL story and answer in MCE, read English and answer in ASL, etc.). On the ASL stories, of course the deaf of deaf group did much better than the deaf of hearing group. On the MCE stories, they were about equal. On the written English stories, the children ages 7-9 did about the same. The deaf of deaf and deaf of hearing all answered about half of the questions correctly. But this changed with age. By the ages of 13-15, the deaf of deaf group answered nearly all of the questions correctly. The deaf of hearing group was still getting about half correct. ASL did not prevent these children from learning to read, and spoken English did not help these children learn to read. They went to the same school, with the same method of instruction. They were equally intelligent and spoke equally well. Their home language was the only difference between the two groups. It looks like ASL helped the deaf children learn English literacy.

So what do we do?

It looks like a strong language foundation is the most important thing--any language. A deaf child does not need to know spoken English in order to read English. This is great for deaf children of deaf parents. They have built-in language dispensers. Deaf children with hearing parents are at a disadvantage, and they will need interventions. They will need early exposure to fluent users of a language they can access. (None of this "wait a year until his implant is activated before laboriously teaching him a language that he will never have full access to.") But look at hearing children who struggle with reading. Learning language is not enough. (I would argue that many of these children have difficulty with language, but that's a topic for another day.)

Children need to learn the mapping/relationship between the language they know and print. It could be the mapping between spoken English and written English. It could be the mapping between ASL and written English. The teaching process seems to be different for hearing and deaf children. One technique that can be used is called "chaining."

Chaining is where you show the printed word, the spelled word, and the sign. Often an initialized sign is also used. The example given is the word "volcano" (this example assumes that the children understand the concept of what a volcano is). Write the word on the board. Fingerspell the word. Sign "volcano" using a V handshape. Sign "volcano" the regular way (C handshape). This is to make it obvious to the children that all of these things (writing, fingerspelling, initialized sign, ASL sign) mean the same thing. Deaf teachers already do this, and hearing teachers should, as well. 

To sum up:

-Children must learn a language before they can learn to read. Deaf children who use ASL are often better readers than deaf children who use MCE or spoken language. Deaf readers often use a visual code rather than sound-based phonology when reading. Spoken phonology is not necessary for deaf children to learn to read. But as deaf children improve reading ability, they seem to improve phonological ability. So phonology does not seem to be dependable as far as reading. Language IS.

-Children cannot learn a first language through print. The printed code leaves out a lot of information that spoken or signed language has. Written language is not interactive. It is not a natural way to learn language (funny, I don't remember the article discussing this, but it's in the summary).

-Children need to be taught to read. Learning to read is different than learning to speak/sign a language. Learning to speak (for hearing) or sign (for deaf) a language is easy. No effort required. Effort is required to learn to read. It must be taught. Chaining is one strategy. We need more strategies.