Article Review – Literacy Skills In Children With Cochlear Implants

Language skills are important for learning to read. Since children with hearing loss are at a higher risk for developing language delays, it makes sense that children with hearing loss might also be at risk for developing delays in reading skills. Studies have shown that there is a lot of variability in reading skills of children with cochlear implants (CIs), with some children on par with normal hearing children but others lagging substantially behind.

There could be a lot of reasons for this variability – for example, the age at which the child received CIs, their language skills prior to learning to read, and family factors, such as socioeconomic status or parental education levels. One other potential source of variability is how parents interact with their children while reading books together. Reading books together is an important (and fun!) activity, but there are lots of ways to read together – the parent can simply read the words out loud, the parent can describe what’s on the page, the parent can ask questions to try to elicit conversation, etc. DesJardin et al. published an article (PDF available for free!) sharing results from a study that looked at how different techniques used by parents when reading with their children related to their children’s reading skills. (“Literacy Skills in Children With Cochlear Implants: The Importance of Early Oral Language and Joint Storybook Reading.” 2008. J. Deaf Stud. Deaf Edu. pgs. 22-43).

The researchers studied 16 mother-child pairs, and measured the children’s language abilities at a first time point (T1), which was prior to the children learning to read, and then measured their reading abilities 3 years later (T2). The children were an average of 4 years 4 months at T1, ranging from 2.7-6.3 years, and all children were cochlear implant users.

At T1, in addition to measuring the children’s language abilities, the researchers also videotaped the mothers interacting with their children while reading a book to them. In particular, the researchers coded each utterance by the mother during the book reading into one of ten types of facilitative language techniques, which are described in Tables 3 and 4 of the article and are reproduced below. Table 3 describes four types of “higher-level” facilitative language techniques, and Table 4 describes four types of “lower-level” facilitative language techniques. In general, the higher-level techniques are intended to elicit longer and more detailed responses from children. The authors said that the higher-level techniques are appropriate for children who are beginning to string two and three words together in phrases, rather than merely making single-word utterances. They also said that all of the children in the study at T1 were capable of stringing two and three words together, and therefore, were capable of participating in the higher-level techniques.


Table 3 of DesJardin et al. – Higher-Level Facilitative Language Techniques


Table 4 of DesJardin et al. – Lower-Level Facilitative Language Techniques

The researchers then looked at how the types of facilitative language techniques used by the mothers while reading with their children at T1 related to the children’s reading skills measured three years later, at T2. (They looked at other relationships too, but for simplicity, I’ll focus on this relationship).

The researchers found that mothers’ usage of the higher-level techniques of recast and open-ended questions at T1 while reading with their children were associated with better reading skills (particularly in the areas of vocabulary in the case of recast and word identification and comprehension in the case of open-ended questions) measured three years later, at T2. Additionally, they found that mothers’ usage of the lower-level technique of linguistic mapping at T1 while reading with their children was associated with worse reading skill performance at T2 (in the areas of vocabulary and word identification).

The authors speculated that the higher-level language techniques used by the mothers might be related to better reading skills in their children because the higher-level techniques tend to elicit more conversation and expose children to a wider variety of language (for example, synonyms of words). The researchers also emphasized the need for parents to use facilitative language techniques appropriate for their child’s language level, rather than only or primarily using techniques below their child’s language level. For example, they stated that it was possible that “mothers’ use of lower level techniques did not sufficiently support their children’s language level,” and that the children at T1 were at ages that were in “a critical language age range when children are starting to put two to three word utterances together and may have required higher level techniques to support their emerging language skills.” (DesJardin, et al. pg. 37).

Although T (8.5 months old) is still too young for the higher-level language techniques described here, I think there are still some interesting takeaways from this study. We have been reading to T since he was just a few weeks old (before his eyes could even focus on the page!), and since that time, reading to him has mostly been a one-way monologue where we read the story and describe the pictures to him. However, now that he is older and capable of verbally responding (with single syllables like “ba” or “ga,” or with longer babbles), we are trying to pause while we read to ask him questions and wait for him to respond verbally. For example, we stop frequently to ask him questions like “What does the cow say?” This is new to us, and interacting with him in this new way while reading with him is taking some practice! Even though he isn’t yet able to answer “correctly,” he’s learning to say something when we ask him a question and hearing words repeated multiple times (e.g., “What does the cow say?” “Yeah, the cow says MOO!”). This study is a reminder that, in time, when he begins stringing multiple words together, we’ll need to be mindful to change our interactions with him to match his new language abilities – rather than simply asking what the cow says, we could ask him, for example, what’s happening on the page, and give him the chance to say more and learn more words from us.

This study provides evidence that our adapting our interactions with T while reading to him as his language skills develop might provide benefit to both his language skills and, in a few years, his pre-reading and reading skills.



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