“It’s like putting together a puzzle without all the pieces”.
“I try to grasp with one sense, information intended for another.”
Extracts from the essay “Seeing at the Speed of Sound” by Rachel Kolb
Despite adjustments in healthcare, like newborn hearing screenings and advancements in sound amplification technology like hearing aids or cochlear implants, deaf children continue to be at risk of poor literacy skills, including reading, writing and speaking.
Importantly deaf children continue to fall behind their hearing peers on spoken language skills, such as vocabulary and grammar, even before they enter school.
If we bear in mind that deaf children have certain barriers when learning language, these deficits are not at all surprising. In English, most of the grammatical information is expressed by high-frequency sounds (e.g. “s”) at the end of words, to which deaf children have limited auditory access. As a result, deaf children often make errors when using verb tenses (e.g. “she walks”) and possessives (e.g. “the dog’s”).
Even amongst deaf children, the type of technology that they are aided with affects the way in which spoken language is acquired. For example, in the past, CIs have been linked to better speech production and overall language outcomes compared to HAs.
Our motivation
If we understand the different developmental trajectories of spoken language between deaf and hearing children we can learn when to best screen for potential language difficulties.
Specific language impairment (SLI) is a language disorder that affects 7% of the population and is diagnosed when language skills are below the expected age level. It is crucial to identify language difficulties, like SLI, early in life given that a lack of an intervention can lead to lower educational achievement and poorer employment prospects.
Schools need a quick screening tool that is easy enough to be used by teachers and non-professionals in ordinary classroom settings to systematically screen large cohorts of children.
One such screener that has been proposed is the Grammar and Phonology Screening (GAPS) test that can be carried out in just 10 minutes! The test has two subtests which are sentence and non-word repetition, i.e. established clinical markers of language difficulties.
Our aims and research questions
Much uncertainty still exists about the developmental differences between deaf and hearing children in their spoken language, therefore, in our study, we wanted to understand what differences remain between these two populations after one year of formal schooling.
To reflect current practices we wanted to see whether there still exists an influence of sound amplification technology despite the updated standards of modern technology.
Finally, we wanted to examine the effectiveness of the GAPS as a screener of grammatical difficulties at two time points.
Our aims led us to the following research questions:
1. How does spoken language change from preschool to reception in deaf vs hearing children?
2. How does spoken language change as a function of hearing aid technology (HAs vs CIs)?
3(a). How effective is the GAPS as a longitudinal screener for identifying children with grammatical difficulties between preschool and reception?
3(b). How effective is the GAPS as a concurrent screener for identifying children with grammatical difficulties during reception?
What did we do?
This project was part of a larger longitudinal study investigating children’s literacy skills at The Literacy and Deafness Development Research Lab (LADDER Lab).
To reflect the multifaceted nature of spoken language we administered a battery of spoken language assessments targeting vocabulary, expressive grammar, receptive grammar, sentence and nonword repetition.
We collected data from children across schools and nurseries in London and the South-East when they were 3-4 years old (preschool) and a year later when they were 4-5 years old (reception).
What did we find?
1. Spoken language development:
- We found that hearing children had higher raw scores on all spoken language measures in preschool compared to deaf children.
- BUT both deaf and hearing children made gains in their raw scores on all spoken language measures between preschool and reception.
- The amount and rate of progress in spoken language measures was the same for deaf and hearing children yet deaf children were unable to close the gap and catch up to their hearing peers.
2. Influence of hearing aid technology
- Children with HAs performed significantly better than children with CIs only on assessments which targeted sentence-related skills.
3. The GAPS
- We found the GAPS to be highly accurate in identifying grammatical difficulties of both deaf and hearing children as a longitudinal screener between preschool and reception and a concurrent screener during reception.
Why is this important?
Our findings show that deaf children are already behind in spoken language development even after one year of formal schooling. While it is encouraging that deaf children are making gains in their spoken language these are not enough to close the gap with their hearing peers.
Seeing as, spoken language skills in childhood predict future academic achievement, we need to implement language interventions in classrooms to target the needs of deaf children.
Current practices by teachers should be updated in the following ways:
- Words should be strategically introduced based on their acoustic properties.
- Clear auditory input should be ensured to facilitate spontaneous learning of grammatical markers, i.e. “s”, “z”, “t”, and “d” at the end of words.
Reflection
To help you understand the importance of clear auditory input, here’s a glimpse into the world that deaf people face every day.
When all surrounding sounds are amplified deaf people must rely on “lip reading”, but people’s faces are not a legible book…
References:
- Kolb, R. (2013, March). Seeing at the Speed of Sound. Stanford Magazine. https://stanfordmag.org/contents/seeing-at-the-speed-of-sound
- Wood, S. A., Sutton, G. J., & Davis, A. C. (2015). Performance and characteristics of the Newborn Hearing Screening Programme in England: The first seven years. International journal of audiology, 54(6), 353–358.
- Nittrouer, S., & Caldwell-Tarr, A. (2016). Language and literacy skills in children with cochlear implants: Past and present findings. Pediatric cochlear implantation: Learning and the brain, 177-197. In: Young, N. & Iler Kirk, K. (eds) Pediatric Cochlear Implantation. Springer, New York, NY.
- Werfel, K. L., Reynolds, G., & Fitton, L. (2022). Oral Language Acquisition in Preschool Children Who are Deaf and Hard-of-Hearing. Journal of deaf studies and deaf education, 27(2), 166–178.
- Sininger, Y. S., Grimes, A., Christensen, E. (2010). Auditory development in early amplified children: Factors influencing auditory-based communication outcomes in children with hearing loss. Ear Hear, 31, 166–185.
- Tomblin, J. B., Records, N. L., Buckwalter, P., Zhang, X., Smith, E. and O’Brien, M. (1997). Prevalence of specific language impairment in kindergarten children. Journalof Speech, Language, and Hearing Research, 40, 1245–1260.
- Bercow, J. (2008). A Review of Services for Children and Young People, 0–19, with Speech, Language and Communication Needs (London: Department for Children,Schools and Families).
- Gardner, H., Froud, K., McClelland, A. and Van Der Lely, H. K. J. (2006). Development of the Grammar and Phonology Screening, GAPS, test to assess key markers of specific language and literacy difficulties in young children. InternationalJournal of Language and Communication Disorders, 41, 513–540.
- Conti-Ramsden, G., Botting, N. and Faragher, B. (2001). Psycholinguistic markers for specific language impairment, SLI. Journal of Child Psychology and Psychiatry, 42, 741–748.
- The Ladder Lab (2024, April 29). The Literacy and Deafness Development Research Lab. https://ladder-lab.com/
Credits:
- Cover picture from iStock: https://www.istockphoto.com/search/2/image-film?phrase=child+hearing
- In-text image from Adobe Stock: https://stock.adobe.com/uk/search/free?k=children+with+cochlear+implants+&search_type=usertyped&asset_id=322333235
- Video link from YouTube: https://www.youtube.com/watch?v=n1jLkYyODsc
Word Count: 995, 5-minute read.