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A Steep Hill to Climb: Identifying the
Literacy Crisis for Deaf and Hard of Hearing
StudentsChristine Yoshinaga-
Itano, Ph.D. Professor University of Colorado,
Boulder
THE TIME IS NOW
NO CHILD LEFT BEHIND: INCLUDING
THOSE WHO ARE DEAF OR HARD OF
HEARING
Early Hearing Detection and Intervention Sensitive Periods of
Brain Development An opportunity to
develop language in the typical time frame, achieving milestones at the same time as children with normal hearing.
Critical Milestones with the goal of age appropriate language Screening before 1 month
Identification before 3 months
Amplification within 1 month from identification
Intervention before 6 months
What needs to happen to
meet these goals?
COLLABORATION AND COORDINATION
INTER-AGENCY: BREAKING DOWN THE BARRIERS
INTER-DISCIPLINARY, MULTI-DISCIPLINARY, TRANS-DISCIPLINARY INTERACTION
ACCOUNTABILITY AND DATA MANAGEMENT
FIDELITY OF THE SERVICES PROVIDED
HIGHLY QUALIFIED PROVIDERS
THE OUTCOME OF MEETING
EHDI MILESTONES
OPTIMAL OUTCOMES ARE POSSIBLE
AT ALL AGES FROM BIRTH FOR CHILDREN OF FAMILIES WHO HAVE
CHOSEN SIGN LANGUAGE AS THEIR PRIMARY MODE OF COMMUNICATION
FOR CHILDREN OF FAMILIES WHO HAVE CHOSEN SPOKEN LANGUAGE AS THEIR PRIMARY MODE OF COMMUNICATION
FOR CHILDREN IN FAMILIES FROM ETHNIC MAJORITY CULTURE
FOR CHILDREN IN FAMILIES FROM ETHNIC MINORITY CULTURES
FOR FEMALES AND FOR MALES
OPTIMAL OUTCOMES
FOR ALL CHILDREN WHO ARE DEAF OR HARD OF HEARING – MILD, MODERATE, SEVERE, PROFOUND
FOR CHILDREN IN FAMILIES WHOSE MOTHERS HAVE A HIGH SCHOOL EDUCATION OR LESS
FOR CHILDREN IN FAMILIES WHOSE MOTHERS HAVE GREATER THAN A HIGH SCHOOL EDUCATION
FOR CHILDREN IN FAMILIES ON MEDICAID FOR CHILDREN IN FAMILIES WHO DO NOT
RECEIVE MEDICAID FOR CHILDREN WITH HEARING LOSS ONLY FOR CHILDREN WITH HEARING LOSS AND
ADDITIONAL DISABILITIES
FAILURE IS NOT AN OPTION
IF APPROPRIATE SERVICES ARE
NOT PROVIDED, THE LACK OF APPROPRIATE
SERVICES CREATES AN
ENVIRONMENTALLY-CAUSED
DISABILITY AS SERIOUS AS A
COGNITIVE DEVELOPMENTAL
DELAY
How lasting is the effect?
Longitudinal study of children birth through 84 months (7 years)
Age appropriate vocabulary skills Age appropriate receptive syntax skills
Primary predictors: account for 72% of the variance of the language outcome at 84 months of age. Non-verbal cognitive development Amount of language the child is exposed to in the
home Language development at 3 years of age Degree of hearing loss Age of identification and initiation of early
intervention Maternal level of education
MCDI-EL and TACL-3 (Baca, 2009)
Some delays still exist
ArticulationPragmatic language development – the socially appropriate use of language
Expressive syntax
ASSURING QUALITY
ADOPT BEST PRACTICE STANDARDS OF CARE AND IMPLEMENT AN ACCOUNTABILITY SYSTEM
DEVELOP A DATA MANAGEMENT SYSTEM: FOLLOW FROM AGE OF IDENTIFICATION – EHDI DATA BASE HAS THAT POTENTIAL AGE OF IDENTIFICATION, THE AGE OF ACCESS
TO LANGUAGE/ INTERVENTION START IS CRITICAL
LONGITUDINAL DEVELOPMENT ONLY WAY TO GUARANTEE THAT ALL
CHILDREN WHO ARE DEAF OR HARD OF HEARING ARE INCLUDED
ASSURING QUALITY
QUALIFICATIONS OF THE EARLY INTERVENTION PROVIDER WITH ADDITIONAL QUALIFICATIONS FOR BOTH
LISTENING AND SPOKEN LANGUAGE AND FOR SIGN LANGUAGE
DEVELOP AND IMPLEMENT A MECHANISM FOR PROVIDERS TO IMPROVE THEIR SKILLS AND KNOWLEDGE
DOCUMENT DEVELOPMENTAL PROGRESS, PROVIDE FEEDBACK TO FAMILIES AND PROVIDERS IMPLEMENT A STATEWIDE PROTOCOL, COMMON
ASSESSMENT TOOLS THAT WILL BE USED WITH ALL CHILDREN AND FAMILIES
ASSURING QUALITY
ASSURE MEANINGFUL INVOLVEMENT OF PARENTS OF CHILDREN WHO ARE DEAF OR HARD OF HEARING AT ALL LEVELS OF THE SYSTEM
ASSURE MEANINGFUL INVOLVEMENT OF DEAF AND HARD OF HEARING ADULTS AT ALL LEVELS OF THE SYSTEM DEVELOP AND IMPLEMENT LEADERSHIP
TRAINING DESIGN AND IMPLEMENT A SYSTEM OF
SERVICES
ASSURING QUALITY
DEVELOP AND IMPLEMENT STRATEGIES FOR FAMILIES WHO DO NOT SPEAK ENGLISH IN THE HOME
DEVELOP AND IMPLEMENT STRATEGIES FOR FAMILIES WHOSE CHILDREN HAVE ADDITIONAL DISABILITIES
DEVELOP AND IMPLEMENT STRATEGIES FOR FAMILIES FOR DIVERSE CULTURES AND DIVERSE SOCIO-ECONOMIC BACKGROUNDS
DEVELOP SYSTEMS THAT PROVIDE EQUITABLE CARE WHEREVER THE FAMILY AND CHILD LIVE IN THE STATE
PREDICTORS OF OPTIMAL LANGUAGE AND LITERACY
EMOTIONAL AVAILABILITY
MATERNAL/PATERNAL BONDING PARENTAL STRESS
RECIPROCAL EMOTIONAL AVAILABILITY IN THE COMMUNICATION BETWEEN PARENT AND CHILD
SCAFFOLDING: KNOWING WHEN TO SUPPORT JUST ENOUGH FOR THE CHILD TO SUCCEED IN WHAT S/HE IS ATTEMPTING
STRATEGIES FOR DEALING WITH FRUSTRATION AND ANGER
STRONG EMOTIONAL AVAILABILITY LEADS TO
BETTER VOCABULARY DEVELOPMENT
LOWER PARENTAL
STRESS IS RELATED TO BETTER LANGUAGE
A POWERFUL PREDICTOR OF
VOCABULARY DEVELOPMENT:
AMOUNT OF PARENT TALK TO THE CHILD
Total Number of Parental Words
• Accounts for an 11.07% of the language outcome at 84 months and 14.04% of the rate of language development from 4 to 7 years
High Maternal Level of Education
• Number of Parent Words not included
• High Maternal level of Education accounts for 10.81% of the variance of the language outcome at 84 months and 7.48% of the variance of the rate of language development from 4 to 7 years
Maternal Level of Education + Number of Parental Words
• Accounts for 16.38% more variance of the language outcome at 84 months and 13.71% of the rate of language development from 4 to 7 years
Both Maternal level of education and Number of Parental Words are
predictors of language at 84 months
• Maternal level of education emerges as a significant predictor of language outcome between 48 and 84 months of age
• Number of parental utterances in the birth through 48 month age group is a significant predictor of language outcome at 84 months of age and rate of language growth from 4 to 7 years of age
Relationship Maternal Level of Education and Number of
Parental Words
• Amount of variance accounted for by the variables High Maternal Level of Education and Number of Parental Words spoken to the Child appear to be accounting for overlapping variance
• Number of Parental Words accounts for more variance
EOWPVT differences by Maternal Level of Educational Level (Baca,
2009)– 35 month language age
difference at 84 months of age between group with mean age level for mothers with educational level less than 12 years (HS grad) as compared to group for mothers with educational level 16 years or greater (college)
55.75 months versus 91.33 months
THE IMPACT OF MATERNAL LEVEL OF EDUCATION CAN BE OVERCOME WITH EXCELLENT INTERVENTION
• Colorado studies indicate that Maternal level of education does not predict language outcomes of children with hearing loss – birth through 36 months
VOCABULARY DEVELOPMENT IS THE MOST SIGNIFICANT PREDICTOR OF LITERACY FOR CHILDREN WHO ARE
DEAF OR HARD OF HEARING
JUST AS IT IS FOR CHILDREN WITH NORMAL HEARING
EMERGENT LITERACY
Early sources: Emergent Literacy - Construction of
knowledge about the uses and nature of written language
Story telling Experiences with children’s books TV
NARRATIVE DEVELOPMENT
Literary devices Narrators Distinct voices of characters Setting Identities of characters Shifts in time or place Connectives (relationships between
events in stories)- (relationships between previous and upcoming events) cohesion
Storytelling is both social and cognitive Increasing sophistication in pragmatic
uses, i.e. (because)
META-LINGUISTIC AWARENESS
Knowing what to do in failures of communication
Conscious awareness of adjustments Re-wording – vocabulary changes Changing syntax
WHY EMERGENT LITERACY, NARRATIVE DEVELOPMENT,
METALINGUISTIC KNOWLEDGE ARE SO CRITICAL FOR CHILDREN WHO ARE DEAF OR HARD OF HEARING
Study Participants
Normal Hearing Group
N=109 Age Range: 2-7 years Normal hearing and
cognition
Hearing Loss Group N=126 Age Range: 3-7 years All Levels of hearing
loss Normal cognition
Children with Normal Hearing
44% (20 of 45) of the items were mastered using complex language by 3 years of age
95.5% (43 of 45) of the items were mastered by 4 years of age
98% by 5 years 100% by 6 years
Final Items to Master for NH group
Provides information on request Name, date of
birth, address (2 of 3 items)
Makes promises
Children with Hearing Loss
6.6% (3 of 45) of the items were mastered with complex language by six years of age
69% (31 of 45) of the items were mastered by 7 years of age
Items not Mastered by 7yrs (HL Group)
Provides information on request
Repairs incomplete sentences Ends conversations Interjects Apologies Request clarification Makes promises Ask questions to problem
solve Asks questions to make
predictions Retells a story Tells 4-6 picture story in right
order Creates original story Explains relationships between
objects-action-situations Compares and contrasts
Percentage of Items Mastered by Age for NH and HL groups
The proportion achieving 50% or more of the items with complex language
NECAP: NATIONAL EARLY CHILDHOOD ASSESSMENT PROJECT:
DEAF AND HARD OF HEARINGASSOCIATION OF UNIVERSITY
CENTERS ON DISABILITY: CENTERS FOR DISEASE CONTROL
STATE COMMITMENTS TO DEVELOP SYSTEMS TO COLLECT STANDARD ASSESSMENT DATA FROM ALL CHILDREN WHO ARE DEAF OR HARD OF HEARING
• Assessment Components• Demographic form• Release of audiologic information• Minnesota Child Development Inventory• MacArthur-Bates Communicative
Development Inventories• Additional assessments on request (e.g.,
play, listening skills, speech intelligibility, etc.)
Participating States
• Arizona• California• Colorado• Idaho• Indiana
• Texas• Wisconsin• Wyoming• Nebraska• Oregon
Assessments Completed
• 259 assessments completed (not including Colorado)
• 162 children assessed 1 to 4 times each
• Colorado: 225 assessments per year
Participant Characteristics (excluding Colorado)
• Bilateral loss = 249; Unilateral loss = 10
• Auditory Neuropathy = 7• English-speaking home = 239; Spanish-
speaking home = 20• No additional disabilities = 229; Have
additional disabilities = 30• Boys = 140; girls = 119
Degree of Hearing Loss
Participant Criteria for Language Outcomes Analysis
• Bilateral hearing loss• English-speaking home• No other disabilities that would affect speech or language development
States Represented in Current Language Outcomes Analysis
• Arizona• Colorado• Idaho• New Mexico (previous participant)• Texas• Utah (previous participant)• Wisconsin• Wyoming
Note: CA and IN just initiated NECAP; no data yet
Language Outcomes Analysis:Participant Characteristics
• Chronological age• Range = 6 to 40 months• Mean = 21 months
• Boys = 130; Girls = 140
• Number of assessments = 270
Assessment 1: Minnesota Child Development Inventory (1992)
• 8 areas of development assessed• Language, Motor, Social, Self Help, Pre-
Literacy
• Parent report• Parents respond “yes” or “no” to a variety
of statements about their child• Example: “Has a vocabulary of 20 or more
words”
• Scales adapted to reflect abilities in both spoken and sign language
Assessment 2: MacArthur-Bates Communicative Dev. Inventories
• Assesses spoken and sign vocabulary• Expressive and receptive for younger
children• Expressive vocabulary for older children
• Parent-report instrument
Determining Language Quotient
Language Age/Chronological Age x 100 If LQ = 100, Language Age = CA If LQ < 100, Language Age < CA If LQ > 100, Language Age > CA
LQs of 80+ are within the normal range compared to hearing children
Median Language Quotients
Percent of Scores in the Average Range (LQ = 80+)
Minnesota CDI: Median Language Quotients
MacArthur-Bates: MedianVocabulary Production Quotients
Conclusions
• Almost 80% of children scored within the average range on the Minnesota Expressive Language subtest
• On average, children in all states scored more poorly on cognitive-linguistic items (Minn Lang Comp) compared to more superficial language items (Minn Exp Lang)
Conclusions
• Acquiring an age-appropriate lexicon is a challenge for many children with 43% demonstrating significant delays
• Differences in language outcomes are apparent between some states
• As more assessments are collected, factors predictive of better language outcomes will be identified
Colorado Individual Performance Profile: Criteria for Placement
decisions
Describe the student's current service delivery system. Do NOT include the services of an educational interpreter when counting these hours to identify a category of services below. __1_Indirect Service: Monitor (No IEP, 100% of time in general education); check here if student has a 504 Plan___.__2_Indirect Service: Consultation (IEP, 100% of time in general education classroom)__3_Direct Service: (>60% of time in general education classroom), 1-4 hours of instructional services per week from a licensed teacher of the Deaf/HH or combination of teacher of Deaf/HH or other special education team __4_Direct Service: (21-60% of time in general education classroom), 1-2 hours instructional services daily from a licensed teacher of the Deaf/HH or combination of teacher of Deaf/HH & other special education team; may be team or co-taught __5_Direct Service: (<21% of time in general education classroom), 3 or more hours per day of instructional services from a licensed teacher of the Deaf/HH or combination of teacher of Deaf/HH & other special education team; student is still receiving his/her academic instruction in the general classroom a portion of the school day; may be team or co-taught __6_Direct Service: (Separate Facility), all instruction from a licensed teacher of the Deaf/HH and other special education professionals in hearing services___Other: Please explain______________________________________________________________CSDB students only: ___day student ___residential
Comparison of CSAP Reading Score to Level of Service
400
450
500
550
600
650
IS:Monitor
IS:Consult
DS:>60%
Gen Ed
DS: 21-60% Gen
Ed
DS:<21%
Gen Ed
CSAP Reading Score
CSAP Reading Performance Growth 2004 vs 2005
Reading grades 3-10 N=751 students Adequate Yearly Progress or 1 years
growth in 1 year 40% made 1 years growth 40.8% made > 1 years growth 18.7% made < 1 years growth
Deaf Child’s Bill of Rights
Deaf Child’s Bill of Rights
http://www.cde.state.co.us/cdesped/download/pdf/dhh-DeafChildBillRts.pdf
that each child’s “unique communication mode is respected, utilized, and developed to an appropriate level of proficiency”,
that teachers and other providers who work with children who are Deaf or Hard of Hearing are specifically trained for this population, including proficiency in the primary language mode of the children with whom they work,
that an education with a sufficient number of language mode peers with whom direct communication is possible and who are of same age and ability level is available,
Deaf Child’s Bill of Rights
Deaf Child’s Bill of Rights
that each child’s “unique communication mode is respected, utilized, and developed to an appropriate level of proficiency”,
that teachers and other providers who work with children who are Deaf or Hard of Hearing are specifically trained for this population, including proficiency in the primary language mode of the children with whom they work,
that an education with a sufficient number of language mode peers with whom direct communication is possible and who are of same age and ability level is available,
that parent involvement and, where appropriate, people who are Deaf and Hard of Hearing, determine the extent, content, and purpose of educational programs,
that children who are Deaf and Hard of Hearing benefit from an education in which they are exposed to Deaf and Hard of Hearing role models,
that programs provide direct and appropriate access to all components of the educational process, including but not limited to recess, lunch, and extra-curricular activities,
Deaf Child’s Bill of Rights
Deaf Child’s Bill of Rights
that parent involvement and, where appropriate, people who are Deaf and Hard of Hearing, determine the extent, content, and purpose of educational programs,
that children who are Deaf and Hard of Hearing benefit from an education in which they are exposed to Deaf and Hard of Hearing role models,
that programs provide direct and appropriate access to all components of the educational process, including but not limited to recess, lunch, and extra-curricular activities,
that programs provide for the unique vocational needs, including appropriate research, curricula, programs, staff, and outreach,
that the least restrictive environment for each child who is Deaf or Hard of Hearing takes into consideration the legislative findings and declarations of this law, and
that due to the unique communication needs of children who are Deaf and Hard of Hearing, the development and implementation of state and regional programs would be beneficial.
Deaf Child’s Bill of Rights
SUMMARY
Set a GoalMeasure the BaselineDevelop a PlanInstitute the PlanMeasure the progress
FOR THE SAKE OF OUR CHILDREN: WE CAN ACHIEVE OUR GOAL
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