ADEF….Geez!! Accelerating Early Literacy Skills in ...€¦.Geez!! Accelerating Early Literacy...

ABCDEF….Geez!! Accelerating Early Literacy Skills in

Children with Hearing Loss

Michael Douglas, MA, CCC-SLP, LSLS, Cert AVT

Today’s Agenda Literature Review

Constructs of Pre-literacy Skills

Assessment and Instructional Principles

Evidenced-Based Instructional Methods

What do we know about Reading in Children with Hearing Loss?

Current Outcomes

(Harris and Terletsi, 2011; Marshark, Roten & Fabich, 2007)

Annual growth rate ½ grade per year 3rd or 4th Grade level

(Geers & Hayes, 2012)

Children with cochlear implants

(Geers & Hayes, 2012)

Role of Auditory Information in

Speech and Language Production

Articulatory Organization

(Tye-Murray, 2009; Tye-Murray, Spencer, & Woodworth, 1995)

Auditory Feedback

What happens in the event of

hearing loss?

Sound becomes filtered

If HL is not corrected, developed sounds will gradually become

more and more aberrant

Those without adequate access to sound will plateau early in life.

Human ear range 250-20K Hz

Cochlear implant range 250-8000 Hz

(Ambrose, Fey, Eisenberg, 2012) EVEN IF ITS CORRECTED….

Additional Factors

that can further impact an already diminished speech signal

• Not appropriately amplified

• Inconsistent use of the device

• Undiagnosed learning problem

• Ineffective teaching

Not appropriately amplified

Inconsistent Device Use

Listening Environment

Teacher-Child Relationship

Ineffective Teaching

Undiagnosed Learning Problem

Memory Personality

Fatigue

Vulnerable Home Environment

They cannot overhear their parents or other people talking

They can’t overhear others talking!

Teacher visibility

They may not receive the same formal instruction as children with typical hearing

They may not have received formal instruction

They do not receive extensive practice in using language

Not enough Practice!

Late Identified and Fit

What are the constructs for Pre-literacy skills in CHL?

Pre- Literacy Constructs

Vocabulary

Syntax

Alphabetic Knowledge

Phonological Awareness

World/Life Experiences

Lederberg, Schick & Spencer, 2013; Webb, Lederberg, Branum-Martin & Connor, 2015

What do we know about Phonological Awareness?

Children with Typical Hearing

Receptive vocabulary skills are directly related and linked to phonological awareness skills (Rvachew, 2006)

Speech perception skills are linked to improvements in phonological awareness and articulatory accuracy (Rvachew, 2006)

But, there is no direct correlation between phonological awareness and articulation skills

(Rvachew, 2006)

Maximizing spoken language development can have a large effect on later phonological awareness skills (Rvachew, 2006)

What do we know about Phonological Awareness?

Children with Hearing Loss

Profound deafness inhibits but does not preclude the development of phonological awareness (PA).

(Kyle & Harris, 2010)

PA lags behind the PA of children with normal hearing

(Ambrose, Fey, & Eisenberg, 2012)

PA can develop in the same general pattern as in children with normal hearing

(James, Rajput, Brown, Sirimanna, Brinton, & Goswami, 2005)

(Rvachew, 2006)

Reading

Vocabulary is the strongest and most consistent predictor of later reading achievement in this population

Early weaknesses in grammatical skills are related to later reading difficulties

Why Is the acquisition of phonological awareness a challenge

for some children?

(Liberman & Shankweiler, 1991)

Lexical Restructuring Hypothesis

(Walley, Metsala, & Garlock, 2003)

Discuss with your shoulder partner

Is PA instruction effective for Children with Typical Hearing?

Phonological awareness training is more effective in helping children move out of the “poor ability” range in reading than working on decoding skills alone (Forman, Francis, Fletcher, Schatschneider, 1998)

Training preschool children in phonological awareness skills before

beginning to read has been proven to be effective

(Lundberg, Frost & Peterson, 1988, Schuele & Boudreau, 2008)

Is PA intervention effective for Children with Hearing Loss?

(Smith and Wang, 2010)

(Miller, Lederberg and Easterbrooks, 2013; Werfel and Schuele, 2014)

Consider lessons learned

Continue 30-35 min Sessions 2-3/week

Longer term? Daily 10-15 minute sessions Entire school year?

<10 min. lessons

Daily Entire school

Fatigue In Preschool Children

/t/ /d/

/s/ /z/

(Werfel and Schuele, 2014)

Transferability, Intensity, Modifications

(Werfel, Douglas, & Ackal, 2014)

Vocabulary

Syntax

Is intervention for alphabet knowledge effective? Children with Typical Hearing

Is intervention for alphabet knowledge effective? Children with Hearing Loss

(Bergeron, Lederberg, Easterbrooks, Miller & Connor, 2009)

Semantic-Association Strategy

Werfel, Douglas, & Ackal, 2014

Daily Chant Approach

Letter name

Sessions 1-5 Weeks 1-9

(Chatham & Douglas, 2014)

Contrasting Features Approach

Contrasting Features

Sessions 1-5 Weeks 1-9

(Chatham & Douglas, 2014)

Poor attendance

All three

Got something right

In Summary

Reading Gains

Laying the Foundation

Provide all babies and children emerging and pre literacy experiences

Vocabulary

Syntax

Schickedanz, (1999). Much more than the ABCs: The early stages of reading and writing. Washington, DC:

NAEYC.

BrainWonders & Sharing Books with Babies www.zerotothree.org/BrainWonders

What does emerging literacy development

look like?

Observable Behaviors

(Schickedanz, 1999)

Book Handling Behaviors

Looking and Recognizing

Picture Story and Comprehension

Story “Reading” Behaviors

Summary

Early literacy development refers to the interactions that young children have with such literacy materials as books, paper, and crayons,

and with the adults in their lives.

These experiences are the building blocks for language, reading and writing development.

Phonological Awareness Assessment

Vocabulary

Syntax

DON’T ASSESS: Provide all children with phonological awareness experiences as part of preschool and kindergarten curriculum. ASSESS only after instruction to determine the need for further instruction/intervention

Assess with Intention

Make a link from your question to the assessment

Assess with Intention

Make sure the test expectations match the expectations of the classroom

Assessments for Baseline Data

Assessment Instruments

to Identify Children with Delays/Deficits

Assessment to Determine Potential for Change

Dynamic Assessment

Assess to Evaluate Weekly Progress Progress Monitoring

What is it?

A valid and efficient assessment procedure for gauging the effectiveness of instruction and/or

curriculum

National Research Center on Learning Disabilities

Why do it?

Think-Pair-Share

How do you do it?

Shoulder Partner

Assessment to Determine Annual Progress

PALS-PreK

PALS-K

Teaching Children with Hearing Loss:

Learning and Instructional

Principles

Quick Review

Handout

Principles

Instructional Principles

Handout

Teach, don’t test! • Provide the amount of support that makes the child

successful – they must know EXACTLY what to do

• Model a think-aloud strategy.

• Begin with maximal support, decrease support as the child gains ability

• Child always ends with success

Scaffolding

Emerging

Developing

Mastery

How we teach is more important than what we teach

Individual Turns, Group Turns

• In group instruction, every child should benefit from every turn

• Make responding and learning the focal point of each turn

• Engage all children in all turns

Pay attention to errors!

• Child’s errors provide the indication of his or her skill and learning

• Anticipate errors and formulate teaching strategies to respond to errors

• Log children’s errors. Over time, build a bank of response strategies

Vocabulary

Syntax

Meaningful Experiences

Pre-literacy learning for children with hearing loss

requires maximal

implicit instruction and

explicit intervention

Implicit Instruction

What is it?

Indirect instruction procedures that exploits print and opportunities to provide phonological

and/or phonemic awareness input

Why Provide Implicit Instruction?

Emergence of phonological awareness comes in preschool years from interactions in a literate environment.

Why Provide Implicit Instruction?

There is evidence that there may be a developmental period when phonological

awareness abilities are responsive to environmental inputs

Create a literacy–rich classroom environment

Display students’ written work on the wall

Use shared book readings while making reference to print

concepts and alphabetic properties

THINK OUT LOUD

Read alphabet books to the children as you talk through how you segment and isolate sounds and words

Teach parents strategies to use during their day during meal times, book reads, car rides, etc.

Final Thoughts

Implicit Instruction is Important!

PA in children with CIs will develop faster depending on

– Frequency of quality parental episodes

– Experience with literacy materials

– Quality of preschool literacy experiences

(Dickenson, McCabe, Chiarelli, & Wolf, 2004)

Explicit Intervention

WAIT Instruction Intervention

Why do I need to train phonological awareness explicitly?

As humans, we are not programmed for phonological awareness

What is automatic for us in phonological awareness does not come easy for children with

hearing loss

Explicit Intervention

Vocabulary

Syntax

Planning Top-Down Approach

Determine Targets from Assessments

e.g. Audition Speech and Language

Align with Standards: e.g. Reading and Life Science

Develop your line of inquiry

e.g. How can one investigate the soil?

Vocabulary Syntax Pre/Reading Alphabet

Knowledge Experience

(Carrera-Carillo & Smith, 2006; Moog & Stein, 2008)

Learning Activities – Tiered/Bottom-Up

Spontaneous Production of Targets

Real Talking

Conversational Language Activities

Show and Tell, Language Experiences, Stories, Science and Social Studies

Vocabulary Syntax Alphabet

Knowledge Phonological Awareness

Formal

Informal

(Gillam, Gillam & Reece, 2012; Faulk, 2012; Pullen, Tuckwiller, Konold, Maynard & Coyne, 2010)

Contextualizing Intervention

Vocabulary

Syntax

Experiences

Implicit PA Instruction

Explicit PA Instruction

(Gilliam, Gilliam & Reece, 2012)

Vocabulary

Syntax

Vocabulary

What do we know about vocabulary and hearing loss?

The Problem

Data from Nott et al., 2009

What do you have to do to learn a new word?

Connection

Phonological Representation

Integration

(e.g., Capone Singleton, 2012; Collins & Loftus, 1978; Nelson & Nelson, 1990; McGregor et al., 2002)

Intervention Implications

TEACH THE LEARNING PROCESS

Connection: How can you help?

• Explicitly match a word with its meaning, particularly on first introduction

• Practice attending to known versus unknown words

• Identify unknown words during incidental teaching opportunities

Phonological Representation: How can you help?

• Give lots of examples – bring the word to life!

• Teach phonological rehearsal

• Repeat, repeat, repeat!

Integration: How can you help?

• Provide additional experience

– Linguistic

– Physical

– Contextualized into increasingly meaningful contexts

How do we teach vocabulary?

Vocabulary Instruction Methods

• Pictures

• Examples/ experiences

• Follow-in labeling

• Child-elicited labeling

• Storybook reading

• Discussion

Building Conversation: Increasingly meaningful contexts

Embedding Vocabulary into Increasingly Meaningful Contexts

Scaffold and Contextualize Intervention

Beidenstein; 2009, Nippold, Mansfield & Billow, 2007; Gillam, Gillam

& Reece, 2012; Faulk, 2012

What does intervention data say?

Does learning process-driven skills generalize for learning other words?

Lund, E., & Schuele, C. M. (2014). Effects of a word-learning training on children with cochlear implants. Journal of Deaf

Studies and Deaf Education, 19, 68-84.

Do repetition and richness really matter?

Lund, E., Douglas, W. M., & Schuele, C. M. (2015). Semantic richness and word learning in children with hearing loss developing spoken language.

1 = 2 < 3

Expressive Vocab Receptive Vocab Language NVIQ Articulation

77 75 61 71 78

1< 2 = 3

Expressive Vocab Receptive Vocab Language NVIQ Articulation

92 89 96 92 77

Would a child-led (follow-in) word-learning scenario work better for

teaching vocabulary?

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

Whole Word Count

Intervention 1

Intervention 2

Untreated

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6

Whole Word Count

Intervention 1

Intervention 2

Untreated

(Lund &Douglas, 2016)

How do I choose words?

First 250

Words in Child’s life

Important Concepts

Words in stories and themes

Explicit Vocabulary Lesson Procedures for Young Children with Hearing Loss

1. Establishing the Words – here the teacher brings the new

word to life, draws on past experiences, then relates it to a photo

2. Speech Practice

3. Receptive Practice

4. Expressive Practice

5. Systematic Review/planned redundancy

(Brooks, Stein, Beidenstein, & Gustus; 2003; Barker, 2003; Lund, Douglas & Schuelue, 2015 )

Take Home Points

• Children with hearing loss have a particular deficit in vocabulary knowledge

• Teach the process of:

Connection, Representation and Integration!

• Direct instruction and providing explicit semantic richness are key components of intervention that improve outcomes

Vocabulary

Syntax

SYNTAX LESSONS

Brooks, Stein, Biedenstein & Gustus, 2003; Moog and Stein, 2008, Nippold, Mansfield, & Billow, 2007; Feng and Powers, 2005; Gray, 2007

Syntax Lessons Activities

• Toy manipulation

• Card games

• Board games

• Picture cards

• Guessing games

• Picture descriptions

• Commands

• Predictable Pattern Books

• Commercially prepared materials

• Color forms

• File folder games

• Lotto games

• Bingo

How do I teach a syntax lesson?

Receptive Practice

Expressive Practice

How do I improve phonological awareness in vocabulary and

syntax lessons?

Make it N(ice)!

(Gillon, 2005; Rvachew, 2006, Terry, 2016)

How do I choose targets?

(Schuele, 2010)

Vocabulary

Syntax

Some things worth mentioning

Don’t have to wait to start teaching phonological awareness, children with hearing loss can learn letter sound identification even

with low vocabulary scores.

Print knowledge is a strength for children with cochlear implants: its more constrained and less

related to language

(James, Rajput, Brown, Sirimana, Brinton, & Goswami, 2005)

Children with cochlear implants can get age appropriate print knowledge: this bodes well for them because this highly correlates with literacy

(James, Rajput, Brown, Sirimana, Brinton, & Goswami, 2005)

(James, Rajput, Brown, Sirimanna, Brimton, & Goswami, 2005)

Orthographic knowledge can be used to bootstrap

phonemic awareness

Because….

Ortho cues help to make later judgments on the smaller units

Letter-Sound Knowledge

Goal for Preschooler’s vs. School Age

Alphabetic Knowledge Evidenced-Based Methods

Daily Chant Semantic-Association Contrasting Features

Model of Working Memory (Baddeley, 2000)

Daily Chant

(Schuele, 2008)

Daily Chant

(Schuele, 2008)

Semantic-Association Strategy

(Bergeron et al, 2009)

Contrast provides Clarity

(Chatham & Douglas, 2014, Werfel & Schuele, 2015, Werfel, Ackal & Douglas, 2016)

Distinctive Features Approach

/t/ /d/

/s/ /z/

(Anthony & Francis, 2005)

Clarity in Contrast

Mistake Prompting

• Acoustic Highlighting – “Listen”: (Whispering) t-t-t-t T”

• Successive Approximations – Pairing contrasting sounding letters and later

similar sounding letters • E.g. M with B then M with P then M with S later M

with N

Mistake Prompting

• Modeling and Imitation – “good try, say it like this “khhhssss” (for X)

Don’t forget recall!!

• Conversion Modeling – “Oh You thought I said “V”, I actually said “B”

Find “b-b-b B”

Vocabulary

Syntax

Some things worth mentioning

Don’t have to wait to start teaching phonological awareness, children with hearing

loss need exposure to the language of phonological awareness

Don’t need to over look performance gaps in CA vs. CI Age – they can still work on par with CA

peers for phonological awareness skills –

(Ambrose, Fey & Eisenberg, 2012)

Phonological Awareness emerges in the deaf child in 2 stages

– Large units of syllable and rime

– Small units of phonemes

It’s the same in children with typical hearing

(James, Rajput, Brown, Sirimanna, Brimton & Goswami, 2005)

Children with cochlear implants can learn syllable and rime without the use of orthographic cues

PA develops independently from print knowledge

Speech reading skills play a significant role in later word reading ability

(Ambrose, Fey & Eisenberg, 2012)

Visual strategies are helpful in increasing phonological knowledge

Explicit PA Intervention

• What skills do I need to teach?

• In what order do I need to teach?

• How do I teach it?

Skills to Teach (stepping stones)

Foundation critical to early literacy success

Words into syllables

Rhyming

Initial sounds

Final sounds

Segmenting

Blending

(Adapted from Scheule & Boudreau, 2008)

Instructional Sequence Age What Should the Child Do?

Preschool Segmentation of words into syllables Some rhyming ability Some beginning sound ability

Early Kindergarten Judge rhyming words Generate rhyming words

Middle Kindergarten Match words with same beginning then final sounds, segment initial and final sounds

Late Kindergarten Segment sounds in two and three sound words (CV, VC, CVC)

Early First Grade Segment sounds in words with blends (CCVC, CVCC)

(Schuele, 2012)

Utilize a Facilitative Organization

of Instructional Stimuli

Words into Syllables

1. Segment sentences of monosyllabic words

2. Segment two-syllable compound words

3. Segment two-syllable words

4. Segment multi-syllabic words

Utilize a Facilitative Organization of Instructional Stimuli

Stimuli

Foundation critical to early literacy success

Words into syllables

Rhyming

Initial sounds

Final sounds

Segmenting

Blending

(Adapted from Scheule & Boudreau, 2008)

Activity Sequence for Each Stimuli

1. Judging

2. Odd one out

3. Matching

4. Sorting

5. Segmenting

6. Generating Maintain this sequence so The child only has to learn one New thing at a time and spend less time on learning a new activity

(Schuele & Dayton, 2000)

Rhyming

• can scaffold to make them successful and if nothing else, expose them to the language of rhyming

• Start with Monosyllabic words, words in the child’s lexicon

(Schuele, 2012)

Rhyming

• Begin with words that when visibly produced, are maximally different:

– E.g. Does hat rhyme with shoe?

• Focus children on similarity of sounds and similarity of production

(Schuele, 2012)

Initial Sounds

Initial Sounds • Initial sounds before final sounds

• Words in the child’s lexicon

• Initial CV or CVC not CCVC or VC

• monosyllable words are easier than multisyllabic

• Consonants are easier than vowels

• Continuant sounds before stop sounds

• Avoid /h, r, l/

• Certain gestures are helpful

(Schuele, 2012)

Final Sounds

• Words in the child’s lexicon

• VC or CVC

• Consonants are easier than vowels

• Avoid /h, r, l/

• Certain gestures can be helpful

(Schuele, 2012)

Segmentation and Blending

• Words in child’s lexicon, words encountered in prior lessons, monosyllabic words

• The shape of the syllable makes it easier not the number of sounds – ex. Seek vs. ski

– CV, VC, then CVC

– Must target CCVC and CVCC

(Schuele, 2012)

Other components

Successful intervention

Time Activity Teacher 1 Activity Teacher 2/TA

8:40 Vocab/Syntax AB Centers CDEFGH

9:00 Conv. Lang. Act. AB Centers CDEFGH

9:20 Vocab/Syntax CD Centers ABEFGH

9:40 Conv. Lang Act. CD Centers ABEFGH

10:00 RECESS RECESS

10:45 Phonological Awareness

AB Phonological Awareness

11:00 Phonological Awareness

CD Phonological Awareness

11:15 Read Aloud ABCD Read Aloud EFGH

11:30 ` LUNCH LUNCH

12:00-2:00 NAP NAP

2:15 Experience/ Chart Story

ABCD Experience/ Chart Story

2:30 Handwriting ABCD Handwriting EFGH

2:45 Go home Go home

Internal Study on small groups HL 1 HL2 Normal

Hearing 3

Normal

Hearing 4

HL5, 6

# expressive

responses

HL 1 HL2

# expressive

responses

Large Group – 6 children 4 with deafness: 23 minute session

Small Group – 2 children both with deafness: 20 minute session, remaining 4 to Discovery Room

Accelerating Early Literacy Skills in Children with Hearing Loss

In Summary

Vocabulary

Syntax

Constructs of PA

Maximal Implicit Instruction Explicit Intervention

(Miller, Lederberg and Easterbrooks, 2013; Werfel and Schuele, 2014)

Contextualized Intervention

Vocabulary

Syntax

Experiences

Implicit PA Instruction

Explicit PA Instruction

(Gilliam, Gilliam & Reece, 2012)

Utilize a Facilitative Organization of Instructional Stimuli

Instruction is Data Driven

PALS-PreK

PALS-K

Final Thought

Student achievement and success are directly related to the teacher’s accuracy in diagnosing student skills, prescribing

appropriate teaching activities, structuring the lessons to ensure

success, giving clear direction for what is expected, and giving feedback on the

child’s responses. Moog and Stein, 2008

Moog, Stein, Biedenstein, & Gustus, 2003

https://www.youtube.com/watch?v=uRDNLTMaZqo

ADEF….Geez!! Accelerating Early Literacy Skills in ...€¦.Geez!! Accelerating Early Literacy...

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