Academic excellence for business and the professions
Reading and dyslexia in deaf children
Dr Rosalind Herman
City University London
Childhood deafness• 44,0004 children in the UK have a permanent
hearing loss• A quarter have a severe-profound level of loss
that significantly impacts access to spoken language
• Of these, approximately two thirds use spoken language
4CRIDE 2012
Recent developments
• Reading develops more slowly • Reading delay increases with age5,6
• Are all deaf readers dyslexic? • No, good deaf readers do exist7,8
• BUT some may be dyslexic
Reading and deaf children
5Conrad 1979, 6Wauters et al. 2006, 7Marschark et al. 2007, 8Gravenstede & Roy 2009
Reading in deaf and hearing children
• Hearing children with reading difficulties are likely to be diagnosed as dyslexic
• Deaf children’s difficulties are attributed solely to their sensory loss
• Given the genetic basis of dyslexia2, might some deaf children also be dyslexic?
1Allen, 1986; Conrad, 1979; Kyle & Harris, 2010; 2011; Wauters, van Bon & Tellings, 2006; 2Pennington & Olson, 2005
5
• Evidence reading develops in same way as hearing children
• For both, phonological skills are important – Hearing children rely on listening– Deaf children additionally use lip-reading
(speechreading)9
Why start with oral deaf children?
9Kyle & Harris 2010; 2011
Identification of dyslexia in deaf readers: the challenges
•No tests for deaf children•Can we use tests developed for hearing
children?
Phase 1: Oral deaf children
Aims:1. Investigate the suitability of literacy and
dyslexia-sensitive tests for deaf children 2. Collect data from a representative sample of
oral deaf children3. Compare deaf readers to hearing children
with and without dyslexia 4. Find out if some deaf children have dyslexia
Phase 2: Signing deaf children
Participants in Phase 1• 79 severely-profoundly children deaf from birth
• Year 6 (10-11years), primary education in English
• 61% cochlear implants, 39% digital hearing aids: no difference in reading and phonological skills so combined into one group
• Reference group of 20 hearing dyslexic children
Measures
Literacy
Phonological skills
Vocabulary
Non-verbalSpeech readingSpeech intelligibility
Namingspeed
Test battery
11
Literacy– Single words, nonword reading, reading comprehension, spelling
Phonological tasks– Digit span– Fluency: rhyme, alliteration– Phoneme deletion (rein/deer)– Spoonerism (fun with “b”; riding boot)– Naming speed
Non verbal IQ Expressive vocabulary Speechreading and speech intelligibility Familiar sequences
Parent and teacher questionnaires
12
• Family history of speech/language, hearing, reading problems
• Child’s hearing background, type of amplification (hearing aid/cochlear implant), any additional difficulties
• Parental education, ethnicity• School and home communication method• Methods used for teaching reading
Could the children do the tests?
Deaf-friendly test administration: listening conditions
• Quiet and distraction free test environment, important for hearing aid/cochlear implant users
• Amplification fully functional prior to assessment
14
• Optimal seating and lighting• Access to clear speech patterns to support
speechreading
15
Deaf-friendly test administration: visual access
• Signing/gesture/writing used as needed to explain tasks
• Additional practice items offered where needed
• Sensitivity to deaf children’s speech patterns in scoring
Note: all tests administered using spoken language only in Phase 1
16
Tester skills
Are deaf children with cochlear implants better readers?
• 61% with implants • 39% with hearing aids• No differences between groups
Differences among children with cochlear implants
• Small group of children implanted ≤18mths: no below average scores
• Children implanted ≥2yrs: mixed picture, good and poor readers
19
Comparing deaf participants with hearing test norms
• Deaf children had below average scores (<-1SD) on most of the literacy and phonological tasks
• Deaf children particularly poor on vocabulary• Deaf children showed a normal spread of scores on naming speed for digits, NVIQ, speech reading, semantic fluency
Comparing deaf and hearing dyslexic children:
Single word reading
52%
48%
Deaf children
Average readers
Poor readers70%
30%
Hearing dyslexic children
Average readers
Poor readers
70%
30%
Hearing dyslexic children
Average readersPoor readers
52%42%
6%
Deaf children
Average readers
Poor readers
Extremely poor readers
Comparing deaf and hearing dyslexic children:
Single word reading
Other literacy scores for deaf group
Reading comprehension: • 39% deaf in normal range
Spelling:• 60% deaf in normal range
22
•Vocabulary•Phoneme deletion
Word reading
•Phoneme deletion•Spoonerisms
Nonword reading
•Vocabulary•Naming speed for digitsSpelling
Evaluating our measures: Predictors of literacy skills
24
Can we identify dyslexia in oral deaf children?
Dyslexic readers
(PR)
Average readers
Poor readers,
poor language (PR + PL)
Average readers,
poor language
(PL)
Poor Gooddecoding decodingskills skills
(Nonword reading)
Poor language skills(Expressive vocabulary)
Good language skills
Deaf 30%
Deaf 22%Deaf 48%
Deaf 0%
Classification of reading skills
Deaf children’s range of scores on single word reading and vocabulary
27
Deaf children compared with hearing dyslexic children
Can we separate poor reading from language difficulties in deaf children?
Can we separate poor reading from language difficulties in deaf children?
What about deaf children’s phonological skills?
Comparing deaf children and hearing dyslexic children with below average scores
Literacy, language and
phonological scores
Hearing dyslexic children: % Below average literacy scores
Deaf and hearing dyslexic children: % Below average literacy scores
Deaf and hearing dyslexic children: % Below average language and
comprehension scores
Reading comprehension Vocabulary0
20
40
60
Deaf Hearing dyslexic
Deaf and hearing dyslexic children: Below average phonological skills
Spelling errors: Use of phonological route?
Types of spelling errors:phonetic error ‘lepered’ non-phonetic ‘cuircle’
Spelling errors: Use of phonological route?
Better literacy Poorer literacy
Limited early language experience
Poor speech perception and production
Poor phonological representations and awareness
Inefficient word learningPoor reading
Why do deaf children have reading problems? The role of early language experience
Poor vocabulary development
So were any deaf readers dyslexic?
Average readers
Poor readers
6% ‘extremely poor’ deaf readers:• severe phonological deficits• lowest scores across all measuresWe cannot tell if they have dyslexiaTheir response to intervention may be informative
40
We looked at all poor deaf readers’ performance on measures that identified poor reading in the hearing dyslexic group
41
Eight deaf children with average speech intelligibility and nonverbal scores BUT low scores on naming speedThree with average non-word reading unlikely to be dyslexic
Naming speed a key measure in identifying dyslexia
42
Of the five remaining, all had:– Very poor spelling (phonetic spelling errors)– Very poor phonological skills (spoonerisms, phoneme
deletion)– Very poor sequencing skills (months in correct sequence)– 4/5 were boys
These children fit the typical dyslexic profile
Some oral deaf children do have a dyslexic profile BUT these are not the only poor readers
Half* our oral deaf sample are poor readers, all with poor language and weak phonological skills
The phonological deficits are the same as those found in hearing children with dyslexia
*Using more recent norms for BAS single word reading test, 71% are poor readers
Phase 1: Conclusions
These children are poorly equipped for secondary school All poor deaf readers need support not just the few with
dyslexia Interventions that work with hearing dyslexic children
should be available to poor deaf readersLike hearing children with severe reading difficulties, deaf
children need intensive, individualised, ongoing interventions to address their language and phonological deficits
Ideally, intervention should be early to prevent these problems
What happens next?
Breaking the cycle
Through learning to read and spell, children can develop their phonological awareness skills and extend their vocabularies
Phase 2: Deaf signing children Questions we hope to answer
What does a good reader in this group look like using our tests?
If signing helps language development, is reading better among children with good signing skills?
Are phonological skills important to reading in signers?What is the profile of good and poor readers? Is there a dyslexic profile among signers?What might help reading development in signers who
struggle with reading?46
“the Government wants every child to succeed…the ability to read well is key to success in education and an essential life skill… (the need for) high quality provision
for securing literacy for all children”
The Rose Report, 2009
What about deaf children?
AcknowledgementsThanks to…
My collaborators, Penny Roy & Fiona KyleThe Nuffield Foundation All the children, families and schools who took partOur research assistants: Zoe Shergold for phase 1 and
Catherine Barnett for phase 2 Advisory group: Sue Brownson, Margaret Harris, Mairead MacSweeney, Barbara Maughan, Ian Noon, Kate Rowley, Karen Simpson, Maggie Snowling, Ruth Swanwick & Tyron Woolfe
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