Differentiating Language for Students Who Are Deaf or Hard of Hearing: A Practice-Informed Framework for Auditory and Visual Supports.

PURPOSE: Speech-language pathologists (SLPs) serving students who are d/Deaf or hard of hearing (Deaf/hh) and their deaf education counterparts must navigate complexities in language that include modalities that are spoken or signed and proficiency, which is often compromised. This tutorial describes a practice-informed framework that conceptualizes and organizes a continuum of auditory and visual language supports with the aim of informing the practice of the SLP whose training is more inherently focused on spoken language alone, as well as the practice of the teacher of the Deaf/hh (TDHH) who may focus more on visual language supports. METHOD: This product resulted from a need within interdisciplinary, graduate programs for SLPs and TDHHs. Both cohorts required preparation to address the needs of diverse language learners who are Deaf/hh. This tutorial includes a brief review of the challenges in developing language proficiency and describes the complexities of effective service delivery. The process of developing a practice-informed framework for language supports is summarized, referencing established practices in auditory-based and visually based methodologies, identifying parallel practices, and summarizing the practices within a multitiered framework called the Framework of Differentiated Practices for Language Support. Recommendations for use of the framework include guidance on the identification of a student's language modality/ies and proficiency to effectively match students' needs and target supports. CONCLUSIONS: An examination of established practices in language supports across auditory and visual modalities reveals clear parallels that can be organized into a tiered framework. The result is a reference for differentiating language for the interdisciplinary school team. The parallel supports also provide evidence of similarities in practice across philosophical boundaries as professionals work collaboratively.

Deaf Children's Engagement with American Sign Language-English Bilingual Storybook Apps.

Design features of American Sign Language (ASL)-English bilingual storybook apps on the tablet computers, based on learning research, are intended to facilitate independent and interactive learning of English print literacy and of ASL skill among young learners. In 2013, the Science of Learning Center on Visual Language and Visual Learning introduced the first in a series of storybook apps for the iPad based on literacy and reading research. The current study, employing a sample of signing deaf children examined children's self-motivated engagement with the various design features presented in the earliest of the apps, The Baobab, and analyzed the relationships of engagement with ASL skill and age of first exposure to ASL, ASL narrative ability, and grade-appropriate English reading ability. Results indicated a robust level of engagement with the app, and a relationship between app pages specifically targeting reading and early exposure and skill levels in ASL. No evidence of relationships between narrative and vocabulary skills and app reading engagement was found. Topics for future research, and strategies for app improvement are discussed.

Think-Aloud: Effect on Adolescent Deaf Students' Use of Reading Comprehension Strategies.

This study examined the effect of explicit instruction of reading comprehension strategies, such as identification of unknown vocabulary and relating text to background knowledge, on four deaf and hard of hearing students' use of strategies and reading comprehension performance pre- and post-intervention. Explicit instruction of strategies consisted of discussion of targeted strategies and think-aloud (verbalizing one's thought processes while reading) to model strategies. The data presented is from a more in-depth study completed during the 2017-2018 academic year. Few studies have implemented think-aloud in evaluating deaf adolescents' reading challenges and the efficacy of strategy use. This study provided insight into both of these issues. Results show an increase in the variety of strategies used by students and frequency of strategy use post-intervention. Results also indicate improved comprehension scores for two students. Close examination of the data, however, reveals ongoing metacognitive challenges (such as lack of consistent identification of key unknown words and lack of awareness of comprehension breakdowns) and inconsistency in the efficacious use of strategies. Findings indicate a need for ongoing assessment of the depth and efficacy of strategy use and individualized instruction.

Unveiling teachers' beliefs on visual cognition and learning styles of deaf and hard of hearing students: A Portuguese-Swedish study.

Vision is considered a privileged sensory channel for deaf and hard of hearing (DHH) students to learn, and, naturally, they recognize themselves as visual learners. This assumption also seems widespread among schoolteachers, which led us to analyse the intersection between teachers' beliefs on deaf and hard of hearing students' academic achievement, visual skills, attentional difficulties, and the perceived importance of image display in class. An online survey was designed to analyse the beliefs of the schoolteachers about the deaf and hard of hearing students learning in educational settings from Portugal and Sweden. Participated 133 teachers, 70 Portuguese and 63 Swedish, from the preschool to the end of mandatory education (ages 3-18) with several years of experience. The content analysis and the computed SPSS statistical significance tests reveal that surveyed teachers believe that deaf and hard of hearing students have better visual skills when compared with their hearing peers yet show divergent beliefs about visual attentional processes. Within the teachers' perceptions on learning barriers to DHH students, the distractibility and cognitive effort factors were highlighted, among communicational difficulties in class. Conclusions about the prevalence of learning misconceptions in teachers from both countries analysed, corroborate previous studies on neuromyths in education, and bring novelty to Deaf Education field. The work of translation of scientific knowledge, teacher training updating, and partnership between researchers and educators are also urgently needed in special education.

Implicit learning of non-verbal regularities by deaf children with cochlear implants: An investigation with a dynamic temporal prediction task.

Some deaf children continue to show difficulties in spoken language learning after cochlear implantation. Part of this variability has been attributed to poor implicit learning skills. However, the involvement of other processes (e.g. verbal rehearsal) has been underestimated in studies that show implicit learning deficits in the deaf population. In this study, we investigated the relationship between auditory deprivation and implicit learning of temporal regularities with a novel task specifically designed to limit the load on working memory, the amount of information processing, and the visual-motor integration skills required. Seventeen deaf children with cochlear implants and eighteen typically hearing children aged 5 to 11 years participated. Our results revealed comparable implicit learning skills between the two groups, suggesting that implicit learning might be resilient to a lack of early auditory stimulation. No significant correlation was found between implicit learning and language tasks. However, deaf children's performance suggests some weaknesses in inhibitory control.

The Experiences of and Teaching Strategies for Deaf and Hard of Hearing Foreign Language Learners: A Systematic Review of the Literature.

Although foreign language (FL) educational experiences for students with disabilities including deaf and hard of hearing (DHH) students, are becoming more common, there is little research available on this topic. The purpose of the present review was to identify research examining DHH students' FL learning experiences and teaching strategies used in the FL class to facilitate language learning. The search showed that few studies have explored this area, and even fewer have met quality standards. Among the existing studies, the results revealed that communication methods in FL class instruction that do not meet the communicative needs of DHH students can hinder learning and lead to demotivation. Conversely, the presence of individualized learning goals and an emphasis on reading and writing, over speaking and listening, appear to support FL learning. Finally, the use of technology is a promising tool for FL instruction.

The French Cochlear Implant Registry (EPIIC): Perception and language results in infants with cochlear implantation under the age of 24 months.

OBJECTIVE: Multi-centre study of the National French Registry (EPIIC) of patients with cochlear implants, focusing on infants who were operated-on under the age of 24 months between 2012 and 2016. PATIENTS AND METHODS: A total of 615 profoundly deaf infants, who received cochlear implants (CIs) before their second birthday, were included in the registry by different CI centers. Epidemiological, surgical, speech therapy and school, follow-up data were included in the registry, 12, 24, 36 and 48 months thereafter. The following parameters were studied: type of implantation (uni- or bilateral), complications, cause of deafness, category of auditory perception (CAP), Open-set word recognition score (OSW), speech intelligibility rating, lexical comprehension with EVIP (Peabody), communication mode and type of schooling. Bilateral simultaneous CI (BiCI) and unilateral CI (UniCI) groups were compared. RESULTS: There were 744 implantations. The explantation-reimplantation rate, within the four-year follow-up, was just 3.6%. Mean implantation age was 16.0 months, and similar in the two groups (BiCI/UniCI). A total of 51% of children had their first implant between 12 and 18 months, and 15% before 12 months. Implantation was unilateral in 52% of cases. Fifty-six percent of the bilateral procedures were sequential, with a mean delay of 16.8 months for the second implantation. The cause of deafness was unknown in 52% of cases. Of the 48% (297/615) of attributed cases, 32% had clear genetic causes. The remaining deafness was due to cytomegalovirus (CMV, 8%), inner-ear malformation (5%) and meningitis (3%). The main complications were from infections (47%) and internal device failure (25%). Four years post-operation, 84% of the UniCI and 75% of BiCl groups had a CAP≥5, and 83% of UniCl and 100% BiCI had OSW≥80%. Furthermore 74% of UniCI and 77% of BiCI communicated orally and 85% of UniCI and 90% of BiCI integrated into mainstream schooling. CONCLUSION: The French Registry of cochlear implants (EPIIC) is the only such national registry in the world. Our analysis illustrates the immediate benefits of, either single or double, cochlear implantation for language, perception skills and schooling.

The Evidence-Based Sexual Abuse Prevention Program: Strong With Sam.

The present study was initiated to design and evaluate a sexual abuse prevention program for deaf and hard of hearing (DHH) children. This evidence-based prevention program is the first of its kind for DHH children. A total of 92 DHH children aged 8-12 years participated in the program "STARK mit SAM" (Strong with Sam, SmS), a program conducted in primary schools for DHH children in Germany. The program evaluation consisted of a pretest-posttest design. As per class, the subjects were assigned to either the experimental or the wait list control group. Participants from both groups were pretested for their knowledge about content related to the prevention of sexual abuse. The experimental group received the prevention program and both groups were posttested to examine the effects of the program. Additionally, the experimental group was tested again 6 months after the program. DHH children who participated in the SmS program showed a significant knowledge gain and a nonsignificant change in their anxiety. No significant factor affecting the children's significant knowledge gain was found. SmS is an effective sexual abuse prevention program for DHH children, which can be offered without incurring anxiety in the children.

The Effects of a Vocabulary Intervention on Teaching Multiple-Meaning Words to Students Who Are d/Deaf and Hard of Hearing.

Building vocabulary knowledge, especially breadth and depth of word meanings, is a crucial step in assisting students to read and comprehend print independently. A large body of research has documented the low reading achievement levels of a number of Deaf and hard-of-hearing (DHH) students. The goal of the present study was to examine the effects of a vocabulary intervention to teach 24 multiple-meaning words to fourth-grade DHH students in Saudi Arabia by utilizing a single-case experimental design (multiple probe design across participants). A total of 5 students with a profound hearing loss participated in the study. About 3 of 5 received the intervention, whereas two other students served as an additional control component and were administered the pretest and posttest only. The data showed that there was a significant improvement in the recognition and comprehension scores of students who received the intervention. In contrast, students who did not receive the intervention showed no significant improvement on the posttest.

Analysis of subjective perception and influencing factors of different inclusive education models among prelingually deaf children with a cochlear implant.

OBJECTIVE: We aimed to explore the educational outcome and influencing factors of ongoing verbal rehabilitation training together with inclusive education among prelingually deaf children with a cochlear implant. METHODS: Prelingually deaf children who underwent cochlear implantation, rehabilitation, and had inclusive education placement were randomly divided into two groups: one group received continuous verbal rehabilitation training under inclusive education status; the other group did not receive this training. Speech discrimination scores were determined. RESULTS: Among 60 included children, subjectively perceived academic adaptability, peer relations, initiative communication, and teacher's involvement under inclusive education, as well as speech discrimination scores, were all significantly different between groups. Continuous verbal rehabilitation training influenced the subjective perception of children and resulted in higher speech discrimination scores and more positive subjective perception. Subjective perception was not significantly correlated with chronological age, sex, age at the time of cochlear implantation, or duration of inclusive education. CONCLUSION: Ongoing verbal rehabilitation training within inclusive education can largely improve the education placement outcomes of prelingually deaf children with cochlear implants.

Effect of video-guided educational intervention on school engagement of adolescent students with hearing impairment: Implications for health and physical education.

BACKGROUND/OBJECTIVE: Hearing impaired students still face stigmatization and marginalization especially in inclusive classrooms in developing regions. This negatively impacts their school engagement. The present study aimed at ascertaining the effect of video-guided educational intervention on school engagement of hearing impaired students. METHOD: Randomized controlled trial design was adopted for the present study. A total of 46 junior secondary school students with hearing impairment and low school engagement symptoms participated in this study. The students were randomly assigned to groups - intervention group and care-as-usual control group. A video-guided educational intervention package which consists of 13-minutes captioned video clips with school engagement themes served as the treatment intervention. Data were collected at 3 different times (pre-test, post-test and follow up) using School Engagement Scale created by Fredericks, Blumenfeld, Friedel and Paris (2005). Data were analyzed using independent sample t-test, paired sample t-test, Cohen d and Chi-square. RESULTS: Results showed that the video-guided educational intervention significantly improved school engagement level among hearing impaired adolescent students in the intervention group in comparison with the students in the care-as-usual control group as measured by the Student Engagement Scale [Behavioral: t(24) = -9.305, P < .001; Emotional: t(24) = -7.772, P < .001; Cognitive: t(24) = -7.330 P < .001) as well as total student engagement (t(24) = 12.022, P < .001, Δ = 5.362). Also, the students who took part in the video-guided educational intervention maintained improved school engagement at follow-up. CONCLUSION: Video-guided educational intervention is an effective intervention for improving school engagement of hearing impaired adolescent students. Since acquiring relevant education is essential for leading a quality life especially among the special needs population, it was recommended that students with hearing impairment should be helped to acquire life skills through education by fostering their school engagement.

Technical Characteristics of Curriculum-Based Measurement With Students Who Are Deaf.

This study compared the reliability and validity of student scores from paper-pencil and e-based assessments using the "maze" and "silent reading fluency" (SRF) tasks. Forty students who were deaf and hard of hearing and reading between the second and fifth grade reading levels and their teachers (n = 21) participated. For maze, alternate form reliability coefficients obtained from correct scores and correct scores adjusted for guessing ranged from r = .61 to .84 (ps < .01); criterion-related validity coefficients ranged from r = .33 to .67 (most ps < .01). For SRF, reliability coefficients obtained from correct scores ranged from r = .50 to .75 (ps < .01); validity ranged from r = .25 to .72. Differences between student performance on paper-pencil and e-based conditions were generally non-significant for maze; significant differences between conditions for SRF favored the paper-pencil condition. Findings suggest that maze holds promise, with inconclusive results for SRF.

The Limits of "Communication Mode" as a Construct.

Questions about communication mode (a.k.a. "communication options" or "communication opportunities") remain among the most controversial issues in the many fields that are concerned with the development and well-being of children (and adults) who are d/Deaf or hard of hearing. In this manuscript, we argue that a large part of the reason that this debate persists is due to limitations of the construct itself. We focus on what we term "the crucial question": namely, what kind of experience with linguistic input during infancy and toddlerhood is most likely to result in mastery of at least one language (spoken or signed) by school entry. We argue that the construct of communication mode-as currently construed-actively prevents the discovery of compelling answers to that question. To substantiate our argument, we present a review of a relevant subset of the recent empirical literature and document the prevalence of our concerns. We conclude by articulating the desiderata of an alternative construct that, if appropriately measured, would have the potential to yield answers to what we identify as "the crucial question."

Outcomes for School-Aged Children with Aural Atresia.

This study compared the language, reading, classroom, and quality of life outcomes of primary school-aged children with aural atresia (AA) to matched controls. Participants included 10 children with AA (eight unilateral) and 10 children with typical hearing matched by chronological and mental age. All children with AA had been fitted with an amplification device. Outcome measures included standardized tests of language, reading, and functional communication questionnaires of children's classroom performance and hearing quality of life. The children with AA recorded significantly reduced hearing quality of life. The two groups did not differ on any other measures. The present preliminary findings suggest that children with AA who receive early amplification have similar language, communication, reading, and classroom outcomes as their typically hearing peers. Despite these promising outcomes, however, the children's quality of life is significantly reduced. Further research is needed to further elucidate these findings.

Do d/Deaf and Hard of Hearing Children Need Access to a Spoken Phonology to Learn to Read? A Narrative Meta-Analysis.

A meta-analysis was conducted to investigate phonology's role in d/Deaf and hard of hearing (d/Dhh) children's development of reading, and their ability to access spoken-language phonology. A systematic search of databases and journals identified 27 studies, 7 of which met the inclusion criteria. The included studies, experimental or quasi-experimental in nature, were conducted over a 20-year period (1995-2016) with students ages 3-18 years. Other literature was identified to enhance the discussion and support the interpretations. The review showed that spoken language's phonology is one of the literacy skills d/Dhh students must possess in order to learn to read. Further, the study found that d/Dhh students can access phonology using techniques like Visual Phonics and Cued Speech. These findings support the qualitative similarity hypothesis, which states that phonology is important for reading development and that d/Dhh children have the ability to access it.

English Literacy Outcomes in Sign Bilingual Programs: Current State of the Knowledge.

The authors (a) examine the available peer-reviewed research documenting the literacy achievement of deaf children educated in sign bilingual programs, (b) identify gaps in the empirical literature, and (c) propose directions for future research. This review was limited to studies that reported reading and writing outcomes. On this basis, only 3 studies were identified, representing those published over a period of approximately 20 years (1997-2017) and collectively reporting literacy outcomes for 127 deaf students. Overall, the studies indicate that the majority of participants were not achieving reading comprehension scores in the average range; further, a wide range of variability in achievement was reported across the 3 studies. Factors potentially affecting achievement, such as the presence of additional disabilities, level of American Sign Language proficiency, use of hearing technologies, and parental hearing status, are also discussed.

Invited Article: The Bright Triad and Five Propositions: Toward a Vygotskian Framework for Deaf Pedagogy and Research.

L. S. Vygotsky's contributions to social research shifted paradigms by constructing now-foundational theories of teaching, learning, language, and their educational interactions. This article contextualizes a nearly forgotten, century-old research corpus, The Fundamentals of Defectology. Drawing on Defectology, two dialectic arguments are developed, which synthesize Vygotsky's corpus, then juxtaposed it against contemporary theories and evidence. The first describes three principles of Vygotsky's framework for deaf pedagogy: positive differentiation, creative adaptation, and dynamic development. The second posits five propositions about deaf development: the biosocial proposition, the sensory delimitation-and-consciousness proposition, the adapted tools proposition, the multimodal proposition, and the conflict proposition. By leveraging Vygotsky's optimism in response to the absorbing and difficult challenges of experimental, methodological, and theoretical research about deafness, including the psychology of disability and special methods of pedagogy, both arguments constitute a future-oriented call to action for researchers and pedagogues working in deaf education today.

Implications of a Sight Word Intervention for Deaf Students.

The effectiveness of a sight word intervention designed for Deaf students was investigated. Thirty students, grades 1-7, in an urban school for the Deaf received an 8-month intervention. A pretest/posttest design using a teacher-designed instrument, the Cumulative Bedrock Literacy Sight Word Assessment, and the Test of Silent Word Reading Fluency (Mather, Hammill, Allen, & Roberts, 2004) assessed increases in the number of sight words students could identify and the rate at which they could identify them. Paired-samples and independent-samples t tests and Pearson product-moment correlations were used to analyze data. Results indicated a significant increase in the number of sight words participants could identify postintervention. Also, younger students increased their sight word vocabularies at a faster rate than older students. No significant differences based on home language or gender were found. The authors make suggestions for further research and program application.

A Technology-based Intervention to Increase Reading Comprehension of Morphosyntax Structures.

The purpose of this study was to examine the effectiveness of a technology-based intervention (LanguageLinks: Syntax Assessment and Intervention®; Laureate Learning Systems, Inc., 2013) to improve reading comprehension for d/Deaf and hard of hearing (DHH) elementary students. The intervention was a self-paced, interactive program designed to scaffold learning of morphosyntax structures. Participants included 37 DHH students with moderate to profound hearing levels, 7-12 years of age, in Grades 2-6. Assessment data were collected pre- and post- an 8-week intervention using a randomized control trial methodology. Findings indicate the intervention did not appear to be effective in improving performance, and 17 out of 36 morphosyntax structures were found difficult to comprehend for participants in the treatment group. These difficult structures included aspects of pronominalization, the verbal system, and number in nouns. Results are compared to previous research, with recommendations for future areas of research related to increasing knowledge of morphosyntax for learners who are DHH.

Single-Case Design Research on Early Literacy Skills of Learners Who Are d/Deaf and Hard of Hearing.

A systematic review explored the evidence base of literacy intervention studies that examined the early years of schooling (preschool through first grade) of participants who were d/Deaf or hard of hearing (d/Dhh). Specific inclusion criteria were used to select single-case design (SCD) studies published in peer-reviewed journals between 2004 and 2017. Fourteen studies met the criteria. Studies were evaluated according to the quality indicators for evidence-based research, individually and across studies (Horner et al., 2005; Institute for Educational Sciences, 2017; Kratochwill et al., 2013). Five of the 14 studies were categorized as "Meets Standards Without Reservations"; 7 as "Meets Standards With Reservations"; and 2 as "Does Not Meet Standards." None met the established criteria for an evidence base. Recommendations for future research are provided, with specific studies highlighted for replication to build evidence-based practices using SCD in the field of educating students who are d/Dhh.