Speechreading Ability Is Related to Phonological Awareness and Single-Word Reading in Both Deaf and Hearing Children

Purpose Speechreading (lipreading) is a correlate of reading ability in both deaf and hearing children. We investigated whether the relationship between speechreading and single-word reading is mediated by phonological awareness in deaf and hearing children. Method In two separate studies, 66 deaf children and 138 hearing children, aged 5-8 years old, were assessed on measures of speechreading, phonological awareness, and single-word reading. We assessed the concurrent relationships between latent variables measuring speechreading, phonological awareness, and single-word reading. Results In both deaf and hearing children, there was a strong relationship between speechreading and single-word reading, which was fully mediated by phonological awareness. Conclusions These results are consistent with ideas from previous studies that visual speech information contributes to the development of phonological representations in both deaf and hearing children, which, in turn, support learning to read. Future longitudinal and training studies are required to establish whether these relationships reflect causal effects.

Computerized Speechreading Training for Deaf Children: A Randomized Controlled Trial

Purpose We developed and evaluated in a randomized controlled trial a computerized speechreading training program to determine (a) whether it is possible to train speechreading in deaf children and (b) whether speechreading training results in improvements in phonological and reading skills. Previous studies indicate a relationship between speechreading and reading skill and further suggest this relationship may be mediated by improved phonological representations. This is important since many deaf children find learning to read to be very challenging. Method Sixty-six deaf 5- to 7-year-olds were randomized into speechreading and maths training arms. Each training program was composed of a 10-min sessions a day, 4 days a week for 12 weeks. Children were assessed on a battery of language and literacy measures before training, immediately after training, and 3 months and 11 months after training. Results We found no significant benefits for participants who completed the speechreading training, compared to those who completed the maths training, on the speechreading primary outcome measure. However, significantly greater gains were observed in the speechreading training group on one of the secondary measures of speechreading. There was also some evidence of beneficial effects of the speechreading training on phonological representations; however, these effects were weaker. No benefits were seen to word reading. Conclusions Speechreading skill is trainable in deaf children. However, to support early reading, training may need to be longer or embedded in a broader literacy program. Nevertheless, a training tool that can improve speechreading is likely to be of great interest to professionals working with deaf children. Supplemental Material https://doi.org/10.23641/asha.8856356.

Eye Movements During Visual Speech Perception in Deaf and Hearing Children

For children who are born deaf, lipreading (speechreading) is an important source of access to spoken language. We used eye tracking to investigate the strategies used by deaf (n = 33) and hearing 5-8-year-olds (n = 59) during a sentence speechreading task. The proportion of time spent looking at the mouth during speech correlated positively with speechreading accuracy. In addition, all children showed a tendency to watch the mouth during speech and watch the eyes when the model was not speaking. The extent to which the children used this communicative pattern, which we refer to as social-tuning, positively predicted their speechreading performance, with the deaf children showing a stronger relationship than the hearing children. These data suggest that better speechreading skills are seen in those children, both deaf and hearing, who are able to guide their visual attention to the appropriate part of the image and in those who have a good understanding of conversational turn-taking.

Predicting reading ability in teenagers who are deaf or hard of hearing: A longitudinal analysis of language and reading

BACKGROUND

Deaf and hard of hearing (D/HH) children and young people are known to show group-level deficits in spoken language and reading abilities relative to their hearing peers. However, there is little evidence on the longitudinal predictive relationships between language and reading in this population.

AIMS

To determine the extent to which differences in spoken language ability in childhood predict reading ability in D/HH adolescents.

METHODS

and procedures: Participants were drawn from a population-based cohort study and comprised 53 D/HH teenagers, who used spoken language, and a comparison group of 38 normally hearing teenagers. All had completed standardised measures of spoken language (expression and comprehension) and reading (accuracy and comprehension) at 6-10 and 13-19 years of age.

OUTCOMES

and results: Forced entry stepwise regression showed that, after taking reading ability at age 8 years into account, language scores at age 8 years did not add significantly to the prediction of Reading Accuracy z-scores at age 17 years (change in R² = 0.01, p = .459) but did make a significant contribution to the prediction of Reading Comprehension z-scores at age 17 years (change in R²  = 0.17, p < .001).

CONCLUSIONS

and implications: In D/HH individuals who are spoken language users, expressive and receptive language skills in middle childhood predict reading comprehension ability in adolescence. Continued intervention to support language development beyond primary school has the potential to benefit reading comprehension and hence educational access for D/HH adolescents.

Language and reading comprehension in middle childhood predicts emotional and behaviour difficulties in adolescence for those with permanent childhood hearing loss

BACKGROUND

Permanent childhood hearing loss (PCHL) is associated with an elevated level of emotional and behaviour difficulties (EBD). In children and adolescents with PCHL, EBD has been found to be linked to language ability in children with PCHL. The present study was designed to test whether childhood language and/or reading comprehension abilities of children with PCHL predict subsequent EBD in adolescence.

METHODS

Language comprehension (LC) and reading comprehension (RC) were measured at ages 6-10 years (Time 1) and 13-20 years (Time 2) in participants with PCHL who preferred to communicate using spoken language (n = 57) and a hearing comparison group (n = 38). EBD was measured at both time points by parent and by teacher ratings on the Strengths and Difficulties Questionnaire.

RESULTS

Within the PCHL group there were negative correlations between EBD scores and concurrent LC and RC scores at Time 1 and at Time 2. Cross-lagged latent variable models fitted to the longitudinal data indicated that the associations between LC, RC and teacher-rated EBD were more likely to arise from the impact of LC and RC on behaviour rather than the other way around.

CONCLUSIONS

In those with PCHL, poor language and reading comprehension in middle childhood increased the risk of emotional and behaviour difficulties at school in the teenage years. The results suggest that effective language and literacy interventions for children with hearing loss may also bring benefits to their mental health.

Societal costs of permanent childhood hearing loss at teen age: a cross-sectional cohort follow-up study of universal newborn hearing screening

OBJECTIVE

To investigate the effects in adolescence of bilateral permanent childhood hearing loss (PCHL) > 40 dB and of exposure to universal newborn hearing screening (UNHS) on societal costs accrued over the preceding 12 months.

DESIGN SETTING PARTICIPANTS

An observational cohort study of a sample of 110 adolescents aged 13-20 years, 73 with PCHL and 37 in a normally hearing comparison group (HCG) closely similar in respect of place and date of birth to those with PCHL, drawn from a 1992-1997 cohort of 157 000 births in Southern England, half of whom had been exposed to a UNHS programme.

INTERVENTION

Birth in periods with and without UNHS.

OUTCOME MEASURES

Resource use and costs in the preceding 12-month period, estimated from interview at a mean age of 16.9 years and review of medical records. Effects on costs were examined in regression models.

RESULTS

Mean total costs for participants with PCHL and the HCG were £15 914 and £5883, respectively (difference £10 031, 95% CI £6460 to £13 603), primarily driven by a difference in educational costs. Compared with the HCG, additional mean costs associated with PCHL of moderate, severe and profound severity were £5916, £6605 and £18 437, respectively. The presence of PCHL and an additional medical condition (AMC) increased costs by £15 385 (95% CI £8532 to £22 238). An increase of one unit in receptive language z-score was associated with £1616 (95% CI £842 to £2389) lower costs. Birth during periods of UNHS was not associated with significantly lower overall costs (difference £3594, 95% CI -£2918 to £10 106).

CONCLUSIONS

The societal cost of PCHL was greater with more severe losses and in the presence of AMC and was lower in children with superior language scores. There was no statistically significant reduction in costs associated with birth in periods with UNHS.

TRIAL REGISTRATION NUMBER

ISRCTN03307358, pre-results.

Emotional and behaviour difficulties in teenagers with permanent childhood hearing loss

OBJECTIVES

It is known that during the middle childhood years those with permanent childhood hearing loss (PCHL) are at increased risk of showing emotional and behaviour difficulties (EBD). It has yet to be established whether this risk continues into the late teenage years. There is a paucity of longitudinal studies on the association between PCHL and EBD.

METHODS

The Strengths and Difficulties Questionnaire (SDQ) was used to measure EBD based on parent, teacher and self-ratings in 76 teenagers with PCHL and 38 in a hearing comparison group (HCG) from a population sample of children that was followed up from birth to adolescence.

RESULTS

On parent-rated SDQ, the PCHL group had significantly higher Total Difficulties score than the HCG (Standardised mean difference (SMD) = +0.39, 95%CI 0.00 to 0.79). Amongst the PCHL group the presence of disabilities other than hearing loss had a substantial impact on the level of parent-rated EBD (SMD = +1.68, 1.04 to 2.33). There was a relationship between receptive language ability and EBD in both the HCG (r = -0.33, 95%CI -0.59 to -0.01) and the PCHI group (r = -0.33, 95%CI -0.53 to -0.02). The effect of PCHL on EBD became non-significant when receptive language was included as a covariate (F = 0.12, df = 1,95, p = 0.729). Early confirmation of hearing loss (i.e. before 9 months of age) did not have a significant effect on EBD scores (SMD = +0.31, 95%CI -0.15 to 0.77).

CONCLUSIONS

PCHL continues to be associated with elevated EBD scores as measured by parent rated SDQ into the late teenage years but the degree of this elevation is less than in childhood and is not apparent on teacher or self-ratings. Poor receptive language ability appeared to account for these elevated EBD scores in the group with PCHL. Particular attention needs to be paid to the mental health of children and adolescents with PCHL that is accompanied by other disabilities and to those with poor receptive language ability. However, the majority of teenagers with PCHL do not show clinically significant elevated levels of EBD.

Speechreading in Deaf Adults with Cochlear Implants: Evidence for Perceptual Compensation

Previous research has provided evidence for a speechreading advantage in congenitally deaf adults compared to hearing adults. A 'perceptual compensation' account of this finding proposes that prolonged early onset deafness leads to a greater reliance on visual, as opposed to auditory, information when perceiving speech which in turn results in superior visual speech perception skills in deaf adults. In the current study we tested whether previous demonstrations of a speechreading advantage for profoundly congenitally deaf adults with hearing aids, or no amplificiation, were also apparent in adults with the same deafness profile but who have experienced greater access to the auditory elements of speech via a cochlear implant (CI). We also tested the prediction that, in line with the perceptual compensation account, receiving a CI at a later age is associated with superior speechreading skills due to later implanted individuals having experienced greater dependence on visual speech information. We designed a speechreading task in which participants viewed silent videos of 123 single words spoken by a model and were required to indicate which word they thought had been said via a free text response. We compared congenitally deaf adults who had received CIs in childhood or adolescence (N = 15) with a comparison group of hearing adults (N = 15) matched on age and education level. The adults with CI showed significantly better scores on the speechreading task than the hearing comparison group. Furthermore, within the group of adults with CI, there was a significant positive correlation between age at implantation and speechreading performance; earlier implantation was associated with lower speechreading scores. These results are both consistent with the hypothesis of perceptual compensation in the domain of speech perception, indicating that more prolonged dependence on visual speech information in speech perception may lead to improvements in the perception of visual speech. In addition our study provides metrics of the 'speechreadability' of 123 words produced in British English: one derived from hearing adults (N = 61) and one from deaf adults with CI (N = 15). Evidence for the validity of these 'speechreadability' metrics come from correlations with visual lexical competition data.

The impact of universal newborn hearing screening on long-term literacy outcomes: a prospective cohort study

OBJECTIVE

To determine whether the benefits of universal newborn hearing screening (UNHS) seen at age 8 years persist through the second decade.

DESIGN

Prospective cohort study of a population sample of children with permanent childhood hearing impairment (PCHI) followed up for 17 years since birth in periods with (or without) UNHS.

SETTING

Birth cohort of 100 000 in southern England.

PARTICIPANTS

114 teenagers aged 13-19 years, 76 with PCHI and 38 with normal hearing. All had previously their reading assessed aged 6-10 years.

INTERVENTIONS

Birth in periods with and without UNHS; confirmation of PCHI before and after age 9 months.

MAIN OUTCOME MEASURE

Reading comprehension ability. Regression modelling took account of severity of hearing loss, non-verbal ability, maternal education and main language.

RESULTS

Confirmation of PCHI by age 9 months was associated with significantly higher mean z-scores for reading comprehension (adjusted mean difference 1.17, 95% CI 0.36 to 1.97) although birth during periods with UNHS was not (adjusted mean difference 0.15, 95% CI -0.75 to 1.06). The gap between the reading comprehension z-scores of teenagers with early compared with late confirmed PCHI had widened at an adjusted mean rate of 0.06 per year (95% CI -0.02 to 0.13) during the 9.2-year mean interval since the previous assessment.

CONCLUSIONS

The benefit to reading comprehension of confirmation of PCHI by age 9 months increases during the teenage years. This strengthens the case for UNHS programmes that lead to early confirmation of permanent hearing loss.

TRIAL REGISTRATION NUMBER

ISRCTN03307358.

Emotional and behavioural difficulties in children and adolescents with hearing impairment: a systematic review and meta-analysis

The aim of this study is to estimate the extent to which children and adolescents with hearing impairment (HI) show higher rates of emotional and behavioural difficulties compared to normally hearing children. Studies of emotional and behavioural difficulties in children and adolescents were traced from computerized systematic searches supplemented, where appropriate, by studies referenced in previous narrative reviews. Effect sizes (Hedges' g) were calculated for all studies. Meta-analyses were conducted on the weighted effect sizes obtained for studies adopting the Strength and Difficulties Questionnaire (SDQ) and on the unweighted effect sizes for non-SDQ studies. 33 non-SDQ studies were identified in which emotional and behavioural difficulties in children with HI could be compared to normally hearing children. The unweighted average g for these studies was 0.36. The meta-analysis of the 12 SDQ studies gave estimated effect sizes of 0.23 (95% CI 0.07, 0.40), 0.34 (95% CI 0.19, 0.49) and -0.01 (95% CI -0.32, 0.13) for Parent, Teacher and Self-ratings of Total Difficulties, respectively. The SDQ sub-scale showing consistent differences across raters between groups with HI and those with normal hearing was Peer Problems. Children and adolescents with HI have scores on emotional and behavioural difficulties measures about a quarter to a third of a standard deviation higher than hearing children. Children and adolescents with HI are in need of support to help their social relationships particularly with their peers.

The Cambridge Face Memory Test for Children (CFMT-C): a new tool for measuring face recognition skills in childhood

Face recognition ability follows a lengthy developmental course, not reaching maturity until well into adulthood. Valid and reliable assessments of face recognition memory ability are necessary to examine patterns of ability and disability in face processing, yet there is a dearth of such assessments for children. We modified a well-known test of face memory in adults, the Cambridge Face Memory Test (Duchaine & Nakayama, 2006, Neuropsychologia, 44, 576-585), to make it developmentally appropriate for children. To establish its utility, we administered either the upright or inverted versions of the computerised Cambridge Face Memory Test - Children (CFMT-C) to 401 children aged between 5 and 12 years. Our results show that the CFMT-C is sufficiently sensitive to demonstrate age-related gains in the recognition of unfamiliar upright and inverted faces, does not suffer from ceiling or floor effects, generates robust inversion effects, and is capable of detecting difficulties in face memory in children diagnosed with autism. Together, these findings indicate that the CFMT-C constitutes a new valid assessment tool for children's face recognition skills.

Poor comprehenders in the classroom: teacher ratings of behavior in children with poor reading comprehension and its relationship with individual differences in working memory

Differing etiological explanations have been proposed to account for poor comprehenders' difficulties with reading comprehension, with some researchers emphasizing working memory deficits and others arguing for oral language weaknesses playing a key causal role. The authors contrasted these two theoretical accounts using data obtained from direct measures of working memory and from teacher ratings of poor comprehenders' behavior in the classroom. At the group level, poor comprehenders showed weaknesses on verbal but not nonverbal working memory tasks, in keeping with the "language account." However, they also showed evidence of elevated levels of problem behaviors specifically associated with working memory deficits. Further analysis revealed that these group differences in working-memory-related problem behaviors were carried by a small subgroup of poor comprehenders who also displayed domain-general (verbal and nonverbal) working memory problems, argued to be reflective of "genuine" underlying working memory deficits.

The impact of early identification of permanent childhood hearing impairment on speech and language outcomes

It is well established that permanent childhood hearing impairment (PCHI) has a detrimental impact on speech and language development. The past two decades have seen the gradual introduction of universal newborn hearing screening (UNHS) programmes coupled with early intervention programmes. We review studies that have capitalised on the advent of newborn hearing screening to assess the impact of early identification of PCHI on language outcomes in deaf children. The research supports the conclusion that, in children with PCHI, newborn hearing screening and early identification lead to beneficial effects on language development, with the most consistent evidence provided for links between early identification of PCHI and positive language outcomes. Future research needs to encompass a wider range of outcomes and to assess the impact of UNHS in adolescents and young adults.

Understanding words, understanding numbers: an exploration of the mathematical profiles of poor comprehenders

BACKGROUND

Poor comprehenders are children who show significant deficits in their reading comprehension performance, despite average, or above-average word reading ability. To date, there have been no in-depth studies of the mathematical performance profiles of such children.

AIMS

This study aimed to explore the mathematical profiles of poor comprehenders. Given that language impairment is associated with difficulties with mathematics, and that poor comprehenders tend to have oral language weaknesses, we hypothesized that poor comprehenders would show relative weaknesses in aspects of mathematical performance.

SAMPLE

From a sample of 109 children aged 7-8 years, we selected 14 poor comprehenders and 14 controls with age-appropriate reading comprehension ability. The groups were matched on non-verbal ability, multiple measures of reading accuracy, and chronological age.

METHODS

We compared the performance of the group of poor comprehenders with that of the matched controls on two standardized measures of mathematical ability, one measuring procedural arithmetic prowess and the other tapping higher-level mathematical reasoning.

RESULTS

Although there were no group differences in performance on the arithmetic measure, the poor comprehenders showed significantly lower scores than the controls on the mathematical reasoning task. The poor comprehenders exhibited impaired verbal ability relative to controls, with these differences in verbal ability associated with the group differences found on the test of mathematical reasoning.

CONCLUSIONS

Poor comprehenders' deficits are not limited to the domain of literacy; their underlying profile of impairments also seems to selectively impact on certain components of mathematical ability.

Understanding words, understanding numbers: an exploration of the mathematical profiles of poor comprehenders

BACKGROUND

Poor comprehenders are children who show significant deficits in their reading comprehension performance, despite average, or above-average word reading ability. To date, there have been no in-depth studies of the mathematical performance profiles of such children.

AIMS

This study aimed to explore the mathematical profiles of poor comprehenders. Given that language impairment is associated with difficulties with mathematics, and that poor comprehenders tend to have oral language weaknesses, we hypothesized that poor comprehenders would show relative weaknesses in aspects of mathematical performance.

SAMPLE

From a sample of 109 children aged 7-8 years, we selected 14 poor comprehenders and 14 controls with age-appropriate reading comprehension ability. The groups were matched on non-verbal ability, multiple measures of reading accuracy, and chronological age.

METHODS

We compared the performance of the group of poor comprehenders with that of the matched controls on two standardized measures of mathematical ability, one measuring procedural arithmetic prowess and the other tapping higher-level mathematical reasoning.

RESULTS

Although there were no group differences in performance on the arithmetic measure, the poor comprehenders showed significantly lower scores than the controls on the mathematical reasoning task. The poor comprehenders exhibited impaired verbal ability relative to controls, with these differences in verbal ability associated with the group differences found on the test of mathematical reasoning.

CONCLUSIONS

Poor comprehenders' deficits are not limited to the domain of literacy; their underlying profile of impairments also seems to selectively impact on certain components of mathematical ability.