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Reading, Writing, and Phonological Processing Skills of Adolescents With 10 or More Years of Cochlear Implant Experience

Geers, Ann E.1; Hayes, Heather2

doi: 10.1097/AUD.0b013e3181fa41fa
Research Articles

Objectives: This study had three goals: (1) to document the literacy skills of deaf adolescents who received cochlear implants (CIs) as preschoolers; (2) to examine reading growth from elementary grades to high school; (3) to assess the contribution of early literacy levels and phonological processing skills, among other factors, to literacy levels in high school.

Design: A battery of reading, spelling, expository writing, and phonological processing assessments were administered to 112 high school (CI-HS) students, ages 15.5 to 18.5 yrs, who had participated in a reading assessment battery in early elementary grades (CI-E), ages 8.0 to 9.9 yrs. The CI-HS students' performance was compared with either a control group of hearing peers (N = 46) or hearing norms provided by the assessment developer.

Results: Many of the CI-HS students (47 to 66%) performed within or above the average range for hearing peers on reading tests. When compared with their CI-E performance, good early readers were also good readers in high school. Importantly, the majority of CI-HS students maintained their reading levels over time compared with hearing peers, indicating that the gap in performance was, at the very least, not widening for most students. Written expression and phonological processing tasks posed a great deal of difficulty for the CI-HS students. They were poorer spellers, poorer expository writers, and displayed poorer phonological knowledge than hearing age-mates. Phonological processing skills were a critical predictor of high school literacy skills (reading, spelling, and expository writing), accounting for 39% of variance remaining after controlling for child, family, and implant characteristics.

Conclusions: Many children who receive CIs as preschoolers achieve age-appropriate literacy levels as adolescents. However, significant delays in spelling and written expression are evident compared with hearing peers. For children with CIs, the development of phonological processing skills is not just important for early reading skills, such as decoding, but is critical for later literacy success as well.

A battery of reading, writing, and phonological processing tests was completed by 112 high school students who received a cochlear implant in preschool. Reading scores were comparable with hearing age-mates for at least half of the sample, but fewer students achieved age-appropriate levels in writing, spelling, and phonological processing. Comparison of high school reading scores with those obtained from the same subjects in elementary grades indicated that they maintained consistent standing in relation to hearing norms. Phonological processing skills were a critical predictor of literacy after child, family, and implant characteristics were controlled.

1Dallas Cochlear Implant Program, Callier Advanced Hearing Research Center, The University of Texas at Dallas and Department of Otolaryngology-Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas TX. 2Heather Hayes, Program in Audiology and Communication Sciences, Washington University School of Medicine, St. Louis, MO.

This work was supported by grant DC008335 from the National Institutes of Health to the University of Texas at Dallas.

Address for correspondence: Ann E. Geers, Callier Advanced Hearing Research Center, 1966 Inwood Road, Dallas, TX 75235. E-mail:

Received March 19, 2010; accepted August 20, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.