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Emergent Literacy in Kindergartners With Cochlear Implants

Nittrouer, Susan1; Caldwell, Amanda1; Lowenstein, Joanna H.1; Tarr, Eric1; Holloman, Christopher2

doi: 10.1097/AUD.0b013e318258c98e
Research Articles

Objective: A key ingredient to academic success is being able to read. Deaf individuals have historically failed to develop literacy skills comparable with those of their normal-hearing (NH) peers, but early identification and cochlear implants (CIs) have improved prospects such that these children can learn to read at the levels of their peers. The goal of this study was to examine early, or emergent, literacy in these children.

Method: Twenty-seven deaf children with CIs, who had just completed kindergarten were tested on emergent literacy, and on cognitive and linguistic skills that support emergent literacy, specifically ones involving phonological awareness, executive functioning, and oral language. Seventeen kindergartners with NH and eight with hearing loss, but who used hearing aids served as controls. Outcomes were compared for these three groups of children, regression analyses were performed to see whether predictor variables for emergent literacy differed for children with NH and those with CIs, and factors related to the early treatment of hearing loss and prosthesis configuration were examined for children with CIs.

Results: The performance of children with CIs was roughly 1 SD or more below the mean performance of children with NH on all tasks, except for syllable counting, reading fluency, and rapid serial naming. Oral language skills explained more variance in emergent literacy for children with CIs than for children with NH. Age of first implant explained moderate amounts of variance for several measures. Having one or two CIs had no effect, but children who had some amount of bimodal experience outperformed children who had none on several measures.

Conclusions: Even deaf children who have benefitted from early identification, intervention, and implantation are still at risk for problems with emergent literacy that could affect their academic success. This finding means that intensive language support needs to continue through at least the early elementary grades. Also, a period of bimodal stimulation during the preschool years can help boost emergent literacy skills to some extent.

This study reports data on emergent literacy and related skills for children with cochlear implants, comparing their outcomes with those of children with normal hearing or hearing loss mild enough to require only hearing aids. Results showed that children with cochlear implants performed more poorly on all measures compared with children in the other two groups. Factors related to variability in outcomes are discussed.Supplemental Digital Content is available in the text.

1Department of Otolaryngology, The Ohio State University, Columbus, Ohio, USA;

2Statistical Consulting Service, The Ohio State University, Columbus, Ohio, USA.

Supplemental digital content is available for this article. A direct URL citation appears in the printed text and is provided in the HTML and text of this article on the journal’s Web site (

ACKNOWLEDGMENTS: This work was supported by Grant R01 DC006237 from the National Institute on Deafness and Other Communication Disorders, the National Institutes of Health. The authors gratefully acknowledge the helpful suggestions from Bruce Pennington, Ph.D.

Address for correspondence: Susan Nittrouer, Otolaryngology Head & Neck Surgery, The Ohio State University, 915 Olentangy River Road, Columbus, OH 43212, USA. E-mail:

Received May 16, 2011

Accepted March 27, 2012

© 2012 Lippincott Williams & Wilkins, Inc.