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Fostering Precursor Skills to Word Reading of Children with Hearing Loss

Chan, Yi-Chih, PhD

doi: 10.1097/
Pediatric Audiology

Dr. Chan is a research fellow at the Children's Hearing Foundation in Taiwan. His research interest is reading development of children with hearing loss.

Reading is an essential skill that children must master to achieve strong academic performance. Word decoding, the ability to read a series of isolated words, is the most fundamental component of reading comprehension that is significantly fostered by a child's experience with the spoken language (Rem Spec Educ. 1986; 7(1):6). For example, decoding a written word is dependent partly on one's sensitivity to the phonological components and structures of spoken words. For children with congenital hearing loss, their auditory channel for the spoken language is restricted to an extent that what they hear is not similar to what their normal-hearing peers hear, even when they use hearing amplification devices. Consequently, their word reading skills could be hampered. Children with hearing loss depend a lot on parents and caregivers, who in turn look to the expertise of hearing health professionals. Clinicians can equip parents and caregivers with intervention skills to help improve a child's word reading performance.

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The first barrier to reading that children with hearing loss face is difficulty decoding written words. Helping them to successfully recognize words is a priority. Studies have shown that phonological and morphological awareness present a great challenge to children with impaired hearing (J Speech Lang Hear R. 2012;55(3): 811; Commun Disord Q. 2017;38(2): 67). While phonological awareness enables children to blend the sounds of letters to pronounce a word, morphological awareness engages children in analyzing the word part that carries meaning or syntactic function in word recognition. Here are techniques to share with parents, teachers, and caregivers to improve the phonological and morphological awareness of children with hearing loss.

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Before fostering the phonological awareness of children with hearing loss, parents should first ensure that their child's hearing is sufficient to hear spoken sounds at all frequencies. Regular hearing tests (e.g., the Ling Six Sounds Test) can facilitate this process. Here are some activities to develop the phonological awareness of children with hearing loss:

  1. Clapping the sounds: This technique is usually used in counting syllable(s) in words. Parents can say a word, pausing between syllables (e.g., e. le. phant) and clapping once for each syllable to make it more salient to the child. After several demonstrations, parents can give the child other words to clap for.
  2. Exaggerating the sounds: This technique is often applied to elongate sounds that can be lengthened, such as vowels (e.g., /a, e, i, o, u/), nasal consonants (e.g., /m, n/), and fricative consonants (e.g., /s, z, sh/), to attract children's attention to those sounds in a word. Parents can endeavor to elongate these sounds at any position in a word one at a time, such as ca—at, s—sit, or wash—sh. Thus, the child can more easily be made aware of a specific sound in a word.
  3. Visualizing the sounds: This technique involves displaying the sounds in a word to the child. Parents can prepare colorful squares to represent all the sounds within a word. For example, parents can point at a red square, a blue square, and a yellow square to respectively represent the sounds /f/, /a/, and /t/ while saying the word fat. A green square representing the sound /m/ can then be substituted for the red square representing the sound /f/ to make a whole new word, mat. Alternatively, the red square representing the sound /f/ can be removed to make another new word, at. Thus, the child can learn what and how sounds are combined to make a word.
  4. Categorizing the sounds: This technique helps children detect a specific sound shared by different words. Parents can prepare several pictures, with the names of some pictures beginning or ending with an identical sound, such as cat, kite, dog, cake, mop, jam, jog, hug, etc.; subsequently, they can have the child select pictures with names beginning with the /k/ sound (e.g., cat, kite, cake) or ending with the /g/ sound (e.g., dog, jog, hug).
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In contrast to the techniques proposed for phonological awareness that focused primarily on sounds, the techniques proposed for morphological awareness training entail the use of meaningful visual orthographic chunks, which have been shown to be beneficial to many children with hearing loss.

  1. Formation of words: This technique entails instructing the child to make words by combining a base word with prefixes or suffixes. Parents can prepare cards containing base words familiar to the child (e.g., write, read, view), along with a prefix card (e.g., re-) and a suffix card (e.g., -er). Parents then explain the meanings of the prefix (e.g., re- means again) and the suffix (e.g., -er means a person). Placing the prefix card in front of the base word cards one at a time, parents can then explain the whole meaning of the prefixed word (e.g., rewrite means write again, reread means read again, review means view again).
  2. Similarly, parents can move the suffix card at the end of each base word card while explaining the meaning of the suffixed word (e.g., writer means a person who writes, reader means a person who reads, viewer means a person who views). After several rounds of moving the cards and making sure the child understands the activity, parents can present another set of base word cards, asking the child to follow the same procedure and explain the meanings of the new words themselves.
  3. Grouping of words: This technique requires the child to sort affixed words based on their prefixes and suffixes. Parents can prepare cards with affixed words written on them, such as unhappy, florist, unfunny, typist, artist, unable, and dentist. Parents group the words based on the prefix (e.g., by grouping unhappy, unfunny, and unable together) or the suffix (e.g., by grouping typist, florist, artist, and dentist together), then explain what these grouped words have in common (e.g., the words unhappy, unfunny, and unable all start with un-, meaning not; the words typist, florist, artist, and dentist all end with –ist, meaning a person who practices something). After several rounds of word grouping, parents can provide the child with another set of affixed word cards, and have the child follow the same procedure and explain what the grouped words have in common.
  4. Identification of word families: This technique equips the child with knowledge of the word families, which are words composed of a base word plus its prefixes and/or suffixes, such as happy, happiness, unhappy, happily, unhappily, and unhappiness. Parents can write on a piece of paper several words that belong to a family, such as friend, friendly, unfriendly, friendliness, and unfriendliness, and circle the base word (i.e., friend). After the demonstration, parents can prepare other word families and ask the child to circle the base word. Parents are recommended to first present to the child a family of words with similar spellings, such as the friend family, followed by a family of words with slightly dissimilar spellings, such as the happy family (e.g., happy, happiness).

These training techniques for morphological awareness are not limited to affixed words, but are also applicable to compound words. For example, parents can create cards for the words tooth, pick, paste, ache, head, back, and stomach, and rearrange them to produce the following compound words: toothpick, toothpaste, toothache, headache, backache, and stomachache. Alternatively, parents can prepare cards for these compound words and have the child group them based on recurring word parts, such as tooth or ache, to familiarize the child with the concept of word families.

As the old Chinese saying goes: “Good craftsmanship depends on the use of the right tools.” Good reading comprehension is rooted in a strong ability of word reading. Parents or caregivers should start training their children with hearing loss by using the aforementioned strategies as early as possible to avoid learning difficulties later in life.

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