Abstract
Purpose:
Because children with hearing loss experience difficulty in developing word decoding and spelling skills, effective phonological awareness instruction for this population is vital. Children with hearing loss are often delayed in their development of phonological awareness compared to peers with normal hearing; however, the developmental progression appears to be the same for both groups of children. Some modifications to typical phonological awareness instruction are warranted for this population.
Conclusion:
This article synthesizes recent research on phonological awareness instruction for children with hearing loss from several research groups into six big ideas that have led to impressive gains in phonological awareness skills for this population.
Keywords: Phonological Awareness, Hearing Loss, Deafness, Literacy, Early Intervention
Children with hearing loss experience difficulty in developing literacy skills, with particular difficulty in word decoding (Geers & Hayes, 2011). Even with technological innovations of hearing devices such as digital hearing aids and cochlear implants, the median reading outcomes of children with hearing loss in the United States have not increased since the 1970s (Qi & Mitchell, 2012). There is a need, therefore, for interventions beyond use of amplification to foster literacy acquisition in children with hearing loss who use spoken language. Decades of research have confirmed that one important foundational component of word decoding skills for children with normal hearing is adequate phonological awareness (Adams, 1990; Hulme et al., 2002; NICHD, 2000).
What is Phonological Awareness?
Phonological awareness is an individual’s ability to analyze the sound structure of spoken words, separate from meaning and spelling (Mattingly, 1972). Importantly, phonological awareness does not involve analysis of letters; the inclusion of letters in a task results in an activity that does not target purely phonological awareness. For instance, asking a child how to spell cat targets their letter knowledge whereas asking them the sounds in the word cat targets their phonological awareness skills. The National Reading Panel recommendations include phonological awareness as an active ingredient in effective literacy instruction and emphasize the distinction of learning to analyze sounds and letters (NICHD, 2000). Awareness of individual speech sounds, especially the ability to segment and blend phonemes in words, has been linked to early literacy success in children with normal hearing (Stahl & Murray, 1994; Wagner & Torgesen, 1987).
Historically, it was thought that reading instruction for children with hearing loss should be focused on visual features of text such as orthography, and not on phonology (e.g., Musselman, 2000). With advances in amplification technology, children with hearing loss now have better access to sound than ever before. Consequently, skills related to sound, like phonological awareness, have received increased attention in research for this population. This increased attention has resulted in evidence that phonological awareness instruction is effective for children with hearing loss and that this populations requires specific instructional modifications in order to be successful in this skill set (Smith & Wang, 2010; Werfel, Douglas, & Ackal, 2016; Werfel & Schuele, 2014).
The purpose of this article is to summarize research on phonological awareness development in this population and provide six big ideas for providing phonological awareness intervention to children with hearing loss.
Phonological Awareness Development in Children with Hearing Loss
Children with hearing loss perform poorly on phonological awareness tasks compared to their peers with normal hearing (Cuples et al., 2014; Easterbrooks, Lederberg, Miller, Bergeron, & Connor, 2008; Kyle & Harris, 2011; Miller, 1997; Moeller et al., 2007; Most, Aram, & Andorn, 2006; Sterne & Goswami, 2000; Werfel, 2017). Additionally, the average attainment of phonological awareness skills in children with hearing loss does not appear to be sufficient to support proficient reading (Paul, 2009). It is not the case, however, that children with hearing loss are unable to develop phonological awareness skills (e.g., Gilliver et al., 2016; Harris & Beech, 1998; Miller, 1997; Sterne & Goswami, 2000). Although delayed, the development of phonological awareness in children with hearing loss seems to follow the same general sequence of development as phonological awareness development in children with typical hearing (Gilliver et al., 2016; Sterne & Goswami, 2000). That is, children with hearing loss first develop awareness of larger units of speech (i.e., syllables) and later develop awareness of phonemes (James, Rajput, Brown, Sirimanna, Brinton, & Goswami, 2005; Sterne & Goswami, 2000). Reduced access to sound, therefore, appears to slow but not prevent the acquisition of phonological awareness in this population. Effective intervention is vital for children with hearing loss to achieve levels of phonological awareness sufficient to support literacy acquisition. The development of phonological awareness in children with hearing loss is related to literacy development (Easterbrooks et al., 2008).
Phonological Awareness Intervention for Children with Hearing Loss
Despite having imperfect access to sound, phonological awareness intervention can be effective for children with hearing loss (Gilliver et al., 2016; Miller, Lederberg, & Easterbrooks, 2013; Smith & Wang, 2010; Werfel, Douglas, & Ackal, 2016; Werfel & Schuele, 2014). To be effective, however, this instruction must be modified from typical classroom phonological awareness instruction (Miller, 2013). Recent research from multiple research groups has provided evidence for six big ideas in teaching phonological awareness to children with hearing loss (see Figure 1). These ideas are discussed below.
Figure 1.
Six big ideas in phonological awareness instruction for children with hearing loss.
Big Idea #1: Be explicit.
Explicit, systematic instruction is vital for children with hearing loss across a variety of language domains (Lund & Douglas, 2016), and phonological awareness is no exception. Explicit, systematic phonological awareness intervention programs have been implemented successfully for children with hearing loss individually and in small groups (see Miller et al., 2013; Werfel & Schuele, 2014; and Werfel et al., 2016 for more information about each of these studies). For children with hearing loss, incidental instruction in phonological awareness, such as reading rhyme books, is not sufficient (Gilliver et al., 2016; Harris & Beech, 1998). Instead, instruction for this population must include explicit, systematic instruction in analyzing and manipulating the sounds of spoken words.
Several teaching strategies can be used to explicitly target phonological awareness with children with hearing loss. First, children with hearing loss have sufficient semantic knowledge of the terms that will be used in instruction (e.g., word, syllable, rhyme, beginning, same, different). Lund and Douglas (2016) present a model of explicit vocabulary instruction that can be used with children who do not demonstrate understanding of these terms. Second, teachers should model analysis of the sounds of spoken words. A think-aloud strategy is useful for demonstrating to children how to solve the problem of analyzing the sounds of spoken words. For example, to model initial sound matching, teachers could say:
I am trying to figure out if these two words begin with the same sound. Hmm, I wonder if they start with the same sound. Let’s say them out loud and listen for the sound at the beginning of these words. My two words are ‘mouse’ and ‘sun.’ Mmmmmmouse. Ssssssun. I do not hear the same sound at the beginning of those words, and my mouth feels different at the beginning of the words. Let’s look in the mirror while we say the words. Mmmmmmouse. Ssssssun. Nope, those do not start with the same sound. Mouse and sun start with different sounds.
Third, teachers should set up instructional activities so that the child is maximally successful from the beginning. Early in this explicit instruction, therefore, the child’s participation might be as minimal as simply repeating the answer (Schuele & Boudreau, 2008). Over time, teachers can systematically remove support as the child gains skill. Fourth, it may be necessary to explicitly teach each target phoneme for children with hearing loss (Werfel & Schuele, 2014). Children in the Werfel and Schuele study did not generalize initial sound segmentation abilities to sounds that were not taught explicitly. Finally, teachers should provide appropriate feedback as the child attempts phonological awareness tasks independently. As with instruction, this feedback should be explicit. Teachers should not just tell the child whether he or she arrived at the correct analysis, but include reasoning for the child’s success or nonsuccess with the task. For example, feedback for a correct response could include:
You’re right. ‘Fan’ starts with /f/. When I say that word slowly, ‘ffffffaaaaaannnnnn’, /f/ is the first sound that I hear and feel my mouth make. Fan starts with /f/.” Feedback for an incorrect response could include, “Oh, fan does not start with /d/. Let’s say that word again. ‘Ffffffaaaaannnn’ When I say that word, I feel an /f/ on my mouth at the beginning. Let’s look while we say it again: ‘ffffffaaaaaannnnnn’. Yep, I hear and see /f/ at the beginning of ‘fan’. ‘Fan’ starts with /f/. Your turn. What’s the first sound in fan?
Big Idea #2: Follow Developmental Progression.
The second big idea is to follow the developmental progression of the ability to analyze increasing smaller units of sounds. Phonological awareness reflects one underlying skill – analyzing sounds of words – that varies with respect to the different size of sound units (Anthony & Francis, 2005). Children’s ability to analyze the sound structure of words proceeds in a predictable development progression related to the size of the sound unit being analyzed. Children first are able to analyze larger units of sounds, such as words within sentences and syllables within words. As the development of phonological awareness skills progresses, children are able to analyze increasingly smaller units of sounds, such as onsets/rimes within syllables and individual phonemes of words.
Because children with hearing loss develop phonological awareness in the same developmental order as children with normal hearing (Gilliver et al., 2016; Sterne & Goswami, 2000), the same model should be used when planning phonological awareness instruction. Within spoken words, analysis of syllables should be targeted first, such as “the word ‘popcorn’ has two syllables, pop-corn, let’s clap it out, pop [clap] corn [clap]. How many syllables are in the word ‘happy’ ?Let’s clap it out together “happ [clap] y [clap]. Say ‘birthday.’ Let’s take away one syllable of that word. What is ‘birthday’ without birth? Birth [clap] day [clap]. Let’s take away the first syllable. What is left is ‘day.’” Analysis of onsets and rimes would come next, such as “say ‘space’. Let’s take away the first part of space. ‘Space’ without ‘sp’ is ‘ace.’” Finally, should come analysis of individual phonemes, for example, “Let’s find the first sound in the word ‘snake.’ SSSSSnake. It’s /s/. /s/ is the first sound in snake. Say the word ‘peach.’ Now let’s change the /p/ sound to a /t/. What word does that make? ‘peach’ becomes ‘teach.’” Figure 2 illustrates this developmental sequence in terms of increasing smaller units of sound to target in instruction.
Figure 2.
Illustration of developmental progression of phonological awareness from word to phoneme level.
Big Idea #3: Pay Attention to Task Difficulty.
Children’s ability to analyze sounds within each size unit depends on the task difficulty (Anthony, Lonigan, Driscoll, Phillips, & Burgess, 2003). Therefore, in addition to sequencing instruction to match the developmental progression in terms of size of sound units, teachers should consider task difficulty when planning activities. When the size of the sound unit is held constant, tasks that require judgment are the least difficult. Judgment tasks require children to decide if two words contain the same sound; for example, “Do ‘mop’ and ‘hat’ start with the same sound?” [no]. These tasks are least difficult in the task hierarchy, because the words and sounds have already been provided and children are only comparing two units. Judgment tasks put less demand on other cognitive domains such as short-term memory. The next level of task difficulty is matching sounds. Matching tasks require children to find words that contain the same sound; for example, “duck, lamp, dad, Which words start with the same sound?” [duck, dad]. More difficult than matching tasks are oddity tasks. In oddity tasks, children are asked to select a word that does not match the others; for example, “laugh, win, one, Which word does not start with the same sound as the others?” [laugh]. Finally, the most difficult task within each size sound unit is generation. In generation tasks, children are required to provide the target sound unit on their own; for example, “What is the first sound in ‘park’?” [/p/]. See Table 1 for a summary of each level of task difficulty.
Table 1.
Task Difficulty within Levels of Phonological Awareness
|
Big Idea #4: Strategically Introduce Classes of Sounds.
In most published phonological awareness instructional programs, properties of phonemes have not been considered when choosing target words for activities. Recent research, however, has indicated that strategically introducing classes of sounds is an important consideration when teaching children with hearing loss (Werfel & Schuele, 2014). Teachers should carefully consider the properties of the target phonemes when designing instructional activities for children with hearing loss (Werfel & Schuele, 2014). Given the impact of acoustic and visual properties of phonemes for children with impaired auditory access, target words should be selected based on the acoustic and visual properties of their comprised sounds. Children with hearing loss may not have adequate auditory access to sounds that are high in frequency (e.g., /s/ or /f/). The same may be true for sounds that are produced with minimal visual cues (e.g., sounds produced back in the mouth such as /k/ and /g/). One principle of explicit instruction discussed above was to ensure success for children. Thus, it would be beneficial for phonological awareness instruction for children with hearing loss to begin with sounds that are easier for these children to successfully analyze. Continuant sounds, during which a sound is made for a longer period of time (e.g., /m/ or /f/), are longer in duration and easier for children with normal hearing to analyze than stop sounds, which are shorter (e.g., /b/ or /k/). Continuants, therefore, should be targeted first for children with hearing loss as there is a longer opportunity for children to hear the sound. Additionally, teachers may see the best outcomes by choosing words with target phonemes that are low frequency and produced with visual cues early in instruction before moving on to other sounds as children gain skills in each level of phonological awareness. A child that shows mastery with sounds with visual cues that occur in the front of the mouth on the lips and teeth (e.g. /b/, /m/, /v/) may continue to struggle with sounds that are less visible (e.g. /k/, /l/, /r/). Table 2 provides a classification of English consonants by these properties. All English vowels are low frequency and continuant.
Table 2.
Properties of English Consonants
| Phoneme | Example Word | Continuant? | Frequency* | Place in Mouth of Production+ |
|---|---|---|---|---|
| /p/ | pot | no | high | front |
| /b/ | boy | no | low | front |
| /t/ | top | no | high | middle |
| /d/ | dog | no | low | middle |
| /k/ | cup | no | high | back |
| /g/ | gum | no | low | back |
| /m/ | man | yes | low | front |
| /n/ | nap | yes | low | middle |
| /ŋ/ | ring | yes | low | back |
| /f/ | fun | yes | high | front |
| /v/ | vase | yes | low | front |
| /θ/ | thief | yes | high | front |
| /ð/ | they | yes | low | front |
| /s/ | sock | yes | high | middle |
| /z/ | zoo | yes | low | middle |
| /ʃ/ | ship | yes | high | middle |
| /ʒ/ | beige | yes | low | middle |
| /h/ | hot | yes | high | back |
| /tʃ/ | chop | no | high | middle |
| /dʒ/ | job | no | low | middle |
| /j/ | yell | yes | low | middle |
| /w/ | win | yes | low | front |
| /r/ | red | yes | low | middle |
| /l/ | light | yes | low | middle |
Low frequency is defined as below 1000 Hz, and high frequency is above 1000 Hz.
Front of the mouth is defined as lips or teeth, middle is alveolar ridge to soft palate, and back is velum or vocal folds.
Big Idea #5: Repeat, Repeat, Repeat.
Miller et al. (2013) reported that phonological awareness takes months to develop in children with hearing loss even when receiving four hours per week of intervention and that mastery is unlikely to occur with lower intervention dosage. Children with hearing loss require more intense intervention than children with normal hearing to achieve the same gains in phonological awareness skills. It may be necessary to repeat phonological awareness lessons at least three more times for children with hearing loss than teachers would for children with normal hearing (Werfel & Schuele, 2014; Werfel et al., 2016). Successful phonological awareness instruction for children with hearing loss has generally consisted of short lessons (5 – 15 minutes) that occur at least 4 days per week (Miller et al. 2013, Werfel et al., 2016). It is worth noting that longer sessions (20–30 minutes) occurring once per week with a take home worksheet to practice the lessons at home were associated with positive outcomes (Gilliver, 2016). Teachers should use formative assessment of children’s phonological awareness skills to guide decisions to repeat lessons or move on to new instructional targets (Werfel et al., 2016). Even after moving on to new targets, teachers should return to earlier instructional targets occasionally to ensure maintenance of skills (Werfel & Schuele, 2014). For instance, if a student has advanced to generalization tasks with individual phonemes, earlier skills such as judgement tasks or syllable-level units may occasionally be targeted.
Big Idea #6: Link to Letters…Eventually.
Finally, effective phonological awareness intervention teaches children to apply what they learn about analyzing the sound structure of spoken words to decoding words when reading and encoding words when spelling (see NICHD, 2000 for a review). Importantly, though, phonological awareness instruction should not include letters until children demonstrate the ability to analyze sounds in words (Mattingly, 1972). Until that point, alphabet knowledge should be targeted separately from phonological awareness (as in Werfel et al., 2016). When letters are included in a teaching activity, the focus of instruction is phonics, not phonological awareness. Phonological awareness activities do not contain letters, whereas phonics activities teach children to combine their phonological awareness and alphabet knowledge to decode and spell words. Table 3 provides definition of common “phon” terms for clarity. The separation of sound-based and letter-based activities is particularly important for children with hearing loss, who will focus on visual information heavily at the expense of auditory information. After children have achieved knowledge of the alphabetic principle (i.e., the names of the letters and their corresponding sounds) and the ability to analyze sounds in words separately, phonics instruction should be implemented to teach children how to combine these skills to sound out and spell words. For example, “The sounds in the word ‘web’ are [/w/ /ɛ/ /b/]. What letters do we use to spell the sounds in that word?”
Table 3.
Definitions of “Phon” Terms
| Term | Definition |
|---|---|
| Phoneme | individual sound of spoken language; smallest unit into which spoken words can be divided |
| Phonological Awareness | analysis of the sound structure of spoken words; units of analysis can be any size |
| Phonemic Awareness | analysis of the sound structure of spoken words; units of analysis are individual sounds |
| Phonics | instructional approach that involves teaching sound-letter correspondences to decode or spell words |
Final Thoughts
Reading outcomes for children with hearing loss lag behind their peers with normal hearing (Geers & Hayes, 2011; Qi & Mitchell, 2012), but today’s children with hearing loss have increased access to auditory information through the use of cochlear implants and digital hearing aids than those of yesterday. Although this access makes phonological awareness instruction, which is related to literacy development in children with hearing loss (Easterbrooks, et al., 2008), potentially more effective for this population than ever before, better access to auditory information alone is not likely to lead to maximum learning. Instead, recent research in this area has identified six big ideas for effective phonological awareness instruction for children with hearing loss. There is a relatively limited amount of research that exists on phonological awareness in children with hearing loss; existing findings should be corroborated by further research. Effective instruction for these children is explicit, follows a developmental progression and task hierarchy, introduces sounds in a systematic order, contains a lot of repetition, and eventually links children’s sound knowledge to their letter knowledge, but late enough to ensure children are not relying too heavily on letters. Phonological awareness instruction for children with hearing loss will be most effective when teachers follow these principles and are intentional in their selection of instructional activities and strategies.
Acknowledgements
Some of the research synthesized herein was conducted by the author and funded by the National Institutes of Health/National Institute on Deafness and other Communication Disorders (R03DC014535; R01DC017173) and the American Speech-Language-Hearing Foundation (Early Childhood Language Development Student Research Grant) awarded to KLW. The content is solely the responsibility of the author and does not necessarily represent the official views of NIH/NIDCD or the ASHFoundation.
Appendix A. Scripted Examples
Big Idea #1: Be explicit:
I am trying to figure out if these two words begin with the same sound. Hmm, I wonder if they start with the same sound. Let’s say them out loud and listen for the sound at the beginning of these words. My two words are ‘mouse’ and ‘sun.’ Mmmmmmouse. Ssssssun. I do not hear the same sound at the beginning of those words, and my mouth feels different at the beginning of the words. Let’s look in the mirror while we say the words. Mmmmmmouse. Ssssssun. When I say ‘mouse’ my lips are together. When I say ‘sun’, my lips are not together and I can see a little bit of my teeth. That’s a clue that they are different sounds. Nope, those do not start with the same sound. Mouse and sun start with different sounds.
Big Idea #2: Follow Developmental Progression:
The word ‘popcorn’ has two syllables, pop-corn, let’s clap it out, pop [clap] corn [clap]. How many syllables are in the word ‘happy’? Let’s clap it out together “happ [clap] y [clap]. Say ‘birthday.’ Let’s take away one syllable of that word. What is ‘birthday’ without birth? Birth [clap] day [clap]. Let’s take away the first syllable. What is left is ‘day.’”
Analysis of onsets and rimes would come next, such as “say ‘space’. Let’s take away the first part of space. ‘Space’ without ‘sp’ is ‘ace.’”
Finally, should come analysis of individual phonemes, for example, “Let’s find the first sound in the word ‘snake.’ SSSSSnake. It’s /s/. /s/ is the first sound in snake. Say the word ‘peach.’ Now let’s change the /p/ sound to a /t/. What word does that make? ‘peach’ becomes ‘teach.’”
Big Idea #3: Pay Attention to Task Difficulty:
| Judgment Examples |
Do jump and bump rhyme? [yes] Do boat and ship rhyme? [no] Do ‘mop’ and ‘hat’ start with the same sound? [no] |
| Matching Examples |
Which words rhyme? mouse, sail, west, house [mouse, house] Which words start with the same sound? duck, lamp, dad [duck, dad] |
| Oddity Examples |
Which word does not rhyme with the others? ham, lamb, road, jam [road] Which word does not start with the same sound as the others? laugh, win, one [laugh] |
| Generation Examples |
Tell me a word that rhymes with car. What is the first sound in ‘park’? [/p/] |
Big Idea #4: Strategically Introduce Classes of Sounds:
Introduce sounds that are lower in pitch, longer (continuants) and visible on the mouth first.
Do ‘man’ and ‘pop’ start with the same sound?” [no]
Which words start with the same sound? moon, vat, milk [moon, milk]
What is the first sound in ‘mark’? [/m/]
Later, introduce sounds that have higher frequencies, such as /s/.
Do ‘sit’ and ‘pat’ start with the same sound?” [no]
Which words start with the same sound? spoon, sweet, talk [spoon, sweet]
What is the first sound in ‘sun’? [/s/]
Or that are less visible on the mouth, such as /k/ or /g/.
Do ‘car’ and ‘kid’ start with the same sound?” [yes]
Which words start with the same sound? train, kiss, coin [kiss, coin]
What is the first sound in ‘goat’? [/g/]
Big Idea #5: Repeat, Repeat, Repeat:
Earlier this week we were working on figuring one which sound is not like the others. Do you remember we were trying to figure out which word starts with a different sound as the others? Today, we are going to do something that we worked on a few weeks ago. Which words start with the same sound? tide, rug, top [tide, top]
Let’s play a game that we played a few days ago. I’m going to tell you some words and you are going to tell me if they rhyme. Do ‘lime’ and ‘time’ rhyme? [yes] What about ‘sock’ and ‘hop’? [no]. Why don’t you think these sounds rhyme?
Big Idea #6: Link to Letters…Eventually:
The sounds in the word ‘web’ are [/w/ /ɛ/ /b/]. What letters do we use to spell the sounds in that word?
What sounds are in the word ‘king’?
[/k/ /i/ /n/ /g/]
What letters do we use to spell those sounds?
[k i n g]
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