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THE IMPACT OF HEARING LOSS ON LANGUAGE AND LITERACY DEVELOPMENT IN CHILDREN

Kim Sesing, AuD, CCC-A, FAAA

Elizabeth Eernisse, Ph.D., CCC-SLP

CUW School of Health Professions Conference

1/21/19

SPEAKER CONFLICTS OF INTEREST:FINANCIAL AND NON-FINANCIAL

Kim Sesing, AuD, CCC-A, FAAA

Elizabeth Eernisse, Ph.D., CCC-SLP

An expect at ion of our employment as faculty members of Concordia University Wisconsin is

scholarship ( sharing our expert ise). W e receive a salary in t his employment. Beyond t hat, there are

no ot her financial or non-financial conflicts of int erest associated with this presentation.

TODAY

Review the fundamentals of hearing

anatomy and hearing loss in preschool

and elementary populat ions.

Describe the impact of hearing loss on

language and literacy development.

Discuss considerat ions for children w ith

hearing impairment to opt imize learning

environments and opportunit ies.

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HOW DO WE HEAR?

The ear is divided into 3 main parts:

Outer Ear

M iddle Ear

Inner Ear

Pinna Ear Canal

Eardrum Audit ory Nerve

Cochlea

Hammer Anvil Stirrup

Out er Ear M iddle Ear I nner Ear

HOW HEARING WORKS

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WHEN DO WE TEST?

New born Hearing Screening

Screenings related to

Speech/language delay

ENT issues

Trauma

I llness

Parental concern

School screenings

UNIVERSAL NEWBORN HEARING SCREENING

➢ W isconsin screens 99% of all newborns

➢ In 2016, 121 babies w ere diagnosed w ith permanent hearing loss through Wisconsin’s UNHS program

➢ UNHS has changed early intervention

WHAT DO WE TEST?

Pure tones – aka “beeps”

Air conduction thresholds

Bone conduction thresholds

Indiv idual ear v s. soundfield

Speech testing

Tympanometry

OAEs

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HOW DO WE TEST HEARING?

➢ Results are plotted on

an audiogram

➢ Documents how loud

the st imulus needs to

be in order to be

heard (threshold)

AUDIOGRAM LAYOUTFrequency (Hertz)

Inte

nsi

ty (

dB

HL)

SPEECH BANANA

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HEARING LOSS EXAMPLE

WHAT IS IT LIKE TO HAVE HEARING LOSS?

CAUSES OF HEARING LOSS

Wax

Ear infections

Eardrum perforations

Problems with the middle ear bones

Trauma

Syndromes

Viral infections

Noise exposure

Aging

Heredity

Ototoxic medications

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TYPES OF HEARING LOSS

Sensorineural

Conductive

Mixed

Fluctuating

Unilateral

AUDIOGRAM

BILATERAL HEARING LOSS

➢Prev alence of permanent childhood hearing loss v aries based on criteria, but is generally estimated 1 to 3 per 1,000 children are born with a hearing loss (Center for Disease Control and Prev ention, 2009).

➢What does hearing loss sound like?

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UNILATERAL HEARING LOSS

UNILATERAL HEARING LOSS

➢ I s it a problem?

➢ Vary ing opinions on effects/t reatments

➢ Academic effects

➢ Right vs left

➢ Lack of localizat ion

➢ Difficulty w ith background noise

➢ Speech-language effects

➢ Answ er: it can be a problem

FLUCTUATING/TRANSIENT HEARING LOSS

➢ Research/Lack of causal links

➢ Mistaken perceptions/Behavioral problems

➢ Case by case basis

➢ Similar recs as some other types of hearing loss

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EFFECTS OF HEARING LOSS Embarrassment , fat igue, irrit abilit y

Tens ion/st ress

Avoidance of social act ivit ies

W ithdraw al from personal relat ionships

Depress ion

Danger t o personal safet y

Social reject ion by ot hers

I mpaired memory and abilit y t o learn new t asks

Reduced job performance and earning pow er

Diminished psychological and overall healt h

(Bet t er Hearing I nstitute, 2009)

HOW DOES HEARING LOSS AFFECT CHILDREN IN SCHOOL?

Pot ent ial Educat ional Impact of Hearing Loss

Delayed speech and language development

Poor attention skills

Difficulty following directions

Problems with phonemic awareness, which can result

in reading delays

Delayed social skills

Difficulty hearing in noise

Difficulty localizing sound

Poor organizational skills

Fatigue

Decreased background knowledge

A CLOSER LOOK – LANGUAGE

AND LITERACY

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THE SPEECH CHAIN (DENES & PINSON (1993))

COMPONENTS OF LANGUAGE

SEMANTICS

Vocabulary develops more slow ly .

Concrete w ords like cat , jum p, five, and r ed are

learned more easily than abstract w ords like befor e,

aft er , equal t o, and jealous.

Difficulty w ith function w ords like the, an, ar e, a.

Difficulty understanding w ords w ith multiple

meanings.

Limited conceptual categories, generally related to

self.

Vocabulary gap w idens w ith age

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PHONOLOGY Impact on phonology depends on configuration of the

hearing loss

May not hear their own voices when they speak

Difficulties with:

Volume

Pitch

Intelligibility

Stress/inflection

Rate

Difficulties with phonological awareness

SYNTAX/MORPHOLOGY

Comprehend and use shorter and

simpler sentences than peers

Difficulty comprehending and w rit ing

complex sentences, such as those w ith

relative clauses or passive voice

Often cannot hear word endings such as

-s or –ed which leads t o er rors in:

Verb tense

Pluralizat ion

Subject/verb agreement

Possessives

PRAGMATICS

Difficult ies w ith social interact ion

May have self-described feelings of

isolat ion, ex clusion, embarrassment,

annoyance, confusion, and helplessness

May refuse to part icipate in group

activ it ies

May ex hibit low er performance on

measures of social maturity

May have significant problems follow ing

direct ions

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IMPACT ON LITERACY

➢ Children w ith mild to moderate

hearing losses, on average,

achieve one to four grade levels

low er than their peers w ith

normal hearing, unless

appropriate management

occurs.

➢ I ssues w ith components of

language are reflected in

reading and w rit ing.

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EMERGENT LITERACY(NELP 2008; WERFEL, 2017)

➢ Oral Language

➢ M orphosyntax

➢ Vocabulary

➢ W ord Learning

➢ Phonological Process ing

➢ Phonological Aw areness

➢ Phonological M emory

➢ Print K nowledge

➢ Relat ive strength

PHONOLOGICAL AWARENESS

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PRACTICAL SOLUTIONS –INSTRUCTION

➢ Quality instruction in general

➢ Quality instruction for reading

➢ Technology

➢ Classroom modifications

➢ Communication/teaching strategies

QUALITY INSTRUCTION - GENERAL

BEST PRACTICES

➢ Development of Higher Order Thinking Skills

➢ Comprehensible Communicat ion

➢ Visual Supports for imagery , organizat ion and

memory

➢ Ex plicit Inst ruction

➢ Scaffolding and Mediated Learning

HOTS and COVES (Easterbrooks & Beal-Alvarez, 2004)

QUALITY INSTRUCTION - LITERACY

National Reading Panel -https://lincs.ed.gov/publications/pdf/PRFbooklet.pdf

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TECHNOLOGY

➢ Hearing aids

• BAHA

• CROS

• U nilateral

➢ FM system

• Soundfield

• Personal

➢ U nderstanding the purpose/function of

accommodat ions/technology

➢ Daily equipment checks

➢ Demonst rate to all students for opt imal class use

CLASSROOM MODIFICATIONS

➢ Preferent ial seat ing for all

configurat ions

• Consider noise sources

➢ Reduce noise levels

➢ Control light ing

➢ Provide v isual supports w hen

appropriate

COMMUNICATION/TEACHING STRATEGIES

➢ Set a classroom expectation for having only one

speaker at a time.

➢ Repeat questions/comments verbatim.

➢ M ake sure student can see any speaker's face.

➢ Encourage listening skills by using a

"sandw ich" approach.

➢ Teachers/service providers/families need to

understand student’s language history, hearing

loss, and communication preferences.

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WRAP UP

SELECTED REFERENCESCenters for Disease Control and Prevention. (2009). Summary of 2009 national CDC EHDI data[2009 CDC EHDI Hearing

Screening & Follow-up Survey (HSFS)]. Retrieved fromwww.cdc.gov/ncbddd/hearingloss/2009-

Data/2009_EHDI_HSFS_Summary_508 _OK.pdf.

Consequences of hearing loss (n.d.) Retrieved from http://www.betterhearing.org/heari ngpedia/consequences -hearing-

loss .

Denes, P. B., & Pinson, E. N. (1993). The speech chain: The phys ics and biology of spoken language . New York, N.Y: W.H.

Freeman.

Effects of hearing loss on development. (n.d.) Retrieved from https://www.asha.org/public/hearing/effects -of- hearing-

loss -on-development/

Easterbrooks, S. & Beal-Alvarez, J. (2013). Literacy instruction for s tudents who are deaf and hard of hearing. New York,

NY, Oxford Univers ity Press .

National Early Literacy Panel. (2008). Developing early literacy. Report of the National Early Literacy Panel. Washington,

D.C.: National Institiute for Literacy.

National Institute on Deafness and Other Communication Disorders . (n.d.). Quick statis tics . Retrieved

from http://www.nidcd.nih.gov/healt h/statis tics/Pages/quick.aspx.

National Reading Panel (U.S.), & National Institute of Child Health and Human Development (U.S.). (2000). Report of the

National Reading Panel: Teaching children to read : an evidence -based assessment of the scientific research literature

on reading and its implications for reading instruction : reports of the subgroups . Washington, D.C.: National Institute of

Child Health and Human Development, National Institutes of Health.

Werfel, K. (2017). Emergent literacy skills in preschool children with hearing loss who use spoken language: Initial findings

from the Early Language and Literacy Acquis ition (ELLA) Study. Lang Speech Hear Serv Sch. 2017 Oct 5;48(4):249-259. doi:

10.1044/2017_LSHSS-17 -0 023 .

Wiscons in Sound Beginnings. 2017. Data Report 2016 Early Hearing Detection and Intervention. Madison, WI: State of

Wiscons in Department of Health Services Divis ion of Public Health.

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