A Steep Hill to Climb:
Identifying the Literacy
Crisis for Deaf and Hard
of Hearing Students
Christine YoshinagaItano, Ph.D. Professor
University of Colorado,
Boulder
THE
TIME IS
NOW
NO CHILD LEFT
BEHIND:
INCLUDING THOSE
WHO ARE DEAF OR
HARD OF HEARING
Early Hearing Detection and Intervention


Sensitive Periods of Brain
Development
An opportunity to
develop language in the
typical time frame,
achieving milestones at
the same time as children
with normal hearing.
Critical Milestones with the goal of
age appropriate language
Screening before 1
month
 Identification
before 3 months
 Amplification
within 1 month
from identification
 Intervention before
6 months

What needs to
happen to
meet these
goals?
COLLABORATION AND COORDINATION

INTER-AGENCY: BREAKING DOWN THE
BARRIERS

INTER-DISCIPLINARY, MULTI-DISCIPLINARY,
TRANS-DISCIPLINARY INTERACTION

ACCOUNTABILITY AND DATA MANAGEMENT

FIDELITY OF THE SERVICES PROVIDED

HIGHLY QUALIFIED PROVIDERS
THE OUTCOME
OF MEETING
EHDI
MILESTONES
OPTIMAL OUTCOMES ARE POSSIBLE






AT ALL AGES FROM BIRTH
FOR CHILDREN OF FAMILIES WHO HAVE
CHOSEN SIGN LANGUAGE AS THEIR PRIMARY
MODE OF COMMUNICATION
FOR CHILDREN OF FAMILIES WHO HAVE
CHOSEN SPOKEN LANGUAGE AS THEIR
PRIMARY MODE OF COMMUNICATION
FOR CHILDREN IN FAMILIES FROM ETHNIC
MAJORITY CULTURE
FOR CHILDREN IN FAMILIES FROM ETHNIC
MINORITY CULTURES
FOR FEMALES AND FOR MALES
OPTIMAL OUTCOMES
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
FOR ALL CHILDREN WHO ARE DEAF OR HARD OF
HEARING – MILD, MODERATE, SEVERE, PROFOUND
FOR CHILDREN IN FAMILIES WHOSE MOTHERS
HAVE A HIGH SCHOOL EDUCATION OR LESS
FOR CHILDREN IN FAMILIES WHOSE MOTHERS
HAVE GREATER THAN A HIGH SCHOOL EDUCATION
FOR CHILDREN IN FAMILIES ON MEDICAID
FOR CHILDREN IN FAMILIES WHO DO NOT
RECEIVE MEDICAID
FOR CHILDREN WITH HEARING LOSS ONLY
FOR CHILDREN WITH HEARING LOSS AND
ADDITIONAL DISABILITIES
FAILURE IS NOT AN OPTION
IF APPROPRIATE
SERVICES ARE NOT
PROVIDED, THE
LACK OF
APPROPRIATE
SERVICES CREATES
AN
ENVIRONMENTALLY
-CAUSED DISABILITY
AS SERIOUS AS A
COGNITIVE
DEVELOPMENTAL
DELAY
How lasting
is the effect?
Longitudinal study of children birth
through 84 months (7 years)



Age appropriate vocabulary skills
Age appropriate receptive syntax skills
Primary predictors: account for 72% of the variance
of the language outcome at 84 months of age.






Non-verbal cognitive development
Amount of language the child is exposed to in the home
Language development at 3 years of age
Degree of hearing loss
Age of identification and initiation of early intervention
Maternal level of education
MCDI-EL and TACL-3 (Baca, 2009)
Some delays still exist
 Articulation
 Pragmatic
language
development –
the socially
appropriate use
of language
 Expressive syntax
ASSURING QUALITY


ADOPT BEST PRACTICE STANDARDS OF CARE
AND IMPLEMENT AN ACCOUNTABILITY SYSTEM
DEVELOP A DATA MANAGEMENT SYSTEM:
FOLLOW FROM AGE OF IDENTIFICATION –
EHDI DATA BASE HAS THAT POTENTIAL



AGE OF IDENTIFICATION,THE AGE OF ACCESS TO
LANGUAGE/ INTERVENTION START IS CRITICAL
LONGITUDINAL DEVELOPMENT
ONLY WAY TO GUARANTEE THAT ALL CHILDREN
WHO ARE DEAF OR HARD OF HEARING ARE
INCLUDED
ASSURING QUALITY

QUALIFICATIONS OF THE EARLY INTERVENTION
PROVIDER



WITH ADDITIONAL QUALIFICATIONS FOR BOTH
LISTENING AND SPOKEN LANGUAGE AND FOR SIGN
LANGUAGE
DEVELOP AND IMPLEMENT A MECHANISM FOR
PROVIDERS TO IMPROVE THEIR SKILLS AND
KNOWLEDGE
DOCUMENT DEVELOPMENTAL PROGRESS,
PROVIDE FEEDBACK TO FAMILIES AND PROVIDERS

IMPLEMENT A STATEWIDE PROTOCOL, COMMON
ASSESSMENT TOOLS THAT WILL BE USED WITH ALL
CHILDREN AND FAMILIES
ASSURING QUALITY


ASSURE MEANINGFUL INVOLVEMENT OF
PARENTS OF CHILDREN WHO ARE DEAF OR
HARD OF HEARING AT ALL LEVELS OF THE
SYSTEM
ASSURE MEANINGFUL INVOLVEMENT OF DEAF
AND HARD OF HEARING ADULTS AT ALL LEVELS
OF THE SYSTEM


DEVELOP AND IMPLEMENT LEADERSHIP TRAINING
DESIGN AND IMPLEMENT A SYSTEM OF SERVICES
ASSURING QUALITY



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DEVELOP AND IMPLEMENT STRATEGIES FOR
FAMILIES WHO DO NOT SPEAK ENGLISH IN THE
HOME
DEVELOP AND IMPLEMENT STRATEGIES FOR
FAMILIES WHOSE CHILDREN HAVE
ADDITIONAL DISABILITIES
DEVELOP AND IMPLEMENT STRATEGIES FOR
FAMILIES FOR DIVERSE CULTURES AND DIVERSE
SOCIO-ECONOMIC BACKGROUNDS
DEVELOP SYSTEMS THAT PROVIDE EQUITABLE
CARE WHEREVER THE FAMILY AND CHILD LIVE
IN THE STATE
PREDICTORS OF OPTIMAL
LANGUAGE AND LITERACY
EMOTIONAL AVAILABILITY

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MATERNAL/PATERNAL BONDING
PARENTAL STRESS
RECIPROCAL EMOTIONAL AVAILABILITY IN THE
COMMUNICATION BETWEEN PARENT AND
CHILD
SCAFFOLDING: KNOWING WHEN TO SUPPORT
JUST ENOUGH FOR THE CHILD TO SUCCEED IN
WHAT S/HE IS ATTEMPTING
STRATEGIES FOR DEALING WITH FRUSTRATION
AND ANGER
STRONG EMOTIONAL
AVAILABILITY LEADS TO
BETTER VOCABULARY
DEVELOPMENT
LOWER PARENTAL
STRESS IS RELATED TO
BETTER LANGUAGE
A POWERFUL
PREDICTOR OF
VOCABULARY
DEVELOPMENT:
AMOUNT OF PARENT
TALK TO THE CHILD
Total Number of Parental Words
• Accounts for an
11.07% of the
language
outcome at 84
months and
14.04% of the
rate of language
development
from 4 to 7 years
High Maternal Level of Education
• Number of Parent
Words not included
• High Maternal
level of Education
accounts for
10.81% of the
variance of the
language outcome
at 84 months and
7.48% of the
variance of the
rate of language
development from
4 to 7 years
Maternal Level of Education +
Number of Parental Words
• Accounts for
16.38% more
variance of the
language outcome
at 84 months and
13.71% of the rate
of language
development
from 4 to 7 years
Both Maternal level of education and
Number of Parental Words are
predictors of language at 84 months
• Maternal level of education emerges as a
significant predictor of language outcome
between 48 and 84 months of age
• Number of parental utterances in the
birth through 48 month age group is a
significant predictor of language outcome
at 84 months of age and rate of language
growth from 4 to 7 years of age
Relationship Maternal Level of
Education and Number of Parental
Words
• Amount of variance accounted for by
the variables High Maternal Level of
Education and Number of Parental
Words spoken to the Child appear to
be accounting for overlapping
variance
• Number of Parental Words accounts
for more variance
EOWPVT differences by Maternal
Level of Educational Level (Baca,
2009)
– 35 month language age difference at
84 months of age between group
with mean age level for mothers
with educational level less than 12
years (HS grad) as compared to
group for mothers with educational
level 16 years or greater (college)
55.75 months versus 91.33 months
THE IMPACT OF MATERNAL LEVEL
OF EDUCATION CAN BE OVERCOME
WITH EXCELLENT INTERVENTION
• Colorado studies indicate that
Maternal level of education does not
predict language outcomes of
children with hearing loss – birth
through 36 months
VOCABULARY
DEVELOPMENT IS THE
MOST SIGNIFICANT
PREDICTOR OF LITERACY
FOR CHILDREN WHO ARE
DEAF OR HARD OF
HEARING
JUST AS IT IS FOR
CHILDREN WITH NORMAL
HEARING
EMERGENT LITERACY

Early sources:

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Emergent Literacy - Construction of knowledge
about the uses and nature of written language
Story telling
Experiences with children’s books
TV
NARRATIVE DEVELOPMENT

Literary devices

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Narrators
Distinct voices of characters
Setting
Identities of characters
Shifts in time or place
Connectives (relationships between events in stories)(relationships between previous and upcoming
events) cohesion
Storytelling is both social and cognitive

Increasing sophistication in pragmatic uses, i.e.
(because)
META-LINGUISTIC AWARENESS


Knowing what to do in failures of
communication
Conscious awareness of adjustments


Re-wording – vocabulary changes
Changing syntax
WHY EMERGENT LITERACY,
NARRATIVE DEVELOPMENT,
METALINGUISTIC KNOWLEDGE
ARE SO CRITICAL FOR CHILDREN
WHO ARE DEAF OR HARD OF
HEARING
Study Participants

Normal Hearing Group

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N=109
Age Range: 2-7 years
Normal hearing and
cognition
Hearing Loss Group

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N=126
Age Range: 3-7 years
All Levels of hearing loss
Normal cognition
Children with Normal Hearing

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44% (20 of 45) of the
items were mastered
using complex language
by 3 years of age
95.5% (43 of 45) of the
items were mastered by
4 years of age
98% by 5 years
100% by 6 years
Final Items to Master for NH group

Provides information on
request


Name, date of birth,
address (2 of 3 items)
Makes promises
Children with Hearing Loss


6.6% (3 of 45) of the
items were mastered
with complex language
by six years of age
69% (31 of 45) of the
items were mastered by
7 years of age
Items not Mastered by 7yrs (HL
Group)
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Provides information on request
Repairs incomplete sentences
Ends conversations
Interjects
Apologies
Request clarification
Makes promises
Ask questions to problem solve
Asks questions to make predictions
Retells a story
Tells 4-6 picture story in right order
Creates original story
Explains relationships between
objects-action-situations
Compares and contrasts
Percentage of Items Mastered by Age for NH
and HL groups
The proportion achieving 50% or more of the
items with complex language
NECAP: NATIONAL EARLY
CHILDHOOD ASSESSMENT
PROJECT: DEAF AND HARD OF
HEARING
ASSOCIATION OF UNIVERSITY
CENTERS ON DISABILITY:
CENTERS FOR DISEASE CONTROL
STATE COMMITMENTS TO DEVELOP
SYSTEMS TO COLLECT STANDARD
ASSESSMENT DATA FROM ALL CHILDREN
WHO ARE DEAF OR HARD OF HEARING
•
Assessment Components
•
•
•
•
•
Demographic form
Release of audiologic information
Minnesota Child Development Inventory
MacArthur-Bates Communicative Development
Inventories
Additional assessments on request (e.g., play, listening
skills, speech intelligibility, etc.)
Participating States
•
•
•
•
•
Arizona
California
Colorado
Idaho
Indiana
•
•
•
•
•
Texas
Wisconsin
Wyoming
Nebraska
Oregon
Assessments Completed
•
•
•
259 assessments completed (not including
Colorado)
162 children assessed 1 to 4 times each
Colorado: 225 assessments per year
Participant Characteristics (excluding
Colorado)
•
•
•
•
•
Bilateral loss = 249; Unilateral loss = 10
Auditory Neuropathy = 7
English-speaking home = 239; Spanish-speaking
home = 20
No additional disabilities = 229; Have additional
disabilities = 30
Boys = 140; girls = 119
Degree of Hearing Loss
Participant Criteria for Language Outcomes
Analysis
•
•
•
Bilateral hearing loss
English-speaking home
No other disabilities that would affect
speech or language development
States Represented in Current Language
Outcomes Analysis
•
•
•
•
•
•
•
•

Arizona
Colorado
Idaho
New Mexico (previous participant)
Texas
Utah (previous participant)
Wisconsin
Wyoming
Note: CA and IN just initiated NECAP; no data yet
Language Outcomes Analysis:
Participant Characteristics
•
Chronological age
•
•
Range = 6 to 40 months
Mean = 21 months
•
Boys = 130; Girls = 140
•
Number of assessments = 270
Assessment 1: Minnesota Child Development
Inventory (1992)
•
8 areas of development assessed
•
•
Parent report
•
•
•
Language, Motor, Social, Self Help, Pre-Literacy
Parents respond “yes” or “no” to a variety of statements
about their child
Example: “Has a vocabulary of 20 or more words”
Scales adapted to reflect abilities in both
spoken and sign language
Assessment 2: MacArthur-Bates
Communicative Dev. Inventories
•
Assesses spoken and sign vocabulary
•
•
•
Expressive and receptive for younger children
Expressive vocabulary for older children
Parent-report instrument
Determining Language Quotient

Language Age/Chronological Age x 100
 If
LQ = 100, Language Age = CA
 If LQ < 100, Language Age < CA
 If LQ > 100, Language Age > CA

LQs of 80+ are within the normal range
compared to hearing children
Median Language Quotients
Percent of Scores in the Average Range (LQ
= 80+)
Minnesota CDI:
Median Language Quotients
MacArthur-Bates: Median
Vocabulary Production Quotients
Conclusions
•
•
Almost 80% of children scored within the
average range on the Minnesota
Expressive Language subtest
On average, children in all states scored
more poorly on cognitive-linguistic items
(Minn Lang Comp) compared to more
superficial language items (Minn Exp
Lang)
Conclusions
•
•
•
Acquiring an age-appropriate lexicon is a
challenge for many children with 43%
demonstrating significant delays
Differences in language outcomes are
apparent between some states
As more assessments are collected,
factors predictive of better language
outcomes will be identified
Colorado Individual Performance
Profile: Criteria for Placement
decisions
Describe the student's current service delivery system. Do NOT include the services of
an educational interpreter when counting these hours to identify a category of services
below.
__1_Indirect Service: Monitor (No IEP, 100% of time in general education); check
here if student has a 504 Plan___.
__2_Indirect Service: Consultation (IEP, 100% of time in general education
classroom)
__3_Direct Service: (>60% of time in general education classroom), 1-4 hours of
instructional services per week from a licensed teacher of the Deaf/HH or combination of
teacher of Deaf/HH or other special education team
__4_Direct Service: (21-60% of time in general education classroom), 1-2 hours
instructional services daily from a licensed teacher of the Deaf/HH or combination of
teacher of Deaf/HH & other special education team; may be team or co-taught
__5_Direct Service: (<21% of time in general education classroom), 3 or more
hours per day of instructional services from a licensed teacher of the Deaf/HH or
combination of teacher of Deaf/HH & other special education team; student is still
receiving his/her academic instruction in the general classroom a portion of the school
day; may be team or co-taught
__6_Direct Service: (Separate Facility), all instruction from a licensed teacher of the
Deaf/HH and other
special education professionals in hearing services
___Other:
Please
explain___________________________________________________________
___CSDB students only: ___day student ___residential
Comparison of CSAP Reading
Score to Level of Service
650
600
550
CSAP Reading Score
500
450
400
IS:
IS:
Monitor Consult
DS:
DS: 21DS:
>60% 60% Gen <21%
Gen Ed
Ed
Gen Ed
CSAP Reading Performance Growth 2004 vs
2005



Reading grades 3-10
N=751 students
Adequate Yearly Progress or 1 years growth in 1
year



40% made 1 years growth
40.8% made > 1 years growth
18.7% made < 1 years growth
Deaf Child’s
Bill of Rights
Deaf Child’s Bill of Rights
http://www.cde.state.co.us/cdesped/downlo
ad/pdf/dhh-DeafChildBillRts.pdf
Deaf Child’s Bill of Rights



that each child’s “unique communication mode is
respected, utilized, and developed to an appropriate level
of proficiency”,
that teachers and other providers who work with
children who are Deaf or Hard of Hearing are specifically
trained for this population, including proficiency in the
primary language mode of the children with whom they
work,
that an education with a sufficient number of language
mode peers with whom direct communication is possible
and who are of same age and ability level is available,
Deaf Child’s Bill of Rights



that each child’s “unique communication mode is
respected, utilized, and developed to an appropriate
level of proficiency”,
that teachers and other providers who work with
children who are Deaf or Hard of Hearing are
specifically trained for this population, including
proficiency in the primary language mode of the
children with whom they work,
that an education with a sufficient number of language
mode peers with whom direct communication is
possible and who are of same age and ability level is
available,
Deaf Child’s Bill of Rights



that parent involvement and, where appropriate, people
who are Deaf and Hard of Hearing, determine the extent,
content, and purpose of educational programs,
that children who are Deaf and Hard of Hearing benefit
from an education in which they are exposed to Deaf and
Hard of Hearing role models,
that programs provide direct and appropriate access to all
components of the educational process, including but not
limited to recess, lunch, and extra-curricular activities,
Deaf Child’s Bill of Rights



that parent involvement and, where appropriate, people
who are Deaf and Hard of Hearing, determine the
extent, content, and purpose of educational programs,
that children who are Deaf and Hard of Hearing benefit
from an education in which they are exposed to Deaf
and Hard of Hearing role models,
that programs provide direct and appropriate access to
all components of the educational process, including
but not limited to recess, lunch, and extra-curricular
activities,
Deaf Child’s Bill of Rights



that programs provide for the unique vocational needs,
including appropriate research, curricula, programs, staff,
and outreach,
that the least restrictive environment for each child who
is Deaf or Hard of Hearing takes into consideration the
legislative findings and declarations of this law, and
that due to the unique communication needs of children
who are Deaf and Hard of Hearing, the development and
implementation of state and regional programs would be
beneficial.
SUMMARY
Set a Goal
Measure the Baseline
Develop a Plan
Institute the Plan
Measure the progress
FOR THE SAKE OF OUR CHILDREN:
WE CAN ACHIEVE OUR GOAL