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Literacy Skills in Children with Cochlear Implants: The Importance of Early Oral Language and Joint Storybook Reading

  • Dr. Jean DesJardin/Canisius College, NY was available from 08/11/08 until 08/31/08 to answer questions and share ideas concerning her research and its implications for parents of children who are deaf/hard of hearing, their teachers and other professionals who work with them.
  • You are encouraged to read the research summary below and review the attached discussion.

Abstract: The goal of this study was to longitudinally examine relationships between early factors (child and mother) that may influence children’s phonological awareness and reading skills three years later in a group of young children with cochlear implants (N = 16). Mothers and children were videotaped during two storybook interactions and children’s oral language skills were assessed using the Reynell Developmental Language Scales-III. Three years later, phonological awareness, reading skills, and language skills were assessed using the Phonological Awareness Test, the Woodcock-Johnson III Diagnostic Reading Battery, and the Oral Written Language Scales. Variables included in the data analyses were child (age, age at implant, language skills) and mother factors (facilitative language techniques), and children’s phonological awareness and reading standard scores. Results indicate that children’s early expressive oral language skills and mothers’ use of a higher-level facilitative language technique (open-ended question) during storybook reading, although related, each contributed uniquely to children’s literacy skills. Individual analyses revealed that the children with expressive standard scores below 70 at T1 also performed below average (<85) on phonological awareness and total reading tasks three years later. Guidelines for professionals are provided to support literacy skills in young children with cochlear implants.

Cochlear implants provide young children with the opportunity to achieve age-appropriate spoken language (Svirksy et al., 2000) and phonological awareness skills (James et al., 2007). These particular skills are important precursors for reading development. Although many children with cochlear implants achieve better reading skills than some children with hearing aids, extreme variability has been noted with many elementary school-aged children and young adults with cochlear implants substantially lagging behind compared to their hearing peers (James et al., 2007; Spencer et al., 2003; Vermeulen et al., 2007). Variability in reading skills for children with cochlear implants may be, in part, due to children’s early literacy skills and their literacy environment.

Early literacy skills:
For hearing children, early child factors such as oral language skills, phonological awareness, and print knowledge are all important to literacy development (Whitehurst and Lonigan, 2001). Young children’s vocabulary knowledge, for instance, plays a central role in learning to read (Senechal, Ouellette, & Rodney, 2006). The ability to understand and manipulate various sounds to make new words – phonological awareness – is also a strong predictor for later reading success in hearing children (Phillips & Torgesen, 2006) and potentially for deaf children, especially those children who are implanted early (<4 years) (James et al., 2007). Phonological awareness is thought to include rhyming, alliteration, word awareness, syllable awareness, and phoneme awareness (Ezell & Justice, 2005).

Home literacy environment: Parent-child joint book reading is an essential activity for later phonological awareness and reading achievement (Burgess, Hecht, & Lonigan, 2002; Hoover, 2002). The way in which parents or caregivers talk with their children during storybook reading has shown to guide children’s oral language skills in children with cochlear implants (DesJardin & Eisenberg, 2007). Specific techniques such as open-ended questions, recasts, and expansions encourage participation and conversation during storybook reading, eliciting more complex vocabulary and syntactic skills in young children with cochlear implants.
The present study investigated the relationships between early child factors (e.g., oral language skills and mothers’ language techniques) and later reading skills in a group of 16 mothers and their children with cochlear implants (M = 4.4 years at time point one; M = 7.5 years at time point two or three years later). All of the children used spoken English as their primary mode of communication. As a group, the children were identified with hearing loss at 9.8 months and received their cochlear implant at 25.9 months of age. Eight of the children had been fitted with their cochlear implant between the ages of 1.0 and 2.0 years (M = 20.9 months). The other eight children were fitted later, between the ages of 2.2 and 3.3 years (M = 30.9 months). Children’s language skills at both time points were lower than their chronological age, yet were commensurate to or higher than their length of implant use (M = 2.2 years at time one and M = 5.3 years at time point two).

-Children’s early expressive language skills were positively related to later:
o phonological awareness abilities in the sub-skill areas of rhyming, segmentation, isolation, deletion, and blending.
o reading skills in the areas of word attack, letter-word identification, and reading vocabulary.
o Most importantly, children who had expressive language standard scores at 70 or higher at time one also performed at or
better than average (SS = 85 or 1 standard deviation above the mean) on all literacy skills three years later.

- Mothers’ use of a higher-level technique, open-ended question, during storybook reading supported children’s phonological awareness and reading skills (i.e., letter-word identification, passage comprehension). Similarly, mothers’ use of recast was positively related to reading sub-skills areas of oral and reading vocabulary.

- Mothers of the children with higher standard scores also seemed to use more higher level facilitative techniques (e.g., open-ended questions, expansions), whereas mothers of children with lower standard scores utilized more lower level techniques (e.g., closed-ended questions, imitations).

Implications for early intervention professionals and parents:

In order for better reading skills, young children with cochlear implants need:

  1. A strong foundation in oral language skills (vocabulary, syntax, phonemic awareness)
  2. Multiple opportunities to listen to storybooks with caregivers who provide their children with appropriate language rich interactions to ensure the most beneficial use of storybook time. As young children develop more complex vocabulary and syntactic structures of language, the use of higher-level language techniques by parents, such as open-ended questions, will be important for optimizing children’s communicative competencies and reading skills.
  3. Well-designed literacy programs with explicit language and literacy instruction for families (e.g., natural communication exchanges, incidental listening activities, language rich environment).
  4. Explicit teaching of phonological awareness (e.g., rhyming, deletion, segmentation).
  5. A variety of storybooks such as Dear Zoo (Campbell, 2007) and Is Your Mama a Llama? (Guarino, Kellogg, & Madigan, 2006) that contain a variety of vocabulary words (e.g., fierce, heavy, fragile) and important concepts (e.g., rhyming words) that are not likely used in children’s everyday environments.

Resources for professionals and families:

Beginning with Books Center for Early Literacy

Bannister, K.F, Preston, K.R., & Primozich, J.T. (2006). Happily ever after: Using
storybooks in preschool settings. Hillsboro, OR: Butte Publications.

DeBruin-Parecki, A. (2008). Effective early literacy practice: Here’s how, here’s why.
Baltimore: MD: Paul H. Brookes Publishing.

Ezell, H.K., & Justice, L.M. (2005). Shared storybook reading: Building young children’s
language and emergent literacy skills. Baltimore, MD: Paul H. Brookes Publishing

Linder, T.W. (2004). Read, play, and Learn! Storybook activities for young children.
Baltimore, MD: Paul H. Brookes Publishing.

Vukelich, C., Christie, J., & Enz, B. (2002).
Helping your children learn language and literacy. Boston: Allyn & Bacon.

Zevenbergen, A. A., & Whitehurst, G. J. (2003). Dialogic reading: A shared picture book
reading intervention for preschoolers. In A. van Kleeck, S. A. Stahl, & E. B. Bauer (Eds.), On reading books to children: Parents and teachers (pp. 177-200). Mahwah, NJ: Erlbaum.


Burgess, S., Hecht, S., & Lonigan, C. (2002). Relations of the home literacy environment (HLE) to the development of reading-related abilities: A one-year longitudinal study. Reading Research Quarterly, 37, 408-426.

Campbell, R. (2007). Dear Zoo. New York, NY: Little Simon Publishers.

DesJardin, J.L., & Eisenberg, L.S. (2007).
Maternal contributions: Supporting language development in children with cochlear implants. Ear and Hearing, 28, 456-469.

Ezell, H.K., & Justice, L.M. (2005). Shared storybook reading: Building young children’s
language and emergent literacy skills. Baltimore, MD: Paul H. Brookes Publishing.

Guarino, D., Kellogg, S., & Madigan, A. (2006). Is your mama a llama? New York, NY:
Scholastic Press.

Hoover, W. A. (2002). The importance of phonemic awareness in learning to read.
Southwest Educational Development Laboratory, 14, 9-19.

James, D., Rajput, K., Brinton, J., & Goswami, U. (2007). Phonological awareness, vocabulary, and word reading in children who use cochlear implants: Does age of implantation explain individual variability in performance outcomes and growth? In: Journal of Deaf Studies and Deaf Education (2007). Oxford University Press. Available at

Philips, B.M., & Torgesen, J.K. (2006). Phonemic awareness and reading: Beyond the growth of
initial reading accuracy. In D.K. Dickinson & S. B. Neuman (Eds.), Handbook of early literacy research volume 2 (pp. 101-112). New York: Guilford Press.

Senechal, M., Ouellette, G., & Rodney, D. (2006). The misunderstood giant: On the predictive role of
early vocabulary to future reading. In D.K. Dickinson & S. B. Neuman (Eds.), Handbook of early literacy research volume 2 (pp. 173-184). New York: Guilford Press.

Spencer, L.J., Barker, B.A., & Tomblin, J.B. (2003). Exploring the language and literacy outcomes of
pediatric cochlear implant users. Ear and Hearing, 24, 236-248.

Svirsky, M.A., Robbins, A.M., Kirk, K.I., Pisoni, D.B., & Miyamoto, R.T. (2000). Language development in profoundly deaf children with cochlear implants. Psychological Science, 11, 153-158.

Vermeulen, A.M., van Bon, W.H.J., Schreuder, R., Knoors, H., & Snik, A. (2007). Reading comprehension of deaf children with cochlear implants, Journal of Deaf Studies and Deaf Education, 12(3), 283-302.

Whitehurst, G.J., & Lonigan, C.J. (2001). Emergent literacy: Development from prereaders to readers. In S.B. Neuman, & D.K. Dickinson (Eds.), Handbook of early literacy research volume 1 (pp. 11-29), New York: The Guilford Press.

Dr. Jean DesJardin, Sophie E. Ambrose and Laurie S. Eisenberg
Literacy Skills in Children with Cochlear Implants: The Importance of Early Oral Language and Joint Storybook Reading
J. Deaf Stud. Deaf Educ., 2008