A Steep Hill to Climb: Identifying the

Literacy Crisis for Deaf and Hard of Hearing

StudentsChristine Yoshinaga-

Itano, 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

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

ArticulationPragmatic 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

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

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: 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 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

N=109 Age Range: 2-7 years Normal hearing and

cognition

Hearing Loss Group N=126 Age Range: 3-7 years All Levels of hearing

loss Normal cognition

Children with Normal Hearing

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)

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 HEARINGASSOCIATION 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• Language, Motor, Social, Self Help, Pre-

Literacy

• Parent report• 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: MedianVocabulary 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

400

450

500

550

600

650

IS:Monitor

IS:Consult

DS:>60%

Gen Ed

DS: 21-60% Gen

Ed

DS:<21%

Gen Ed

CSAP Reading Score

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/download/pdf/dhh-DeafChildBillRts.pdf

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

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,

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

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,

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.

Deaf Child’s Bill of Rights

SUMMARY

Set a GoalMeasure the BaselineDevelop a PlanInstitute the PlanMeasure the progress

FOR THE SAKE OF OUR CHILDREN: WE CAN ACHIEVE OUR GOAL