1. Academic excellence for business and the professions Reading and dyslexia in deaf children Dr Rosalind Herman City University London

2. Childhood deafness 44,000 4 children in the UK have a permanent hearing loss A quarter have a severe-profound level of loss that significantly impacts access to spoken language Of these, approximately two thirds use spoken language 4 CRIDE 2012

3. Recent developments

4. Reading develops more slowly Reading delay increases with age 5,6 Are all deaf readers dyslexic? No, good deaf readers do exist 7,8 BUT some may be dyslexic Reading and deaf children 5 Conrad 1979, 6 Wauters et al. 2006, 7 Marschark et al. 2007, 8 Gravenstede & Roy 2009

5. Reading in deaf and hearing children Hearing children with reading difficulties are likely to be diagnosed as dyslexic Deaf children’s difficulties are attributed solely to their sensory loss Given the genetic basis of dyslexia 2, might some deaf children also be dyslexic? 1 Allen, 1986; Conrad, 1979; Kyle & Harris, 2010; 2011; Wauters, van Bon & Tellings, 2006; 2 Pennington & Olson, 2005 5

6. Evidence reading develops in same way as hearing children For both, phonological skills are important – Hearing children rely on listening – Deaf children additionally use lip-reading (speechreading) 9 Why start with oral deaf children? 9 Kyle & Harris 2010; 2011

7. Identification of dyslexia in deaf readers: the challenges No tests for deaf children Can we use tests developed for hearing children?

8. Phase 1: Oral deaf children Aims: 1.Investigate the suitability of literacy and dyslexia-sensitive tests for deaf children 2.Collect data from a representative sample of oral deaf children 3.Compare deaf readers to hearing children with and without dyslexia 4.Find out if some deaf children have dyslexia Phase 2: Signing deaf children

9. Participants in Phase 1 79 severely-profoundly children deaf from birth Year 6 (10-11years), primary education in English 61% cochlear implants, 39% digital hearing aids: no difference in reading and phonological skills so combined into one group Reference group of 20 hearing dyslexic children

10. Measures Literacy Phonological skills Vocabulary Non-verbal Speech reading Speech intelligibility Naming speed

11. Test battery 11  Literacy – Single words, nonword reading, reading comprehension, spelling  Phonological tasks – Digit span – Fluency: rhyme, alliteration – Phoneme deletion (rein/deer) – Spoonerism (fun with “b”; riding boot) – Naming speed  Non verbal IQ  Expressive vocabulary  Speechreading and speech intelligibility  Familiar sequences

12. Parent and teacher questionnaires 12 Family history of speech/language, hearing, reading problems Child’s hearing background, type of amplification (hearing aid/cochlear implant), any additional difficulties Parental education, ethnicity School and home communication method Methods used for teaching reading

13. Could the children do the tests?

14. Deaf-friendly test administration: listening conditions Quiet and distraction free test environment, important for hearing aid/cochlear implant users Amplification fully functional prior to assessment 14

15. Optimal seating and lighting Access to clear speech patterns to support speechreading 15 Deaf-friendly test administration: visual access

16. Signing/gesture/writing used as needed to explain tasks Additional practice items offered where needed Sensitivity to deaf children’s speech patterns in scoring Note: all tests administered using spoken language only in Phase 1 16 Tester skills

17. Are deaf children with cochlear implants better readers? 61% with implants 39% with hearing aids No differences between groups

18. Differences among children with cochlear implants Small group of children implanted ≤18mths: no below average scores Children implanted ≥2yrs: mixed picture, good and poor readers

19. 19 Comparing deaf participants with hearing test norms Deaf children had below average scores (<- 1SD) on most of the literacy and phonological tasks Deaf children particularly poor on vocabulary Deaf children showed a normal spread of scores on naming speed for digits, NVIQ, speech reading, semantic fluency

20. Comparing deaf and hearing dyslexic children: Single word reading

21. Comparing deaf and hearing dyslexic children: Single word reading

22. Other literacy scores for deaf group Reading comprehension: 39% deaf in normal range Spelling: 60% deaf in normal range 22

23. Vocabulary Phoneme deletion Word reading Phoneme deletion Spoonerisms Nonword reading Vocabulary Naming speed for digits Spelling Evaluating our measures: Predictors of literacy skills

24. 24 Can we identify dyslexia in oral deaf children?

25. Dyslexic readers (PR) Average readers Poor readers, poor language (PR + PL) Average readers, poor language (PL) Poor Good decoding skills (Nonword reading) Poor language skills (Expressive vocabulary) Good language skills Deaf 30% Deaf 22% Deaf 48% Deaf 0% Classification of reading skills

26. Deaf children’s range of scores on single word reading and vocabulary

27. 27 Deaf children compared with hearing dyslexic children

28. Can we separate poor reading from language difficulties in deaf children?

30. What about deaf children’s phonological skills?

31. Comparing deaf children and hearing dyslexic children with below average scores Literacy, language and phonological scores

32. Hearing dyslexic children: % Below average literacy scores

33. Deaf and hearing dyslexic children: % Below average literacy scores

34. Deaf and hearing dyslexic children: % Below average language and comprehension scores

35. Deaf and hearing dyslexic children: Below average phonological skills

36. Spelling errors: Use of phonological route? Types of spelling errors: phonetic error ‘lepered’ non-phonetic ‘cuircle’

37. Spelling errors: Use of phonological route? Better literacyPoorer literacy

38. Limited early language experience Poor speech perception and production Poor phonological representations and awareness Inefficient word learning Poor reading Why do deaf children have reading problems? The role of early language experience Poor vocabulary development

39. So were any deaf readers dyslexic? Average readers Poor readers 6% ‘extremely poor’ deaf readers: severe phonological deficits lowest scores across all measures We cannot tell if they have dyslexia Their response to intervention may be informative

40. 40 We looked at all poor deaf readers’ performance on measures that identified poor reading in the hearing dyslexic group

41. 41 Eight deaf children with average speech intelligibility and nonverbal scores BUT low scores on naming speed Three with average non-word reading unlikely to be dyslexic Naming speed a key measure in identifying dyslexia

42. 42 Of the five remaining, all had: – Very poor spelling (phonetic spelling errors) – Very poor phonological skills (spoonerisms, phoneme deletion) – Very poor sequencing skills (months in correct sequence) – 4/5 were boys These children fit the typical dyslexic profile

43.  Some oral deaf children do have a dyslexic profile BUT these are not the only poor readers  Half* our oral deaf sample are poor readers, all with poor language and weak phonological skills  The phonological deficits are the same as those found in hearing children with dyslexia *Using more recent norms for BAS single word reading test, 71% are poor readers Phase 1: Conclusions

44.  These children are poorly equipped for secondary school  All poor deaf readers need support not just the few with dyslexia  Interventions that work with hearing dyslexic children should be available to poor deaf readers  Like hearing children with severe reading difficulties, deaf children need intensive, individualised, ongoing interventions to address their language and phonological deficits  Ideally, intervention should be early to prevent these problems What happens next?

45. Breaking the cycle Through learning to read and spell, children can develop their phonological awareness skills and extend their vocabularies

46. Phase 2: Deaf signing children Questions we hope to answer  What does a good reader in this group look like using our tests?  If signing helps language development, is reading better among children with good signing skills?  Are phonological skills important to reading in signers?  What is the profile of good and poor readers?  Is there a dyslexic profile among signers?  What might help reading development in signers who struggle with reading? 46

47. “the Government wants every child to succeed…the ability to read well is key to success in education and an essential life skill… (the need for) high quality provision for securing literacy for all children” The Rose Report, 2009 What about deaf children?

48. Acknowledgements Thanks to…  My collaborators, Penny Roy & Fiona Kyle  The Nuffield Foundation  All the children, families and schools who took part  Our research assistants: Zoe Shergold for phase 1 and Catherine Barnett for phase 2  Advisory group: Sue Brownson, Margaret Harris, Mairead MacSweeney, Barbara Maughan, Ian Noon, Kate Rowley, Karen Simpson, Maggie Snowling, Ruth Swanwick & Tyron Woolfe  r.c.herman@city.ac.ukr.c.herman@city.ac.uk 48