Nittrouer, S., (2020). The duality of patterning in language and its relationship to reading in children with hearing loss. Perspectives of the ASHA Special Interest Groups, 5, pp. 1400-1409.
By the time we reach adulthood, reading is something we do without thinking about it. However, reading is a task that we spend years of our lives learning to do and practicing as children. It involves coordinating multiple skills, from recognizing the letters on a page to understanding the meaning behind what is written. Nittrouer (2020) discusses the concept of duality of patterning in which two different levels of structure are involved in reading: the semantic level, referring to the words that make up speech and their meanings, and the phonological level, referring to the sounds that make up words. These two levels work together in language, but develop somewhat separately. When learning a new language, development begins with the semantic level (or meaning) followed by the phonological level (or sounds).
For children with hearing loss, some of the auditory information they hear will be degraded (even with hearing aids), which causes more problems for learning phonological than semantic information. To look at how this impacts the learning to read in children, Nittrouer (2020) followed a group of 122 US children: 49 with normal hearing (NH), 19 with moderate hearing loss and using a hearing aid (HA), and 54 with moderate-to-profound hearing loss and using a cochlear implant (CI) from infancy to grade 8. The researchers found that those with hearing loss had lower vocabulary skills than those with normal hearing, with the CI group showing lower performance than the HA group. On measures of phonological structure, children with normal hearing had higher scores than their peers with hearing loss, and again, those with CIs scored lower than those with HAs. Although these skills improved for everyone, by grade 8, the CI group had reached a level equivalent to that of the normal hearing group in grade 2, suggesting significant difficulty for the CI group in phonological structure. In reading, the normal group used phonological processes for phonological tasks and semantic processes for semantic tasks. In contrast, however, the groups with hearing loss used both phonological and semantic processes for phonological and semantic tasks, suggesting that they relied on a combination of both, especially for the phonological tasks.
The authors suggest that intervention for children with hearing loss should include the use of meaningful structures, visual speech signals, and target both the semantic and phonological levels of structure throughout childhood.
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