Today’s blog, about a topic I consider critical (literacy), is written by my friend Krista Heavner, CCC-SLP, LSLS Cert AVT. Krista is a Cochlear Implant Consumer Specialist for Advanced Bionics, providing support and education for cochlear implant candidates and recipients, their families, and professionals in the southeastern part of the US. Prior to this position, Krista was a consultant for deaf and hard of hearing with the Division of Exceptional Children with the NC Department of Public Instruction. She has experience both in the educational and clinical settings, and has been teaching spoken language to children who are deaf and hard of hearing since 1999.  


Children with hearing loss have more potential to learn to listen and speak than ever before due to the amazing new technology that is developed almost daily to help access sound. Cochlear implants, digital hearing aids, FM and DM systems like Roger, and more, have provided access that those of us in the field of hearing health could have only imagined many years ago. For example, it is now possible to stream music and phone calls directly from a smart phone or tablet to a hearing aid and/or a cochlear implant; with bilateral cochlear implants and hearing aids, phone calls can be streamed from one ear to the other simply by holding the phone to one ear; technology like the Roger pen give parents the ability to speak directly to their child through their hearing technology using a normal tone of voice from up to 60 feet away.

All of these features are wonderful and can help young children gain access to music, spoken language, and the world around them. However, a child can merely HEAR these sounds, without true COMPREHENSION of the words being spoken. Hearing technology is the means by which children access sound, but the foundation is laid long before a child is interested in talking on the phone or streaming their favorite tunes on the computer.

Dr. Seuss sums up this relationship between reading and life success: “The more that you read, the more things you will know. The more that you learn, the more places you’ll go.” 
― Dr. SeussI Can Read With My Eyes Shut!

Hearing and speaking provide many of the prerequisite skills necessary for reading and where once children who are deaf had poor reading skills, children with hearing loss who receive a cochlear implant early in life have the potential to learn to read as well as children with normal hearing. (see ASHA Sig9 Perspectives


Where do I start?

The first question many professionals and parents may have regarding reading is “How do I get started teaching the child with a significant hearing loss who is accessing sound through hearing technology to read?” First, it is important that the therapist or teacher is knowledgeable about the milestones of children with typical hearing. The Listening and Spoken Language (LSL) approach to teaching language to children with hearing loss utilizes the developmental milestones of children with typical hearing to develop treatment plans. Once a child has access to sound, the use of developmental milestones for learning to read can be used in establishing long-term and short-term goals and planning therapy.

Below are some ways that adults, whether a teacher, therapist, parent, or other family member, can help develop a love for reading from a very young age using behaviors and milestones of a child with normal hearing.


Read Aloud

…and read aloud some more. Spoken language and vocabulary provide the foundation for reading, which is the reason that reading aloud to all children is necessary. In the same manner that spoken language ability is the foundation for reading, listening comprehension feeds reading comprehension. A child who has been read to from a young age is not only better prepared to read, but has heard more than 30 million words by age 3 and has a vocabulary of 20,000 words by age 6.

Reading out loud to a child is a very easy way to develop a love for books, to bond with a child, and to introduce to them the importance of the printed word. As indicated below, each of these milestones includes reading aloud as a means to teach vocabulary and language from infancy to school age.



At this stage the adult can read just about anything and using a “sing-song” voice that educators call “parentese,” and the child will attend. This often does not come naturally to those of us who are not therapists or have experience with children. For example, I had to model for my husband how to read to our child because he had never read to an infant. Once he started paraphrasing and using a “fun” voice (as he calls it), our babies paid much more attention when he read. You also do not have to read every word on a page, but paraphrase and point out the pictures and use silly faces. The infant will pair fun with reading and will enjoy this time with an adult one-on-one. Using a board book or a simple book with interesting pictures will likely gain the baby’s attention as well.

Until a child is four months old, it doesn’t matter a great deal what you read, as long as you are reading. —Jim Trelease, author of “The Read Aloud Handbook.” (See more here: Trelease on Reading)


6-12 Months

Continue with parentese at this stage as well, but as a baby starts to recognize faces and understand some words, reading can become even more interactive. Keep books low on shelves, or in a basket or box on the floor where a crawling baby can reach them. It may be helpful to give a child this age a teething toy while you read so the book does not become the item that goes in the mouth, as this is the teething stage. The adult can start to follow the child’s lead at this point and demonstrate how to turn pages. The child’s attention span increases, too, so actual stories and more words may be more engaging, and the child can pair the meaning of words to the pictures in the books.


Toddler Stage (12-24 months)

As a baby starts to be more mobile, and is walking and running, it may be more challenging to hold a captive audience for reading. Creativity on the part of the adult is important at this stage as a child may not want to sit in a lap on a chair or in the floor like in the younger stages. Use a child’s “favorite” books, or topics about things the child likes, as preferences are developing at this stage. For instance, if a child loves to watch airplanes outside, a book about airplanes would gain his or her attention over a book about animals. However, it is still important to work in that vocabulary for things in which the child does not show much interest. For instance, if a child is not really interested in animals, make it fun by making animal sounds or acting like an animal while reading the book. Yes, it sounds extreme, but it is a fun way to make reading exciting and you are giving the child access to new experiences and vocabulary. Also at this age a child may start to look at books and “read” by looking at the pictures and this behavior means they are understanding that books tell stories and demonstrating their interest in spoken language.


2-3 Years Old

Now we start having some fun! At this stage of development, children are generally able to understand and relay a short story. Props, such as finger puppets or hand puppets, can add to a story and make it more memorable. Acting out a story is also fun for this age. The adult can often use less of the parentese voice as used in the earlier stages, but still using various pitches of the voice to highlight vocabulary can be exciting. For example, while reading “The Three Bears,” you may use varying pitches to indicate the baby bear, mama bear, and papa bear. Children can also start to fill in the blanks of familiar stories, so pausing to allow the child to help read the story may be a way to make story time interactive. Rhyming books are good for this age, too, and now that the child has more vocabulary, he/she can understand characters and different roles in the stories. A strategy used by many teachers is “sabotage,” where the adult does something on purpose to elicit a response or language from a child, and this can be used in reading to label or read something incorrectly to get the child to engage during reading.


Try not to…

  • Test the child. Often I see parents or teachers asking a child with hearing loss (or typical hearing, too), “what’s that?” or “who’s that?” during a story while the adult knows the child knows the answer. Instead, use this opportunity to pair a word the child knows with a new, more impactful vocabulary word.

For example,

Say this: “Look at that big truck! It is so huge! It is gigantic.”

Not this: “What’s that?”


  • Get discouraged when you think your child is not interested in books or reading. Keep trying different topics and books. Take trips to the library and story time at book stores for exposure to books in a group setting.
  • Stop reading aloud. Even high schoolers can benefit from read aloud, as well as adults. I enjoy a good audio book in the car or while working around the house.


Do…Keep reading!

The words of a parent of a child born with profound hearing loss whose child is now 14 years old: Reading to and with Amelia has contributed vastly to her spoken language skills by giving me more opportunities to change the pitch and tone of my voice as well as providing me more topics and new words to discuss. She then learned to model that. Before Amelia had CI’s and I was told to read to her, I didn’t think it was crazy because it really gave me a glimmer of hope when I was doing anything I could to help her learn with the hope that maybe she was at least picking up something!! If she wasn’t hearing anything at all through the hearing aids, we were at least bonding and interacting through sight. Looking back now, I’m glad I pushed through even when I had no clue if she was benefiting at all. Out of my 3 children, she is the only one with hearing loss yet, she is the one who likes reading the most and is my best reader!! I know I spent more time reading with her because I knew she needed it. Her reading has upped her language and vocabulary skills and she frequently tests above her “typical hearing” peers!”

Denise, parent of Amelia, Michigan.



Hearing First

The Listening Room

Reading Rockets

Trelease on Reading

AG Bell


Thirty Million Words



*image courtesy Scott Air Force Base





Editor’s Note: This post garnered most readership in 2017. It first appeared on June 27, 2017 at Hearing and Kids.


An article published last week in Pediatrics reports on research which will add critical information to the debate about using sign language and/or spoken language when educating children who are deaf and hard of hearing.

As we all know, 92% of children with hearing loss are born to families with normal hearing who do not know sign language. When they have a child who is born with a hearing loss, they are overwhelmed with information and decisions about how to make decisions for their child. Unfortunately, parents do not always have all the information they need when they are making decisions. The article published this week by Geers and colleagues will go a long way to adding actual data to this debate.


Spoken Language and Sign Language and the Effect of Language and Literacy


Everyone seems to be sure that they know exactly what is the best method to educate children with hearing loss. The problem is that everyone has a different answer. Obviously, the same answer is not the same for every child and for every family but that has not prevented us from acting as if there was only one right answer. Each of us will provide the best possible language modeling for our children if we communicate in the language we know well. Each child is different and what works for one will not work for all. Children born into families with deaf parents who are fluent signers are in a different situation than children born to families with normal hearing parents who do not know sign language at the time of diagnosis. While families who are fluent signers will be able to provide their children with good language, families who don’t sign will not. Think about how it is to learn a new language. I am trying to learn Italian. I feel sorry for any child who has to learn Italian from me.

But there is an additional issue and that is literacy. Language learning is critical for developing literacy. Children who do not have good language  and phonologic will not have good literacy. And, if you want a child to learn to read in English, they need to have good English language skills. ASL skills do not necessarily transfer to English literacy skills.


The Geers et al study


Ann Geers is a well respected clinician and researcher as are her co-authors. Geers has published extensively. Her most recent paper was just published in Pediatrics. She evaluated the relationship between early sign language exposure and cochlear implant benefits. The article reports that most children with hearing loss learn spoken language and that most children with hearing loss are born to parents who have normal hearing and do not know sign language. The debate that has been raging for as long as I have been in this field (more than 50 years) is whether parents should be encouraged to learn sign language and to teach their deaf children to sign. This study evaluated parents use of sign language before and after cochlear implantation and the influence of parents sign language use on speech recognition, speech intelligibility, spoken language, and reading outcomes.

Three groups of children with CI’s from a national data base who were matched for demographic, auditory and linguistic characteristic but differed in duration of early sign language exposure provided in their homes were compared through elementary school grades.

Children without early sign language exposure achieved better speech recognition skills over the first three years after implantation and were statistically significantly better in spoken language and reading near the end of elementary school then children who were exposed to sign language. Over 70% of children who had no sign language exposure had age appropriate spoken language compared to only 39% of those exposed to sign language for 3 or more years. Early speech perception predicted speech intelligibility in middle school years.




All three groups received reading comprehension scores similar to hearing peers in early years but those without sign language exposure exhibited a statistically significant reading advantage over the long term sign subjects. For children with no sign language exposure only 11% were delayed in early elementary years increasing to 23% in late elementary years. For children exposed to sign language in early years, the percentage of children with less than average reading scores increased from <20% in early elementary years to >50% in late elementary years.


Study discussion


This article clearly provides the most compelling evidence that there is no advantage to early sign language use. Children who’s families used spoken language only, had better auditory speech recognition and more intelligible speech than children who’s families used sign language. Even short term sign use resulted in poorer speech intelligibility in elementary school. Even children whose families who used sign language minimally had poorer outcomes then children not exposed to sign language.


My conclusions


Most parents of children with hearing loss do not know sign language and the process of learning sign language, just like learning any other language, is long and arduous process meaning that they will not be exposing their children to good language models during the early years. The children who are listening exclusively to spoken language have the opportunity to hear good spoken language models and incorporate this into their speech recognition and spoken language. Children with poor reading skills have limited employment opportunities.Very significantly, the reading results alone  make a case for using spoken language exclusively by parents.


THE WORLD HAS CHANGED. Newborn hearing screening and improvements in technology have changed the world for children with hearing loss. When I started in this field children where identified with hearing loss at age 2-3 years and if they had severe to profound hearing loss they did not do well with hearing aids. They lost lots of time and many never successfully learned spoken communication but NO MORE. Babies are now identified at birth and fit with technology in early months. As soon as they receive technology they are hearing their families speak to them and learning language.

Children who have good listening and spoken language and good literacy skills have opportunities in life that those who do not have those skills just don’t have. Learning sign language later is always an option but learning it early destroys possibilities. That is the point – it only works if children have early exposure to spoken language.

It is unfair to be making decision for today’s children based on results of children who did not have the same opportunities – who were identified later and had technology that did not provide sufficient gain. Please let’s stop doing it.