Abstract

A total of 86 deaf children aged between 12 and 16 years were recruited from schools for the deaf, specialist units attached to a school, and mainstream schools. Approximately one-third used hearing aids, one-third had received a cochlear implant before 42 months, and one-third had been implanted later. The 3 subgroups were matched for age and nonverbal IQ, and all had an unaided hearing loss of at least 85 dB. Assessments revealed mean reading ages that were several years below chronological age for all 3 groups. However, participants in the hearing aid group performed best. Reading levels were not predicted by age of diagnosis or degree of hearing loss, but there was a relationship between reading level and presence of phonetic errors in spelling. There were also differences in educational setting, with the great majority of children in the hearing aid group in a school for the deaf and relatively more of the children with cochlear implants being educated in a unit or mainstream setting.

Attaining functional literacy is a key to success in a literate society, yet many children and young people, especially those who are born deaf or become so in the first months of life, find this a difficult if not impossible achievement. Numerous studies, conducted over the last 30 years, have shown that the great majority of deaf children find literacy a challenge, achieving significantly less than hearing peers in both reading (Allen, 1986; Conrad, 1979; DiFrancesca, 1972; Lane & Baker, 1974; Lewis, 1996; Moog & Geers, 1985; Trybus & Karchmer, 1977) and writing (Mayer, 1998, 2007).

The gap between deaf children and hearing peers tends to widen with age (Marschark & Harris, 1996) and so difficulties become more apparent as children progress through school. A recent study (Kyle & Harris, 2010) found a mean delay of 1 year in the reading scores of a group of 8-year-old deaf children: This had increased to a 3-year delay at age 11 years. A comparable cohort of 14-year-old deaf children (Harris & Moreno, 2004) showed an average reading delay of over 4 years. These average delays hide a very considerable degree of individual variation. For example in, the Kyle and Harris cohort, some children made no reading progress at all in 1 year whereas others achieved a whole year of reading progress over the same period.

In order to understand why literacy is so challenging for many deaf children, it is pertinent to consider the skills that underpin learning to read an alphabetic script, such as English, for hearing children. Two key components—knowledge of spoken English and phonological awareness—have been found to underpin the development of literacy. Oral language and vocabulary predict reading development (Bowey & Patel, 1988; Dickinson, McCabe, Anastasopoulos, Peisner-Feinberg, & Poe, 2003); and the ability to identify and manipulate phonemes within words—core aspects of phonological awareness—have been shown to be key to early reading success for hearing children (Muter, Hulme, Snowling, & Stevenson, 2004).

The emerging picture of predictors of deaf children's literacy suggests that broadly similar skills are important although there are some notable differences. As with hearing children, the most compelling data come from longitudinal studies that have examined factors predicting reading outcomes over a period of 1 or more years. One such study (Harris & Beech, 1998) found that, between the ages of 5 and 7 years, speech intelligibility, phonological awareness, and language comprehension predicted reading development. In a study of 6-year-old French children, early phonological awareness skills, including rhyme judgment and rhyme generation, predicted the reading progress made over 1 year (Colin, Magnan, Ecalle, & Leybaert, 2007). A recent study (Kyle & Harris, 2010) examined reading progress over a 3-year period, from the age of 7 years. Although most children showed reading delays at the end of the study, those with better vocabulary and speechreading skills at age 7 years exhibited less severe delays. This latter finding was consistent with the results of a comparison between matched groups of good and poor deaf readers at age 8 (Harris & Moreno, 2006), which showed a significant difference in speechreading ability in favor of the better readers. All these studies, with the exception of Colin et al. (2007), assessed deaf children from a variety of educational settings so these findings are not specific to preferred mode of communication. Indeed, knowledge of spoken English and speechreading skills appear to be as important for children who sign and for those whose education is predominantly oral.

The longitudinal relationship between phonological awareness and speechreading appears to be a complex one. In Kyle and Harris (2006), phonological awareness was not correlated with reading ability at age 7 when the children were first assessed. However, at that age phonological awareness was strongly associated with speechreading. Early speechreading also predicted phonological awareness 1 year later. By the end of the study, 3 years later, phonological awareness was significantly correlated with reading ability (Kyle & Harris, 2010) but it was reading ability that predicted later phonological awareness rather than the other way round. These patterns of results suggest that deaf children's phonological abilities may develop as a consequence of learning to read rather than being a prerequisite of reading, as in hearing children, and that, in the early stages, development is mediated by speechreading.

The complementary roles of speechreading—as a mediator of phonological awareness—and knowledge of English, especially English vocabulary, are illustrated by the finding from Kyle and Harris (2006) that speechreading was the strongest predictor of single word reading ability, whereas vocabulary knowledge was the strongest predictor of written sentence comprehension. This echoes the principle of the simple view of reading (Hoover & Gough, 1990) that two components, decoding and linguistic comprehension, underpin the development of skilled reading. It would appear that this is equally true for deaf and hearing children.

Although speechreading appears to provide a route to the development of phonological awareness among deaf children, it might be expected that increased access to sound would promote knowledge of the oral language and provide a direct route to phonological awareness. This would, in turn, be expected to have an impact on literacy. The technological developments in hearing aids that have taken place over the last two decades have held out the prospect of increased access to speech for deaf children. Chief among the innovations that have taken place is the provision of cochlear implants. In the United Kingdom, these are provided by the National Health Service and so have become increasingly available for children, irrespective of parental means (Archbold, Harris, et al., 2008).

There is now a substantial body of evidence showing that cochlear implantation improves speech perception and production and facilitates the development of spoken language (Archbold et al., 2000; Cleary, Pisoni, & Geers, 2001; Geers, 2002; O'Donoghue, Nikplopoulos, & Archbold, 2000; Pisoni & Geers, 1998; Tait, Nokolopoulos, Archbold, & O'Donoghue, 2001; Thoutenhoofd, et al., 2005; Watson, Archbold, & Nikolopolous, 2006; Watson, Hardie, Archbold, & Wheeler, 2008). In contrast to the findings about spoken language development, evidence concerning the impact on reading and writing has been inconsistent (Archbold, Harris, et al., 2008; Marschark, Rhoten, & Fabich, 2007).

There are a number of issues to consider in evaluating literacy outcomes. Many children who receive a cochlear implant have complex needs that place limitations on their capacity to become literate (Edwards, 2007). In addition, there are other deaf children who do not have any recognized additional needs but who have a level of nonverbal intelligence that is significantly below normal. Arguably, children with an IQ score that is more than 1 standard deviation (SD) below the mean would not be expected to show age-appropriate levels of reading. However, many studies do not assess nonverbal IQ in evaluating literacy outcome following implantation so it is not possible to fully evaluate their findings.

Another important factor is age at implantation (Archbold, Harris, et al., 2008). This has been falling steadily since the first pediatric implants were carried out and, in the United Kingdom, many children are now implanted around the age of 2 years or even younger. This was not the case a few years ago, and depending on the point at which data were collected, age at implantation may have been considerably higher than current norms. For example, a small-scale study (Boothroyd & Boothroyd-Turner, 2002) found continued delays in reading ability 4 years after implantation but the average age at implantation was 5.8 years. Another small-scale study (Spencer, 2004) investigated the language performance of children who had been implanted before 36 months. She reports reading comprehension scores within 1 SD of hearing peers and a strong correlation between spoken language and reading. In a study of 181 children, all of whom had received an implant before the age of 5 years (Geers, 2003), over half were reading at an age-appropriate level. Notably, there was considerable variability within the group although a number of factors predicted reading competence, namely, mainstream educational placement, wide dynamic range using recent technology, longer memory span, and use of phonological coding. As in the Spencer (2004) study, reading ability was predicted by linguistic competence (Tobey, Geers, Brenner, Altuna, & Gabbert, 2003). However Geers (2003) did not find an association between reading level and age at implantation as many other studies have done (Archbold, Harris, et al., 2008).

Two recent European studies compared literacy attainment in deaf children with cochlear implants and peers with hearing aids. Among a sample of 152 deaf pupils in Scotland, those with cochlear implants scored comparatively higher on reading and writing than peers with hearing aids (Thoutenhoofd, 2006); and a similar pattern emerged from a study of 550 deaf pupils in the Netherlands (Vermeulen, van Bon, Schreuder, Knoors, & Snik, 2007). Notably, however, both studies found children with implants to be delayed when compared with hearing children. In the former study, the mean age at implantation was 37 months for primary school pupils and 91 months for secondary school pupils. In the latter study, the mean age at implantation was 74 months and the mean age at which reading was assessed was 153 months.

Perhaps the most optimistic view of the benefits of cochlear implantation comes from a study of children in the United Kingdom who were implanted by the Nottingham Cochlear Implant Team (Archbold, Harris, et al., 2008). This study followed up 105 children and assessed their reading levels at 5 and 7 years post-implantation. There was a wide variation in age at implant and so the sample was divided into those implanted relatively early (at or before the age of 42 months) and those implanted later, that is between 43 and 84 months. There was a strong and positive association between outcomes and age at implantation, and among the subgroup of children whose nonverbal IQ was 85 or above, those who had been implanted at or under the age of 42 months were reading at an age-appropriate level at both assessment points.

Seven years post-implantation most of the children in the Archbold, Harris, et al. (2008) study were approaching the end of primary schooling where the demands of literacy begin to increase as readers are required to deal with more complex sentences, abstract concepts, and the integration of ideas across extended text. There are analogous demands on writing skills. These demands continue to increase as children move into secondary school and, in their final years of schooling, adult levels of literacy are required. The question remains as to how well children and young people with a cochlear implant fare as they cope with these demands. Evidence from a follow-up study (Geers, Tobey, Moog, & Brenner, 2008) suggests that early levels of attainment tend not to be sustained. Geers et al. (2008) were able to follow up 26 of the children assessed in an earlier study (Geers, 2003) and found that, although they were reading at an age-appropriate level when they were 8–9 years old, they had an average reading delay of 2 years by the time they were 15–16 years old (for a discussion of this finding, see Marschark et al., 2007). This suggests that early reading success following a cochlear implant may not be sustained in the final years at school.

The Archbold, Harris, et al. (2008) study focused exclusively on children with a cochlear implant and it did not compare outcomes with those of deaf peers using a conventional hearing aid. There have been considerable technological advances in hearing aids (Ackley & Decker, 2006) and many children in the United Kingdom are now using digital aids that would be expected to give them better access to speech. It is therefore legitimate to ask whether children with a cochlear implant have higher literacy levels than peers who rely on hearing aids.

The aim of this article was to examine the literacy attainment of deaf children aged between 12 and 16 years. The study compared three groups of children who were similar in age, nonverbal IQ, and levels of hearing loss but who differed in the type of aid that they were using. One group used hearing aids, and two had received a cochlear implant either before 42 months or later. The study assessed reading of both single words and text, using standardized tests, and also gathered data on spelling. The spelling data were designed to reveal spelling strategies. Previous studies (Harris & Moreno, 2004, 2006; Mayer, 1998; Sutcliffe, Dowker, & Campbell, 1999) have shown that, in comparison to hearing children of similar reading age, deaf children tend to make very few phonetic spelling errors that correctly capture the sound of a spoken word. Such errors (e.g., spelling scissors as sissers) are very common in the misspellings of hearing children and are taken as evidence that they are using a phonological strategy. The study sought to find out whether there was evidence that children with a cochlear implant were making greater use of a phonological strategy than peers with hearing aids. Finally the study examined the relationship between use of phonological coding and reading level to see whether good readers made greater use of a phonological strategy than poor readers.

Methods

Participants

There were three groups of children and young people in this study, 27 deaf participants with digital hearing aids, 30 early implanted (at or before 42 months), and 29 late implanted (after 42 months). They ranged in age from 12 to 16 years. The three criteria for inclusion were that all deaf participants had an unaided hearing loss of at least 85 in the better ear, a nonverbal intelligence score of at least 85, and no additional visual or cognitive problems. After initial assessment, 25 potential participants were excluded from the study either because their IQ score fell below 85 or (occasionally) because detailed records showed that their hearing loss did not meet our criterion.

Schools were initially approached through e-mails and, where there was a willingness to participate, the head teacher gave written consent. In addition, written consent was obtained from all parents unless they had assigned this responsibility to the school. In all, a total of 17 sites took part in the study. These included special schools for the deaf, specialist units for deaf and hard-of-hearing children attached to mainstream schools, and mainstream schools in England and Northern Ireland. Table 1 shows the distribution of participants over the three types of educational setting. Participants also varied with respect to their preferred mode of communication. This was determined by asking how they would prefer to communicate with the experimenter. The distribution of participants by preferred mode of communication is shown in Table 2.

Table 1

Distribution of the sample according to educational setting

 Educational setting
 
 
Aiding group Mainstream school Specialist unit School for the deaf Total 
Hearing aids 25 27 
Late CI 18 30 
Early CI 10 12 29 
Total 13 18 55 86 
 Educational setting
 
 
Aiding group Mainstream school Specialist unit School for the deaf Total 
Hearing aids 25 27 
Late CI 18 30 
Early CI 10 12 29 
Total 13 18 55 86 

Note. CI, cochlear implant.

Table 2

Distribution of the sample according to preferred mode of communication

 Preferred mode of communication
 
 
Aiding group Speech Signing Both Total 
Hearing aids 10 27 
Late CI 17 12 30 
Early CI 11 16 29 
Total 37 11 38 86 
 Preferred mode of communication
 
 
Aiding group Speech Signing Both Total 
Hearing aids 10 27 
Late CI 17 12 30 
Early CI 11 16 29 
Total 37 11 38 86 

Note. CI, cochlear implant.

Tasks

Assessment of reading.

All participants were initially given a test of single word reading ability, taken from the British Ability Scales II (Elliott, Smith, & McCulloch, 1996). They were allowed to sign the words or to say them out loud. The reading age on this test was then used to identify which of the four levels of the Edinburgh Reading Test was appropriate for each child (Edinburgh, 2002). The Edinburgh Reading Test assesses a wide range of reading comprehension skills including understanding of vocabulary, syntax, and sequence of ideas as well as story comprehension. It is suitable for deaf children as there is no requirement to read aloud.

Spelling test.

The spelling test was adapted from Harris & Moreno (2004). Their test was designed for use with deaf children, and each word to be spelled was depicted by a line drawing (Snodgrass & Vanderwart, 1980). The original test was designed for use with younger children than those in this article and so some highly frequent monosyllabic words (e.g., car and fox) were replaced with less frequent multisyllabic words (e.g., kangaroo and magician). As in the original version, this test was not intended to produce a standardized spelling age but, rather, to provoke spelling errors. Thus, the majority of words were irregular (see Appendix 1).

The analysis of spelling errors was identical to Harris & Moreno (2004) and was designed to uncover the use of a phonological strategy. The primary analysis was concerned with phonetic errors. An incorrect spelling was classed as phonetic if it contained at least one instance where a sound was correctly represented by the use of an incorrect letter or letters. For example, the following spellings of PIGEON were considered to be phonetic: pigin, pidgeon, pigion, piggen, pigen, pegain, and pigion. Thus, in the case of PIGIN, the IN spelling is a legal, though incorrect, spelling of the second syllable, and in PIDGEON, PIDGE is a plausible spelling of the first syllable.

Nonverbal intelligence.

Nonverbal IQ was assessed using a subtest—Pattern Construction—from the British Ability Scale II (Elliott et al., 1996). This has been used in previous research with deaf children and has been shown to correlate highly with the composite nonverbal IQ score that is measured using this subtest and two others. For example, in the data collected by Harris and Moreno (2004), the correlation of the matrices score with the composite score was over .7 (r = .75, N = 62, p < .001). The main purpose of the IQ measure was to ensure that none of the participants had a mild or moderate learning difficulty that had gone undetected and so to ensure that the three groups were comparable in intellectual functioning (Archbold, Harris, et al., 2008).

Procedure

All participants were assessed in their school. The Pattern Construction test, Single Word Reading Test, and spelling task were administered individually. The Edinburgh Reading Test was administered either individually or in small groups. All assessments were normally carried out in one session but, in some cases, it was necessary to complete assessments on a second day. In two schools, pupils had completed the Edinburgh Reading Test within 6 months and so they were not retested.

Results

There was a significant association between the type of aid participants used and their educational placement (χ2 = 16.88, degrees of freedom [df] = 4, p = .002). Table 1 shows that all but two of the children and young people with hearing aids were in schools for the deaf whereas those with a cochlear implant were more equally divided between the three educational settings. There was also a significant association between aiding group and preferred mode of communication (χ2 = 12.16, df = 4, p = .016). As Table 2 shows, participants with hearing aids were almost equally likely to prefer sign, speech, or both whereas those with a cochlear implant preferred to use either speech or speech and sign together, but not sign alone.

Table 3 shows the mean chronological age, hearing loss, age at diagnosis, age at implantation, and nonverbal IQ for the three groups. Participants were well matched for chronological age and nonverbal IQ. There was a small, but significant, difference in degree of hearing loss in favor of participants with hearing aids. Post hoc analysis revealed a significant difference between the hearing aid and late-implanted groups (p = .015), but no other comparisons were significant. There was also a significant difference in age of diagnosis. This was highest in the late-implanted group who were, on average, not diagnosed for hearing loss until 16 months of age. Post hoc analysis revealed a significant difference between the late- and early-implanted groups (p = .016), but no other comparisons were significant. In light of these intergroup differences, regression analyses were carried out to determine whether either of these variables was a significant predictor of reading scores. These showed that neither single-word reading nor the Edinburgh scores were predicted by degree of hearing loss or age of diagnosis.

Table 3

Mean (SD) of age, hearing loss, age at diagnosis, age at implantation, and nonverbal IQ

Aiding group Chronological age, years:months Hearing loss, dB Age of diagnosis, months Age at implantation, years:months Nonverbal IQ 
Hearing aids 14:0 (16.14 months) 94.81 (2.92) 9.78 (12.78 months)  108.41 (11.33) 
Late CI 13:9 (16.20 months) 97.60 (4.18) 16.67 (15.57 months) 7:5 (35.26 months) 114.23 (13.57) 
Early CI 13:6 (13.41 months) 96.48 (3.33) 6.90 (8.69 months) 3:0 (3.90 months) 114.45 (15.30) 
Significance Not significant p = .015 p = .013 p < .001 p = .175 
Aiding group Chronological age, years:months Hearing loss, dB Age of diagnosis, months Age at implantation, years:months Nonverbal IQ 
Hearing aids 14:0 (16.14 months) 94.81 (2.92) 9.78 (12.78 months)  108.41 (11.33) 
Late CI 13:9 (16.20 months) 97.60 (4.18) 16.67 (15.57 months) 7:5 (35.26 months) 114.23 (13.57) 
Early CI 13:6 (13.41 months) 96.48 (3.33) 6.90 (8.69 months) 3:0 (3.90 months) 114.45 (15.30) 
Significance Not significant p = .015 p = .013 p < .001 p = .175 

Note. CI, cochlear implant.

As might be expected, the three literacy measures were highly intercorrelated. Table 4 shows the correlations between the two reading measures and the spelling score, partialling out both chronological age and nonverbal IQ. The highest correlation of just over .7 was between the two reading measures with smaller but significant correlations of just over .5 between each of the reading measures and the spelling score.

Table 4

Correlation of literacy measures (controlling for age and nonverbal IQ)

 Edinburgh Reading Test Single-Word Reading Picture Spelling Task 
Edinburgh Reading Test   
Single-Word Reading .71**  
Picture Spelling Task .59** .56** 
 Edinburgh Reading Test Single-Word Reading Picture Spelling Task 
Edinburgh Reading Test   
Single-Word Reading .71**  
Picture Spelling Task .59** .56** 

Note. **p < .001.

Table 5 shows the mean reading and spelling scores for the three groups. It can be seen that all groups showed reading delays on both reading tests but there was very considerable variability in performance within each of the three groups, as indicated by the wide range and large SD. In all groups, some participants were reading very well—above their chronological age—whereas others were reading several years below. In this respect, these findings appear very similar to those of earlier studies of literacy in comparable UK populations (Harris & Moreno, 2004, 2006; Kyle & Harris, 2006, 2010).

Table 5

Mean (SD), minimum (min), and maximum (max) for reading laga and spelling scores

Aiding group Single word reading (months) Edinburgh Reading Test lag (months) Picture spelling test (max = 40) 
Hearing aids −40.30 (31.89); min: −97; max: 32 −22.56 (39.49); min: −93; max: 48 30.37 (8.17); min: 8; max: 40 
Late CI −36.03 (34.67); min: −86; max: 38 −39.70 (35.89); min: −100; max: 46 25.80 (9.99); min: 3; max: 40 
Early CI −37.28 (29.71); min: −81; max: 47 −45.10 (29.68); min: −97; max: 27 25.07 (10.79); min: 3; max: 40 
Mean −37.79 (31.86); min: −97; max: 47 −36.14 (36.01); min: −100; max: 40 26.99 (9.91); min: 3; max: 40 
Aiding group Single word reading (months) Edinburgh Reading Test lag (months) Picture spelling test (max = 40) 
Hearing aids −40.30 (31.89); min: −97; max: 32 −22.56 (39.49); min: −93; max: 48 30.37 (8.17); min: 8; max: 40 
Late CI −36.03 (34.67); min: −86; max: 38 −39.70 (35.89); min: −100; max: 46 25.80 (9.99); min: 3; max: 40 
Early CI −37.28 (29.71); min: −81; max: 47 −45.10 (29.68); min: −97; max: 27 25.07 (10.79); min: 3; max: 40 
Mean −37.79 (31.86); min: −97; max: 47 −36.14 (36.01); min: −100; max: 40 26.99 (9.91); min: 3; max: 40 

Note. CI, cochlear implant.

a

A minus sign indicates that a reading score fell below chronological age.

For single-word reading, there was relatively little difference between the three groups, and this was confirmed by analysis of variance (ANOVA) (F[2, 83] = 0.13, not significant [NS]). There was a larger difference for the Edinburgh Reading Test with the smallest delay—just over 2 years—being shown by participants with hearing aids. ANOVA confirmed that the effect of aiding group was just significant (F[2, 83] = 3.11, p = .05, η2 = .07). Post hoc testing, using Tukey, indicated that there was a significant difference between the hearing aid and early-implanted groups (mean difference = –22.55, p = .049), but no other contrasts were significant. There were no significant differences among spelling scores (F[2, 83] = 2.41, NS) although, as for the Edinburgh Reading Test, it was the pupils with hearing aids who performed best.

In order to gain a clearer picture of reading levels in the three groups, participants were divided into two subgroups. Following earlier comparisons (e.g., Harris & Moreno, 2006), those reading within 12 months of chronological age on the Edinburgh Reading Test were classed as good readers. Those reading at 12 months or more below chronological age were classed as poor readers. Using this classification, 13/27 participants with hearing aids were classed as good readers. This compared with only 6/30 in the late-implanted group and 5/29 in the early-implanted group. Chi square revealed a significant association between aiding and reading level (χ2 = 8.07, df = 2, p = .018), and further analysis, combining the two groups with a cochlear implant and using Fisher's exact test, showed a highly significant association between the type of hearing aid and reading level (p = .009).

Because there was an association between type of hearing aid and educational setting, a further analysis was carried out to examine the association between setting and reading level. Thirteen participants were in a mainstream school and almost half (46%) were good readers. Eighteen were in a specialist unit but only one was a good reader (6%). In all, 55 of our participants attended a school for the deaf and 17 (i.e., 31%) were good readers. Chi square revealed a significant association between educational setting and reading level (χ2 = 6.87, df = 2, p = .032).

The final analysis was concerned with the prevalence of phonetic spelling errors. As can be seen in Table 5, the overall mean score for correct spellings was 27 out of 40 and the SD was almost 10. This reflects the fact that the best spellers were at or close to ceiling on the spelling test. In all, 14 participants achieved scores of 38 or more. In order to examine phonetic errors, these good spellers were excluded. For the remaining 72 participants, the relationship between percentage of phonetic errors and reading and spelling was examined. There was a significant correlation between percentage of phonetic errors and single-word reading (r = .34, N = 72, p = .004) and a smaller, but still significant, correlation with score on the Edinburgh Reading Test (r = .24, N = 72, p = .047). There was also a significant correlation between percentage of phonetic errors and number of correct spellings (r = .31, N = 72, p = .009). There was, however, no difference among the groups in the percentage of phonetic errors (F[2, 69] = 0.21, NS).

Discussion

The main conclusion to emerge from this study is that, between the ages of 12 and 16 years, children and young people who had received a cochlear implant were reading no better than their peers who were using a hearing aid. Furthermore, on the Edinburgh Reading Test, the highest proportion of participants reading within 12 months of chronological age was in the group with hearing aids; and, overall, those in the hearing aid group read significantly better than those with a cochlear implant, inserted before 42 months.

Before reflecting on these findings, and their implications, it is pertinent to consider whether there were any systematic differences among the participants in the three groups that might have had an impact on their literacy skills. The most likely participant characteristics to affect literacy are chronological age, nonverbal IQ, age of diagnosis, and degree of hearing loss. Participants in this study were well matched for both chronological age and nonverbal IQ. There were small, but significant difference, in both unaided hearing loss and age of diagnosis but a regression analysis showed that neither was a significant predictor of reading level. Only one participant in the sample became deaf as a result of meningitis at the age of 24 months. In all other cases, it is likely that the hearing loss was present from birth although it was not always diagnosed until a few months later because Universal Newborn Nearing Screening was only at a pilot stage in the United Kingdom at the time these children were born. On these measures, then, there do not appear to be any systematic differences among participants in the three groups that might account for differences in reading level.

If we accept the conclusion that pupils with a cochlear implant were not showing age-appropriate levels of literacy, this can be seen as consistent with the finding of Geers et al. (2008) that early cochlear implantation does not result in age-appropriate reading levels at age 15–16 years for the majority of students. At first sight, the present findings are not, however, consistent with those of Archbold, Harris, et al. (2008) that children with an early cochlear implant were reading at an age-appropriate level. The children and young people in this article were similar in terms of nonverbal IQ and degree of hearing loss to those assessed by Archbold, Harris, et al.; and the division of age at implantation into early and late was made at an identical age point of 42 months. The children in both studies also came from the United Kingdom and the exclusion criteria were identical. Furthermore, both studies used the Edinburgh Reading Test to assess reading. There was, however, one important difference.

In the study of Archbold, Harris, et al., the children with an early implant were aged between 16 and 41 months when they received their implant. This means that they were between 8 and 10 years old at the time of the assessment that was carried out 7 years after implantation. They were therefore several years younger than the children and young people in this article whose mean age was nearly 14 years. Because Geers et al. (2008) found that there was a decline in reading ability between the ages of 8–9 and 15–16 years, the relatively poor performance of the pupils in this article may be explained by the fact they were older. There is some evidence of a fall off in reading ability between the two post-implant assessment points in the Archbold, Harris, et al. (2008) study. Not all of the children were seen at the later assessment point and so some caution has to exercised in making a direct comparison between the two points. However, at 5 years post-implant, the children with an early implant were reading 8 months above chronological age but 2 years later they were reading just below chronological age level.

Marschark et al. (2007) suggest that the fall off in reading progress for children with cochlear implants may arise because the latter stages of acquiring literacy are not supported by explicit teaching. However, this is the case for all children and young people learning to read and so the issue is why this might pose a particular problem for deaf people. In a seminal paper, Stanovich famously coined the term “Matthew effect” to characterize these later stages of learning to read where it is the process of reading itself that drives further progress: Children who read a lot become increasingly competent readers (Stanovich, 1986). One particular aspect of reading competence that plays an important role in higher level literacy is the ability to read infrequent and abstract vocabulary. Unlike early vocabulary development, which is driven by exposure to spoken (or signed) language, later-acquired vocabulary comes mainly through exposure to complex text. Consider as an example, some of the items in the British Ability Scales word reading test that we used in this study. At the age of 14 years, children are expected to be able to read word like GENERATION and CHARACTER. By the time they are 17, they are expected to read CATASTROPHE and METICULOUS and to attain a reading age of 18 years they need to know words like MNEMONIC and ARCHAIC. Words like these are going to be encountered most often when reading rather than in everyday conversation.

Exposure to print interacts with reading ability. Many studies, including those carried out by Stanovich and colleagues, have shown that early reading levels are a good predictor of later levels. For example, in a longitudinal study that followed a group of children from 1st to 11th grade (Cunningham & Stanovich, 1997), reading in first grade was a strong predictor of reading 10 years later even after individual differences in cognitive ability had been accounted for. However, a key factor in the sustained development of reading ability was continuing exposure to print. As predicted by the ‘Matthew effect’, children who read a lot continued to develop their reading skills. Cunningham and Stanovich suggest that children who find it easy to learn to read will most naturally spend time reading. Conversely, children who find reading difficult will be less inclined to do so. So the question arises as to how much time deaf children and young people devote to reading?

This is clearly an important issue for future research but there are reasons for thinking that many deaf readers will be less inclined to read for pleasure than hearing peers. In this article, there was an association between the use of phonological coding – as evidenced by the presence of phonetic spelling errors in – and reading ability. As might be expected, the correlation was highest for single-word reading where the effect size was medium. This finding is consistent with that of Geers (2003) that phonological awareness was a predictor of reading level among children with cochlear implants. Because phonological skills continue to be important both for the acquisition of new vocabulary in reading and for reading itself, weak phonological skills could be seen as a barrier to becoming a skilled reader. In other words, poor phonological skills – and hence poor decoding skills – make reading a difficult task and so do not pave the way for reading fluency to develop.

The finding that many adolescents with a cochlear implant are not reading at an age-appropriate level can be seen as consistent with previous findings. However, the suggestion that peers with hearing aids may actually be doing better will be seen as controversial. What might explain this finding in this article? After all, the general point that reading becomes an increasingly self-driven process as children progress through school applies equally to children with a cochlear implant and to hearing aid users. There is, however, one difference between the two groups that might be important. As shown in Table 1, none of the children with hearing aids was in a mainstream school and the majority attended a school for the deaf. By contrast, 13 of the children with cochlear implants were attending a mainstream school and a further 16 were in a specialist unit where they would spend some time in a mainstream classroom. Might it be the case that the supportive environment of a school for the deaf provides a better setting for the continuing development of literacy skills?

This is a difficult question to answer, not least because the placement of deaf pupils in a particular educational setting is determined by many different factors including local policy, pupil and parental preferences, and the perceived need for additional support. It is important to note that almost half the participants in our study were reading very well in a mainstream classroom. The setting that appeared most problematic was the specialist unit attached to a mainstream school. Placement in such a unit, rather than solely in a mainstream classroom, implies a perceived need for continuing support and it may be for these children, for whom acquiring literacy is a struggle, that the support of a school for the deaf is particularly beneficial.

There is some evidence that children placed in a mainstream setting can experience difficulties. A study of children with cochlear implants, who were aged between 7 and 12 years and in mainstream schools (Mukari, Ling, & Chani, 2007), noted their “inability to access classroom instructions delivered orally.” Others have emphasized the crucial role of education in ensuring the children with cochlear implants develop to their maximum potential, highlighting the need for continuing specialist teaching even when children are taught in a mainstream classroom (Archbold, O'Neil, & Gregory, 2008). What is clear from our study is that, even with the considerable advances in hearing aid technology, many deaf adolescents continue to find literacy challenging, and it appears that many will require specialist support throughout their time at school.

Funding

Economic and Social Research Council (RES-000-22-2947) to M.H.

Conflicts of Interest

No conflicts of interest were reported.

We would like to thank all the pupils and teachers who assisted us in our study.

Appendix

A Words used in the spelling test

Aeroplane Ashtray Battery Biscuit(s) 
Butterfly Cake Church Circle 
Clown Elephant Envelope Eye 
Flute Giraffe Gloves Heart 
Kangaroo Magician Leopard Mouse 
Mushroom Onion Orange Peacock 
Piano Pigeon Scissors Screwdriver 
Shoe Snail Square Squirrel 
Strawberry Sword Telephone Television 
Tortoise Toothbrush Umbrella Helicopter 
Aeroplane Ashtray Battery Biscuit(s) 
Butterfly Cake Church Circle 
Clown Elephant Envelope Eye 
Flute Giraffe Gloves Heart 
Kangaroo Magician Leopard Mouse 
Mushroom Onion Orange Peacock 
Piano Pigeon Scissors Screwdriver 
Shoe Snail Square Squirrel 
Strawberry Sword Telephone Television 
Tortoise Toothbrush Umbrella Helicopter 

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