and Blending Skills in Hearing Nithreen Said*, Mirahan Thabet*, Rasha ElKabarity*, Faculty of Medicine, Ain Shams University, Egypt عظيما"

Transcription

1 Phonemic Comparison, Segmentation and Blending Skills in Hearing Impaired Children Nithreen Said*, Mirahan Thabet*, Rasha ElKabarity*, Hassan Ghandour** Audiology Unit*,Phoniatric Unit**, Faculty of Medicine, Ain Shams University, Egypt الرحمن الرحيم بسم االله " و علمك مالم تكن تعلم و كان فضل االله عليك و علمك مالم تكن تعلم و كان فضل االله عليك عظيما"

2 Reading achievement among hearing impaired children has received considerable attention over the past two decades. The evidence continues to document severe reading deficits for this population.

3 To learn reading, the child must be able to hear phonemes,, see letters and relate them to each other. When this becomes automatic and efficient, the child can read words ( Moats, 2000 ). + = Phonological awareness is defined as the ability to abstract and manipulate segments of spoken language ( Anthony et al., 2005, James et al., 2008 ). Phonological awareness is the first step in teaching the child the code to read ( Billard et al., 2009, Nathan et al., 2004 ).

4 Three distinct levels of phonological awareness are proposed: p breaking individual words into smaller units from words to syllables, then into the onsetrime level and finally into the phoneme Level ( Anthony et al., 2003, Stahl & Murray, 1994 ). Words Syllables Onset-rime Phonemes Phonemic awareness is the highest level of phonological awareness which is focused only on the manipulation of phonemes ( Anthony & Francis, 2005, Hulmeetal., 2007, Lonigan et al., 1998 ). It is the most crucial level in phonological awareness skills to success in reading and spelling. ( Lonigan et al., 1998, Wagner et al., 1994 ).

5 Hearing impaired children have got many challenges to acquire phonemic awareness and subsequently reading skills as inability to access phonological information through auditory channel is a barrier to phonological processing skill acquisition. Accordingly, this study was designed to explore issues related to the development of auditory phonemic awareness skills in hearing impaired children.

6 Subjects and methods The study group comprised of: Fourteen children with sensorineural hearing loss ranging in age from 7-13 years. The children were recruited from the Audiology Unit, Ain Shams University hospitals during the year 2009.

7 Subjects and methods The criteria for inclusion were that all children had: Sensorineural hearing loss with regular binaural hearing aid use. Average intellectual t l ability as evidenced d by Arabic Hiskey Nebraska test for learning aptitude. Good reading ability and scholastic achievement as evidenced by parent's report. Subjects and methods The study was conducted on fourteen children with sensorineural hearing loss with age range between 7-13 years (mean 10.3 ± 1.88). All children had average IQ with Arabic Hiskey Nebraska test t for learning aptitude (91 ± 6.992). All the children were attached to mainstream schools and used aural-oral route for communication mainly.

8 Subjects and methods All hearing impaired children were using hearing aids binaurally and regularly with satisfactory aided response. Subjects and methods All children were subjected to the following: History taking including full medical and audiological i l history. Full audiological i l assessment. Immittancemetry was done to exclude middle ear problems. Psycho-social evaluation using Arabic Hiskey- Nebraska test of learning aptitude to assess their intellectual ability.

9 Subjects and methods All children were subjected to the following: Language test using standard Arabic language test t ( Kotby et al., 1995 ). Assessment of phonemic awareness skills. Subjects and methods Assessment of phonemic awareness skills (comparison, segmentation and blending): These abilities were assessed using informal remediation test material developed in Arabic language in Audiology Unit, Ain Shams University ( Tawfik et al., 2005 ). In this study, certain material were selected to assess the phonemic comparison, segmentation and blending which is presented through auditory channel.

10 Subjects and methods Phonemic comparison skill: two tasks were used: Task I: to identify the word that starts with the initial phoneme of an assigned word. e.g Magazine Cat, Monkey, Donkey, Basket. (Stipulated as phoneme identification or isolation in other reference ( Picard, 2002 ). Subjects and methods Phonemic comparison skill: two tasks were used: Task II: to find three words that start with the initial phoneme of an assigned word. e.g. find three words that start with the first phoneme in the word Bat. Bat Bag, Bad, Ball.

11 Subjects and methods Phonemic segmentation skill: two tasks were used: Task I: to omit a phoneme from a word and mention the rest of the word. e.g. Dog without g Do. (Stipulated as phoneme manipulation or deletion in other references. ( Picard, 2002, Carroll et al ). Subjects and methods Phonemic segmentation skill: two tasks were used: Task II: to count the number of phonemes in a word. e.g. Cat c, a, t 3.

12 Subjects and methods Phonemic blending skill: to blend a number of letters in a correct order to form a word. The number of letters used ranged from two to six. e.g. a, r, m arm.

13 The study was conducted on fourteen children with sensorineural hearing loss with age range between 7-13 years (mean 10.3 ± 1.88). All children had average IQ with Arabic Hiskey Nebraska test for learning aptitude (91 ± 6.992). All the children were attached to mainstream schools and used aural-oral l route for communication mainly. The results of the current study were divided into three sections: Demographic analysis of the hearing impaired children. of phonemic awareness tasks. Effect of different variables.

14 Demographic analysis of the hearing impaired children. Table 1. Mean and Standard Deviation (SD) of hearing parameters (from history) among hearing impaired children. Hearing parameters Mean SD Onset of hearing loss 2.3 years 1.9 Duration of hearing loss 7.7 years 2.6 Relative hearing loss duration* 73.9 % 19.8 Time in sound 8.6 years 2.7 Relative time in sound 74.6 % 29.0 * Relative hearing loss duration is a percent ratio between the duration of hearing loss and the chronological age of the child. Time in sound is the sum of duration of use of amplification and the duration of auditory experience before hearing loss (25). Relative time in sound is a percent ratio between the time in sound and the chronological age of the child.

15 Fig 1. Pie chart to show distribution of the hearing impaired children according to the onset of hearing loss. Table 2. Mean and Standard Deviation (SD) of audiological parameters among hearing impaired children. Hearing parameters Mean SD Average pure tone in the better ear 77.9 db HL 22.6 Speech discrimination in the better ear 44.8 % 28.6 Average aided d pure tone 31.5 db HL

16 Fig 2. Average pure tone threshold and aided threshold in the better ear A A A A O X X A X A O X Code: O O O O O O AC O X-----X No BC A A Aided Hz Fig 3. Pie chart to show distribution of the hearing impaired children according to the degree of hearing loss.

17 Fig. 4: Bar chart to show language test results in the hearing impaired children. of phonemic awareness of phonemic awareness tasks

18 Fig. 5: Bar chart to show comparison between hearing impaired children performance and normative data in phonemic awareness tasks (Tawfik et al., 2005).. Hierarchy of phonemic awareness development in normal children: Identification Blending (age 6) (age 6) Segmentation (age 6-7) Deletion (Age 7+)

19 Hierarchy of phonemic awareness development in normal children: Identification Blending Segmentation Deletion (age 6) (age 6) (age 6-7) (Age 7+) Table 5. Correlation coefficient among phonemic awareness tasks results in hearing impaired children using Multivariant Analysis of Variances (MANOVA) test. Aspects of phonemic awareness tasks Comparison(I) Comparison (II) Segmentation (I) Segmentation (II) Blending Comp. (I) Comp. (II) Segm. (I) Segm. (II) Blending r P * r P ** ** r P *** ** r P ** *** 0.898*** ** r P 1.000

20 Comp. Blend Segm. Ident. Delet. Phonemic awareness Effect of different variables Intellectual ability (IQ). Hearing parameters.

21 Table 6. Correlation coefficient between phonemic awareness results and intellectual abilities in hearing impaired children using MANOVA)test. Aspects of phonemic awareness tasks Comparison (I) (Identification) Correlation Coefficient r p 0.580* Comparison (II) 0.837*** Segmentation (I) 0.820*** (Deletion) Segmentation (II) 0.652* Blending 0.619* Table 7. Correlation coefficient between phonemic awareness results and hearing parameters in hearing impaired children using (MANOVA) test. Aspects of phonemic awareness tasks Onset of hearing loss Relative duration of hearing loss Relative time in sound Comparison (I) (Identification) r P * * Comparison (II) r P * Segmentation (I) (Deletion) r P Segmentation (II) r P Blending r P

22 conclusion Hearing impaired children performance in phonemic awareness tasks is characterized by a longer and more protracted learning phase than hearing counterparts. Early, proper and regular amplification will fasten the phonemic awareness acquisition.

23 recommendations To test phonemic awareness skills in hearing impaired children. Training on phonemic awareness skills should be routinely enrolled hand in hand with auditory training for hearing impaired children which in turn enhance their reading skills.

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