Episode 36 Show Notes 

(Read the episode transcript below) 

 On episode 36 of All Ears at Child’s Voice: A Hearing Loss Podcast, Wendy and Haley are joined by Dr. Krystal Werfel, a research scientist in the Center for Childhood Deafness, Language, and Learning at Boys Town National Research Hospital, where she also directs the Written Language Lab. Dr. Werfel has a bachelor’s degree in Child Development from the University of Tennessee, and completed her master’s in Speech-Language Pathology and her PhD in Hearing and Speech Sciences at Vanderbilt University. She is passionate about literacy in children with hearing loss, conducting research to better the outcomes for this population.  

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Episode Transcript:  

Haley: 

Welcome to all ears at child’s voice, a podcast has discussing all things, hearing loss. We aim to connect parents of children with hearing loss, with the professionals who serve them. I’m Haley Gubbins 

Wendy: 

And I’m Wendy Deters today on the show we talk to Dr. Krystal Werfel, a research scientist in the Center for Childhood Deafness, Language, and Learning at Boys Town National Research Hospital, where she also directs the Written Language Lab. Dr. Werfel has a bachelor’s degree in Child Development from the University of Tennessee, and completed her master’s in Speech-Language Pathology and her PhD in Hearing and Speech Sciences at Vanderbilt University. Krystal, thank you so much for being with us today. We’re excited to talk to you. 

Krystal: 

Thank you for having me. I’m excited to be here. 

Haley: 

Well, we’re so excited too, but before we jump in into our main discussion, we always ask our guests to share a little story from the past week or just a recent story from your life. It can be anything to help the listeners learn a little something about you. So does anything cute or funny or heartwarming come to mind? 

Krystal: 

Well, I have a 10 month old, so all of my stories currently have to do with him, but his newest thing is he’s not that interested in his toys. He mostly just wants to play in the laundry basket. So that makes our life pretty easy. 

Haley: 

Yeah isn’t it funny? They always wanna play with the thing, like not the thing you spent money on, but something around the house. 

Krystal: 

Yep. That’s awesome. So we’re not doing as much laundry, but he’s having fun.

Wendy: 

Clothes in it or clothes out of it? 

Krystal: 

The clothes out of it. And we’ve been putting his little pillow in it so that he has a little cushion. 

Wendy: 

Krystal, we know that there are so many things that we could talk to you about. You have such a wonderful body of work in terms of your research with children, with hearing loss, but today we’re gonna focus in on literacy. But before we do that, can you just tell us a little bit more about yourself? How did your journey as a research scientist come to be? 

Krystal: 

I always say that I became a scientist sort of on accident. I am from a really small town. And when I was growing up, the things that, you know, the guidance counselor would give as career options, were all the big things, doctor, lawyer, teacher. And so thinking about careers like speech, language pathology, wasn’t a thing that I was ever exposed to until college. And I was an early childhood education major. And my advisor actually had been an SLP before she went back to become a teacher. And as we got to know each other more, she said, “Krystal, I really think that speech language pathology is where you would be really happy.” So I started taking classes in that department. It was too late to get a degree there in terms of switching. And then the professor that I was working in her lab studied literacy in children with hearing loss. So it sort of was a happy accident and right away, I knew that that is what I wanted to do for the rest of my career. 

Haley: 

That’s such a unique way to come about being an SLP. And as an early childhood educator, I’m working with the three-year-olds right now. I can see how that one thing leads to another, but I find it really awesome that you are studying literacy and children with hearing loss, because as we know a lot of children only reach like the fourth grade level of reading and that’s something I was taught in my undergrad, and I’m sure Wendy, that’s something that you’ve heard as well. And so can you talk a little bit more about that because it’s such an interesting piece to the hearing loss that I don’t think people always think about and why a hearing loss might lead to later developing literacy skills. 

Krystal: 

Yeah. So I think there’s so many things we can talk about there. One is the fourth grade reading level. When you think about how you progress through elementary school in particular, in the lower grades, really your goal is to learn how to read and then you get to fourth grade, maybe third grade. Now everything seems to be shifting down a little bit in terms of expectations. There’s really a shift and you don’t have a reading class anymore. Instead, we now expect you to use these reading skills that you’ve acquired to learn the content areas. So I think it’s no surprise that we really see this plateau of a fourth grade reading level because in the schools we’ve really stopped teaching reading skills, folks who are struggling a bit often have additional services, but in terms of a comprehensive approach. It’s just not there anymore. And then when you think about the task of reading in terms of the complexity of the texts that we expect from early elementary school to fourth grade, and then on into middle school, some of the skills that you can sort of get by on, in elementary school, when the text gets more complex, when you have a lot more complex syntax to understand when you have words that you’re decoding, that don’t follow a simple sound to letter correspondence anymore, that really starts to break down. Another thing that I’ve been hearing a lot of, because I cite this fourth grade reading level a lot at the data we have is not that current for this number. And so I think it’s interesting to think about with the advances, both in amplification technology that we’ve had in the past couple decades, and also just in the science of reading. So not thinking about hearing loss, but just the science of reading and how do children learn to read the advances over the past few decades have been amazing. And so I think this is one area where we really need a lot more research is are we still seeing the same fourth grade plateau we’ve called it or has that shifted a bit? 

Wendy: 

Yeah, That’s what I was going to ask you. If you still feel like that statistic is relevant today and are you or other researchers looking at sort of breaking that down, you know, kids that do plateau at fourth grade, what kind of consistencies are you seeing across those kids? What factors really impact success in reading with kids, with hearing loss, 

Krystal: 

The main study that we have, most of our students haven’t made it to fourth grade level yet. So we start with them when they’re four years old and we follow them over time. The majority of our students now are in second grade. And so I can talk about the second grade and then I’ll talk about the fourth grade in a bit. So what we’re seeing in first and second grade is really that by school entry, it seems like we’re probably going to be able to predict who’s gonna go on to have difficulty with reading and who’s not going to. And what we’ve really seen as the main predictor of reading skills and spelling skills also is alphabet knowledge. So for children, with hearing loss, generally alphabet knowledge is not a skill that we’re concerned about at all. Consistently time after time, we see that in preschool, alphabet knowledge for children with hearing loss is as good as, and sometimes better than their peers who have typical hearing. But when you have a child with hearing loss in preschool or at school entry who has difficulty with letter names or letter sounds, that’s a real red flag that reading’s going to be really difficult. 

Wendy: 

So our alphabet sounds different than phonemic awareness or is phonemic awareness part of alphabet sounds? 

Krystal: 

So those two things are separate and then to be successful decoders, you have to put them both together. So letter names, there’s controversy of is this important or not, it’s a really good predictor, but is it related or is it just an indication of if you know, letter names you also will have these other kinds of skills. Letter sounds are really important. So being able to see a letter and know what the possible sounds are that it makes. And the phonemic awareness is understanding the sound structure of words, completely separate from letters. So, what we’ve seen with adults actually is that we can trick you into analyzing the sounds incorrectly. If we give you words where the letters don’t match up. So once you become literate, it’s really interesting. What we’ve found is that the letters really, really drive the way you think about sounds in a word. And one of the accommodations that we think about for students with hearing loss is, oh, well, let’s do a lot of orthographic kinds of things. And I think that’s something to be really careful for because we know that letters really override the way that you analyze sounds. And if you’re an adult, who’s a good reader, then that’s not that big of a deal because you’re not spending a lot of time sounding out new words that you come to. Or if you’re like me and you’re reading a book and you come to words, you don’t know, you just skip over it. It doesn’t make that much difference in your comprehension. But if you are having difficulty with reading and you’re having to sound out a lot of words, relying on letters, where the letters don’t give you a good idea of what that word might be in terms of traditional sound, to letter things, then that can make the task of reading even more difficult for you, because you’re not just trying to figure it out. You’re trying to overcome something that’s telling you the wrong thing. 

Haley: 

I taught actually some fourth graders, my first year of teaching, they were in a self-contained classroom. So they weren’t at that fourth grade reading level, but just kind of that piece where you were talking about, it’s so much harder to comprehend what you’re reading if you have to stop and sound it out. And I’m just thinking of, I had to take a phonetics class in college and water is spelled with a T, but we don’t say “waTer,” we say “waDer.” And that affects your reading and your comprehension. And just knowing that certain letters play into the word, they affect another sound within that word. And so just thinking about this starts in preschool as a preschool teacher. Yes. It makes sense that you should know the letter sounds and the letter name, but I didn’t necessarily think that that’s the predictor of if you’re gonna be a strong reader or not. That’s crazy that it starts so young. I mean, it makes sense, but that’s crazy to think about it three and four years old, that could be a big predictor of their success in the future. 

Wendy: 

So thinking about that, we can predict some reading skills pretty early on. What do you see as some things that are factors in success for children with hearing loss? Is it early amplification, good speech perception? What are the things that you’re seeing that tend to predict better reading outcomes? 

Krystal: 

So this is not reading, this is language, but we have a, a recent paper by Britney Gray who’s our lead SLP on the project. We looked at the rate at which children met the early hearing detection and intervention benchmarks, the screen by one month diagnosis by three months into early intervention by six months. And what we found is that the predictor of preschool language outcomes was entering early intervention by six months. So as long as you had made it through that process, by six months, it wasn’t as important if your screening had happened by one month or your diagnosis by three, but really making it through the whole bit by six months, the children who had that had much higher language outcomes than the children who had a more extended timeline of identification and starting early intervention. So that’s one thing that we think is really interesting in terms of how we counsel families through that process at the time, either of birth or the time that they start to suspect that something might be going on with hearing. So that doesn’t exactly answer your question, but in terms of language, that’s one thing we’ve seen. In terms of literacy. We really see that alphabet knowledge at all points in preschool predicts all the literacy skills that we’ve looked at so far. So non-word reading real word, reading, spelling, and reading comprehension, and the other kinds of traditional predictors that you would expect predict individual reading skills. So phonemic awareness is a really strong predictor of decoding words, conceptual print knowledge and oral vocabulary, complex syntax, grammar knowledge. Those are big predictors of reading comprehension, even as young as first grade. So it seems that with the exception of alphabet knowledge, which seems for children with hearing loss to be a particularly good indicator across all kinds of literacy skills, I think probably because most children with hearing loss don’t have difficulty with alphabet knowledge. So when you have someone who does, it’s a good indicator that extra intervention and extra support will be needed. And then so far what we found is that the predictors that you would expect for children who have typical hearing are really the same sorts of predictors for children with hearing loss. 

Haley: 

That’s really cool to know, because I think we think that everything has to be different for a child with hearing loss. And so that’s encouraging to hear that the predictors would be the same, but how do children with hearing loss learn literacy skills differently than children with typical hearing? Or is it the same? Are there differences or is it the same? 

Krystal: 

So I think there are definitely differences. So we know that in terms of, so if phonemic awareness is an area that I’ve studied a lot. So when we look at the acquisition of those skills in children with hearing loss, it seems that it follows the same broad developmental trajectory as for children with typical hearing. So we expect you to be able to analyze larger chunks of words like syllables or rhyming before you can analyze phonemes. That holds true for children with hearing loss and within each of those sound chunks that you’re analyzing, there’s an order of difficulty in terms of the task that we might ask you to do. So it’s easiest to match sounds, it’s most difficult to generate something. So if I ask you to tell me what sound does cat start with? That’s much more difficult than if I ask you, oh, do car and cat start with the same sound. That’s a much easier task. So in some ways, learning to read and acquiring these foundational literacy skills is quite similar to children with typical hearing. And that makes sense because we’re all learning to read the same language and the language really drives a lot of the things that are necessary in terms of acquiring the ability to successfully read or speak or understand any of those things. Some of the things we’ve seen that are different for children with hearing loss are specific approaches to intervention that we might need to consider. I study phonemic awareness a lot. My colleague, Emily Lund, who is a principal investigator on the ELLA study with me, she studies word learning and vocabulary. And one of the things that we found across both of these skills is that a much higher number of repetition of teaching episodes is necessary for children with hearing loss, to acquire F awareness and for word learning and vocabulary intervention. 

Wendy: 

That probably makes parents feel a lot better about how many times they have to say the word cat before their child learns cat and be less annoyed with us as professionals that are like repetition, repetition. 

Krystal: 

Repetition is a huge piece that we’ve seen is just, you have to repeat things so much more than you think are necessary. So I think it’s interesting to think about are we sometimes giving up too soon and switching to a new approach? So that’s one of the things we’re really interested in Emily and I are. We’re working on a grant proposal now to determine for early literacy skills, phonemic awareness, conceptual print, knowledge and, and vocabulary. What is the dose that’s necessary for children with hearing loss and are there demographic characteristics about particular children where we might have different kinds of dose levels? So we’re thinking about things like when you first received your amplification, if you were early identified and got hearing aids or implants early on, maybe you need a different dose level for intervention than someone who was much later for that process. So we’re thinking about things like that. 

Wendy: 

Yeah. And I wonder if that dosage falls off after a certain point, or if you’ve seen any of that, it’s like once the child really gets the concept, they seem just clinically what, what I see is over time, closer to three years old, that the dosage that they need decreases because they’ve gotten that pattern of learning words and then they don’t need as many repetitions. 

Krystal: 

I think that makes total sense because in any intervention, we’re not just teaching you that skill. So if we’re doing word learning, we’re not just teaching you, this is a book, a book is a thing that you read, but we’re also teaching you how to learn new words. So as you have more practice learning, new words, you need less instruction for that process. The same is true for phonemic awareness. So one thing that we see, we typically start with either syllables or rhyming, and it requires a lot of instruction to make some change in those skills. But then as we keep going, there’s less instruction that’s typically needed. Not because the task gets easier necessarily, but because the child brings more knowledge about how you do this task to the table, it’s always an interesting interplay and a balance between, how do you learn to do this task and how learned the skill? 

Haley: 

That’s so interesting to hear like your perspective, Wendy, as an SLP and you see them so young. And we talk about repetition all the time and in the school system, I feel like it’s a lot harder to spend that much time on certain words. We use Michael Haggerty here, which is Theon awareness program. And you do the whole at cat, put it together, cat. And sometimes you just feel like you can’t spend the right amount of time on it. So that child has had it solidified. And especially when you are in a larger group setting, like in a general education classroom, and you have children with hearing loss that really need these interventions. Sometimes as a teacher, it’s really hard to make sure you’re getting those repetitions to make sure they are so solid in those foundations. And of course our hope is like, you were saying, Krystal, with time, it will come, but you also wanna make sure they are so solidified in those basic understandings because man, that is a big, big indicator of what’s to come for them. Once they hit fourth grade, it’s not learning to read, it’s reading to learn.

Krystal: 

Well. And that’s one of the reasons that we think that intervention dose work is so important. One, because we need to know these things. As SLP, as teachers, we need to know how many teaching episodes should I expect a child to need to make progress. And how do I determine do I need to keep doing the same? Or when is it time to take a different approach? We need work that tells us those things for the sake of knowing them. But we also need work that tells us those things for the sake of advocating for appropriate services for children. So advocating to third party payers, that this is the amount of intervention that science says the, that we need. And so you need to pay for it and advocating to schools and the Department of Education that for a child, with these characteristics, being in a group of five kids for 30 minutes a week, where you’re maybe getting four or five minutes that focus on your particular skills, and maybe you got lucky and someone else in the group has similar goals to you. And maybe you didn’t because you’re going because you all have the same sort of schedule in your classroom. Not because you have the same goals. And I know that that’s not true everywhere, but it happens in enough settings that we need science to tell us these sorts of things. So then we can go and advocate for what our children need. 

Wendy: 

Well, I think as we’ve started to get into some conversations and I’ve had conversations with other people, we’re really trying to look into the difference between performance on standardized tests and actual functional performance, because what we’re seeing even more of now in our kids, their standardized testing scores by three years old, look within average. But then as we analyze their language further and look at things like number of different words, variety of language, just like you’re saying, those are huge indicators for reading. If you only have one word for big and you don’t have any other synonyms for that, if it comes up in print or in a story, you’re gonna have a hard time understanding that story. So I think we’re really all excited to have your research and learn more about dosage and about the specifics of language and not just relying on standardized test scores to determine what kids need in terms of services. 

Krystal: 

If you do a deep dive into my papers, you will learn very quickly that I am not a huge fan of standardized tests at all. And so. 

Haley: 

Me either! They’re not my favorite. I wonder why. 

Krystal: 

So I have a paper from, I think it was 2017 with Michael Douglas, and we looked at our preschoolers in the ELLA study early on the children who had language standardized test scores that would not qualify them for school based services in our area, which is one and a half standard deviation cut mark. And then we compared language samples of children who were matched on the standardized test child with hearing loss, child with typical hearing matched on the standardized test, raw score. And we looked at things like MLU, and we looked at all of Brown’s morphemes. And what we found was shocking. It wasn’t shocking to us, but it should be shocking that we have all these children who we say, oh, well, you don’t qualify for services. But when we look at your actual language use every day talking to another human, it’s not the same. Our kids are older now. And so we’re working on analyzing our first graders the same way. So looking at our first graders, standardized test scores, where in schools, they wouldn’t be getting services. A third party payer probably wouldn’t pay for them to receive services. So they’re getting anything, the parents are having to pay out of pocket, which shouldn’t happen. So now we’ll be looking at complex syntax as well as MLU and we haven’t separated out just the children and who have high standardized test scores yet, but we have looked at some complex syntax at the end of preschool. And one of the really interesting things that we found, I think really illustrates the interplay between vocabulary and grammar. So our children with hearing loss use a lot more headless relative clauses, for example, the one that twirls around. So children with hearing loss use a lot more of that sort of structure than children with typical hearing. And when you look through the samples, we thought, “why is this happening? This is a really later developing structure that these children with hearing loss are really good at.” And when you read the context of those structures occurring, the children with hearing loss are clearly talking around words that they don’t know. So a child with typical hearing would say, oh, the pinwheel. And the child with hearing loss doesn’t know that word. And so they’re talking around trying to describe what they’re seeing. That is amazing. 

Haley: 

I didn’t even think about that, but now that you’re saying it, I have students that say like, no, the red one, the red one do you mean the apple and you catch it. And that makes so much sense. They talk around what they don’t know. They find a different way to tell you.

Krystal: 

In some ways that’s really good coping strategies. Yeah. Still communicating. That’s great. But also for us thinking about there are a lot of routes to get to the same score on a standardized test and very rarely do any of those routes make a difference for the actual way that you talk to other people. 

Wendy: 

I know we don’t wanna get too far into this, but do you see any difference in terms of type of instruction or communication modality and how that affects kids reading levels? 

Krystal: 

That’s not something that we have a lot of in our study because we narrowed the communication modality. So to be eligible for our study, you have to primarily use spoken English. So we do have some children who also use some sign language, but it’s always in a support modality rather than as a language from our data, we definitely can’t make any comments about that. There are some literacy based approaches like visual phonics and things like that that use not sign language per se, but use multiple modalities. And in the dyslexia literature, multisensory reading instruction is something that has really had a lot of attention recently and seems to be really effective. So I think in terms of reading as many different ways as you can experience the literacy task, that seems to be really helpful. For children with hearing loss it seems that having language, whether it’s spoken language or sign language is a good predict of later reading skills, but in terms of really narrowing down who should be choosing which modalities for long term outcomes, I don’t think that our science is there because it seems that that choice is most often made based on the particular counseling that individual families receive and not necessarily based on a scientific approach to choosing the best way for an individual child to learn language. So that’s an area. I think we have a lot of work ahead of us. 

Haley: 

I’m glad though, that you talked about the multisensory approach because I’m currently in graduate school and we talk a lot about the universal design for learning is making sure everybody has access to everything through multisensory approaches and doing something like a visual phonics or something just as a support to make sure that child is getting all of those sounds, is understanding that certain phoneme, I just love how that can tie in together. So you might have a child with a hearing loss who might need a little bit more support and doing a multi-sensory approach to it or direct instruction through a universal design for learning is great. How do parents ensure that their child is in a good reading program at school? What should they look for and what should they, you mention advocate for, if their child isn’t getting everything they need, what should they be looking for and how do they approach that? 

Krystal: 

It’s always tricky because it’s very hard for anyone to go into a school and say, you need to change the way that you teach treating. And it’s also not feasible for you to figure out, “oh, the school that I’m zoned for is not doing what I would prefer. And how do I get to a new school?” That’s a hard place to be in, in terms of a good reading program. I think what you want to look for in elementary school is that there’s explicit instruction for phonemic awareness, that there’s explicit phonics instruction, and that there are authentic reading experiences that occur. So perhaps you learn phonics in books like “See spot run” that don’t have a lot of story, but that there are other experiences in the classroom where you have these really beautifully illustrated story books that are available for children to interact with on their own. And that also the teacher is doing a lot of reading and really scaffolding children up to that comprehension level. So I think you really wanna have both. You want to be learning the basics of how do I decode this text that’s on the page and how do do I comprehend. Once I break the code and I’ve figured this part out, how do I make sure that I understand what I read? And I think what I see is very important for children with hearing loss is that this can be really hard. Learning to read can be really hard. And how do we keep you loving reading, where it’s not something that is a chore and that you only do exactly what someone tells you you have to do. And then you never get to experience that as a lifelong enjoyment activity. 

Wendy: 

Yeah, That was gonna be another question I have taking it back even further to knowing if your child’s in a good reading program at school, what can families do at home starting, even as babies? What are some things that you would suggest parents incorporate into their home environment to facilitate reading growth? 

Krystal: 

We’re developing an intervention program right now for conceptual print knowledge and conceptual print knowledge is things like children know how books work. So where’s the front of the book? How do you turn the pages in the book that in English we read from left to right? And from top to bottom, those sorts of things, and also knowing how words work. So some words can be long. Some words can be short, generally the length of the word maps to how long it is when you say it. Although that’s not always true. The space in between words tells you where the boundaries are, those kinds of things. So in your book reading sessions that you do at home choosing books that are particularly salient for the print, I think is really helpful. Some of the “Spot” books are really good at that. So they have not a lot of text on the page. The text is usually large print and there’s a lot of words embedded in the illustration. So that gives the opportunity to really point out “Spots saying right here”, explicitly directing the children’s attention to the text and explicitly talking about how the words are written on the page. That’s how I know what to say. This is a big word. This is a little word. This word starts with this letter and really integrating, talking about the text. That’s one skill that we’ve seen with children with hearing loss, where in preschool, they score much lower on measures of conceptual print knowledge than their peers with typical hearing. And that’s the opposite of what we see with alphabet knowledge. So thinking about what children with hearing loss know about print, alphabet knowledge, really as strength, knowing more of the concepts of books and text is more of a place where I think parents could take an opportunity and something you’re already doing to add in some explicit instruction. 

Haley: 

Yeah. It sounds like you’re suggesting to be intentional with that time. I know a lot of people say, oh, we’ll read before bed, but make it more than just reading a book. It’s pointing out those words, it’s pointing out the pictures and how that relates to the words that are on the page. Like you said. So it’s really just making the most of that time for that 10 minutes reading and pointing out those little things that we wouldn’t really think to do, but it could benefit children with hearing loss in the long run. 

Krystal: 

Yeah, exactly. And when you go to the library or to the bookstore, flipping through books and picking one that have texts where a lot of children’s books have just typical black text, like you would expect, but then you can also find where the font changes, the color changes. Any of those sorts of visual changes are really helpful for directing children’s attention to the text and really being able to start those sorts of conversations. 

Haley: 

Those are the words that the kids like, I’m just thinking of when you read old McDonald had a farm, E I E I O is always bigger and the pig noises are in pink. So it’s just bringing their attention. I didn’t even think about that. That’s such an easy way. We do it all the time as teachers and as parents, but to be more intentional about it. 

Wendy: 

In relation, Krystal, you were pointing out long words versus short words, there’s a really incredible book. It’s not great for kids under three, but “The Book With No Pictures” is so fun. I was just thinking about the length of sounds that you make. And the words in that book is super fun. 

Krystal: 

Yes. My son’s favorite book right now is the “Pout Pout Fish”. Every time it goes through the chorus of the book, there’s “blob blob blob”, and he’s 10 months and he loves it and I’ve started to notice him paying more attention. I’ll track the word and I track it the same length that I say that word and he’s starting to notice that text. So simple things like that take no extra time in the book reading and really can make a difference. 

Wendy: 

Well, one other question we wanted to ask you about children with hearing loss and literacy. I was looking through your research and you have a paper on location and literacy. We had an episode about healthcare disparities in children with hearing loss. Can you tell us a little bit about what you found in terms of location or where children live in terms of reading in their prognosis? 

Krystal: 

At the outside of the study, we didn’t set out to be able to about healthcare disparities. When the study started, Emily was based in Texas and I was based in South Carolina and neither of us are at large centers that serve children with hearing loss. So we had to just be creative in recruiting enough participants to be able to ask this, the research questions that we were interested in. So we ended up using Facebook as a recruitment tool, and we have participants in 38 of the states in the US. And they’re in a wide variety, some live in urban environments, a lot live in suburban or rural environments. So in this latest paper, we were interested in location effects on literacy, because we just had intuitively noticed that the further from a major center you lived, the more parents talked about struggling to get services for their child. Or we noticed that sometimes skills were not as strong as what we saw with kids who were located near a preschool, specifically for children with hearing loss or major healthcare center that really specialized in cochlear implants or hearing aids. So in this paper, we found that alphabet knowledge for children with hearing loss in rural locations was lower than children with typical hearing. 

Wendy: 

Sounds like what you’re saying is similar to what we talked about with Dr. Bush that the further away are from a major medical center or access to services that throws on another layer of challenge when we’re talking about kids with hearing loss. 

Krystal: 

Yeah, absolutely. And I think it’s also interesting to think about what we know in the literature about children with hearing loss, including studies that I’ve been involved in in the past, generally children are recruited from these major healthcare centers where they’re receiving pretty good services. Last weekend, I was visiting one of our families and this family lives in an area where they’ve really had to fight tooth and nail to get a pediatric audiologist instead of a general practice audiologist and find an early interventionist who’s ever had experience with a child with hearing loss. And so those sorts of things are much more difficult when you live in a place that doesn’t have a lot of resources. So we think telepractice has huge potential to help lessen some of these healthcare disparities that we see based on geographic location. So we’re hoping that as we pass the pandemic and things in person start being the norm, again, that telepractice continues to be an option for families who don’t have the resources to drive three hours a week to get speech and language services from someone who has specialty training in working with children with hearing loss so that they don’t have to make those sorts of decisions for their family. 

Wendy: 

I think we’ve all have gotten a lot better at teletherapy over the last year and a half, whether we like it or not. So hopefully that is, as we’ve talked about many times a positive effect of the pandemic, if there can be any. 

Krystal: 

Well. Yeah. And I think also thinking about third party payers. So I know from South Carolina, that’s where I was living during most of the pandemic. There had to be special policies for telepractice to be covered and they kept getting extended and extended. And so thinking about having science that can be used to advocate for those sorts of things to not have to be lobbied for anymore, but for them to just be typical practice. 

Haley: 

Yeah. It’s making everything more accessible. So we don’t have these disparities. We already know that children with hearing loss might be at a disadvantage when it comes to reading and literacy. And so making these things more accessible. So to wrap up this amazing discussion, what final advice do you have for our listeners when it comes to literacy and hearing loss? 

Krystal: 

Three things first is think that literacy will be tremendously more difficult for a child with hearing loss, I think is something that has been really prevalent in the past. So I would like to see us as a field and as a profession and as partners with families really shift our thinking to not, this is going to be this barely surmountable problem, but really we know enough to in preschool and early intervention really set you up for pretty good success. So my hope is that for children, with hearing loss, who are in the process of early intervention now are being born and will come along later that this is not a conversation that we have to keep having every decade, the way that we have from the beginning of time. And second sort of related to that, thinking about particular types of intervention, modifications that we know are really helpful for children with hearing loss and for listeners who are involved in speech, language, pathology, training programs, early childhood education, teacher of the deaf training programs, thinking about how do we integrate that kind of knowledge in a meaningful way for all of the students. So thinking particularly about speech language pathology, it’s such broad degree with the same degree, there could be 15 of us in a room and all 15 of us work with a different population, different ages, different particular skills that we work on. But if you are a school SLP, you really have to be an expert in everything. And so how do we make sure that training programs are preparing future professionals to do really, really good intervention with children, with hearing loss in particular, but with all populations. And then third, I think if you are a parent or a loved one of a person with hearing loss, really thinking about how you are empowered to teach literacy, so this is true for children with hearing loss, teaching, reading in the us in schools and across English speaking countries actually is an issue that is at high debate right now. What’s the best way to teach reading? How should we be doing it? Should we really be focusing on phonics? Maybe not, that’s one side, should we really be focusing on just providing alls of like, experiences so you can experience a book, but you can’t actually read it. And so thinking about like, how do we meet in the middle and how do we as professionals help families and how do families help professionals promote a well rounded reading program for schools in intervention? We know a lot about how reading works. We know a lot about how children with hearing loss learn to read. And so just as a huge partnership between all of the parties involved, how do we really advocate for those things to happen in practice? 

Haley: 

I think that’s a beautiful way to put it and a beautiful way to end it’s the team effort. Well, thank you so much, crystal, for joining us today, your passion for this topic shines through everything you said today, and I just really appreciate the research that you’re doing for our population. So thank you so much. And thank you for joining us on another episode of all ears at child’s voice. Be sure to join us for our next episode. We release episode once monthly 

Wendy: 

And you can follow us. And this podcast on Instagram with the handle @childsvoicepodcast, 

Haley: 

We’d love to hear from you. So please send us an email@podcastchildvoice.org, and you can find episodes, show notes and archived episodes at our child choice website, child voice.org. And if 

Haley: 

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Haley: 

Thanks for listening. Bye! 

Wendy: 

Bye! 

Krystal: 

Bye! 

 

Haley: 

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Children:  

Bye! Thanks for listening!