Modeling adolescent reading in children who use cochlear implants or hearing aids

The National Institute on Deafness and Other Communication Disorders awarded Father Flanagan's Boys' Home $656,908 on August 1, 2026, under the Research Related to Deafness and Communication Disorders program (CFDA 93.173) to model adolescent reading in children who use cochlear implants or hearing aids.

The research examines the relationship between early oral language, phonological processing, and print knowledge with literacy achievement for deaf and hard of hearing children developing spoken language through amplification. The study addresses a documented gap: deaf and hard of hearing children exhibit delayed literacy skills compared to hearing peers, with performance deceleration beginning around fourth grade. Reading outcomes for deaf and hard of hearing children are worse than for hearing children with reading disabilities. Although cochlear implants and hearing aids have advanced, language and literacy outcomes remain more variable for deaf and hard of hearing than hearing populations. The research seeks to identify which deaf and hard of hearing children face the greatest risk for language and literacy deficits, develop better screening methods, and advance theoretical understanding of literacy development in this population beyond the elementary years, when academic curricula shift from teaching reading to assuming skilled reading ability.

The work is performed in Omaha, Nebraska, with a period of performance from August 1, 2026, through June 30, 2031. The assistance type is a Project Grant.

Abstract

The long-term objective of this programmatic line of research is to elucidate the relation of early oral language, phonological processing, and print knowledge with literacy achievement for deaf and hard of hearing (DHH) children who use amplification and are developing spoken language. This translational work supports nidcd's mission of reducing the burden of communication disorders such as hearing loss and will result in better methods of identifying DHH children who are most at-risk for language and literacy deficits and greater understanding of theoretical approaches to literacy for DHH children. DHH children exhibit delayed literacy skills through childhood compared to children with typical hearing (TH), and progress for DHH decelerates beginning around 4TH grade. Reading outcomes for DHH children are even worse than for TH children with reading disabilities. Even with advances in hearing technology like cochlear implants and hearing aids, or perhaps as a result of audibility differences, language and literacy outcomes are more variable for DHH than TH. After grade 4, schools rarely focus on learning to read; instead, academic curricula assume skilled reading that allows students to learn in the content areas. For DHH children, however, many of whom have difficulties with skilled reading, there is critical concern about the impact of difficulties with spoken language and literacy on academic outcomes during middle school. Not all DHH children experience literacy difficulties, however. Children who use cochlear implants have mean literacy scores below the average range, whereas children who use hearing aids in general have mean literacy scores within the average range. There is a vital need, therefore, for research that elucidates literacy difficulties of DHH beyond the elementary years to identify and, in the future, intervene in a mismatch between development and academic expectations, and to identify which DHH children are most likely to exhibit long-term difficulties with literacy acquisition. The proposed study will include an existing national sample of 144 children, encompassing three groups: children with cochlear implants, children with hearing aids, and children with typical hearing. The aims of this longitudinal study are to (a) determine the developmental trajectories of spoken and written language for DHH children across the middle school years (grades 5 to 9), and (b) evaluate the utility of the simple view of reading theoretical framework for DHH children, including an expansion of this theory to include an evaluation of the contribution of auditory and visual skills to reading. By leveraging this existing sample, we will also be able to determine developmental trajectories of language and literacy acquisition in DHH children from grades 1 to 9. This study will provide a better understanding about how spoken and written language develop in DHH children, as well as how amplification type may differentially influence development. Such knowledge will have a significant long-term impact on identification of DHH children who are most at-risk for spoken language and literacy deficits, as well as the development of high-impact interventions.