Skip to Content

Arnold School of Public Health

Improving Initial Sound Segmentation Skills of Preschool Children with Severe to Profound Hearing Loss

Approximately 12,000 infants are born each year with hearing loss, making hearing loss the most common of all birth defects (NCHAM, 2001; NIDCD, 2003).

Children with hearing loss show delays in developing spoken language and in acquiring preliteracy skills (Paul, 2009).The average 18- to 19-year-old with severe hearing loss reads on a fourth grade level (Stewart & Clarke, 2003). Only 3% of 18-year-olds who are deaf achieve the same reading level as the typical 18-year- old with normal hearing (Marschark, Lang, & Albertini, 2002). Despite technological advances in amplification for children with hearing loss (e.g., cochlear implants), the average reading level for this population has not increased in the past several decades (Trybus & Karchmer, 1977; Paul, 2009).

In children with typical hearing, phonological processing is an important precursor to early literacy skills (see Adams, 1990). Phonological processing deficits, including phonological awareness, in children with hearing loss may contribute to poor reading outcomes.

Phonological awareness is defined as an individual’s ability to analyze the sounds of spoken language (Wagner & Torgesen, 1987). To demonstrate phonological awareness, a child must attend to the speech sound structure of words, separate from a focus on word meaning (Snow, Burns, & Griffin, 1998).

It is generally agreed that children with hearing loss can develop phonological awareness, regardless of type of amplification or mode of communication. However, the development of phonological awareness in children with hearing loss lags behind their peers with typical hearing and does not appear to be sufficiently developed to support proficient reading (Harris & Beech, 1998; Miller, 1997; Paul, 2009; Sterne & Goswami, 2000).

No published studies of the response of children with hearing loss to phonological awareness intervention exist in the literature. The purpose of this single subject study was to evaluate whether initial sound segmentation training increased initial sound segmentation skill in preschool children with hearing loss. This study was the first step toward a group phonological awareness intervention study for this population.

Individual phonological awareness intervention was associated with an increase in phonological awareness skill for these two children with hearing loss. Both participants made gains during each wave of intervention. In addition to demonstrating learning of the skills taught in this study, the two participants demonstrated maintenance of skills learned. However, this maintenance of skills was not complete. Finally, generalization to proficient performance with sounds that were not taught generally was not observed. For children with hearing loss, it may be necessary to explicitly teach many sounds individually before children are able to generalize from phoneme-specific awareness to general awareness of initial sounds.


Werfel, K.L. & Schuele, C.M. (2011, June). Error analysis of initial sound segmentation in children with hearing loss. Poster presented at the Annual Symposium on Research in Child Language Disorders, Madison, WI.

Werfel, K.L. (2011, April). Phonological awareness training for children with hearing loss. Session presented at the Annual Convention of the Council for Exceptional Children, National Harbor, MD.

Werfel, K.L., & Schuele, C.M. (2010, November). Phonological awareness training in preschool children with hearing loss. Poster presented at the Annual Convention of the American Speech-Language-Hearing Association, Philadelphia, PA.