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Arnold School of Public Health

Krystal Werfel extends study on language and literacy acquisition among children with hearing loss with NIH R01 grant

October 8, 2018 | Erin Bluvas,

Communication sciences and disorders (COMD) assistant professor Krystal Werfel has been awarded a $3,267,388 ,five-year R01 grant from the National Institute on Deafness and Other Communication Disorders (NIDCD). She will use the award to support the continuation of an existing project, Early Language and Literacy Acquisition in Children with Hearing Loss, that was funded by an R03 grant from the same organization. 

In the R03 project, which began in 2015, Werfel compared language and literacy acquisition of children with hearing loss to children with normal hearing over the preschool years (ages 4-6). The new grant will allow Werfel and collaborator Emily Lund of Texas Christian University to continue following this cohort through elementary school and enroll new children at the preschool level to allow adequate comparisons between children with hearing loss who use hearing aids and those who use cochlear implants.

“Children with hearing loss, even those who use amplification devices, such as hearing aids and cochlear implants, and develop spoken English are at very high risk for reading and writing impairment,” explains Werfel. “These low literacy skills lead to low educational outcomes, low numbers of students with hearing loss who seek and obtain higher education, and under- or unemployment as adults.”

Werfel, who joined the Arnold School’s COMD department in 2013, conducts research that aims to reveal the development of emergent literacy skills in children with hearing loss and how these foundational skills influence later reading and writing achievement. Lund brings expertise in early word learning and the impact of lexical-semantic on early literacy skills to the project. Their goal is to turn their findings into practical guidance for helping children with hearing loss acquire literacy skills at the preschool level and beyond.

According to NIDCD, two or three out of every 1,000 children in the United States are born with a detectable level of hearing loss in one or both ears. Previous research has shown that despite technological advances in amplification for children with hearing loss, literacy achievement for this population has not increased over the past several decades.

Further, all degrees of hearing loss have been shown to have an adverse impact of reading outcomes ability. The fact that more than 90 percent of children are born to hearing parents compounds the call for research from the scientific community in order to provide essential support to this underserved population.

“There is a critical need to develop methods of identifying which children with hearing loss in the preschool years are most at-risk for later deficits so that high-impact intervention can be initiated as early as possible,” says Werfel, whose initial R03 study showed that children with hearing loss exhibit difficulties in language and literacy acquisition, particularly in phonological awareness (ability to analyze the sound structure of words), conceptual print knowledge (knowledge about books and how language is represented with text), and complex syntax production (ability to use spoken language more complex than simple sentences)—all skills that children with normal hearing develop over the course of the preschool years and ones that serve as moderate to strong indicators of later literacy achievement.

Findings from Lund’s own R03 study suggest that children’s lexical-semantic knowledge deficits (what they know about word meanings and how words are related to each other) underlies the deficits in the three skills that Werfel’s R03 study revealed.

By working together on this R01 project, they aim to identify which skills are most difficult for children with hearing loss and which skills are most important for their later literacy success. Long term, they hope to discover how researchers, teachers, and clinicians can better prepare children with hearing loss to be life-long successful readers and writers—beginning in preschool.


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Werfel expands knowledge base on children with hearing loss who are learning spoken language

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