For Peer Reviewpsibasica.uma.es/javiergarciaorza/upload/personal/inferential_textsC… · For Peer Review Reading comprehension of an inferential text 2 Abstract Purpose: The aim

For Peer ReviewReading Comprehension of an inferential text

in Deaf Students with Cochlear Implants using Cued-Speech

Journal: Journal of Speech, Language, and Hearing Research

Manuscript ID: draft

Manuscript Type: Research Article

Date Submitted by the Author:

n/a

Complete List of Authors: Torres, Santiago; University of Málaga, Basic Psychology Rodriguez-Santos, Jose-Miguel; University of Málaga, Basic Psychology Garcia-Orza, Javier; University of Málaga, Basic Psychology Calleja, Marina; University of Málaga, Basic Psychology

Keywords:Deafness, reading comprehension, Cued Speech, emotional inferences

Journal of Speech, Language, and Hearing Research

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Reading comprehension of an inferential text 1

Running head: READING COMPREHENSION OF AN INFERENTIAL

Reading Comprehension of an inferential text


Santiago Torres, José-Miguel Rodríguez, Javier García-Orza and Marina Calleja

University of Málaga, Málaga (Spain)

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Abstract

Purpose: The aim of the present study was to explore the ability of deaf children to

create emotional mental schemata during the reading process. Method: Five prelocutive

deaf children brought up under the Cued-Oral Model (MOC group), were compared to

30 hearing chronological peers (CA) and 28 young hearing persons with the same

reading level (RA) in an experimental narrative reading task where the target was a

sentence congruent or incongruent with the protagonist's emotion. Results: The reading

time differences between congruent and incongruent sentences showed that the deaf

young people performed similarly to the hearing group. Conclusions: Deaf young

people can reach high levels of reading, if the training program provides them with

wide knowledge on oral language and reading processing. Keywords: Cochlear implant,

cued speech, deafness, emotional inferences, reading comprehension.

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Reading Comprehension of an inferential text


The acquisition of high-level reading abilities, capable of transforming a deaf

child into an autonomous pupil, is a widely studied subject but questions still remain

(Bresson, 1996; Conrad, 1979; Harris and Beech, 1995; Kyle and Woll, 1985;

Lichtenstein, 1998; Marschark & Harris, 1996; Paul & Jackson, 1994; Torres & Santana,

2005).

Several studies have shown that deaf students at the end of their compulsory

education (mean age 17 years) have reading levels similar to or lower than the reading

levels of hearing students around fourth grade (mean age 9 years). The mean scores of

a sample of deaf pupils used as the normative value in the 9th edition of The Stanford

Achievement Test (SAT) have shown that this group did not reach the most basic level

in that test (Traxler, 2000). Thus, this group could be situated between the third and

fourth academic grade. The 80th percentile for this deaf sample is comparable to the

basic or below-basic performance level of hearing people. However, some young deaf

people have demonstrated a performance similar to young hearing people, although

these good results quickly decay with age (Traxler, 2000). Other previous studies have

obtained similar outcomes (Holt, 1993, Holt, Traxler & Allen, 1996). The best results

(Geers & Moog, 1989 and Lewis, 1998) have been attributed to excellent competence in

English oral language.

Skilled reading is the ability to derive meaning from a text accurately and

efficiently. To attain a high level of skill, novice readers must, through instruction and

practice, acquire two sets of abilities that are often studied separately but that actually

develop and operate interactively. First, in order to recognize printed words, children

need to become aware that spoken words are composed of smaller elements of speech

(phonological awareness): to grasp the idea that letters represent these sounds (the

alphabetic principle); to learn the many systematic correspondences between sounds

and spellings (decoding); and to acquire a repertoire of highly familiar words that can

be recognized on sight (word recognition). Second, to acquire strong reading

comprehension skills, they must develop the necessary knowledge base to understand

the messages conveyed by connected text. This includes background knowledge of

facts and concepts; a broad and deep vocabulary; familiarity with syntactic and se-


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mantic sentence structures; verbal reasoning abilities; and knowledge of literacy

conventions.

Becoming a skilled reader requires the development of all these components not

in isolation but interactively. Decoding, for example, depends on understanding and

using the alphabetic principle, which in turn depends on phonological awareness. As a

means to word recognition, however, decoding a letter string is of little value unless

the pronunciation the child arrives at can be paired with the pronunciation of a word

the child already knows in spoken form. Similarly, sophisticated comprehension

strategies will be of little aid in interpreting the passage unless the child can

successfully recognize most of its words. Thus, a low score on a measure of text

comprehension can result from weak comprehension abilities, from slow or inaccurate

word recognition skills, or both. For a review of scientific research on the reading

process and its acquisition, see the report of the Committee on the Prevention of

Reading Difficulties of the National Research Council (Snow, Burns, & Griffin, 1998).

Literacy and Deaf Children: the Language Question

A widely accepted point of view in the reading skills acquisition field is that the

reading process evolves better when oral language is well consolidated (as a function

of mastering oral language) (Dickinson & MacCabe, 2001). The role of oral language in

the education of deaf people has been widely analysed, as well as poor reading

achievement in this population.

Reading skills acquisition is hindered by problems and delays in oral language

acquisition. Hearing loss produces slow or incorrect development in oral language.

Deaf children have limited knowledge regarding oral language being represented in

the written language. Even though most deaf people can develop communication skills

at a functional level by means of other communicative modalities, like sign language,

the lack of good linguistic competence will be a critical problem in access to literacy.

Goldin-Meadow and Mayberry (2001) stated that the first step for the deaf child in

becoming a skilled reader is to ensure that he or she has well-developed language.

Children will never learn to read, unless they have a language from which they can

directly transfer written codes. Whatever kind of language the deaf child has learned

(ASL, CS, etc.), this will encourage him or her to read even if such a language does not

map onto the current one represented in written texts. In fact, it is a widely accepted

fact that good users of sign language show better reading skills than poor users of the


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same communication system. Despite sign and oral languages being organized in a

very different way, some deaf readers can make a correspondence between the

sentences from an oral language in a visual code based on sign language (Lichtenstein,

1998; Padden and Ramsey, 1998). However, it seems that acquiring good phonological

encoding skills is needed to achieve high reading levels. Such skills allow the deaf

child to match the written language to his or her own communicative modality.

In conclusion, an initial well-known and mastered language is necessary for

deaf children to gain access to reading abilities. This linguistic competence will include

decoding skills, lexical access skills, and semantic and syntactic processing skills. All

these enable the correct comprehension of the messages conveyed by connected text,

which also includes background knowledge of facts and concepts.

Sign Language and Literacy

Due to the fact that access to oral language is very difficult in deaf children, and

also based on evidence that they need a well-formed language to access literacy, the

current strategy has turned to sign language as an alternative to oral language.

Sign language accessibility has been used to argue in favour of this

communication system in the educational context. Deaf children can quickly develop

functional linguistic competence and use it to acquire a functional background about

the world as well as to acquire better levels in their reading skills.

Many studies support this choice because some deaf persons using sign

language, although few, are able to reach a good reading level. This performance is

usually accounted for by her or his linguistic skills. A characteristic feature of this good

reading deaf group is that at least one of the parents was deaf. However, Strong &

Prinz (2000) argue that this differential achievement between children of deaf parents

and hearing parents disappears when high levels of mastering the American Sign

Language (ASL) have been reached. A possible explanation of such results (deaf

children born to deaf parents obtained better results in reading tasks) would be that

these deaf children are good users of ASL. The early use of ASL helps deaf people

improve their linguistic competence. However, if this linguistic competence is reached

by other means, whether the parents are hearing or deaf becomes irrelevantand only

ASL proficiency of the child will be a relevant variable. Thus, Lichtenstein (1998)

supports the idea that deaf children can encode written language by means of sign-

based representations. These representations can mediate the reading skills.


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Other studies (Chamberlain and Mayberry, 2000; Hoffmeister et al., 1997;

Strong and Prinz, 1997; Padden and Ramsey, 1998) also maintain that well-developed

sign language enhances literacy acquisition. Moreover, they uphold the idea that this

sign language will provide, from very early in life, a sufficiently strong basis to

understand everything they read. However, it is not enough to know and master a

language. After all, when hearing children access literacy they master the oral language

but their success in reading tasks is not fully guaranteed. Children need to know the

correspondences between the oral or signed language they are using and the written

language present in the text. Deaf children have to know the correspondences between

the sign language they master and written language that they want to learn. In this

sense, because sign language does not have any correspondence with the sounds in the

oral language, there is a serious transfer problem between codes (signed-written

codes).

Despite sign language can establish some correspondences between words and

signs, but this communication system does not have its own orthography (despite

some promising attempts, see Herrero, 2003). This absence of orthography does not

permit deaf children to establish the correspondences between signs (or some of them)

and graphemes, because the alphabetic principle has not been fulfilled. Thus, deaf

persons face a very difficult task: to acquire literacy deaf people have to overcome the

code barrier in which both languages — signed and written language — are

represented. This barrier constitutes the main obstacle for sign language users in

learning to read. As sign language does not have its own orthography, it has to use oral

language orthography. Therefore, when deaf children are reading, they have to

recognize a familiar language (sign language) in non-familiar way (oral language)

coded in a non-familiar writing system (alphabetic orthography).

In the written language the phonological attributes of oral language are

represented instead of spatial attributes or the movements of sign language. Decoding

skills, necessary for an appropriate acquisition of literacy, cannot overcome this code

barrier in an efficient way. In this study, we present the results of a group of deaf

children in a reading comprehension task using another communicative modality,

Cued-Speech (CS henceforth). CS, as a communicative modality, offers some

interesting features for achieving good linguistic competence as well as for overcoming

the code transfer barrier.


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Access to Literacy by Means of the Use of Cued Speech: an Alternative Communicative

Modality

Cued Speech (CS) is a simple oral-based system comprising a limited series of

hand complements used together with the lip patterns of normal speech. The CS

system was created by O. Cornett in 1967 with the aim of offering a possible solution to

oral communication between deaf children and their parents, mainly during the

development of speech and speechreading skills, i.e. in the early years. In CS, two

components, hand complements and speech reading, work together to provide a non-

ambiguous visual representation of speech (Cornett, 1967; Torres & Ruiz, 1996, for the

Spanish version of CS). The main difference between CS and other manual systems are

the hand complements. Any hand complement consists of two parameters (hand

location and handshape), which are perceived simultaneously with the lip movements.

Hand complements, on their own, do not include elements which can offer a unique or

specific meaning. Hand complements play the role of cues to speech reading. Hand

shapes are intended to clarify consonants and hand positions to clarify vowels both on

speech reading. Hand positions and hand shapes are simultaneously produced at the

same rate as speech.

In the last two decades, many studies have been carried out to show the

potential of this system to help deaf people overcome their main problems: to achieve

good linguistic competence, master a language, and, especially, achieve good reading

ability. Thus, important studies have demonstrated that CS improves linguistic

development (see Hage & Leybaert, 2006, for a review), speech intelligibility

(Descourtiex, Groh, Rusterholtz, et al., 1999; Vieu, Mondain, Blanchard, et al., 1998),

cognitive processing (Charlier & Leybaert, 2000), and performance (Capouillez, 1989 ;

Clark, & Sacken, 1998), and finally, has contributed to improving reading levels in deaf

students (Alegría, 2004, for a review). It has been shown that, with CS, deaf children

(from babyhood) can visualise speech thus facilitating the learning of linguistic aspects

such as phonology, syntax and mastering grammatical vocabulary (Santana, Torres &

Garcia, 2003). Regarding speech input, the natural process of verbal learning is restored

by using CS at home (Torres, Moreno-Torres & Santana, 2006).

Using Cochlear Implants within the Oralist Approach

The widespread use of cochlear implants (CI) in the last 10 years has radically

changed the scope of the systems and methods used to cope with rehabilitating the


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deaf. An important consequence is that CI have become strongly allied with oralist

philosophy and, working together, have begun to offer interesting results, mainly in

children implanted at around 3 years old or even younger (see Geers, 2006; Nicholas &

Geers, 2006, for a review).

Several studies have investigated the linguistic competence achieved by deaf

individuals who have undergone very early cochlear implantation (Spencer, 2004;

Szagun, 2004; Svirsky, Lynne, Ying et al., 2002). The results obtained from these

studies, mainly carried out in clinical environments, have led to the idea that CI could

solve any problem concerning the acquisition of oral language in deaf individuals.

However, although it is currently accepted that CI is extremely advantageous for deaf

children, some differences still remain when they are compared to their hearing age

peers (Mukari, Ling and Ghani, 2006). Thus, the acquisition of oral language and, as a

consequence, the acquisition of good literacy, is not an accomplished fact despite CI

becoming technologically more advanced and that the implantation age has

dramatically decreased. The main questions are how to support oral language

development after cochlear implantation, help deaf children achieve good linguistic

competence and help them become skilled readers.

To try to answer the above questions, it is worth analysing the impact of both

CI and CS working together since they have led to important changes in language

acquisition among deaf people in recent years. On the one hand, CI significantly

improves audition and provides important benefits for speech perception (e.g. Blamey,

Sarant, Paatsch, et al. 2001), speech and language production (Horga & Liker, 2006),

linguistic development (McDonald Connor, 2006) and speech intelligibility

(Descourtiex, Groh, Rusterholtz, et al., 1999; Vieu, Mondain, Blanchard, et al., 1998). On

the other hand, data collected in the last 25 years have demonstrated that CS enhances

speech perception through the visual modality (Nicholls and Ling, 1982). As Hage and

Leybaert (2006) state, the introduction of CI has changed the situation of profoundly

deaf children raised with CS. Descourtieux (2003) carried out one of the few published

studies with deaf individuals using both CS and CI. The sample consisted of 55

children from 3 to 16 years old, including 42 who had a CI. Open-set word perception

was assessed in three modalities: auditory alone (A), auditory and speechreading

(A+SR), and speechreading and CS (SR+CS) without any sound. Performance under

A+SR and SR+CS conditions was higher than 80% correct. However, SR+CS conditions

showed a slight advantage over A+SR conditions. They concluded that the slight


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advantage offered by the SR+CS modality may indicate that there is a certain amount

of phonological information that is perceived more precisely through the CS modality

than through A+SR. Even in the group of younger children (3-4 years old) who

underwent implantation before 3 years old, CS seems to remain an efficient tool for

perceiving spoken language. Whatever the benefits of the CI are, intensive use of CS

can help to develop phonology. In this sense the combined use of CI and CS might be

considered a guarantee for language acquisition.

In our study, CS was inserted into an intervention program called MOC (MOC

in Spanish stands for Cued-Oral Model in English). MOC is a structured intervention

program for profoundly deaf children whose families use Cued Speech consistently

and systematically from an early age, before 3 years old. The main goal of MOC is to

improve deaf children's cognitive and linguistic development as a previous step to

reading. The purpose of the MOC program is to diminish or attenuate the impact of

deafness on oral linguistic development which is a hallmark in prelocutive profoundly

deaf individuals. Among the main features of MOC we can highlight the following: 1)

children must start this program before 2 years old; 2) deaf children must be equipped

with hearing aids (preferably cochlear implants) as soon as possible and must use them

in a systematic way; and 3) parents are taught to use CS with their children at home at

all times and in a consistent and systematic way. In order to learn CS, the parents

follow a computer-assisted instruction system (available at: www.uma.es/moc) and

have the permanent support of a specialist during their training to become good CS

users as quickly as possible.

Emotional Inferences in a Reading Comprehension Task

Next, we present a study carried out with a deaf population brought up

within the MOC program while using both cochlear implants (CI) as hearing aids

and Cued-Speech (CS) as a communicative modality. Deaf individuals were asked to

carry out a very complex text comprehension task. This experimental task was

designed to assess their ability to make and use emotional inferences where the goal

was to know whether deaf individuals are able to activate interpersonal schemas

with an emotional content while they are reading the proposed text.

This experimental task, from the reader's perspective, is a high-level task,

involving very complex reading skills. It involves strong pragmatic and cognitive

demands, as elaborative inferences usually do. To solve this task, deaf individuals


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http://www.uma.es/moc

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must activate interpersonal schemas, to assume mental states in their interlocutors

and, finally, to make emotional inferences. The results obtained by deaf people in this

test comprehension task are considered relevant because these results show us

whether deaf individuals in our sample are able to successfully cope with two main

questions: the inferential nature of this task; and, second, the emotional content of

these kinds of inferences. Following current theories on mental models on text

comprehension, building inferences is considered the hardest part in comprehending

narrative texts (van den Broek, Virtud, Gaddy, Tzeng and Sung, 2002). There is no

possible way to make progress in text comprehension without making some

inferences, which demonstrates our ability to build and analyse active information

from stimulation provided by the text. It is assumed that any comprehension text

process involves a strong inferential component either at a local level, -syntactic level-,

or at a global or situational level, -discursive level-. Both levels are interconnected

because, due to the linear character of the reading process, the syntactic level is an

obligatory step in the text comprehension task. In this phase the reader must identify,

store and connect any information to track more global ideas. On the other hand, a text

requires global coherence. Thus, these ideas are situated throughout the text and the

reader must match them and put them together to achieve global comprehension of the

text being read. Picking up these main ideas is usually one of the primary goals in a

text comprehension task.

The special nature of emotional inferences in narrative texts means that

individuals are able to integrate different pieces of information distributed throughout

the text because emotions are linked to the protagonists of the story. From this point of

view, emotions can contribute to providing global text coherence in contrast to the

local coherence provided by most of the other inferences (de Vega et al. 1996).

Emotional representations help to solve ambiguities and incoherences in the text as,

usually, coherence is broken due to the introduction of new characters, changes in

places and time, causal discontinuities, etc.

Method

Participants

Five hearing impaired children educated with MOC (MOC group) took part in

this experiment. The inclusion criteria for the MOC group established that participants


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should be older than 12 years old and they should have followed the MOC program

completely. This led outside of the group other children who have attended the MOC

unit in informal way or that, even attending to MOC and following the program

exigencies, at present were younger than 12 years old. Deaf participant characteristics

are shown in table 1.

A chronological age group (CA group) was formed to compare MOC

participants with hearing participants in the same age range. As our deaf group was

quite heterogeneous (ages: 12, 12:6; 13:4, 13:10, 16:11), the CA group was composed of

30 hearing participants taking into consideration the age proportions in the MOC

group. The deaf and the CA groups did not differ in chronological age (Z= 0.54, p =

.586).

INSERT TABLE 1

Another control group matched in reading age with the MOC group was also

formed (RA group). The group consisted in 28 hearing participants with raw scores in

a reading task similar to those obtained by deaf participants (raw score range: 12-18).

No differences in reading level (measured with the raw score in text comprehension of

PROLEC) between the hearing RA and the deaf groups arose (Z= 0.86, p= .38).

Although MOC participants were slightly younger than their reading age matched

hearing peers no statistical differences in chronological age between both groups

existed (Z= 1.63, p= .1),.

Materials and Design.

To properly compare the hearing and deaf groups according to reading level,

the text comprehension task of the PROLEC-SE (Ramos & Cuetos, 1999) was applied to


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all participants. PROLEC-SE is designed to test reading skills in an age range of 11-16

year-old children. The text comprehension task is the one which shows greater

correlation with the full score of this test and with teacher’s subjective ratings.

Participants were asked to read two short stories and answer 10 questions for each

story, making a direct score of 20.

Deaf participants’ linguistic skills were also evaluated and compared to hearing

people standard values using the Spanish version of CELF-3 (Clinical Evaluation of

Language Fundamentals, Semel, Wiig, & Secord, 1997). This test is designed to

accurately and reliably assess language difficulties. The test was administered to

control for the possible role of deaf participants’ linguistic competence in our narrative

comprehension task.

Inferences play a key role in language as well as in reading comprehension. The

experimental task involved the self-paced reading of emotional narratives that

described familiar situations for elementary school students. They were adapted from

De Vega et al. (1996) and were designed to demand the processing of global inferences

about main character’s emotional situation. Since this information was not explicit, the

correct judgment about emotional states in the narrative involved establishing

inferences about that state. Inferences were global (in opposition to local inferences)

because they were connected to the main character of the narrative during the whole

story. Forty two stories (2 practice stories, 25 emotional narratives and 15 filling

stories) were employed in the experiment. They have the critical segment in the middle

(11 stories) or at the end of the story (14 stories). Two versions of each story were built,

in one of them the critical segment was congruent with the story (v.g., in a context of

uncertainty: El se sintió inseguro/he felt unsafe), in the other, it was incongruent (v.g., in

the same context of uncertainty: El se sintió seguro/He felt safe). Congruent and


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incongruent segments did not differ in number of letters (Z= 1.4, p= .14) nor in word

frequency (Z= 0.3, p= .7).

For administration two sets of emotional narratives were built. The first set

mixed middle-final and congruent-incongruent narratives, and the second set was

constructed with the rest of the conditions, so all the conditions were evaluated in the

two sets. The two sets were counterbalanced across participants, therefore they saw 25

congruent narratives, 25 incongruent narratives and 30 filling stories.

Procedure

PROLEC-SE and CELF-3 were individually administered to participants

following the application norms of the tests. In the experimental task with the

emotional narratives, participants were seated in front of a 14’’ monitor and a

computer equipped with ERTS (Beringer, 1999). This program controlled the

presentation and registered reading times at the millisecond precision level. The

experiment consisted in a self-paced reading task using a non-accumulative moving

window procedure. The task began with three screens giving instructions. Participants

had to press the space bar to read the next segment. Two stories from the filler items

were used as practice texts. When the participant pressed the space bar or seven

seconds elapsed, the next segment was presented. Experimental stories were divided

in different segments. Stories ranged in length between 13 and 20 segments. Segments

never were longer than 10 words. In half of the stories, when the final segment

disappeared, a question followed by two alternatives came out on the screen.

Participants had to press one of the two shifts lateral keys to select their answer, the

key corresponding to the side of the chosen answer. The question was included to force

participants to read for comprehension and it was not related to the emotional state of

the story characters’. The two versions of each story were presented in different sets


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that were applied one after the other, with some minutes between them to rest. Within

each set, text order was randomized. The whole experiment lasted about 50 minutes.

Results

Before commenting data from the reading experiment, it merits attention the

scores obtained by the deaf participants in the text comprehension of PROLEC-SE and

in CELF-3.

In the text comprehension task of PROLEC-SE our five deaf participants

obtained percentiles ranging between 85th and 97 th (M= 90.6, SD= 3.97) (see table 2)

showing reading skills higher than those usually found in deaf participants. Moreover,

according to the normative data provided in the test, the deaf group obtained even

better scores than most of the hearings of the same age (as percentiles have been used,

the (hearing) normative sample of reference has a mean of 50). When deaf participants

were compared to the CA group included in our study (see table 2), statistical

comparison showed that they had better raw scores (Z= 2.11, p= .034). These data

confirm the efficacy of the MOC program in developing reading skills, our MOC group

showed higher reading scores than the group of thirty hearing participants matched in

chronological age.

INSERT TABLE 2

Regarding CELF-3, participants’ raw scores were converted into percentiles

according to their chronological age. Percentiles ranged between 60th and 90th with a

mean of 69 (SD= 12.5) (see table 2). This suggests that our deaf participants had higher

levels of linguistic competence than most of the hearing people of their chronological

age. Hence, in agreement with the data obtained in PROLEC-SE, our deaf participants

not only showed normal linguistic development, they even obtained higher scores than

the mean of hearing people.


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For the experimental task analyses, reading times in the critical segment less

than 500 ms or greater than 6000 ms were excluded. This affected to less than 3.5 % of

the data. Due to the small size of the deaf group two different types of analyses were

carried out. In the first block of analyses data from the deaf participants were subjected

to individual (case study) analyses, in the second block, group analyses considering

hearing participants were carried out.

Case analysis

Through non-parametric analyses with the Wilcoxon test, differences between

congruent and incongruent reading times were studied considering critical segment

position (mid or final). Deaf participants reading times in the critical segment are

shown in table 2 (significant differences in bold). These analyses showed faster reading

times in congruent segments in four of the five deaf participants when data from

middle and final text were collapsed together, suggesting these deaf participants were

able to detect the incongruence in the texts. This difference between congruent and

incongruent condition was maintained in three participants when the analysis was

carried out over position (see ECA, PHL and FGCH). In the case of DOM, the

significant difference found in overall analysis, dissipated when position was taken

into account, although the trend is clear in both positions favouring congruent over

incongruent texts, specially in final position (one tailed p= .07). Finally, although DMF

showed in both cases faster reading times in congruent texts, this trend was not

statistically significant (ps> .05).

Group analysis

In these analyses deaf participants were analysed as a group (despite their

heterogeneity regarding age and reading level) against two groups of hearing

participants, one group matched in age, CA group, and the other matched in reading

level, RA group. According to our hypothesis, and considering the reading scores


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obtained in PROLEC, a similar pattern of data was expected in deaf and hearing

participants with similar reading levels (i.e., significant differences between reading

times in congruent compared to incongruent segments). Regarding the CA group,

differences would depend on differences in reading level between the CA group and

the deaf participants.

Table 3 presents mean reading times in the critical segment for the MOC group

and the two control groups considering segment position and congruency. Non-

parametric analyses (Wilcoxon tests) were carried out in the MOC group regarding

segment position (middle vs. final) and congruency (congruent vs. incongruent). As it

was expected in the light of the case analyses, the MOC group showed significant

effects of congruency in middle position (Z= 2.02; p= .043), final position (Z= 2.02; p=

.043) and when all stories were considered together (Z= 2.02; p= .043). These analyses

indicated that MOC participants as a group were faster in the congruent than in the

incongruent stories, that is, they detected the incongruency, and this caused higher

reading times.

INSERT TABLE 3

In the CA group significant differences between the congruent and the

incongruent texts were found in the final position (Z= 2.87, p= .004) and when middle

and final data were collapsed together (Z= 2.77, p= .006). However, non significant

differences arose when segments in middle position were considered (Z= 0.73, p = .46).

This pattern contrasts with that found in the MOC group, where differences between

congruent and incongruent text always irrespective of critical segment position.

The deaf group was compared to the CA group to explore reading time

differences and, more importantly, the size of the congruency effect. The comparison of

the size of the congruent effect between both groups, using Mann-Whitney non-

parametric tests, showed that MOC participants were more affected by the congruency


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factor than participants in the same chronological group both in middle (Z= 2.97, p=

.003) and final position (Z= 3.21, p= .001), and when these data were collapsed together

(Z= 3.3, p= .001). Comparison also showed that although MOC participants read

numerically faster the congruent segments and slower the incongruent segments than

the CA group, these differences were not statistically significant (all ps > .05).

When the RA group was analysed, differences between the congruent and the

incongruent texts were marginally significant in middle position (Z= 1.65, one-tailed

p= .05), and fully significant in final position segments (Z= 3.28, p= .001) and when all

data were analysed together (Z= 3.8; p< .001). The pattern is closely similar to what has

been found in the MOC group. When the size of the congruency effect was compared

between both groups, results showed that MOC participants were more affected by the

congruency factor irrespective of the position of the critical segment (middle position:

Z= 2.88, p= .004; final position: Z= 2.88, p= .004), than their RA peers. This is the same

result found when the MOC group was compared to the CA group. Regarding the

reading times employed to read the critical segments (both incongruent and

congruent), the analyses pointed out that although MOC participants read numerically

faster the congruent segments and slower the incongruent segments compared to the

RA group, these differences only reached significance in the case of incongruent

segments presented in final position (Z= 1.8, one-tailed p= .03).

Discussion

A solid corpus of studies, carried out over the last 25 years, systematically

confirms the low terminal reading level of the hearing-impaired. Their deficiencies are

evident both in the reading specific processes, -phonological awareness, lexical

processing, problems with orthographic codes-, as well as in nonspecific processes, -

background knowledge, broad and deep vocabulary, familiarity with syntactic and

semantic sentence structures, verbal reasoning abilities, and knowledge and literacy


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conventions- (see Alegría, 2004, for a review; Conrad, 1979; Torres and Santana, 2005,

for Spanish deaf people).

In the present study, we analyzed the reading comprehension of MOC subjects

using texts with emotional inferences, considered an advanced level reading task. The

linguistic command and reading comprehension abilities of the MOC subjects had

been evaluated previously, as the foundation for inferential reading comprehension.

According to the CELF-3 results, the MOC subjects demonstrated a good level

of linguistic competence. They were found to be above the 50th percentile, indicating

their command of the spoken language. These results have important implications for

the process of reading comprehension for two reasons: (1) the reading level

demonstrated by the subjects seems to be related to their level of language skills; and

(2) it is not possible to have good reading skills without good linguistic competence,

whatever the mode of communication. In other words, children who do not possess

any language to serve as a base for its corresponding written symbols will never learn

to read. In the case of the MOC subjects, and as the CELF-3 results indicate, they

reached the objective of a certain level of linguistic competence, in this case with the

spoken word.

Although it may appear that testing reading skills is, to some extent, redundant

in the light of the previous study where the MOC subjects demonstrated a high level of

linguistic capacity, it was considered important to evaluate this capacity independently

since linguistic competence by itself, although necessary, is no guarantee of fully

developed reading skills. Consequently, a reading skill test was administered to ensure

that the results from the experimental tasks were not due to specific problems with the

reading processes (e.g., coding). The results obtained in the PROLEC-SE text

comprehension task confirm a high level of reading skills. All the hearing-impaired

subjects were found to be above the 85th percentile, indicating that they were skilled

readers for their age, not only among hearing-impaired subjects, but also among their

non-hearing-impaired counterparts.

The results described above demonstrate that the skills level for the hearing-

impaired MOC subjects, both in reading and linguistic competence, favourably

positions them for success in reading comprehension tests using texts with emotional

inferences. When we examined the results of these tests, we found significant

differences in the reading time of target sentences used as a dependent variable.

Significant differences between consistent vs inconsistent target sentences were found.


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This led us to conclude that our hearing-impaired subjects, as a group, were able to

detect the inconsistencies in the text. We observed the same effect regardless of the

place of two target phrases, one which appears in the middle of the text, and the other

at the end of the text. In other words, the response pattern was independent of where

the critical sentence was located. All subjects exhibited a similar pattern regarding the

effect of consistent sentences and inconsistent sentences: there was a longer response

time for the critical inconsistent sentences. This difference was significant in all the

subjects except in DMR.

The performance between MOC participants and their CA matched hearing

peers demonstrated some differences. The CA hearing group did not show a

consistency effect when the critical segment was in the middle, although the effect

appeared when it was at the end. It has been argued that some less skilled readers

expect information regarding the protagonist’s story to be updated at the end of the

text. If true, the no-consistency effects in the middle would indicate that the CA

hearing group has a lower reading ability. This argument is supported by the fact that

the MOC group had better scores in the PROLEC-SE test versus the CA group's scores.

When the deaf subjects are compared to their reading age matched hearing

peers (RA group), the results show a very similar pattern to that observed in MOC deaf

subjects: consistency effects in the middle position in the text (although marginal) and

at the end of the text. Based on these results, we can affirm that the MOC deaf people

in this sample have similar reading skills to their hearing peers when they have to

make emotional inferences. Since they have achieved good reading skills and linguistic

command, similar to their hearing peers, they do not experience difficulties in

establishing and updating the protagonist’s emotional state representations involved in

the story while they are reading.

It is important to show that, compared with the hearing children, the MOC deaf

had a bigger discrepancy effect between the congruent and incongruent sentences,

both in CA as well as in RA. This fact shows that the MOC deaf have greater ability to

detect the anomalies included in texts which they were reading suggesting two

important conclusions: a) the effect of incongruence shows us that deaf children have

good comprehension of the text, because that is the only way to detect incongruences;

b) on the other hand, the greater effect of congruence in deaf people than in hearing

people suggests the presence of a bottom-up strategy in the MOC deaf children of

detecting mistakes allowing them to pick up the incongruences, which is highly


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positive, but assumes that comprehension processes are less automated. In support of

this last conclusion, it has been found that the reading time differences in incongruent

sentences are always longer in deaf people than those found in hearing people.

It should also be pointed out that the smaller size of the congruence effect in the

hearing children is not necessarily a direct indicator of lower reading ability. It can

indicate greater tolerance to mistakes allowing them to read more fluently. When good

readers are reading text they rely on the context when they need to solve detected

ambiguities. It is possible that the detection of incongruence is detected by hearing

children, because they are good readers, but it has been considered as not being

sufficiently relevant as to stop (De Vega et al., 1996). In natural conditions, the reading

task has the extraction of the global meaning of the text as a final aim and not the

detection of possible errors present in it. It is possible to attribute such behaviour on

the part of MOC deaf people to the nature of the MOC method as these strategies are

included in the intervention method.

As a whole, the facts of the present study indicate that MOC deaf individuals

cope successfully with a complex emotional inference task. Their results do not place

them in an inferior position in relation to hearing children, either with their CA or RA.

According to the research already mentioned in the first part of this paper, the reasons

which could explain this good performance are outlined below.

1) The communicative modality chosen. The choice of the oral communicative

modality plus CS has demonstrated efficacy in the development of linguistic

competence. In this sense, we can highlight that the communicative modality CS

satisfies all four of the relevant parameters for analysing communication systems in

relation to reading acquisition according to Musselman's (2000; page 25) diagram of

parameters. These parameters are as follows: two point to the relation between the

interpersonal communication systems and the written text: codifiability and structural

isomorphism; the other two point to the degree to which the communication systems

adapt to the deaf children's capacities: accessibility and processability.

The CS system, as described earlier, presents obvious advantages regarding the

properties of codifiability and structural isomorphism. In the first case, this is because

CS is a completely transparent system for the written code. CS is a system of cues

letting us codify the same segments for speech that later will be relevant in reading.

This property lets deaf individuals avoid all the problems inherent to the transposition

of codes that creates so many difficulties in sign or manual systems in general. CS


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involves no code problems because it codifies the same components as the oral

language does regarding the same spelling components. CS practically establishes the

same correspondences. In the case of structural isomorphism, the correspondence with

the oral language is complete because CS is not a language in itself, but a codification

system for oral language. Thus, CS structures and units are exactly the same as the oral

language which the deaf child uses.

In the case of the other two parameters, processability and accessibility, the

results show that they are completely appropriate to the processing capacities of deaf

people, as presented in the introduction. Therefore, these two parameters fulfil their

role as a communicative modality and as a modality of access to information; sign

languages have also shown great efficacy regarding these two aspects. CS does not

pose a problem regarding accessibility, because deaf children learn CS spontaneously

when adults communicate in CS in front of them and with them, independently of the

children's age. Age is not an obstacle to perceiving the system but CS efficacy will be

greater the sooner the child is exposed to the system, both at home and school

(Leybaert and Charlier, 1996). This is the same as hearing children accessing oral

language. Deaf children learn CS with the same natural facility that they learn any

other signed communicative modality. CS acts as a means to acquire oral language

because CS is not an aim in itself; in this case its use is limited to a certain period and

its intensity decreases as linguist development improves.

2) The use of CI. CI plays a key role in explaining our results. The use of CI

can be considered the ideal complement of CS, or vice versa. The main aim of CS is to

make oral language fully visible, different and complete ; thus achieving good

language perception. The direct consequence of fulfilling this objective is it makes the

acquisition of oral language easier. CI pursues the same aim, although it uses

auditory perception instead of visual. Thus, if the oral information is accessible

through the auditory channel (CI) or visual (CS) or both, the acquisition of oral

language will be facilitated. Therefore, CI and CS necessarily complement each other.

Theoretically, depending on the starting time, the number of years exposed to the

system and the amount of input given, CS solves the problem of language

perception and allows deaf individuals to access oral language. In the same way, CI,

also depending on the starting conditions, duration of use and correct use, efficiently

contributes to acquiring oral language. The clear superiority of CI compared to any

other conventional hearing aid has been well demonstrated. Although it is true that


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in some circumstances it is possible to use hearing aids to access a great part of the

auditory information in the environment, CI are the sensory aids that provide more

and better auditory information (see Geers, 2006, for a review). In our study, four out

of the MOC deaf individuals used CI and only one used a conventional hearing aid

(see Table 1).

Even though we have shown the advantages of CS either in spoken

language competence or in reading ability (see Alegría, 2004, for a review; Hage &

Leybaert, 2006), the CI and CS combination is relevant for the present study.

Thus, we note that studies done with deaf children equipped only with CI also

present good language outcomes, but are still not conclusive (Boothroyd &

Boothroyd-Turner, 2002; Nicholas & Geers, 2006; Spencer, Barker, & Tomblin, 2003).

We consider that the results presented in this study are attributable to the joint

long-term working effect of a specific sensory aid system, CI, and a

communication system based on the spoken language, CS.

3) An intervention framework. A major problem pointed out by researchers

studying the use of sign language in reading has been the degree to which the deaf

subjects are expert users of that sign language. It is a fact that most deaf people are

born to hearing parents who do not already have intense and specific training in this

communicative modality and who, therefore, should learn it to interact with their own

children. As stated in the introduction, one problem is ensuring that when deaf

children begin school they have a level of linguistic competence matching their

chronological age. If this is not the case then the most probable scenario is one in which

they have to face the job of learning to read while lacking language competence, thus

hindering the real potential of sign language as an instrument either in interpersonal

communication or for instructional communication at school.

To avoid this situation, our study subjects had completed the MOC program

(1-12 years); a CI was implanted early in life and properly used; they were exposed to

CS at home between 1-2 years old; their parents were deeply involved in the project;

they also received CS support in their classes at school; and last, but not least, the MOC

approach is characterized as being a structured program of cognitive and language

abilities training, with special emphasis on the low- and high-level reading processes.

Conclusion

The present research data, which should be taken with caution because of the

small sample size, are in line with the works by Spencer et al. (2003). These authors


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advise that, in addition to CI, other factors, such as preimplantation auditory

experience, the communication system used, and how strongly the family is engaged,

must be considered. Following this advice, these were the variables most controlled for

in our MOC deaf individuals. Thus, different studies comparing the ages when

implantation was carried out and communication systems, furnish data on the positive

impact that early CI has on oral language acquisition and use as well as on oral

communication systems when compared to other communicative systems. Despite the

clear advantages of early CI, the oral linguistic development of deaf people is not

entirely the same as their hearing peers. Thus, these data suggest maintaining oral

intervention models and systems, like CS, to accurately represent the formal aspects of

oral language present in written text, in combination with the use of CI.


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Author Note

Acknowledgments: This study has been supported by a grant from the Spanish Ministry

of Science and Tecnology (DGICYT Ref. BSO2003-08002/PSCE). We wish to express

our gratitude to Dr. M. de Vega, I. León and J. M. Díaz for his assitance with the

experimental texts and Dr. Rafael Santana and Mauricio Iza for their comments and

assistance with manuscript preparation. We would also like to thank the deaf and

hearing people that have taken part in this study for their cooperation and also to the

staff of the schools where this research has been carried out: Colegio Virgen de Belén and

Instituto Belén (Málaga). Without their help this research would not have been possible.

Correspondence should be sent to Santiago Torres, Facultad de Psicología, Campus de

Teatinos, Universidad de Málaga, 29071 Málaga, Spain (e-mail: [email protected]).


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mailto:[email protected]

For Peer Review


Table 1

Hearing impaired participants’ characteristics

GroupChronol.

Age

Hearing

Loss

Type of

Protesis

and Age

Hearing

Loss

with

Protesis

Hearing

Impairment

Diagnostic

Start of

Rehabilitation

ECA 13.10 >110 dB CI-3 and 7 40dB 7 months 8 months

DMF 13.4 >110 dB CI-7 35 dB 13 months 16 months

PHL 12 110 dB CI-3.3 35 dB 8 months 10 months

DOM 11.6 105 dB CI-3.4 30 dB 12 months 13 months

FGCH 16.11 90 dB Au-1.4 40 dB 11 months 17 months


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For Peer Review

Reading comprehension of an inferential text

1

Table 2

Critical segment reading times (totals, mid and final position) in congruent and incongruent

texts. Note: in bold those pairs that differ significantly according to non-parametric comparison

of means analyses (Wilcoxon test, p< .05).

Age RT

C

CEL

F3S

CE

LF3

P

Incongr

Total

Congru.

Total

Incongr

Mid

Congru.

Mid

Incongr

Final

Congru.

Final

ECA 13.10 19 97 119 90 3143.66 2042.42 3036.47 2250.17 3227.87 1879.18

DMF 13.4 17 90 108 70 1780.76 1356.98 1803.8 1537.38 1763.04 1218.22

PHL 12 13 86 105 65 4127.02 2662.17 4360.12 2935.43 3983.58 2494.01

DOM 11.6 14 90 103 60 2442.19 1764.82 2617.50 1963.79 2304.45 1608.49

FGCH 16.11 17 90 103 60 4820.73 2471.12 2442.19 1764.82 5155.52 2360.61

RTC= Reading Test: Raw Score; RTP= Reading Test: Percentil; CELF3-S= CELF3

Raw Score; CELF3-P= CELF-3 Percentil


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For Peer Review


Table 3

Mean reading times (in ms) in the critical segment in the three experimental groups in

congruent and incongruent texts regarding position (SD in brackets).

Group

Age

(in

years)

Reading

Test

raw-score

Congr.

Middle

Incongr.

Middle

Congr.

Final

Incongr.

Final

Congr.

Total

Incongr.

Total

MOC

N=5

13.04

(1.9)

16

(2.5)

2272

(584)

3221

(1104)

1896

(510)

3286

(1347)

2059

(540)

3272

(1239)

CA

N=30

13.2

(1.5)

12

(3.7)

2772

(508)

2827

(592)

2122

(440)

2328

(458)

2400

(432)

2546

(467)

RA

N=28

14.3

(1.5)

15

(1.7)

2450

(472)

2609

(648)

1927

(487)

2227

(571)

2153

(443)

2394

(561)

MOC: deaf educated with Cued-Speech; CA: Chronological Age; RA: Reading Age.


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