Audiology and Literacy

Audiology and Literacy

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As an audiologist in private practice in the Buffalo, New York, area, I have seen children for suspected auditory processing disorders (APDs) for the last 30 years. Typically, the parents of these children do not have any knowledge of APD but they do know that their child is struggling in school with reading problems for no discernable reason. Most have tried to get help from their child’s school but nothing helped and they do not know where to turn. Our auditory processing evaluation usually revealed that these children were having problems in the area of phoneme awareness, an auditory ability that is related to success in reading. Using current guidelines under consideration (AAA 2010), a problem with phonemic awareness does not, by itself, constitute an auditory processing disorder. However, if we as audiologists know how to guide these parents, then perhaps evaluation of phonemic awareness should remain a part of our evaluation of auditory processing for the time being Education research first demonstrated the strong positive correlation between phonemic awareness and reading skill in the early 1970s (Rosner and Simon, 1971). Phonemic awareness is now recognized as the best predictor of early reading success. In 2000, The National Reading Panel identified over 2000 studies in the area of phonemic awareness and made specific recommendations for the teaching of this skill in early literacy programs. Phonemic awareness is a highly trainable auditory skill; however, improving a child’s phoneme awareness will not have much of an effect on the child’s success in reading if the child continues in an ineffective reading program. Unfortunately, phonemic awareness is poorly understood by most of the educational community as is reading instruction using a phonemically­driven approach.

Before proceeding, let me define phoneme awareness as the ability to hear the individual phonemes (and diphthongs) that comprise words. As a skill related to success in a phonemically­driven reading program, it is also the ability to clearly and consistently produce phonemes in isolation with minimal co­ articulation; the ability to identify the phonemes in words; and the ability to blend those phonemes into words.

I am also the Executive Director of the Magic Penny Early Literacy Institute (a small 501c.3 not­for­profit US corporation). As an audiologist in private practice, this was certainly an unexpected turn of events. Before phoneme awareness was well recognized in the educational community, my wife and I would work with children who we identified as deficient in this auditory skill. We soon realized that improved phonemic skills did not translate into improved reading success in school. We started a summer literacy program using published reading programs and phoneme awareness training. Our frustrations with the published reading programs led us to develop a phonemically­driven reading program that was only intended for use in our summer program. Our summer program lasted 7 weeks; the children were seen in small groups for two 45­minute sessions per week...a total of 10 and a half hours of contact. My wife Sandy, an elementary school teacher, worked with the children and required that the parents observe each session. The parents were also given 10­minute games and activities to play with their child each night to reinforce the concepts being taught. The success of the program was quite remarkable. Most children improved at least one or two grade levels over the summer. Some children made greater gains. This is remarkable when you consider that children spend about 1000 hours in school each year and that reading is a priority in the early grades. It is interesting, but not surprising, that the youngest children made the greatest gains. In general, the longer the struggling reader spent in an ineffective reading program, the more difficult the remediation. It is much easier to teach children right the first time...beginning in Junior Kindergarten (JK). The success of our summer program did not go unnoticed. Several local schools demanded access to our then unpublished materials. Consequently, we have been publishing the Magic Penny Reading Program for the last 8 years. Our phonemically­driven program is now being used in over 200 schools in the United States as well as in several other countries.

After presenting on the topic of literacy at the recent American Academy of Audiology (AAA) convention in San Diego, Sandy and I made a 3­day support visit to several schools that are using our program in the western United States. Significant teacher training and support is essential. As it turns out, most classroom teachers, and even most reading teachers, have never been exposed to anything similar to our phonemically­driven reading program, despite the significant research in this area. The average reading success rate in the United States is about 70%. The success rate of our phonemically­driven reading approach is 99%. International reporting lists Canada as being significantly higher than the United States in literacy but you cannot implicitly trust those numbers, especially for English­speaking countries that score poorly as a group. In the last international ranking, the guidelines allowed a 2.5% subject exclusion rate; the exclusion rate for the US data was about 50%. Despite this bias, those data were accepted and were published (Programme for International Student Assessment, 2006). In other words, the reading scores for 50% of the US children tested were not included in the published data; a cursory examination of the data would only reveal the rankings.

Here is a brief look at some Canadian statistics: Canada ranks #1 in literacy among English­speaking countries and in second place in the world rankings (Programme for International Student Assessment, 2006). “In 2006, 71% of 15­year­old Canadian students performed at or above Level 3, thus meeting or exceeding expectations for reading proficiency” (Human Resources and Skills Development Canada, www.hrsdc.gc.ca). Then again, if we look at the literacy rates published in 2009 by the United Nations Development Programme, both Canada and the United States have literacy rates of 99%. I do not know how to reconcile the above data. To the extent that Canada and the United States use similar reading instructional programs that are published by the large international publishers, our literacy rates should be similar. Here is a summary of the US situation.

• 38% of American fourth graders are functionally illiterate (National Assessment of Educational Progress, 2002) (n= 140,000).
• Reading failure affects every other academic area. (Thus the axiom: “Learn to read then read to learn.”)
• Approximately $70–80 billion is spent annually on special education in the United States.
• 80–90% of US students are in Special Education because they cannot read.
• Reading problems are NOT related to intelligence.
• In schools with economically disadvantaged students, the incidence of reading failure rises to 70%.

So...what’s the problem? That question will be the focus of the rest of this article. However, please let me suggest right now that the problem is not the child. The problem lies in the instructional methodologies that we have been using for the last 30–40 years. We need to stop trying to diagnose defects in our children that do not exist. Instead, we need to recognize what works and what does not work in reading instruction. It might seem surprising that audiologists might play a part in this process; however, since there is an auditory basis for the development of literacy, maybe we should contribute to a better understanding of this problem. We will need to become familiar with the reading techniques that are currently used, but let’s begin with a bit of history.

In the mid­twentieth century, there were two competing methodologies: traditional phonics and the “look and say” or “sight reading” approach. Briefly, traditional phonics taught most of the letter/sound relationships and the rules to account for irregular spellings; the sight approach taught children to memorize words by their appearance. In the late 1960s, the “reading war” between these two competing methods was supposed to be settled by large­scale, statistically based research (most of the previous educational publications had been anecdotal). This research incorrectly concluded that the reading method was not important (Bond and Dykstra, 1967, 1997). Thus began the search for deficiencies in children to account for their poor reading. The confusion that followed this research also opened the door for two new reading approaches: the ineffective “whole language “method and the flawed “phonologic” approach. These two approaches have dominated reading research and reading instruction for the last 30 years despite their ineffectiveness and inaccuracies.

If you decide to help guide patients or parents in the area of literacy it is necessary to be familiar with the various methods and their effectiveness. Let’s take a very brief look at each of these methods.

Traditional Phonics. Traditional phonics approaches, while better than the other approaches reviewed below, are still only about 70% effective. Phonics programs vary significantly. Most phonics programs take a letter orientation and teach that letters “make” sounds. Actually the letters represent phonemes; this is fundamental to the child’s understanding of our written code for spoken language and becomes very important when we teach the “irregular” spellings of English. Additionally, most phonics programs do not model correct phoneme pronunciation and do not provide the necessary auditory phoneme training. Many phonics programs teach letter names at the same time as sounds; this can be confusing for the at­risk child. Most programs do not immediately expose the child to the reversibility of the code; i.e., once the child can decode simple words (sound them out) they need to understand that they can also spell and write those words. Most phonics programs mix in other approaches (e.g., sight words). Many phonics programs do not maintain a phonemic basis and instead mix in other “sound units” (e.g., syllables and word families). There are approximately 50,000 syllables in English and 43 phonemes; therefore, written English uses phonemes because larger sound units (syllables or syllable fragments) cannot possibly work. Further, most phonics programs do not teach all of the 40 common phonemes in English. Most phonics programs use rules to explain irregular spellings; unfortunately, the best phonics rules only work about 40–50% of the time and they depend on a form of logic that is not well understood by the young child.

Sight Reading. This method has great intuitive appeal. As good adult readers, don’t we just look at words to read them? Research in auditory processing of speech has taught us that complex sub­cortical and cortical processing is always active as we listen. Further, this complex processing is just not able to be discerned by thinking about how we listen. As audiologists, we know that there is always bottom­up as well as top­down processing when we are listening to spoken language. The same is true for reading. Good readers are always using bottom­up phonemic processing in addition to top­down, language­ mediated processing. However, as with auditory processing of spoken words, we are not consciously aware of the neurologic processing that is required to read words. In its purest form, sight reading is like memorizing telephone numbers. Keep in mind that the upper limit for memorizing words is about 2000. However, there are about 50,000 English words in common everyday usage and there are about 100,000 words in the average adult lexicon. It is not surprising that children who depend on this method can excel in JK, Kindergarten and first grade; however, by second or third grade, when memory limits are exceeded, these children break down and become some of our poorest readers. Proponents of a sight approach often assert that most words are not decodable using a phonics strategy, when in fact almost all words are decodable (able to be sounded out) if the correct method is used.

Whole Language. This method also has great appeal. The Whole Language method suggests that children should be exposed to great literature instead of the simplistic beginning reading books used in phonics reading programs. The Whole Language approach mistakenly assumes that since children learn language naturalistically, they can also learn to read without specific instruction. The state of California mandated that only Whole Language be taught in their public school system in 1987; by 1992 they had dropped to last place in the United States in reading comprehension. Although this approach is widely recognized as ineffective, techniques from this approach permeate most basal reading programs (“basal” is the common term used in the United States for the expensive reading programs from the large publishers that are used in most schools). A literature­based approach is great for children who can read but Whole Language fails miserably as a reading approach for early literacy.

Phonologic Approach. This theory is derived from one of our field’s most influential studies: “Perception of the Speech Code,” 1967, from A. Lieberman et al.; and, therefore has built­in credibility for audiologists. The authors’ groundbreaking research on co­articulation and categorical auditory perception of phonemes has stood the test of time. The spin­off theory of phonologic development, as applied to reading instruction, has not fared as well. The findings from a previously published work (Gelb, 1963) erroneously postulated that writing systems evolved from representations of whole words, to syllables, and then to phonemes. In the early 1970s, Isabelle Lieberman, the wife of Alvin Lieberman from the original research, synthesized the work of Gelb and the work of her husband’s team into a Phonologic Theory of reading acquisition (I. Lieberman et al., 1974). Although this theory is riddled with flaws, it has had a significant influence on reading instruction for the last 30 years and is a part of the theory that supports the International Dyslexia Association’s position papers on reading instruction (Brady and Moats, 1997). The tenets of this theory are not accurate and should not be used as the basis of our understanding of reading acquisition. For example: contrary to the Phonologic Approach’s assumptions, awareness of phonologic segments does not follow a biologically mediated developmental order from larger to smaller phonologic units; impaired phonologic processing of sound units larger than the phoneme are not a significant cause of reading problems; the effects of co­articulation can be minimized and are not a significant deterrent to teaching an alphabetic (phoneme­based) writing system; and, training in the larger phonologic segments (e.g., syllables, rimes) does not make a significant contribution to reading success.

Eclectic Approaches. Many reading programs today use an eclectic approach. This approach is again intuitively appealing; every child is unique and therefore shouldn’t we use the approach that matches his or her own learning style? Eclectic approaches for teaching early literacy, while appealing, fail to recognize that combining ineffective methods results in an ineffective method. Even a good approach will suffer if it is “eclectically” combined with ineffective approaches. Every non­effective method that we use has the potential for derailing the educational process. Our resource rooms and special education classrooms are living proof.

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If these methods are so ineffective, how can any child possibly learn to read? Interestingly, most children learn to read in spite of ineffective reading methods. Although rare, some children learn to read without any instruction; these children have built­in aptitude for reading. Children in the upper 50%, for what I will call reading aptitude, are very resilient. The other 50% of the children are not as fortunate; these children can all learn to read in a well­designed instructional program but they will be easily confused by multiple strategies or ineffective strategies. Our evidence base, collected over the last 8 years, suggests that 99% of children can learn to read well the first time if they are taught appropriately. There is a growing consensus to suggest that all good readers read phonemically whether they are taught in a phonemically­driven method or not. Current thinking suggests that phonemic decoding (bottom­up processing) is always working even in advanced readers who effectively use language­based, top­down processing. As audiologists, we recognize the similarity between the bottom­up and top­down processing that is used in the auditory comprehension of spoken language; this well­accepted processing paradigm is not a familiar concept in the educational community. In this paradigm, both processing strategies are always being used in a complimentary manner. As the situation dictates, either strategy may dominate. When learning language, infants listen to millions of words. In the earliest stages, the child is using bottom­up processing. As language understanding emerges, top­down processing is also being used; however, rudimentary proficiency with bottom­up processing must be established before the child can effectively use top­down, language­based processing; and, top­down processing cannot exist without bottom­up processing. The same is true with reading. Children must first develop phoneme awareness and then learn the sound/letter correspondences of the English language. Automatic phonemic decoding is the foundation for reading comprehension, or what could also be called written language comprehension. So let me end this paragraph as it began: If existing reading instruction methods are so flawed, how can any child learn to read?

When faced with vague, misleading, or ineffective instruction, children develop their own strategies for reading. McGuiness (1997) analysed the reading strategies that were actually used by first grade children who were taught using the Whole Language method. She determined that the best readers were actually using phonemic decoding. This group had the fewest students. The poorest readers used a typical sight reading approach; most frequently, these children would decode (“sound out”) the first letter and then guess the word based on length and shape. This study reassessed the children in third grade; the phonemic decoders were still the best readers by a large margin. The “whole word guessers” were the worst readers and none had progressed beyond this reading strategy. This argues against a developmental mechanism such as is presumed in the “phonologic theory.”

I will now review our phonemically­driven approach to early literacy. When I present an overview of our program, I am always surprised by its simplicity. First, let’s review a few basic facts:

• Humans have an intrinsic capacity for spoken language but not for written language.
• By comparison to spoken language, writing is a relatively modern human invention. The English alphabetic system has evolved over the last 1400 years into a complex writing system and has only been widely available for a few hundred years.
• The structure of this alphabetic system must be understood before developing instructional methods for teaching reading. With over 50,000 possible syllables, by necessity, written English uses the phoneme to construct words.
• Human memory limitations must be considered when developing methods for reading instruction. The 43 phonemes of the English language can be easily recalled. The upper limit for memorizing words is about 2000. With approximately 50,000 English words in common everyday usage, a sight approach to reading instruction cannot be sustained.
• The reading techniques in common usage today were developed without consideration of how written English was developed (e.g., Whole Language, sight reading, phonologic approach, traditional phonics).
• Those methods are based on premises that are scientifically incorrect and are not as effective as a phonemically­driven method.
• Since reading does not develop naturally, it has to be taught. Reading should be taught using theoretically sound and developmentally appropriate methods in the most logical and systematic manner possible.
• As with all codes, the decryption algorithm must mirror the encryption algorithm.
• If 99% of our children can learn to read using phonemically­driven reading instruction, then we can shift our concern to the 1% failure rate rather than assuming that there is something wrong with the 30% of our children who are not leaning to read with ineffective instructional methods.

Phonemically­Driven Reading Instruction: The English alphabetic writing system is a human invention that must be carefully taught beginning with the phonemes that are the basis for the system. Phoneme awareness depends on being able to hear and identify these sounds. Early instruction stresses listening. Although some children will be able to learn phonemic awareness and sound letter correspondences concurrently, many children require proficient phoneme awareness before learning the basic sound­letter correspondences. The pronunciation of the phonemes is important and is carefully modeled. After teaching the sounds, we teach the letters that represent the sounds, beginning with the simplest. Other conflicting instructional approaches are avoided. Other sound/spelling units are avoided (syllables, rimes, word families, etc.). As soon as the child begins to decode (read) words, she (he) immediately begins to encode and write words, and begins working on reading comprehension. This exposes the child to one of the most important features of any code...reversibility. At this point and throughout this process, spelling words mirror the sound/letter relationships that the child has learned to read (decode). “Sight words” are avoided; since almost all “sight words” are decodable, it is preferable to teach the decoding strategy for a “sight word” that the teacher wants to use in the child’s reading and writing rather than presenting the word as a non­decodable “sight word.” As the child progresses, all phonemes of the language are taught.^[1] Since there are no consistently correct rules to explain the irregularity of English spellings, rule­based phonics is avoided as these systems do not work. Instead, children are taught that the sounds of English can be spelled in different ways; this variation is systematically taught using a well­organized, probability based model. Decoding is developed to the point that it is automatic; automatic decoding frees up the child’s cognitive resources to focus on top­down reading comprehension. Any reading instruction program that carefully follows these (and only these) guidelines will be successful. Unfortunately, most of the commercially available reading programs available today do not meet any of these criteria much less all of them.

Our schools are currently preparing our children for technology jobs that do not now exist. Functionally illiterate, poorly educated North Americans will not be able to compete in a complex technology­driven society in countries without a large domestic industrial base.

We have literature on literacy available in the front office of our audiology practice. I am always surprised by patient interest in this area. Reading problems affect so many lives. It disrupts families and creates children who feel like failures by age 6 or 7. There is no safety net for these children. Most remedial reading programs use the same techniques that have already failed once. Most third graders who are not good readers never become good readers. Their lives are indelibly altered.

Schools and reading instruction methodologies are very difficult to change. It is usually a teacher or principal who can effect change in spite of the restrictive policies and curriculum guidelines indigenous to public education. The niche for our phonemically driven program is in JK, SK, and grade 1. In the United States, our pre­K and Kindergarten (Canada’s JK and SK) are usually looking for early literacy materials and are not encumbered with the same restrictive curriculum guidelines and/or mandated basal reading programs that are encountered in first grade and beyond in the United States. Children can finish our program in 2 to 21⁄2 years culminating in grade 1 with our first chapter book written at a seventh grade reading level. This level of reading proficiency can insulate even the at­risk student from any problems stemming from ineffective reading programs in grades 1 through 3.

When she accepted the 2008 International Reading Association’s Exemplary Reading Program Award in Atlanta, Georgia, Principal Alison Caputy said: “Magic Penny Reading is the great equalizer because it breaks the cycle of poverty.” At that time, Ms. Caputy was the principal of Pine Hill Primary Center in Cheektowaga, New York. Pine Hill Primary has been a Magic Penny school since 2004. However, reading failure affects children without regard to family income or intelligence. Audiologists are in a pivotal position to contribute to literacy. The greater purpose in life is not just to do what we want but to do what needs to be done...this needs to be done. Your practice, your profession, and the lives of many young children will be the better for it.

References:

AAA. 2010. AAA Guidelines on (C)APD: A Preview. Presentation at the 2010 Annual Convention of the American Academy of Audiology. San Diego, California.

Bond, G., and R. Dykstra. 1967. The Cooperative Research Program in First­Grade Reading Instruction. Reading Research Quarterly. 2. 1–142.

Bond, G.R. and R. Dykstra. 1997 (reprint of 1967 paper). The Cooperative Research Program in First­Grade Reading Instruction. Reading Research Quarterly. 32. 348–427. Brady, S., and L. Moats. 1997. Informed Instruction for Reading Success. A Position Paper of the International Dyslexia Association. Baltimore, Maryland.

Gelb, I. 1963. A Study of Writing. Chicago: University of Chicago Press.

Human Resources and Skill Development Canada, 2006. www.hrsdc.gc.ca (accessed June, 2010). Lieberman, A.M., F. S. Cooper, D. P. Schankweiler, and M. Stuttard­Kennedy. 1967. Perception of the Speech Code. Psychological Review. 74. 431–461.

Lieberman , I.Y., D. P. Schankweiler, F. W. Fisher, and B. Carter. 1974. Explicit Syllable and Phoneme Segmentation in the Young Child. Journal of Experimental Child Psychology. 18. 201–212.

McGuinness, D. 1997. Decoding Strategies as Predictors of Reading Skill. Annals of Dyslexia. 47. 117– 150.

McGuinness, D. 2004. Early Reading Instruction. Cambridge, MA: The MIT Press.

National Assessment of Educational Progress. 2002. United States Department of Education. Institute of Educational Science. http://nces.ed.gov/nationsreportcard/reading/ (accessed May 2010)

National Reading Panel. 2000. Report of the National Reading Panel. National Institute of Child Health and Human Development. Washington, D.C.

Programme for International Student Assessment. 2006. Organisation for Economic Co­Operation and Development. Assessing Scientific, Reading and Mathematical Literacy: A Framework for PISA 2006. 11, 1–192.

Rosner,J. and D.P. Simon. 1971. The auditory analysis test: An initial report. Journal of Learning Disabilities.4. 384­392.

Schneider, D. 1985. Educational audiology. In Handbook of Clinical Audiology. 3rd ed. Baltimore: Williams & Wilkins.

Schneider, D. 1992. Audiologic management of central auditory processing disorders. In Central Auditory Processing: A Transdisciplinary View. St. Louis: Mosby Yearbook. United Nations Development Programme: Human Development Report 2009.

hdr.undp.org/en/statistics/ (accessed May 2010).