1	Why Should We Cue at Home? Donna A. Morere, Ph.D. Gallaudet University Donna.Morere@gallaudet.edu Donna.Morere@verizon.net
2	Benefits of CS It can support the development of language and reading skills. It enhances the development of fluent colloquial English skills. It provides access to oral language phonology. As a bonus supports speech and speechreading skill development.
3	"Additionally," Additionally, for language fluency and literacy, the individual must have a knowledge of the syntax and grammar of the language. As it is used in regular communication, CS provides access to this knowledge through.
4	"Research indicates that a depth..." Research indicates that a depth of knowledge of the vocabulary in addition to the range (i.e., knowing multiple words for a concept and multiple concepts for a word) is critical for these skills. CS provides this access by allowing fluent communication in a range of settings.
5	How Does Cued Speech Do This? CS can be used by hearing parents to communicate without having to simplify their vocabulary as well as allow them to read children’s books such as Dr. Seuss that include nonsense words “There’s a wocket in my pocket”. This is important in developing language facility that is critical to pre-reading skill development.
6	Use of Cued Speech to enhance English Speech, Language, and Reading Skills Cued Speech can be used for specific interventions and training to Clarify phonemes the child is seeing/hearing Help the child target sound s/he is trying to produce Learn grapheme-phoneme associations Develop basic reading skills
7	Why not just cue at school? Research indicates that children cued to from an early age at home and in school performed accurate phoneme-grapheme decoding (like hearing children) Those cued to later and only at school and those using only signs did not. Those cued to only at home performed better than signers, but less well than those cued to in all environments. This effect of early, consistent cueing was seen in studies of spelling skills as well.
8	Why not just cue to the profoundly deaf kids? Research compared reading achievement of deaf Cuers with severe hearing loss to those with profound hearing loss. Profound Ss did better!!!!!!!!! Due to decreased amount of Cueing to the severe Ss? Implications for CIs.
9	Cued Speech and Hearing Loss While they exist on a continuum, all children with hearing loss miss speech information. Used as a communication method CS provides ongoing access to the vocabulary and the phonemic structure of the vocabulary. It also provides modeling and exposure to the syntax and grammar of the language.
10	But my kid can hear with his/her CI…
11	What Does the CI Do? The CI allows the child access to sound. Period. The ability to use this sound to discriminate speech is a skill that must be learned.
12	What the CI Doesn't Do It does not make the child “hearing” or even (although on audiological measures they may look like it) hard of hearing. CI’s do not produce “normal” hearing Even the best maps tend to provide 25 – 30 dB The “sounds” are analyzed representations filtered to emphasize speech sounds, but not all acoustic information is conveyed.
13	Speech Perception with a CI Studies of speech reception of CI users indicate gaps in speech perception Experienced CI users ages 8 – 10 using audiotapes of nonwords (so they could not use speechreading or their vocabulary to support their perception). Only 5 % of responses were accurately produced. Some of this may have been speech accuracy. Even considering speech, this suggests inaccurate auditory perception. 64% had the correct number of syllables 61% had the correct placement of stress. Carter, Dillon & Pisoni (2003) Two years after activation, mean recognition of consonants was 71% Vaelimaa, Maeaettae, Loppoenen, & Sorri (2002)
14	What the CI Doesn't Do In addition to the audiological limitations of the CI, it does not provide auditory information in all situations. At night when the lights are out Bath time Swimming When it’s broken (panic!!!) When the dog eats it… On plastic slides and some other playground equipment Any time the CI processor can’t be worn or is not useful.
15	What the CI Doesn’t Do Also, for most implantees, information from the non-implanted side is degraded and more difficulty to “hear”. Noise is extremely difficult to filter out, especially speech-based noise. Classrooms have notoriously bad acoustics “children with hearing impairment obtained perception scores of only 60% as compared to 83% for the normal hearers. In acoustical conditions more commonly reported in the classroom (SNR = +6 dB; RT = 1.2 seconds), children with SNHL obtained perception scores of just 11% as compared to 27% for children with normal hearing.” http://www.phonicear.ca/resourcefiles/PhonicEar-ClassroomAcousticsForChildrenWithNormalHearingAndWithHearingImpairment.pdf Group interactions are more difficult, especially when others in the room or nearby rooms are talking.
16	So? Even in the best of circumstances, children using CI’s will depend to some extent on visual cues and their knowledge of the language to support their auditory language reception.
17	What to do? One simple answer is to Cue. We all know that CS provides clarification of the phonemic information on the lips and mouth. This clarification can be used by CI recipients to support the auditory information that is obtained via the CI. CS addresses all of the factors that have been identified as predicting CI success.
18	CS Supports a CI Success Research indicates that success in developing speech discriminate is in part dependent on: Pre-existing knowledge of the language being spoken. Vocabulary Syntax & Grammar An internal model of the phonology of the language. AKA “auditory memory”, BUT, previous hearing is not required if the child has an internal model of the phonology of the language without hearing (CS). Some research suggests that temporal (sequential) processing “contributes to speech perception by cochlear implant users” (Fu, 2002)
19	How Does CS Support CI Success? Pre-existing knowledge of the language As we have already seen, CS allows for appropriate development of knowledge of both the structure (grammar & syntax) and vocabulary of the language. Studies indicate that profoundly deaf Cue Kids do better than those with less severe hearing losses (those more like CI users). This is counter to the norm, where reading and oral language correlate positively with residual hearing. Likely because people Cue more consistently with the kids with less residual hearing.
20	"Remember," Remember, these kids are learning the language at the same time that they are trying to develop skills (learning to “hear”) with the CI!!! They need ongoing unambiguous access to the language during this process, otherwise, their language skills as well as their listening skills will likely be negatively impacted.
21	How Does CS Support CI Success? Internal model of the phonology of the language. CS provides users with an internal model of the phonology of the language. The internal model allows the CI user to attach new acoustic information provided by the CI to the pre-existing internal model of phonology based on CS This is best achieved by the individual experiencing concurrent Cueing and auditory stimulation
22	Teaching Listening with CS Associative learning (Pavlov's dog) Every time the child hears the phoneme and is alerted to the target phoneme via CS, his ability to accurately identify that phoneme is enhanced. Research with cognitive rehabilitation indicates that it takes hundreds of reinforced (CS confirmation) trials before the brain learns how to accurately and automatically code the information.
23	Accurately and Automatically Cognitively, the development of the ability to accurately and automatically decode the received information is critical. If it is effortful (not automatic), it will fatigue the individual, and they will miss information. cognitive resources will have to be used to decode the information and will be unavailable for comprehension and integration of the input. Similar to parrot reading – the child may be able to say and even understand the words, but not the sentence. If it is too effortful, they will quit trying. If it isn’t accurate, miscommunication occurs.
24	How Does CS Support CI Success? Some research suggests that temporal (sequential) processing “contributes to speech perception by cochlear implant users” (Fu, 2002) Multiple studies have demonstrated that CS enhances verbal sequential processing. This correlates positively with reading comprehension as well as listening comprehension.
25	The Value of Cueing Even children with mild to moderate hearing loss (including CI users) miss things. Important aspects of English are vulnerable to mild loss possessives & plurals (/s/), tense identifiers (/d/, /t/, /id/), etc. Articles and connectors are often missed or slurred in conversation. Children often hear telegraphic speech. Listen to them! They say what they hear. “Joe and I are going to the store” may be heard as “Joan Ire goanuhth store” Small words are often swallowed as we talk
26	Nobody’s Perfect. (When you can’t cue all the time) Although consistent Cueing is preferable, the child may benefit from using Cued Speech to clarify individual words When the child has mispercieved a word, you can cue it to clarify the phonemes involved. Also excellent for spelling tests to ensure that the child is see-hearing the word accurately.
27	You said what? New vocabulary should be introduced using Cues to ensure that the child knows what you really said. Ambiguous information is both confusing and frustrating. You can’t learn a word you can’t perceive clearly. Children may assume “bet” and “bit” really are the same thing. They will also have a better idea of what phonemes to target for their speech.
28	Phonological awareness Deaf/HOH children typically have difficulty with phonemic awareness, and Cueing can be used to develop these skills A key concern in these children’s development of phonological awareness skills is their impaired ability to discriminate individual phonemes of the language E.g., /b/ and /d/ may be indistinguishable even for HOH children.
29	CS and Phonemic Awareness CS clarifies the ambiguous auditory signal Phonemic awareness activities normally presented using speech can be done using Cued Speech. The only adaptation needed is for the parent/teacher/therapist (and, preferably, the child as well) to Cue. This automatically clarifies the phonemic information for the child.
30	Why Not Cue? Audiological myths and bias Fear of interfering with listening skill development. It’s too much work.
31	Why Cue? In the end, our job is to facilitate the child’s education and language development. Cueing does this with minimal added cost. It also makes their lives easier, as they are not constantly struggling to understand what is said and suffering from missed information and miscommunication.