Abstract
Children who are deaf or hard of hearing (DHH) are at risk for language and literacy delays, and parent–child book reading can contribute to developing early literacy foundations. Although many parents read with their children, some parents may be unsure how to utilize effective reading strategies to maximize literacy growth. This multiple case pilot study involved four mothers of preschool-age children with hearing loss who used listening and spoken language (LSL) as their mode of communication. After a short training session on strategies to promote child engagement and increased child interaction during storybook reading, results showed parents increased their use of engaging questions, along with a statistically significant increase in each child’s expressive contribution to the reading activity. Retention data indicated sustained parent reading behaviors that promoted child engagement. Providing parents with supported training may help parents implement effective reading strategies to promote literacy growth in young children who are DHH.
Keywords
The development of age-appropriate reading proficiency is a national educational priority for all children (National Institute for Literacy, 2009). The process of learning to read is both purposeful and active as children develop literacy foundations, such as phonemic awareness, alphabet knowledge, reading fluency, vocabulary, print conventions, the pragmatics of language, and reading comprehension strategies (Beaty & Pratt, 2011; Bennett-Armistead, Duke, & Moses, 2005; National Institute of Child Health and Human Development, 2001). Establishing strong foundations of language and literacy during the preschool years in preparation for kindergarten readiness is among the strongest predictors of later reading achievement and is consistent with the recommendations of the National Reading Panel for K-12 success (National Institute for Literacy, 2009).
Children who are deaf or hard of hearing (DHH) are at risk for delayed or deficient literacy development (Cole & Flexer, 2015; Lederberg, Schick, & Spencer, 2013; Luckner, Slike, & Johnson, 2012). According to the American Speech and Hearing Association (2013), hearing loss in children can cause (a) receptive and expressive speech and language delays, including reduced vocabulary development; (b) adverse impact on academic achievement, primarily due to language and literacy deficits; (c) social isolation; and (d) fewer vocational options. However, with early detection, use of appropriate hearing technology (e.g., digital hearing aids, cochlear implants) and specialized early intervention services, children who are DHH can develop spoken language, communicate with hearing peers, and attend their neighborhood schools (Dornan, Hickson, Murdoch, & Houston, 2009; Hayes, Geers, Treiman, & Moog, 2009; Moeller, 2000; Tomblin, Oleson, Ambrose, Walker, & Moeller, 2014). There is academic consensus that a child’s brain is experiencing the most growth between birth and age of 5 years (Shonkoff & Phillips, 2000; Westby & Wilson-Taber, 2016) and efforts to promote age-appropriate language and literacy foundations during this period can improve successful K-12 entry.
Parents play a vital role in facilitating their child’s early literacy development and have been advised by several national organizations to implement consistent parent–child book reading activities beginning in infancy (e.g., American Academy of Pediatrics, 2014; National Association for the Education of Young Children, 2013; National Institute for Literacy, 2006). Increasing the amount of book reading in the home can enhance receptive and expressive language skills of preschool-age children by exposing them to new vocabulary, social constructs, and opportunities to use complex language (Calderon, 2000; Crain-Thoreson, & Dale, 1999; Whitehurst et al., 1988). The National Institute for Literacy (2009) reported, “shared-reading activities are often recommended as the single most important thing adults can do to promote the emergent literacy skills of young children” (p. 153).
Although shared reading can foster positive literacy experiences and parent–child interactions, a passive approach to book reading may not be enough to maximize children’s language and literacy success (Chen, Pisani, White, & Soroui, 2012). In effective shared reading activities, parents can follow the child’s lead, ask questions, and expand and repeat their child’s utterances. They can utilize techniques such as discussing illustrations or describing the characters in a story, how they feel, and the actions they take (Crain-Thoreson & Dale, 1999; DesJardin, Ambrose, & Eisenberg, 2009; Hindman, Skibbe, & Foster, 2014). Parents can learn to identify opportunities to expand the ideas contained within a literature book and ask the child: “I wonder what might happen if . . . ?” or “what do you think about . . . ?” Children learn they can use their imagination beyond the text of the story, and there are no right or wrong boundaries to contain their thoughts.
Parent–child shared reading can be optimized when literacy engagement strategies are directly taught to parents (Kaiser & Roberts, 2011; National Institute for Literacy, 2006). Without experience, parents may choose a book that is too easy or too hard, passively read while their child listens, restrict their interactions to picture labeling, or not provide enough wait time to allow their child to formulate their thoughts. Parent training workshops held on a regular basis as a component of a reading curriculum have been shown to positively impact child outcomes (Anthony, Williams, Zhang, Landry, & Dunkelberger, 2014). However, availability of such workshops, barriers to consistent workshop attendance due to other family obligations, or time and costs associated with travel can impede participation for many families. Educators may believe they do not play a role in parent education or that there is insufficient time during the school day to support parents in utilizing effective storybook reading strategies. The purpose of this study was to explore the impact of a short training session on how frequently parents posed questions or prompts that promoted expanded dialogue and increased child engagement during home-based storybook reading with preschool-age children who are DHH.
Method
A multiple case pilot study was used to explore parent–child language interactions during storybook reading and the potential benefits of providing a short parent training session to improve language and literacy engagement.
Participants
Pilot study participants included four parents of preschool-age children with hearing loss who used hearing aids or cochlear implants and were enrolled in a preschool program that emphasized listening and spoken language (LSL). Parents were informed of the study purpose and self-selected if the child’s mother or father would be the study participant. In all four families, the mother served as the study participant. All four parents were from White, middle-class families and ranged in age from 25 to 33 years. Two parents had a high school diploma plus some college-level classes, one parent had a bachelor’s degree, and one parent did not provide information about her educational background. The children in the study ranged in age from 4 years 2 months to 5 years 0 month; three males and one female. Two children had a bilateral moderate–severe hearing loss and one child had a bilateral severe hearing loss, each used bilateral hearing aids. One child had a profound hearing loss and used bilateral cochlear implants.
Materials
Participants were provided with five new children’s literature books. Four books were wordless: The Lion and the Mouse (Pinkney, 2009), Pancakes for Breakfast (dePaola, 1978), A Ball for Daisy (Raschka, 2011), and Good Night Gorilla, (Rathmann, 1996). One book, The Umbrella (Brett, 2004) contained written text. Participants were informed they could use the literature books provided or, if their child preferred, they could use books already in the home. The study purpose was not to evaluate the potential differences in parent–child dialogue between wordless books versus books with text, but rather the impact of a short training on parent utilization of child engagement strategies regardless of book type. Parents had informed the researchers prior to study initation that the majority of books in the home were books with text. Therefore, the goal was to ensure a variety of book types were available from which the children and parents could choose.
Each study participant was provided with a recording device to audio record the adult–child reading interactions. The device captured the adult–child storybook reading, and the parent–child word-for-word conversations were manually transcribed and analyzed.
Procedures
Baseline
During the baseline phase, participants recorded their book reading interactions with their child over a 1- to 2-week period until three to four reading segments totaling 15-min each had been obtained. No instructions were provided to participants regarding book reading strategies other than to engage in book reading activities in whatever manner was typical for the parent and child.
Intervention
At the end of the baseline period, each participant engaged in a 20-min training session to learn strategies for increasing child engagement during the book reading. To ensure consistency across participants, the first and second author completed the training for all families, utilizing an eight-slide powerpoint and a 2-min video example to guide the discussion. The training took place in a quiet room at the child’s preschool classroom. During training, the authors described strategies for engaging children in a book reading activity by encouraging natural conversational interactions. Parents were encouraged to use the literature books as an opportunity to expand their child’s thoughts and ideas, to help their child engage with the book through question prompts and story expansion, to gain insight into their child’s thought process, and to encourage conversational turns. For example, the parent training discussed strategies of prompting “I wish . . . I think . . . I wonder . . . What do you think” questions during the book. An example of the instruction using these strategies provided to participants during training: If you were reading the book Snowmen at Christmas (Buehner & Buehner, 2005), you might expand the idea of the book by asking your child “I wonder what would happen if the snowmen went to visit grandma in Florida. Hmmm . . . what do you think would happen?” “I wish we could go sledding with a snowman. What games do you wish we could play with a snowman?” Give your child plenty of time to think about the question and formulate the response. Your child shouldn’t feel forced to answer, so follow your child’s lead. If your child is engaged in the exchange, but having trouble coming up with a response, you can help provide suggestions for him. The answer isn’t the priority, but rather the exchange of thoughts and ideas surrounding the book to promote child engagement.
In these examples, the training emphasized there is no right or wrong answer, and the child can learn that whatever thoughts and ideas are offered are correct and valued; that these discussions can promote critical thinking and text interaction that may not occur when the child plays the role of listener-only. Asking “wh” questions was not discouraged, as meaningful inquiry can be an effective strategy for exploring story and picture comprehension. However, posing more questions is not necessarily better, and parents were cautioned against a tendency to bombard their child with questions that might feel like a therapy session or that encouraged single-word responses from the child. The training emphasized the concept of “wait time” after a question has been posed, and the importance of allowing the child adequate time to consider the question and formulate a response. Finally, the training session provided parents with ideas for promoting phonemic awareness in a fun and natural way, such as playing with sounds and words to create new or silly words or finding the rhyming words in the story. Care should be taken to avoid an atmosphere of “instruction” that would run counter to the purpose and value of a comfortable and natural parent–child book reading experience.
During the training, parents were also provided with a copy of the booklet A Child Becomes a Reader-Birth Through Preschool (National Institute for Literacy, 2006) and Put Reading First-Kindergarten Through Grade 3 (National Institute for Literacy, 2003). These parent-directed booklets published by the National Institute for Literacy provided information about promoting literacy in the home and emphasized concepts relevant to the study goals.
Posttraining recordings
Upon completion of the 20-min training, parents continued with their 15-min book reading over a 2-week period to obtain four to five recorded sessions, implementing the concepts learned.
Retention
After 8 weeks had passed since the posttraining recordings were collected, two additional book reading sessions were recorded to explore retention of skills taught. No additional instructions were provided to participants prior to the final recordings. Parents also completed a three-question, open-ended response questionnaire to provide feedback. The three questions were (a) Describe the information or strategies discussed in the training that were most helpful, (b) Provide an example of your child’s response to the storybook reading, and (c) Offer any additional comments or feedback related to the training session.
Upon study completion, participants returned the recording device but retained all other study materials (five children’s books and literacy information booklets) in appreciation for their participation in the study.
Data Analysis
Using the audio recordings, a research assistant transcribed everything the parents said and everything the child said during each 15-min reading session. A second research assistant listened to all recordings and verified accuracy of the transcription, making corrections as needed. After each recording had been transcribed and verified by the research assistants, the second author listened to 14 of the 33 total sessions (42%) to provide further verification of transcription accuracy and found greater than 99% accuracy in all transcription records. If a session contained recorded information that ran longer than 15 min, only the first 15 min of the reading session was transcribed and used in the analysis.
The first and second authors independently completed a comprehensive analysis on the transcribed data to identify the type and number of questions or interactive dialogue parents used with their child during each 15-min reading session and then compared findings. Any discrepancies were evaluated and clarified based on the written transcription, such that agreement regarding response classification was obtained for all recordings. For example, both researchers independently used the Excel Spreadsheet containing the transcriptions, read the parent–child dialogue, and then coded according to the type of question or prompt used (e.g., a closed-ended question related to the story, such as “where is the dog?” or “how many fish do you see?” or when the prompt was open-ended with no right/wrong answer, such as “what would you do if an elephant was sleeping in your bedroom?”). After the independent coding, the researchers met to compare assignment to categories to ensure interpretation consistency and to finalize analysis for each reading session. They also identified the total number of words spoken by the parent and the total number of words spoken by the child during each 15-min session to identify the percentage that included adult words versus the percentage that included child words. The analysis included only dialogue related to the storybook reading. Incidental discussions unrelated to the storybook activity (e.g., directing the child to get their pajamas, requests for water, what is for dinner) were not included in the analysis. Non-lexical, or filler words, such as “uh” or “um” were not included in the word count or talk time ratio. The type of questions or interactive dialogue were analyzed according to two primary categories to describe the questions or prompts used to promote reading engagement. Response categories were as follows:
1. Parents asked their child a “wh” question related to the book (who, what, where, when, why). Questions were assigned this category when the expected response was associated with the story text. For example, if the parent asked “what is the mouse doing?” or “where is the dog?” while referring to something specifically on the story page. 2. Parents posed general prompts specific to the story text such as “yes/no” questions or “how many?”
3. Parents asked their child the more expansive conversational probe of “what do you think?” This analysis category allowed differentiation when a question prompted the child’s thoughts without regard to response accuracy specific to the text. There were no right or wrong answers to these questions, but rather prompts into what the child was thinking. 4. Parents expanded the text discussion by using prompts “I wonder . . . I think . . . I hope . . .” In these instances, direct questions were not asked, but rather the parent posed a thought and allowed enough wait time to determine whether the child would offer a thought as well.
After the first and second authors completed the analysis, a third researcher who was completely unrelated to the study and was not informed of the study purpose completed an independent review of the analyses for eight (20%) randomly selected book reading segments. This independent researcher evaluated the response coding and assignment to response categories but did not know at which stage of the study each segment was obtained. Comparison with original analyses showed 96.2% agreement.
Results
Parent 1
Baseline
During baseline, there was an average of five parent–child exchanges per book reading session, with 87% of those being Category 1, closed-ended “wh” questions (e.g., “what is that?” or “where is the mouse?”) and 13% Category 2 questions or prompts.
Intervention—Parent training
During the training, the parent was enthusiastic about the suggestions for increasing her child’s engagement during storybook reading and commented that she had felt insecure with going too far outside the written text or the story pictures. As shown in Figure 1, the posttraining recordings showed the parent increased the interactive dialogue, with an average of 29 parent–child exchanges per session, with 48% of those being Category 2. For example, during Good Night Gorilla, the parent remarked, “I wonder if the zoo keeper needs hearing aids.” The parent then waited several seconds while the child thought about this comment. Although not a direct question, the child responded, and this prompted an interesting discussion relevant to the child. The parent also utilized instances of sabotage in which she purposely made funny, nonsensical statements for the child to correct. These instances of sabotage were not coded as they were not part of the coding methods, but they illustrated parent attempts to generalize what she had been taught in the training session to promote child interactions that had not occurred during baseline.
Number of child engagement prompts used during parent–child storybook reading.
Retention
The two recordings obtained 8 weeks after the intervention recordings showed implementation of child engagement prompts similar to those seen in the intervention data. Across the two retention sessions, there was an average of 25 parent–child exchanges per session, with 47% of those being Category 2 (see Figure 1).
Parent 2
Baseline
During baseline, there was an average of 13 parent–child exchanges per book reading session, with 93% of those being Category 1 questions and 7% Category 2 questions or prompts.
Intervention—Parent training
As shown in Figure 1, the posttraining recordings showed the parent increased the interactive dialogue, with an average of 29 parent–child exchanges per session, with 34% of those being Category 2. For example, the parent was reading The Little Mermaid when she stated, “I wish I could swim under the ocean like Ariel.” The parent then paused for several seconds. The child responded “I wish I had red hair.” Based on the recording and the transcript, the parent appeared to be surprised as she asked, “you wish you had red hair?” and then commented on the child’s beautiful hair color. Nowhere in the transcript was it evident that the topic of hair color had previously been discussed, and it appeared to be a genuine “wish” that had come to the child during that book reading moment, presumably related to the hair color of the book character, Ariel.
Retention
The two recordings obtained 8 weeks after the intervention recordings showed implementation of child engagement prompts similar to those seen in the intervention data. Across the two retention sessions, there was an average of 27 parent–child exchanges per session, with 30% of those being Category 2 (see Figure 1).
Parent 3
Baseline
During baseline, there was an average of 11 parent–child exchanges per book reading session, with 93% of those being Category 1 questions and 7% Category 2 questions or prompts. The dialogue was often instructional, in which the parent prompted the child to indicate sounds the letters make, to sound out the words, and to label objects. The parent frequently prompted the child to stay on task, with several directives throughout the sessions to “please come here and pay attention.”
Intervention—Parent training
During the training session, the parent commented her child was becoming a good reader who could sound out words. Decoding skills were important to the parent, but she stated she was interested in adding other child engagement components to their reading activities. As shown in Figure 1, the posttraining recordings showed the parent increased the interactive dialogue, with an average of 27 parent–child exchanges per session, with 55% of those being Category 2. The parent continued to prompt decoding, and she embedded a number of phonemic awareness activities throughout the reading sessions. According to the transcription, the child appeared to be more engaged in discussing the books, with fewer instances of the parent prompting the child to stay on task.
Retention
The family moved shortly after intervention data were collected and were unavailable to participate in the retention data collection period (see Figure 1).
Parent 4
Baseline
During baseline, there was an average of 1.6 parent–child exchanges per book reading session, with 100% of those being Category 1 questions. The child nearly exclusively played the role of listener-only during the baseline recorded readings.
Intervention—Parent training
As shown in Figure 1, the posttraining recordings showed the parent increased the interactive dialogue, with an average of 14 parent–child exchanges per session, with 28% of those being Category 2. One of the child’s favorite books was If You’re Happy and You Know It. This book was included in two of the four postintervention book readings (Sessions 2 and 3). Although the number of question prompts was relatively lower for these book reading sessions, child engagement was high with the musical interactions as documented by the recorded transcription and was an example of the type of book that lends itself to enjoyable and age-appropriate parent–child interactions through singing. Music as part of book reading activities can be highly productive and beneficial for children who are DHH (Nelson, Wright, & Parker, 2016); therefore, although not reflected in the data for the present study, such interactions should be encouraged along with those targeted in the current data set.
Retention
The two recordings obtained 8 weeks after the intervention recordings showed implementation of child engagement prompts similar to those seen in the intervention data. Across the two retention sessions, there was an average of 12 parent–child exchanges per session, with 33% of those being Category 2 (see Figure 1).
Percentage of Child Words Spoken During Storybook Reading
The study also explored each child’s expressive contributions to the reading activity. To measure potential impact of parent behaviors to promote child engagement, the total number of words spoken by the parent and the total number of words spoken by the child for each 15-min book reading session were calculated to determine the percentage of each child’s expressive contribution averaged across sessions. As shown in Figure 2, child contribution toward the total number of words spoken during the reading interaction at baseline averaged 14% and ranged 6% to 29% across participants. After the parent training session, child contribution toward the total number of words spoken for intervention data averaged 22% and ranged 13% to 34%; retention sessions averaged 19% and ranged 10% to 31%. A paired sample t test was calculated to compare average percentage of child expressive contributions during baseline with the average percentage during intervention, demonstrating a statistically significant increase in child expressive contributions at intervention (p = .012). The paired sample t test comparing the average percentage of child expressive contributions during baseline with the average percentage for the retention data approached but did not reach statistical significance (p = .096).
Percentage of words spoken by the child during book reading sessions.
In the parent feedback questionnaire, participants expressed positive experiences with the book reading interactions, including the benefits of their child’s increased participation during reading sessions. Some described greater comfort in going beyond the text of the book to probe their child’s thoughts and imagination. One parent expressed surprise in realizing how interested her son was to know what would happen next in a story, and another parent reported value in using “I wish/I think/I wonder” prompts to engage her child in the book reading activity (see Table 1).
Examples of Parent Comments.
Discussion
Children who are DHH are at risk for language and literacy delays, and parent–child book reading can substantially contribute to developing early literacy foundations. Many parents read with their children and enjoy the shared storybook experiences that come with home reading rituals. However, some parents may be unsure how to promote positive child engagement activities to maximize literacy growth in their preschool children who are DHH. Study findings suggested that parent reading behaviors can be positively affected when they are provided with supports and practical suggestions for implementing effective engagement strategies during home reading practices. The transcript recordings demonstrated that after training, participants increased language expansion and critical thinking opportunities for their child by utilizing engagement prompts, such as “I wonder . . . ,” “I wish . . . ,” “What do you think . . .?” Overall child engagement increased as children asked more questions and posed more comments after intervention as compared with baseline. As parents recognize the vast opportunities to expand language and literacy interactions with their child, there is greater potential for positive impacts on language and literacy growth.
Study findings supported the notion that professionals, such as educators and speech-language pathologists, can play a prominent role in helping parents to understand and implement effective reading strategies at home, and time spent promoting targeted parent–professional literacy collaborations can yield important gains in child outcomes. Study findings also suggested that training can be effective with minimal time expended. During a short training session, the strategies to be targeted should be clearly defined with concrete examples provided. Although it would be unrealistic to expect parents to gain mastery in reading strategies after one short training session, the observed decline in parent–child interactions during the retention data collection period is noteworthy and suggests the importance of ongoing parent support.
Professionals can reinforce to parents that book reading activities with their child should be comfortable and positive experiences and should not place excessive response demands on the child. Some parents may have a tendency to bombard the child with questions, such that it could detract from the story interaction. The caution that “more” is not always “better” may need to be emphasized to help maintain the purpose of a comfortable reading activity. Child engagement prompts such as “what do you think . . .” can minimize the burden of a correct response expectation and might maximize creativity and critical thinking. As shown in the present study, average child contributions to the reading interactions increased from 14% at baseline to 22% after intervention, demonstrating the potential for increased child engagement in the book reading experience when provided the opportunity. Alternately, there may be times when the child prefers not to be an active participant, but would rather just listen to the story. These too are valuable parent–child experiences and being attuned to the child’s needs and desires on any given day can help to maintain the joy of a parent and child coming together for shared book reading routines.
Professionals can also provide parents with available written materials and web-based resources to supplement their knowledge and skills in understanding age-appropriate literacy development and the tools that might support their goals and activities. Professionals can be instrumental in ensuring parents have knowledge of and access to evidence-based recommendations, including concrete and meaningful suggestions for implementation. For example, parents can be provided with guidance through materials available from national resources, such as National Institute for Literacy (2003, 2006, 2009) to better understand the priorities and recommendations shown to promote language and literacy development. In addition, parent friendly websites, such as Reading Rockets (2018) provides literacy suggestions and resources to promote home literacy activities. Helping parents to recognize the importance of phonemic awareness, vocabulary development, and reading fluency to the ultimate goal of proficient language development and reading comprehension can empower them with tools to optimize their child’s growth.
In addition to literacy priorities, other aspects of parent behaviors that promote use of language-enriching strategies can take guidance and practice. For example, implementing effective wait time can be difficult for many adults, yet allowing extra processing time is highly beneficial for young children to formulate their thoughts. An ongoing reminder to incorporate an effective pause after posing a thought or question may be valuable for some parents. Parents may also benefit from suggestions in book selections, along with concrete examples for incorporating age-appropriate prompts. The amount and type of guidance needed for each family will vary and adjusting according to individual needs can increase the likelihood of effective implementation.
Ultimately, parents can be effectively supported in promoting their child’s literacy development while also following their child’s lead in maintaining the most comfortable and positive book reading experience on any given day—utilizing effective child engagement as often as possible but recognizing the needs of the child. Even when the child assumes a passive role, parents can embed expanded thoughts, use engaging voices, and promote story comprehension dialogue.
Study Limitations
It is unknown how parent behaviors may have been altered knowing that the storybook readings were being recorded, resulting in the potential for parents to place a higher than typical focus on utilizing prompts throughout the storybook reading. As a pilot study, there were a low number of study participants. Future studies to further explore parent-directed activities that support preschool literacy achievement involving a higher number of participants may improve generalization of study findings. All participants in the present study were mothers; participation of fathers may have provided additional information or varying outcomes. Additional research is needed to document potential differences in mother versus father reading behaviors with young children who are DHH.
The selection of a 20-min training session was arbitrary based on the authors’ determination of reading strategy priorities and a concise training presentation. The intention was to explore the intervention effectiveness without engaging in a lengthy training workshop. However, the amount of time required for effective training will vary and should be individualized according to parent and family needs. The retention data were collected 8 weeks after intervention data. Therefore, study findings did not explore parent retention of child engagement reading behaviors over a longer period after training.
Conclusion
Parent–child storybook reading provides opportunities for enriched language and literacy interactions within the natural home routine, and children who are DHH can and should be given opportunities to engage with an interactive dialogue just as would occur with typically hearing peers. Although child engagement during storybook reading may be intuitive for some parents of children who are DHH, many others may be uncomfortable with or lack the skills to effectively involve their child in the storybook dialogue beyond the written text. Findings from the present study supported the notion that providing parents with evidence-based interactive reading strategies may promote literacy growth and development in young children. For many parents, instruction time need not be extensive. With focused individualized recommendations from professionals, there is potential for the home book reading experience to increase child engagement, improve literacy comprehension, vocabulary, and critical thinking skills and to foster positive parent–child literacy traditions.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.