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Correlates of Korean Hangul Reading in Children with Hearing Loss

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Title: Correlates of Korean Hangul Reading in Children with Hearing Loss
Language: English
Authors: Park, Soon-Gil, Ryu, Sung-Yong, Cho, Jeung-Ryeul
Source: Journal of Deaf Studies and Deaf Education. Jan 2022 27(1):62-72.
Availability: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://jdsde.oxfordjournals.org/
Peer Reviewed: Y
Page Count: 11
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Descriptors: Written Language, Hearing Impairments, Children, Vocabulary Development, Phonological Awareness, Orthographic Symbols, Foreign Countries, Deafness, Assistive Technology
Geographic Terms: South Korea
DOI: 10.1093/deafed/enab035
ISSN: 1081-4159
Abstract: This study examined the associations of vocabulary and phonological and orthographic awareness with Hangul word reading in Korean children, aged between 7 and 10 years, who were deaf and hard of hearing (DHH) and children with typical hearing (TH). The participants were 24 children with hearing aids (HAs), 24 children with cochlear implants (CIs), and 24 TH children in Korea. The three groups were matched for chronological age, vocabulary age, and nonverbal intelligence. Results showed that there were no differences between children with CIs and those with HAs in reading fluency and cognitive skills, except word-reading accuracy, whereas children with CIs and HAs were delayed in all measures compared with their TH peers. Regression analyses showed that syllable and phoneme awareness uniquely explained word-reading accuracy in children with DHH and those with TH. However, word-reading fluency was uniquely explained by syllable awareness in the DHH children and by vocabulary and orthographic awareness in the TH children. These results suggest that DHH and TH children in Korea rely on phonological awareness for Korean word recognition. However, DHH and TH Korean children tend to use different strategies based on sublexical versus lexical information, respectively, to read Korean words fluently.
Abstractor: As Provided
Entry Date: 2021
Accession Number: EJ1319736
Database: ERIC
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  Value: <anid>AN0154255353;big01jan.22;2021Dec23.07:25;v2.2.500</anid> <title id="AN0154255353-1">Correlates of Korean Hangul Reading in Children With Hearing Loss </title> <p>This study examined the associations of vocabulary and phonological and orthographic awareness with Hangul word reading in Korean children, aged between 7 and 10 years, who were deaf and hard of hearing (DHH) and children with typical hearing (TH). The participants were 24 children with hearing aids (HAs), 24 children with cochlear implants (CIs), and 24 TH children in Korea. The three groups were matched for chronological age, vocabulary age, and nonverbal intelligence. Results showed that there were no differences between children with CIs and those with HAs in reading fluency and cognitive skills, except word-reading accuracy, whereas children with CIs and HAs were delayed in all measures compared with their TH peers. Regression analyses showed that syllable and phoneme awareness uniquely explained word-reading accuracy in children with DHH and those with TH. However, word-reading fluency was uniquely explained by syllable awareness in the DHH children and by vocabulary and orthographic awareness in the TH children. These results suggest that DHH and TH children in Korea rely on phonological awareness for Korean word recognition. However, DHH and TH Korean children tend to use different strategies based on sublexical versus lexical information, respectively, to read Korean words fluently.</p> <p>Abstract</p> <p>In Korea, the number of children who experience cochlear implantation has increased sharply since 2005 due to the application of national medical insurance for cochlear implantation. With cochlear implantation becoming more common, children with cochlear implants (CIs) have improved hearing and spoken language, and their language development has become similar to those of their peers with typical hearing (TH). There is substantial evidence that cochlear implantation improves understanding and production in languages such as Korean and English ([<reflink idref="bib2" id="ref1">2</reflink>]; [<reflink idref="bib10" id="ref2">10</reflink>]; [<reflink idref="bib18" id="ref3">18</reflink>]; [<reflink idref="bib20" id="ref4">20</reflink>], [<reflink idref="bib21" id="ref5">21</reflink>]; [<reflink idref="bib34" id="ref6">34</reflink>], for a review).</p> <hd id="AN0154255353-2">Reading in Children with CIs</hd> <p>Despite a substantial improvement in spoken language skills among children who are deaf and hard of hearing (DHH), they still experience difficulty reading and writing in school ([<reflink idref="bib1" id="ref7">1</reflink>]; [<reflink idref="bib28" id="ref8">28</reflink>]). Many studies have reported that children with CIs lag behind TH children of the same age ([<reflink idref="bib18" id="ref9">18</reflink>]; [<reflink idref="bib20" id="ref10">20</reflink>], [<reflink idref="bib21" id="ref11">21</reflink>]). For example, [<reflink idref="bib18" id="ref12">18</reflink>]) reported that, in a group of U.S. children between the ages of eight and nine who were implanted before the age of five, 52% were reading English words at an age-appropriate level, meaning that 48% achieved below average reading scores for their age. Likewise, [<reflink idref="bib28" id="ref13">28</reflink>] found that DHH children exhibited significant delays on all reading tests, including word reading and reading comprehension, at each testing phase in a longitudinal study, and the average reading delay increased with time. In other words, DHH children had an average 1-year delay in word reading at age eight, but by age nine, the delay had increased to 2 years ([<reflink idref="bib28" id="ref14">28</reflink>]). In a recent study, [<reflink idref="bib21" id="ref15">21</reflink>]) compared the language, phonological awareness, and literacy skills of two cohorts of children with CIs, recruited 10 years apart. They found that English vocabulary, phonological awareness, and reading ability were below chronological age in both cohorts, although English vocabulary was significantly higher in the new cohort. Similarly, in a Korean study ([<reflink idref="bib23" id="ref16">23</reflink>]), a group of Korean children with CIs aged 8 and 9 years fell behind in the performance of word-reading fluency and reading comprehension compared with a group of TH peers, who matched the CI group on chronological age and vocabulary age.</p> <p>However, recent studies reported that children with CIs were not significantly different from TH children of the same age ([<reflink idref="bib15" id="ref17">15</reflink>]; [<reflink idref="bib17" id="ref18">17</reflink>]). For example, [<reflink idref="bib56" id="ref19">56</reflink>]) reported that Chinese students between the ages of 7 and 12 with CIs showed age-appropriate language development and reading skills, including word recognition and reading comprehension. [<reflink idref="bib15" id="ref20">15</reflink>] showed that adolescents with CIs had no significant differences in word reading and reading comprehension compared with their TH peers after controlling for short-term memory span. [<reflink idref="bib17" id="ref21">17</reflink>] found that deaf children who received a CI before 24 months did not show much difference from their TH peers in sentence reading comprehension, whereas deaf children with late-CIs performed significantly worse than TH peers. In addition, several studies reported that children with CIs were significantly different than TH children in reading comprehension but not in word reading or nonword reading ([<reflink idref="bib23" id="ref22">23</reflink>]; [<reflink idref="bib33" id="ref23">33</reflink>]). In short, there seems to be no or a small difference in literacy skills between children with CIs and TH children when using nonwords or word-reading-accuracy tasks ([<reflink idref="bib23" id="ref24">23</reflink>]; [<reflink idref="bib33" id="ref25">33</reflink>]), when testing older children, including adolescents ([<reflink idref="bib15" id="ref26">15</reflink>]; [<reflink idref="bib56" id="ref27">56</reflink>]), or when the CI was done before the age of 2 years ([<reflink idref="bib17" id="ref28">17</reflink>]; [<reflink idref="bib25" id="ref29">25</reflink>]; [<reflink idref="bib34" id="ref30">34</reflink>], for a review).</p> <hd id="AN0154255353-3">Reading in Children with Hearing Aids</hd> <p>These previous studies tend to focus primarily on children with CIs; there are far less studies of DHH children using conventional hearing aids (HAs; e.g. [<reflink idref="bib2" id="ref31">2</reflink>]; [<reflink idref="bib21" id="ref32">21</reflink>]). Indeed, there have been considerable technological advances in HAs ([<reflink idref="bib20" id="ref33">20</reflink>]); as in other developed countries, many children in Korea are now using digital HAs, which can be expected to provide better language accessibility. There have been several studies to investigate whether children with CIs have higher literacy skills than their peers who rely on HAs ([<reflink idref="bib48" id="ref34">48</reflink>]). Two previous nationwide studies in Scotland ([<reflink idref="bib47" id="ref35">47</reflink>]) and the Netherlands ([<reflink idref="bib51" id="ref36">51</reflink>]) showed that children with CIs performed better in reading and writing than their peers with HAs but still lagged behind their TH peers. For example, [<reflink idref="bib51" id="ref37">51</reflink>]) reported that 50 deaf children and adolescents with CIs performed better in word recognition and reading comprehension than 500 deaf children without CIs. Their research seems to have some limitations in that the two groups of DHH children did not match in chronological age, nonverbal intelligence, and other important factors related to literacy (e.g. [<reflink idref="bib34" id="ref38">34</reflink>]). However, in a recent, relatively well-designed study ([<reflink idref="bib21" id="ref39">21</reflink>]), there was no significant difference between children with CIs and those with HAs on the measures of word reading, reading comprehension, vocabulary, and phonological awareness. In this study, the two groups were matched for the children's chronological age, unaided hearing loss, age of hearing loss diagnosis, nonverbal intelligence, and speech intelligibility. Indeed, the wide range of variability in cognitive and literacy skills in DHH children might be related to diverse factors such as the age at which devices were first worn, severity of hearing loss, consistency of device use, socioeconomic status, and others ([<reflink idref="bib34" id="ref40">34</reflink>]; [<reflink idref="bib25" id="ref41">25</reflink>]; [<reflink idref="bib49" id="ref42">49</reflink>]).</p> <hd id="AN0154255353-4">Cognitive Correlates of Reading in Children with DHH</hd> <p>A famous triangle model from connectionist models of word reading asserts that word reading is an interactive process involving phonology, semantics, and orthography ([<reflink idref="bib43" id="ref43">43</reflink>]). The relative importance of the three components in word reading might differ depending on the orthographic depth of writing systems and reading proficiency (e.g. [<reflink idref="bib12" id="ref44">12</reflink>] for a review; [<reflink idref="bib41" id="ref45">41</reflink>]). For example, English is an opaque orthography that is inconsistent between phonemes and letters. Young English readers often read English using basic sight vocabulary. After decoding skills are developed, phonological awareness is strongly associated with English reading. However, in the case of shallow orthographies such as German and Dutch, phonological transparency enables fast and accurate phonological decoding; as a result, young readers rarely show reading errors and the naming speed of letters and digits is more strongly linked to reading fluency than phonological awareness ([<reflink idref="bib55" id="ref46">55</reflink>]).</p> <p>Phonological awareness includes the ability to perceive, store, and manipulate phonological information at the levels of phonemes, syllables, and subsyllabic units ([<reflink idref="bib31" id="ref47">31</reflink>]). This ability plays an important role in understanding the correspondences between letters and phonemes—in other words, the alphabet principle. Phonological awareness is particularly important for reading by TH learners of English and other alphabetical languages ([<reflink idref="bib16" id="ref48">16</reflink>], for a review). However, many previous studies on English literacy development in children with DHH reported that phonological ability plays only a minor role, whereas language skills have a greater impact on reading development ([<reflink idref="bib25" id="ref49">25</reflink>]; [<reflink idref="bib32" id="ref50">32</reflink>], for a review; [<reflink idref="bib37" id="ref51">37</reflink>]). For example, [<reflink idref="bib37" id="ref52">37</reflink>]) found different patterns in predictors of word reading between DHH children and their TH peers: Significant predictors of word reading were found to be English spoken language and syllable counting for DHH children but phoneme awareness for TH peers. [<reflink idref="bib37" id="ref53">37</reflink>] concluded that oral language skills explained more variance in emergent literacy for children with CIs than for TH children. Likewise, in a 3-year longitudinal study of children with DHH and TH between the ages of five and seven ([<reflink idref="bib20" id="ref54">20</reflink>]), the most consistent longitudinal predictor of word reading for DHH children and TH children was English vocabulary and phonological awareness, respectively. In their concurrent data of the third year, vocabulary and phonological awareness significantly contributed to word reading in both groups. However, while vocabulary contributed more to word reading in DHH children, phonological awareness contributed more to word reading for TH peers. Similarly, [<reflink idref="bib25" id="ref55">25</reflink>]) found that vocabulary explained larger percentages of variance in word reading and reading comprehension than phonological awareness among children with CIs between 5 and 15 years of age.</p> <p>Although previous studies on literacy development in English have reported the weak or moderate effects of phonological awareness in English-speaking children with DHH, the relative importance of phonological awareness may differ in other orthographies. For instance, in a French longitudinal study, early phonological awareness skills, including rhyme decision and generation, predicted word recognition among 6-year-old prereaders with DHH to the same extent as in hearing peers of the same chronological age ([<reflink idref="bib11" id="ref56">11</reflink>]). Indeed, studies on reading and its mechanisms in children with DHH in diverse languages other than Indo-European languages have been few. To fill this gap, this study compared literacy, vocabulary, and phonological and orthographic awareness skills in Korean children with both DHH and TH. In addition, this study examined whether Korean DHH children take advantage of cognitive skills similarly to their TH peers in word-reading accuracy and fluency. To our best knowledge, the current study is one of first studies to examine the relative importance of phonological awareness and vocabulary in Hangul reading in Korean children with DHH. This study will add to the knowledge on universal and language-specific properties regarding DHH children's reading processes (e.g. [<reflink idref="bib42" id="ref57">42</reflink>]).</p> <hd id="AN0154255353-5">Cognitive Correlates of Korean Hangul Word Reading in Korean Children</hd> <p>Korean language uses Hangul, which is a shallow alphabetic orthography with 19 consonants (e.g. ㄱ, ㄴ, ㄹ, ㅁ, ㅎ), 21 vowels (e.g. ㅏ, ㅓ, ㅗ, ㅜ, ㅡ), and consistent grapheme–phoneme correspondences. Hangul letters are arranged from left to right (e.g. 나, /na/, meaning "I") or from top to bottom (e.g. 소, /so/, "cow") in a square block of syllable (e.g. 한글, /han.gɨl/, "Hangul"). The nonlinear syllable blocks are visually salient and are considered basic units of visual Korean word recognition in Korean adults ([<reflink idref="bib45" id="ref58">45</reflink>]). Since Hangul syllable blocks encompass alphabetic letters, Hangul is called an alphasyllabary ([<reflink idref="bib46" id="ref59">46</reflink>]), where phonology and orthography are mapping at both the levels of syllables and of phonemes (e.g. [<reflink idref="bib36" id="ref60">36</reflink>]).</p> <p>Korean children learn Hangul syllables earlier than letter names and sounds ([<reflink idref="bib4" id="ref61">4</reflink>]). Most Korean children start learning Hangul at about the age of four and enter the first grade with high levels of decoding skills. Although many Korean words are phonologically transparent and can be read correctly by using grapheme–phoneme mapping rules, some multisyllable words and phrases undergo phonological changes due to the assimilation phenomena of the Korean language and morphophonemic writing principles, making them phonologically irregular. An earlier Korean study reported that Korean children in kindergarten and second grade make use of syllable and phoneme awareness in early Hangul word reading, supporting that Hangul is an alphasyllabary (e.g. [<reflink idref="bib7" id="ref62">7</reflink>]). In a longitudinal study, however, only syllable awareness predicted reading Hangul word recognition a year later among second graders with TH in Korea, whereas phoneme awareness predicted reading English as a second language ([<reflink idref="bib8" id="ref63">8</reflink>]). Since syllable and phoneme awareness play an important role in understanding the correspondences between print and sound in Korean, our study included both skills as cognitive correlates of Hangul word reading.</p> <p>We additionally added vocabulary as a possible correlate of reading in Korean Hangul. Although vocabulary has often been used as a control variable in literacy development of TH children (e.g. [<reflink idref="bib26" id="ref64">26</reflink>]), it is considered an important predictor in English reading among children with DHH (e.g. [<reflink idref="bib20" id="ref65">20</reflink>], [<reflink idref="bib21" id="ref66">21</reflink>]). Vocabulary knowledge includes a variety of information, such as word meaning, sound, spelling, morphology, syntax, and background knowledge ([<reflink idref="bib50" id="ref67">50</reflink>]; [<reflink idref="bib53" id="ref68">53</reflink>]). Note that ~50–60% of Korean vocabulary is estimated to be Sino-Korean, where one syllable represents a morpheme, as is the case in the Chinese language ([<reflink idref="bib46" id="ref69">46</reflink>]). Most Sino–Korean words are compounds that are relatively semantically transparent. Korean children learn conceptually difficult Sino-Korean compounding words and phonologically irregular words in elementary school. In a recent Korean study, vocabulary was found to be important in spelling phonologically irregular targets in 6-year-old Korean children with TH and in Chinese adult learners of Korean as a foreign language ([<reflink idref="bib9" id="ref70">9</reflink>]).</p> <p>This study additionally included a measure of orthographic awareness to test sensitivity to visual and orthographic patterns. Orthographic awareness refers to the use of orthographic knowledge—the graphic patterns of a written language, frequency of letter sequences, and spatial position patterns in words ([<reflink idref="bib3" id="ref71">3</reflink>]; [<reflink idref="bib31" id="ref72">31</reflink>]). Children's orthographic awareness was found to be important for their word recognition and reading fluency beyond phonological processes in the studies of Korean and English learners with TH (e.g. [<reflink idref="bib5" id="ref73">5</reflink>]; [<reflink idref="bib13" id="ref74">13</reflink>]; [<reflink idref="bib26" id="ref75">26</reflink>]; [<reflink idref="bib52" id="ref76">52</reflink>]). However, there are not many related studies in children with DHH, and even if there are, the results do not seem to be consistent. Although deaf children have some enhanced visual processing skills and use orthographic coding, those skills do not seem to be relevant to reading in several studies (e.g. [<reflink idref="bib35" id="ref77">35</reflink>]; [<reflink idref="bib38" id="ref78">38</reflink>]). On the other hand, [<reflink idref="bib19" id="ref79">19</reflink>]) reported that orthographic awareness uniquely explained English word reading for both 8- and 14-year-old children with DHH.</p> <p>In addition to word-reading accuracy, word-reading fluency was measured in the current study, as the relationship between reading fluency and underlying components has not been fully explored in children with TH (e.g. [<reflink idref="bib30" id="ref80">30</reflink>]) and in those who are DHH ([<reflink idref="bib14" id="ref81">14</reflink>]). Word-reading fluency is operationalized as the rate at which an individual correctly reads words in isolation or in a list ([<reflink idref="bib26" id="ref82">26</reflink>]). Reading fluency refers to reading efficiency or automaticity. Reading fluency incorporates multiple cognitive components, which often differ depending on the child's age and orthographies ([<reflink idref="bib26" id="ref83">26</reflink>]; [<reflink idref="bib30" id="ref84">30</reflink>]). For instance, [<reflink idref="bib26" id="ref85">26</reflink>]) reported that vocabulary, rapid automatized naming, and letter knowledge concurrently contributed to word-reading fluency among Korean kindergartners with TH, whereas phonological awareness, orthographic awareness, and letter knowledge contributed to word-reading fluency longitudinally after 1 year. From a longitudinal study of English-speaking students with TH from second grade to sixth grade, [<reflink idref="bib30" id="ref86">30</reflink>] found that the only strong predictor of word-reading fluency across all age groups was phonological awareness. Similarly, [<reflink idref="bib39" id="ref87">39</reflink>] reported that phonological processing significantly contributed to word-reading fluency in Danish fifth graders with TH, whereas vocabulary and semantic processing strongly contributed to reading comprehension.</p> <hd id="AN0154255353-6">Research Questions</hd> <p>This study included three groups of 24 children in Korea who were matched in chronological age, nonverbal intelligence, and vocabulary age: a group with CIs, a group with HAs, and a group with TH. The primary purpose of this study was to compare performances of word-reading accuracy and fluency and cognitive skills, such as vocabulary as well as phonological and orthographic awareness, in the three groups of children. We also examined the relative contributions of cognitive skills to reading accuracy and fluency of Korean words in the children with DHH and those with TH. The specific research questions are as follows:</p> <p>First, are there differences in literacy and cognitive skills in the three groups of children (i.e. those with CIs, HAs, and TH)?</p> <p>Second, which cognitive skills contribute to word-reading accuracy in children with DHH and children with TH?</p> <p>Third, which cognitive skills contribute to word-reading fluency in children with DHH and children with TH?</p> <hd id="AN0154255353-7">Methods</hd> <p>Participants</p> <p>Children who are DHH</p> <p>Twenty-four children with HAs (6 boys and 18 girls) and 24 children with CIs (10 boys and 14 girls) were selected with the collaboration of speech therapists through special children's services located in one of six provinces in South Korea. The DHH children were enrolled in speech therapy programs. The average age was 8.76 years (standard deviation, <emph>SD</emph> = 0.93 and range: 7.42–10.08 years) in the CI group and 8.61 years (<emph>SD</emph> = 0.89 and range: 7.17–10.08 years) in the HA group.</p> <p>In this study, 24 children with CIs and 24 children with HAs were selected based on the following criteria. The two groups of children with CIs and HAs (<reflink idref="bib1" id="ref88">1</reflink>) were enrolled in the first to third grades of mainstream elementary school; and (<reflink idref="bib2" id="ref89">2</reflink>) experienced hearing loss before the age of 2 years; (<reflink idref="bib3" id="ref90">3</reflink>) started wearing an assistive listening device before the age of 3 years; (<reflink idref="bib4" id="ref91">4</reflink>) had no other disabilities except for hearing loss; (<reflink idref="bib5" id="ref92">5</reflink>) had no severe inner ear deformation; (<reflink idref="bib6" id="ref93">6</reflink>) had been continuously using an assistive listening device since before the age of 3 years; (<reflink idref="bib7" id="ref94">7</reflink>) used spoken language as the main means of communication; (<reflink idref="bib8" id="ref95">8</reflink>) had hearing loss of 70 dB or greater in both ears before wearing assistive listening device; (<reflink idref="bib9" id="ref96">9</reflink>) were using assistive listening devices in both ears; and (<reflink idref="bib10" id="ref97">10</reflink>) had parents with educational background of high school graduation or higher.</p> <p>Children with TH</p> <p>The control group of 24 children with TH (10 boys and 14 girls) was selected based on the following criteria: Children (<reflink idref="bib1" id="ref98">1</reflink>) were enrolled in the first to third grades of mainstream elementary school; (<reflink idref="bib2" id="ref99">2</reflink>) had no abnormalities in intelligence and hearing, according to reports from teachers or parents; and (<reflink idref="bib3" id="ref100">3</reflink>) had no sensory, physical, emotional, or behavioral problems, according to reports from teachers or parents. Their average age was 8.57 years (<emph>SD</emph> = 0.90 and range: 7.08–9.92 years). They were selected from a large sample of 150 children in two elementary schools from two provinces in South Korea. They were matched with DHH children in chronological age, nonverbal intelligence, and vocabulary age. Their average scores of the three groups of children are presented in Table 1. The average chronological age was 103.37 months for children with HAs, 105.08 months for children with CIs, and 102.79 months for children with TH. The average chronological age was not significantly different in the three groups of children, <emph>F</emph> (<reflink idref="bib2" id="ref101">2</reflink>, 69) = 0.29, <emph>p</emph> = 0.75. Similarly, one-way analyses of variance (ANOVA) confirmed that there was no significant difference between the three groups of HA, CI, and TH children on nonverbal intelligence, <emph>F</emph> (<reflink idref="bib2" id="ref102">2</reflink>, 69) = 0.06, <emph>p</emph> = 0.94, and vocabulary age in months, <emph>F</emph> (<reflink idref="bib2" id="ref103">2</reflink>, 69) = 1.37, <emph>p</emph> = 0.26.</p> <p>Table 1. Means, SDs, and <emph>F</emph> tests for differences among children with HAs, children with CIs and typical-hearing children for the control variables</p> <p> <ephtml> <table><thead><tr><th rowspan="2">Variable. </th><th colspan="2">Children with HAs (<italic>n</italic> = 24). </th><th colspan="2">Children with CIs (<italic>n</italic> = 24). </th><th colspan="2">Children with TH (<italic>n</italic> = 24). </th><th rowspan="2"><italic>F</italic> (2, 69). </th><th rowspan="2"><italic>p</italic>. </th></tr><tr><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th></tr></thead><tbody><tr><td>Chronological age (months) </td><td>103.37 </td><td>10.65 </td><td>105.08 </td><td>11.10 </td><td>102.79 </td><td>10.79 </td><td>0.29 </td><td>0.75 </td></tr><tr><td>Nonverbal intelligence (raw score: Max = 60) </td><td>33.66 </td><td>4.50 </td><td>33.63 </td><td>4.26 </td><td>34.04 </td><td>4.88 </td><td>0.06 </td><td>0.94 </td></tr><tr><td>Vocabulary age (months) </td><td>103.41 </td><td>12.93 </td><td>105.91 </td><td>14.02 </td><td>109.79 </td><td>13.34 </td><td>1.37 </td><td>0.26 </td></tr></tbody></table> </ephtml> </p> <p>Assessments</p> <p>Excluding nonverbal intelligence and vocabulary, this study measured word-reading accuracy, word-reading fluency, syllable and phonemes awareness, and orthographic awareness using the respective subtests of the Korean Test of Literacy Diagnosis (Cho, Kim & Park, [<reflink idref="bib6" id="ref104">6</reflink>]). In each test, the number of correct scores was used to determine standard scores, with a mean of 100 and a <emph>SD</emph> of 15, according to age norm.</p> <p>Nonverbal intelligence</p> <p>Nonverbal intelligence was measured by the Korean Standard Progressive Matrices (K-SPM; [<reflink idref="bib29" id="ref105">29</reflink>]), a Korean version of Raven's standard progressive matrices ([<reflink idref="bib40" id="ref106">40</reflink>]). The test consists of a total of 60 items, with 12 items in each of five sets from A to E. Each item contains a pattern in which one part is removed. Children were asked to make the best choice to complete the pattern from a set of alternatives shown. The test was stopped if the child made five mistakes consecutively. One point was given for a correct choice, and the maximum score was 60 points. Since the age norm for this test was not provided, raw scores were used for further analysis.</p> <p>Vocabulary</p> <p>An expressive vocabulary subtest included in the Receptive and Expressive Vocabulary Test (REVT: [<reflink idref="bib27" id="ref107">27</reflink>]) was administered to determine the language age of the children. In the expressive vocabulary test, children were presented a picture and were asked to name the picture. The number of items in this task was 185. The children received one point for correctly naming a picture but zero points for an incorrect name or no answer. The number of correct answers was used to determine the age of vocabulary according to the age norm.</p> <p>Word-reading accuracy</p> <p>This test consists of 96 items in total, arranged from easier to more difficult items. The test includes 11 regular words consisting of one or two syllables of consonant-vowel (CV) type at the beginning of the list, 23 regular words with two or three syllables, including consonant-vowel-consonant (CVC) in the middle, and 62 irregular words at the end, due to the application of Korean phonological alternations. If a child read the presented word correctly, one point was given. If the child failed to read the presented word correctly, no points were given. The test was stopped when the child failed to read five words in a row. The maximum score was 96.</p> <p>Word-reading fluency</p> <p>This test consists of a list of 49 two-syllable Korean words. Children were to read the words aloud with speed and accuracy. The child's score was calculated by counting the number of syllables that a child accurately read in 40 s.</p> <p>Syllable awareness</p> <p>Children were asked to listen to an item orally presented, and they were asked to delete one syllable from the item. For example, <emph>ja dong cha</emph> (자동차) without <emph>cha</emph> (차) would be <emph>ja dong</emph> (자동). This task included six three-syllable words, six three-syllable nonwords, and six four-syllable nonwords. Each item was assigned one point for the correct response. The experimenter stopped the test when three consecutive items failed. The maximum score was 18.</p> <p>Phoneme awareness</p> <p>The children were given 18 items in total, consisting of nine one-syllable CVC real words and nine CVC nonwords; for each, they were asked to delete the first phoneme. For example, saying <emph>dog</emph> (독) without the first sound would be <emph>og</emph> (옥). One point was allocated for the correct response. This test ended if a child failed three items in a row. The maximum score was 18.</p> <p>Orthographic awareness</p> <p>In this task, the children were asked to select stimuli in the right direction (e.g. 25, ㅉ, 료, and 뿔) from 80 items of this task. The items included numbers, the Korean alphabet, and Korean syllables. Half of these items were reversed in left and right directions (e.g.</p> <p>Graph</p> <p>,</p> <p>Graph</p> <p>, and</p> <p>Graph</p> <p>). The maximum score was 80.</p> <p>Research Procedure</p> <p>Data collections in this study were conducted from December 2018 to March 2019. Assessments of children with CIs and HAs and scoring of their performances were carried out by the second author, a qualified teacher of special education who has considerable experience in conducting language and literacy assessment with children with DHH. Prior written consent for DHH children was obtained from the children and their guardians. A well-trained graduate student assessed TH children and scored their performances. Written consent for children with TH was obtained from their parents. This study was approved by the Institutional Review Board of Nambu University in Korea. The DHH children were tested in the learning center, in familiar and quiet spaces without distractions. The TH children were assessed in a separate room in their schools. All tasks were administered individually. In order to ensure the child's stable and comfortable condition, a simple story or game session was presented before testing.</p> <p>Based on the standardized test administration procedures, the researcher explained to the children how to perform the task and guided them to practice it with several items before the actual task began. The standardized tests were administered and scored in accordance with the guidelines in the test manual. The tasks were presented in random order. The entire experiment took 40–80 min and was divided into two or three sessions, depending on the child's concentration and performance. The children took a short break after each task. Another research assistant checked all test records to ensure that there were no mistakes or missing data in order to maximize the fidelity of test administration and scoring. If there was a difference in scoring, the tester and the examiner discussed scoring until 100% agreement was reached.</p> <p>Analyses</p> <p>For the first research question, we reported means, standard deviations, and range of the literacy and cognitive measures in the three groups (CI, HA, and TH children) and examined group difference by one-way analyses of variance (ANOVAs) and Scheffe's post-hoc comparison procedure. For our second and third questions, partial correlation analyses were conducted to examine relations between dependent measures and cognitive measures in the three groups (CI, HA, and TH children) after controlling for chronological age. In addition, hierarchical regression analyses were conducted to examine which cognitive variables uniquely contribute to word-reading accuracy and word-reading fluency in children with DHH and in children with TH, after controlling for chronological age and nonverbal intelligence.</p> <hd id="AN0154255353-8">Results</hd> <p>Research Question 1: Are There Differences in Literacy and Cognitive Skills in the Three Groups of Children (i.e. Those with HAs, CIs, and TH)?</p> <p>Table 2 shows descriptive statistics of literacy and cognitive skills in the three groups of children. One-way ANOVA was conducted in each measure. As shown in Table 2, there was a significant group effect in word-reading accuracy [<emph>F</emph>(<reflink idref="bib2" id="ref108">2</reflink>, 69) = 45.49 and <emph>p</emph> < 0.001]. As a result of Scheffe's post-hoc comparison procedure, children with HAs (<emph>M</emph> = 84.95, <emph>SD</emph> = 4.93, and range = 79–94) showed significantly lower performance than children with CIs (<emph>M</emph> = 88.04, <emph>SD</emph> = 3.46, and range = 81–97), and children with CIs showed significantly lower performance than children with TH (<emph>M</emph> = 95.03, <emph>SD</emph> = 2.42, and range = 91–100). There was a significant group effect in word-reading fluency [<emph>F</emph>(<reflink idref="bib2" id="ref109">2</reflink>, 69) = 60.72 and <emph>p</emph> < 0.001]. Scheffe's post-hoc comparison procedure showed that children with HAs (<emph>M</emph> = 84.07, <emph>SD</emph> = 4.56, and range = 77–94) were not significantly different from children with CIs (<emph>M</emph> = 85.22, <emph>SD</emph> = 4.77, and range = 78–97), however, the two groups of HA and CI children performed significantly poorer than children with TH (<emph>M</emph> = 96.64, <emph>SD</emph> = 3.70, and range = 91–103). In addition, one-way ANOVAs revealed significant group effects in syllable awareness [<emph>F</emph>(<reflink idref="bib2" id="ref110">2</reflink>, 69) = 18.57 and <emph>p</emph> < 0.001], phoneme awareness [<emph>F</emph>(<reflink idref="bib2" id="ref111">2</reflink>, 69) = 13.28 and <emph>p</emph> < 0.001] and orthographic awareness [<emph>F</emph>(<reflink idref="bib2" id="ref112">2</reflink>, 69) = 33.25 and <emph>p</emph> < 0.01]. Scheffe's post-hoc comparisons showed that the groups of children with HAs and CIs were not significantly different from each other in the syllable, phoneme, and orthographic awareness measures. The two groups of children with HAs and CIs showed lower performance than the TH group in the three awareness measures.</p> <p>Table 2. Means, SDs, and <emph>F</emph> tests for differences among children with HAs, children with CIs and typical-hearing children for the reading and cognitive variables</p> <p> <ephtml> <table><thead><tr><th rowspan="2">Variable. </th><th colspan="3">Children with HAs<sup>a</sup> (<italic>n</italic> = 24). </th><th colspan="3">Children with CIs<sup>b</sup> (<italic>n</italic> = 24). </th><th colspan="3">Children with TH<sup>c</sup> (<italic>n</italic> = 24). </th><th rowspan="2"><italic>F</italic> (2, 69). </th><th rowspan="2">Scheffe's post-hoc comparison. </th></tr><tr><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th><th><italic>M</italic>. </th><th><italic>SD</italic>. </th><th>Range. </th></tr></thead><tbody><tr><td>Reading accuracy (SS) </td><td>84.95 </td><td>4.93 </td><td>79–94 </td><td>88.04 </td><td>3.46 </td><td>81–97 </td><td>95.03 </td><td>2.42 </td><td>91–100 </td><td>45.49<sup>***</sup></td><td><italic>a</italic> < <italic>b</italic> < <italic>c</italic></td></tr><tr><td>Reading fluency (SS) </td><td>84.07 </td><td>4.56 </td><td>77–94 </td><td>85.22 </td><td>4.77 </td><td>78–97 </td><td>96.64 </td><td>3.70 </td><td>91–103 </td><td>60.72<sup>***</sup></td><td><italic>a</italic>,<italic>b</italic> < <italic>c</italic></td></tr><tr><td>Syllable awareness (SS) </td><td>81.85 </td><td>6.99 </td><td>70–95 </td><td>84.69 </td><td>5.27 </td><td>74–95 </td><td>92.55 </td><td>6.52 </td><td>74–104 </td><td>18.57<sup>***</sup></td><td><italic>a</italic>,<italic>b</italic> < <italic>c</italic></td></tr><tr><td>Phoneme awareness (SS) </td><td>96.77 </td><td>5.67 </td><td>90–111 </td><td>98.37 </td><td>5.63 </td><td>90–111 </td><td>105.10 </td><td>6.49 </td><td>98–119 </td><td>13.28<sup>***</sup></td><td><italic>a</italic>,<italic>b</italic> < <italic>c</italic></td></tr><tr><td>Orthographic awareness (SS) </td><td>86.13 </td><td>3.82 </td><td>81–96 </td><td>87.46 </td><td>3.44 </td><td>83–97 </td><td>94.86 </td><td>4.64 </td><td>85–101 </td><td>33.25<sup>***</sup></td><td><italic>a</italic>,<italic>b</italic> < <italic>c</italic></td></tr></tbody></table> </ephtml> </p> <p> <emph>Note.</emph> <sups>**</sups> <emph>p</emph> < 0.01 and <sups>***</sups><emph>p</emph> < 0.001. SS = standard score<emph>: M</emph> = 100; <emph>SD</emph> = 15.</p> <p>Research Question 2: Which Cognitive Skills Contribute to Word-Reading Accuracy in Children with DHH and Children with TH?</p> <p>Table 3 presents partial correlation coefficients between reading, vocabulary, and phonological and orthographic awareness after controlling for chronological age in each of the three groups. Table 3 showed significant and positive correlations of reading accuracy with syllable awareness (<emph>r</emph> = 0.47), phoneme awareness (<emph>r</emph> = 0.55), orthographic awareness (<emph>r</emph> = 0.65), and vocabulary (<emph>r</emph> = 0.42) in the HA group. Similarly, in the CI group, word-reading accuracy was significantly correlated with nonverbal intelligence (<emph>r</emph> = 0.53), syllable awareness (<emph>r</emph> = 0.45), phoneme awareness (<emph>r</emph> = 0.64), and vocabulary (<emph>r</emph> = 0.51). In the case of the TH group, word-reading accuracy was significantly associated with syllable awareness (<emph>r</emph> = 0.45), phoneme awareness (<emph>r</emph> = 0.63), and orthographic awareness (<emph>r</emph> = 0.42). In addition, vocabulary was significantly related to syllable awareness (<emph>r</emph> = 0.46) and phoneme awareness (<emph>r</emph> = 0.58) in the HA group and with phoneme awareness (<emph>r</emph> = 0.74) in the CI group. However, vocabulary was not significantly associated with syllable and phoneme awareness in the TH group. Since the patterns of correlations appear to be similar in the samples of both HA and CI children, the two samples were combined for subsequent regression analyses.</p> <p>Table 3. Partial correlation coefficients between measures in children with HAs, children with CIs and typical-hearing children after controlling for chronological age</p> <p> <ephtml> <table><thead><tr><th>. </th><th>1. </th><th>2. </th><th>3. </th><th>4. </th><th>5. </th><th>6. </th><th>7. </th></tr></thead><tbody><tr><td colspan="8">Children with HAs </td></tr><tr><td>1. Nonverbal IQ </td><td>1 </td><td>0.48<sup>*</sup></td><td>0.23 </td><td>0.44<sup>*</sup></td><td>0.29 </td><td>0.33 </td><td>0.34 </td></tr><tr><td>2. Syllable awareness </td><td /><td>1 </td><td>0.44<sup>*</sup></td><td>0.64<sup>**</sup></td><td>0.46<sup>*</sup></td><td>0.47<sup>*</sup></td><td>0.69<sup>***</sup></td></tr><tr><td>3. Phoneme awareness </td><td /><td /><td>1 </td><td>0.54<sup>**</sup></td><td>0.58<sup>**</sup></td><td>0.55<sup>**</sup></td><td>0.54<sup>**</sup></td></tr><tr><td>4. Orthographic awareness </td><td /><td /><td /><td>1 </td><td>0.24 </td><td>0.65<sup>**</sup></td><td>0.75<sup>***</sup></td></tr><tr><td>5. Vocabulary </td><td /><td /><td /><td /><td>1 </td><td>0.42<sup>*</sup></td><td>0.12 </td></tr><tr><td>6. Reading accuracy </td><td /><td /><td /><td /><td /><td>1 </td><td>0.81<sup>***</sup></td></tr><tr><td>7. Reading fluency </td><td /><td /><td /><td /><td /><td /><td>1 </td></tr><tr><td colspan="8">Children with CIs </td></tr><tr><td>1. Nonverbal IQ </td><td>1 </td><td>−0.16 </td><td>0.47<sup>*</sup></td><td>0.21 </td><td>0.37 </td><td>0.53<sup>**</sup></td><td>0.09 </td></tr><tr><td>2. Syllable awareness </td><td /><td>1 </td><td>0.08 </td><td>0.24 </td><td>−0.03 </td><td>0.45<sup>*</sup></td><td>0.76<sup>***</sup></td></tr><tr><td>3. Phoneme awareness </td><td /><td /><td>1 </td><td>0.67<sup>***</sup></td><td>0.74<sup>***</sup></td><td>0.64<sup>**</sup></td><td>0.36 </td></tr><tr><td>4. Orthographic awareness </td><td /><td /><td /><td>1 </td><td>0.17 </td><td>0.37 </td><td>0.44<sup>*</sup></td></tr><tr><td>5. Vocabulary </td><td /><td /><td /><td /><td>1 </td><td>0.51<sup>*</sup></td><td>0.05 </td></tr><tr><td>6. Reading accuracy </td><td /><td /><td /><td /><td /><td>1 </td><td>0.57<sup>**</sup></td></tr><tr><td>7. Reading fluency </td><td /><td /><td /><td /><td /><td /><td>1 </td></tr><tr><td colspan="8">Children with typical hearing </td></tr><tr><td>1. Nonverbal IQ </td><td>1 </td><td>0.06 </td><td>0.47<sup>*</sup></td><td>0.31 </td><td>0.67<sup>***</sup></td><td>0.37 </td><td>0.42<sup>*</sup></td></tr><tr><td>2. Syllable awareness </td><td /><td>1 </td><td>0.15 </td><td>−0.08 </td><td>−0.06 </td><td>0.45<sup>*</sup></td><td>0.19 </td></tr><tr><td>3. Phoneme awareness </td><td /><td /><td>1 </td><td>0.29 </td><td>0.35 </td><td>0.63<sup>**</sup></td><td>0.54<sup>**</sup></td></tr><tr><td>4. Orthographic awareness </td><td /><td /><td /><td>1 </td><td>0.19 </td><td>0.42<sup>*</sup></td><td>0.52<sup>*</sup></td></tr><tr><td>5. Vocabulary </td><td /><td /><td /><td /><td>1 </td><td>0.20 </td><td>0.53<sup>**</sup></td></tr><tr><td>6. Reading accuracy </td><td /><td /><td /><td /><td /><td>1 </td><td>0.69<sup>***</sup></td></tr><tr><td>7. Reading fluency </td><td /><td /><td /><td /><td /><td /><td>1 </td></tr></tbody></table> </ephtml> </p> <p> <emph>Note.</emph> <sups>*</sups> <emph>p</emph> < 0.05, <sups>**</sups><emph>p</emph> < 0.01, and <sups>***</sups><emph>p</emph> < 0.001.</p> <p>A hierarchical regression analysis was conducted to determine which cognitive skills uniquely contribute to word-reading accuracy in the combined HA and CI group and in the TH group. For each regression analysis, the predictor variables were chronological age (entered at Step 1), nonverbal intelligence (entered at Step 2), and vocabulary as well as phonological and orthographic awareness (entered at Step 3). Results are shown in Table 4. The final beta weights show that syllable awareness (<emph>β</emph> = 0.47 and <emph>p</emph> < 0.001) and phoneme awareness (<emph>β</emph> = 0.57 and <emph>p</emph> < 0.01) explained unique variance in word-reading accuracy in the combined HA and CI group. Similarly, syllable awareness (<emph>β</emph> = 0.43 and <emph>p</emph> < 0.05) and phoneme awareness (<emph>β</emph> = 0.64 and <emph>p</emph> < 0.05) explained unique variance in word-reading accuracy in the TH group. The predictor variables explained 68% and 72% of the total variance in word-reading accuracy in the combined HA and CI group and in the TH group, respectively.</p> <p>Table 4. Results of hierarchical regression analysis with Hangul word-reading accuracy as the dependent measure in children with DHH and typical-hearing children</p> <p> <ephtml> <table><thead><tr><th rowspan="2">Step. </th><th rowspan="2">Variable. </th><th colspan="2">Children with DHH. </th><th colspan="2">Children with TH. </th></tr><tr><th>Δ <italic>R<sup>2</sup></italic>. </th><th><italic>B</italic>. </th><th>Δ <italic>R<sup>2</sup></italic>. </th><th><italic>B</italic>. </th></tr></thead><tbody><tr><td>1 </td><td>Age </td><td>0.28<sup>***</sup></td><td>0.04 </td><td>0.27<sup>**</sup></td><td>0.32 </td></tr><tr><td>2 </td><td>Nonverbal IQ </td><td>0.04 </td><td>0.21 </td><td>0.10 </td><td>0.13 </td></tr><tr><td>3 </td><td>Syllable awareness </td><td>0.37<sup>***</sup></td><td>0.47<sup>***</sup></td><td>0.34<sup>**</sup></td><td>0.43<sup>*</sup></td></tr><tr><td /><td>Phoneme awareness </td><td /><td>0.57<sup>**</sup></td><td /><td>0.64<sup>*</sup></td></tr><tr><td /><td>Orthographic awareness </td><td /><td>0.01 </td><td /><td>0.29 </td></tr><tr><td /><td>Vocabulary </td><td /><td>--0.04 </td><td /><td>--0.07 </td></tr><tr><td /><td><italic>R<sup>2</sup></italic> Total </td><td>0.68 </td><td /><td>72 </td><td /></tr></tbody></table> </ephtml> </p> <p> <emph>Note.</emph> <sups>*</sups> <emph>p</emph> < 0.05, <sups>**</sups><emph>p</emph> < 0.01, and <sups>***</sups><emph>p</emph> < 0.001.</p> <p>Research Question 3: Which Cognitive Skills Contribute to Word-Reading Fluency in Children with DHH and Children with TH?</p> <p>Table 3 presents partial correlation coefficients between reading fluency and cognitive measures after controlling for chronological age in each of the three groups (i.e. children with HAs, CIs, and TH). Table 3 showed significant and positive correlations of reading fluency with syllable awareness (<emph>r</emph> = 0.69), phoneme awareness (<emph>r</emph> = 0.54), and orthographic awareness (<emph>r</emph> = 0.75) in the HA group. Reading fluency was significantly associated with syllable awareness (<emph>r</emph> = 0.76) and orthographic awareness (<emph>r</emph> = 0.44) in the CI group. In the case of the TH group, reading fluency was significantly associated with nonverbal intelligence (<emph>r</emph> = 0.42), phoneme awareness (<emph>r</emph> = 0.54), orthographic awareness (<emph>r</emph> = 0.52), and vocabulary (<emph>r</emph> = 0.53). Reading fluency was significantly associated with reading accuracy in the three groups (0.57 < <emph>r</emph>s < 0.81).</p> <p>A similar hierarchical regression analysis as done for research question 2 was conducted to determine which predictors were uniquely associated with word-reading fluency in the combined HA and CI group and in the TH group. Results are shown in Table 5. The final beta weights showed that syllable awareness (<emph>β</emph> = 0.48 and <emph>p</emph> < 0.001) explained unique variance in word-reading fluency and phoneme awareness was marginally significant (<emph>β</emph> = 0.28 and <emph>p</emph> < 0.07) in the combined HA and CI group. The negative beta weight for vocabulary (<emph>β</emph> = −0.36 and <emph>p</emph> < 0.05) might be attributed to a suppressor effect as a result of shared variance with phonological awareness. Note that vocabulary was weakly and moderately associated with syllable awareness (<emph>r</emph> = 0.46) and phoneme awareness (<emph>r</emph> = 0.58) in the HA group and strongly associated with phoneme awareness (<emph>r</emph> = 0.74) in the CI group, as shown in Table 3. However, in the TH group, orthographic awareness (<emph>β</emph> = 0.38 and <emph>p</emph> < 0.05) and vocabulary (<emph>β</emph> = 0.80 and <emph>p</emph> < 0.05) explained unique variance in word-reading fluency. The predictor variables explained 84% and 73% of the total variance of the dependent measure in the combined HA and CI group and in the TH group, respectively.</p> <p>Table 5. Results of hierarchical regression analysis with Hangul word-reading fluency as the dependent measure in children with DHH and typical-hearing children</p> <p> <ephtml> <table><thead><tr><th rowspan="2">Step. </th><th rowspan="2">Variable. </th><th colspan="2">Children with DHH. </th><th colspan="2">Children with TH. </th></tr><tr><th>Δ <italic>R<sup>2</sup></italic>. </th><th><italic>B</italic>. </th><th>Δ <italic>R<sup>2</sup></italic>. </th><th><italic>B</italic>. </th></tr></thead><tbody><tr><td>1 </td><td>Age </td><td>0.55<sup>***</sup></td><td>−0.05 </td><td>0.34<sup>***</sup></td><td>--0.29 </td></tr><tr><td>2 </td><td>Nonverbal IQ </td><td>0.01 </td><td>0.14 </td><td>0.12<sup>*</sup></td><td>--0.38 </td></tr><tr><td>3 </td><td>Syllable awareness </td><td>0.28<sup>***</sup></td><td>0.48<sup>***</sup></td><td>0.29<sup>*</sup></td><td>0.22 </td></tr><tr><td /><td>Phoneme awareness </td><td /><td>0.28+ </td><td /><td>0.41 </td></tr><tr><td /><td>Orthographic awareness </td><td /><td>0.15 </td><td /><td>0.38<sup>*</sup></td></tr><tr><td /><td>Vocabulary </td><td /><td>−0.36<sup>*</sup></td><td /><td>0.80<sup>*</sup></td></tr><tr><td /><td><italic>R<sup>2</sup></italic> Total </td><td>0.84 </td><td /><td>73 </td><td /></tr></tbody></table> </ephtml> </p> <p> <emph>Note.</emph> <sups>*</sups> <emph>p</emph> < 0.05, <sups>**</sups><emph>p</emph> < 0.01, <sups>***</sups><emph>p</emph> < 0.001, and <sups>+</sups><emph>p <</emph> 0.07.</p> <hd id="AN0154255353-9">Discussion</hd> <p>The purpose of this study was to compare reading and cognitive skills in Korean deaf children with HAs and CIs with their TH peers. Participants were first, second, and third graders in Korean elementary schools, aged 7–10 years. The three groups of children were paired to have the same chronological age, vocabulary, and nonverbal intelligence. In addition, this study investigated which vocabulary as well as phonological and orthographic awareness skills contribute to Korean word-reading accuracy and fluency after controlling for chronological age and nonverbal intelligence in children with DHH and those with TH. We discuss major findings from the research questions.</p> <p>Comparisons of Children with DHH and Children with TH</p> <p>In this study, the two groups of deaf children with CIs and HAs were not significantly different from each other in Hangul word-reading fluency, syllable and phoneme awareness, and orthographic awareness, except word-reading accuracy. This finding suggests that there have been considerable technological advances in HAs and that, like in other developed countries, many Korean children are now using digital HAs that are expected to improve speech accessibility. Our finding is in line with recent well-controlled studies ([<reflink idref="bib24" id="ref113">24</reflink>]; [<reflink idref="bib20" id="ref114">20</reflink>], [<reflink idref="bib21" id="ref115">21</reflink>]). For instance, [<reflink idref="bib21" id="ref116">21</reflink>]) reported no significant difference between the two groups of deaf children with CIs and HAs in phonological awareness, English word reading, and reading comprehension, after controlling for the age of wearing device, age of diagnosis, and other variables. However, in the current study, children with CIs outperformed those with HAs in word-reading accuracy. As suggested by [<reflink idref="bib21" id="ref117">21</reflink>], superior word-reading accuracy in the children with CIs suggest that, over time, differences between the groups may begin to appear in high levels of literacy skills, such as text reading fluency and comprehension.</p> <p>Both groups of deaf children (those with CIs and those with HAs) performed comparatively poorly on all the tasks measured in this study where TH children were considered. Our result echoes previous findings that children with CIs and HAs lag behind their hearing peers ([<reflink idref="bib18" id="ref118">18</reflink>]; [<reflink idref="bib20" id="ref119">20</reflink>], [<reflink idref="bib21" id="ref120">21</reflink>]; [<reflink idref="bib22" id="ref121">22</reflink>]; [<reflink idref="bib25" id="ref122">25</reflink>]). In spite of the technical advances of the latest digital HAs and early CIs, the cognitive and reading skills of DHH children still do not seem to reach the levels of TH peers in the Korean samples. However, while the standard scores reported in Table 2 indicate lower mean scores for the DHH children as compared with children with TH, these scores primarily fall in the average to low average range. In other words, although the DHH children in this study are performing below expected age norms for hearing children, the results do indicate improved achievement as compared with what has been historically reported for this population of students. For example, [<reflink idref="bib25" id="ref123">25</reflink>]) reported a range of 55–127 standard scores in single-word reading among children with HAs and CIs, indicating that their minimum standard score was much lower than in the current study, which showed a range of 79–97 standard scores in word-reading accuracy in the DHH children.</p> <p>Cognitive Correlates of Word-Reading Accuracy</p> <p>This study examined which skills—vocabulary, phonological awareness, and orthographic awareness skills—contributed to Korean word-reading accuracy after controlling for chronological age and nonverbal intelligence in DHH and TH children. Regression analyses showed that syllable and phoneme awareness uniquely contributed to the reading accuracy of both groups of DHH children and TH children. However, vocabulary did not uniquely explain word recognition in the two groups. Our results are consistent with a previous Korean study, where both syllable awareness and phoneme awareness uniquely contributed to word recognition in Korean kindergarten and second graders with TH ([<reflink idref="bib7" id="ref124">7</reflink>]), suggesting that both DHH and TH children between the ages of five and ten learn the alphasyllabic principles of the Korean language—that is, the correspondences between print and sound at both the syllable and phoneme levels (e.g. [<reflink idref="bib36" id="ref125">36</reflink>]). Likewise, earlier English and French studies reported that young children with DHH rely on phonological awareness such as onset and rhyme awareness in word reading ([<reflink idref="bib11" id="ref126">11</reflink>]; [<reflink idref="bib20" id="ref127">20</reflink>], [<reflink idref="bib21" id="ref128">21</reflink>]; [<reflink idref="bib28" id="ref129">28</reflink>]). Phoneme awareness also contributed to word recognition in English in children with CIs aged between 5 and 15 years ([<reflink idref="bib25" id="ref130">25</reflink>]).</p> <p>However, a big difference between previous English studies and ours lies in the unique role of vocabulary in word recognition. That is, vocabulary did not explain unique variance in Hangul word recognition in Korean children with DHH in this study, whereas vocabulary contributed to English reading more strongly than phonological awareness in English-speaking children with DHH ([<reflink idref="bib20" id="ref131">20</reflink>], [<reflink idref="bib21" id="ref132">21</reflink>]; [<reflink idref="bib25" id="ref133">25</reflink>]; [<reflink idref="bib37" id="ref134">37</reflink>]). This difference may be due to the characteristics of orthographies and early literacy education. Hangul is a relatively shallow orthography, whereas English is a deep orthography. Most Korean children start to learn Hangul at about the age of four and enter the first grade with a high level of decoding skills ([<reflink idref="bib4" id="ref135">4</reflink>]). Korean children with DHH and TH aged between 7 and 10 years are therefore likely to use phonological awareness skills for Hangul word recognition.</p> <p>Cognitive Correlates of Word-Reading Fluency</p> <p>This study found different patterns in cognitive predictors of word-reading fluency between DHH children and TH children. That is, reading fluency was uniquely explained by syllable awareness and marginally by phoneme awareness in the DHH children, whereas vocabulary and orthographic awareness uniquely contributed to reading fluency in TH children. In other words, Korean children with DHH tend to rely on different strategies for Hangul word-reading fluency than do TH children; DHH children rely on phonological information, whereas TH children rely on semantic and orthographic information. As suggested by dual-route models ([<reflink idref="bib12" id="ref136">12</reflink>]; [<reflink idref="bib41" id="ref137">41</reflink>]), less skilled readers of DHH tend to use a phonologically mediated, sublexical route based on grapheme–phoneme mapping rules, whereas more skilled readers with TH use a direct lexical route from orthography to meaning for Hangul word-reading fluency.</p> <p>When integrating the results of reading accuracy in this study, our findings indicate that children with DHH rely on phonological awareness in both Hangul word recognition and word-reading fluency. However, more skilled readers with TH adjust their reading strategies depending on the task: They use phonological information for accurate reading of Korean words but semantic and orthographic information for fluent reading. Similarly, a previous Korean study ([<reflink idref="bib44" id="ref138">44</reflink>]) reported that Korean adult readers are flexible in using either a sublexical or lexical pathway in a list of many Korean filler words or in a list of many Chinese filler words, respectively, in Hangul word recognition. To our best knowledge, this is one of first studies to demonstrate the use of different strategies for fluent reading of Korean words in Korean children with DHH and TH.</p> <p>In this study, orthographic awareness uniquely contributed to word-reading fluency among children with TH, which echoes recent research regarding English-speaking and Korean-speaking children with TH ([<reflink idref="bib5" id="ref139">5</reflink>]; [<reflink idref="bib13" id="ref140">13</reflink>]; [<reflink idref="bib26" id="ref141">26</reflink>]; [<reflink idref="bib52" id="ref142">52</reflink>]). On the other hand, orthographic awareness was not found to be a significant contributor to Hangul reading fluency in DHH children; this finding parallels previous findings on English reading, that orthographic processing is not related to reading, although DHH children have some evidence of enhanced visual and orthographic skills (e.g. [<reflink idref="bib35" id="ref143">35</reflink>]; [<reflink idref="bib38" id="ref144">38</reflink>]). In the study of [<reflink idref="bib19" id="ref145">19</reflink>], however, orthographic awareness uniquely explained English word reading in DHH children, but phonological awareness was not measured in the study. It is not clear whether orthographic awareness would have contributed to English reading in DHH children if both phonological and orthographic awareness measures were used as predictors in their analysis.</p> <p>Correlations of Vocabulary with Phonological Awareness and Reading Skills</p> <p>In this study, the patterns of correlations between vocabulary and phonological awareness appear to be different in children with DHH than in those with TH. Vocabulary was significantly correlated with phoneme and syllable awareness in the HA group and with phoneme awareness in the CI group. However, vocabulary was not significantly correlated with phoneme and syllable awareness in the TH group. This is in line with previous studies on English reading that reported strong correlations between vocabulary and phonological awareness for children with DHH concurrently and longitudinally but no significant associations between them in TH children ([<reflink idref="bib20" id="ref146">20</reflink>], [<reflink idref="bib21" id="ref147">21</reflink>], [<reflink idref="bib54" id="ref148">54</reflink>]). Similar to previous research on English literacy development, vocabulary, and phonological awareness are relatively independent skills for Korean children with TH but less so for Korean children with DHH (e.g. [<reflink idref="bib21" id="ref149">21</reflink>]).</p> <p>In addition, in this study, the patterns of correlations between vocabulary and reading measures differ in children with DHH and their TH peers. That is, vocabulary was significantly correlated with reading accuracy in the two groups of children with CIs and HAs but not in the groups of TH children. However, vocabulary was significantly correlated with reading fluency in the children with TH but not in the deaf children with CIs and HAs. This suggests that vocabulary can be explored as a major factor underpinning the reading process of various languages, including English and Korean (e.g. [<reflink idref="bib9" id="ref150">9</reflink>]).</p> <p>Implications for Future Research and Practice</p> <p>An important finding of this study was that Korean children with DHH rely on phonological awareness skills to read Hangul words accurately and fluently; children with TH, on the other hand, use differing strategies, depending on phonological awareness for accurate Hangul word reading but lexical and orthographic awareness for fluent Hangul reading. Future research needs to replicate these findings with other samples of children with TH and DHH. It is necessary to explore how and when children with DHH develop efficient strategies for fluent Hangul reading compared with their peers with TH.</p> <p>Our findings would give a practical insight on literacy education, training, and intervention programs to enhance accurate and fluent reading of Korean Hangul words for Korean children with DHH. Programs should consider the levels of their literacy skills. Perhaps, training focusing on syllable and phoneme awareness would help improve early Hangul word-reading accuracy, whereas semantic and orthographic knowledge should be emphasized for skilled and fluent reading. That is, in order to achieve accurate Hangul word recognition, early elementary school students with DHH need to master grapheme–phoneme correspondences of the Korean language and alphasyllabic principles focusing on both levels of syllable and phoneme awareness. In addition, phonological change rules of the Korean language should be explicitly taught so that older Korean children with DHH can read and spell irregular words accurately and fluently. In particular, vocabulary knowledge should be promoted by focusing on Sino-Korean compound words that contain difficult morphological information and technical concepts.</p> <p>Limitations</p> <p>Limitations of this study and suggestions for subsequent studies are as follows. First, this study examined associations of word-reading accuracy and fluency and cognitive skills among children with DHH attending mainstream elementary school as first, second, or third graders. Since our sample with DHH showed lower literacy and cognitive performance than their TH peers, future research should include older children with DHH in upper grades of elementary school to examine their level of fluent reading and strategies and to identify when children with DHH achieve fluent and efficient reading similar to peers with TH. Future research should include a variety of literacy and cognitive skills, including reading comprehension, spelling, and morphological awareness. Second, our study did not consider variables other than literacy and cognitive skills. Indeed, literacy development in children with DHH is related to a variety of factors, including the characteristics of children and their parents and surrounding environment. Subsequent research should collect data from a variety of sources, including teachers, parents, and other experts, and should be expanded to cover a variety of variables. Third, this is a correlational study. Further study is needed on the longitudinal predictors of reading development in children with DHH.</p> <hd id="AN0154255353-10">Conclusions</hd> <p>Despite these limitations, it is noteworthy that Korean children with CIs and HAs were compared with their TH peers in reading and cognitive skills. In fact, Korean Hangul reading has rarely been studied in children with DHH. Our findings shed light on several universal and language-specific properties for the reading process of children with DHH. As for some universal evidence, our results are similar to previous studies in that there is no significant difference between deaf children with CIs and those with HAs in reading fluency and cognitive skills, whereas both groups of deaf children showed lower performance than their TH peers (e.g. [<reflink idref="bib18" id="ref151">18</reflink>]; [<reflink idref="bib20" id="ref152">20</reflink>], [<reflink idref="bib21" id="ref153">21</reflink>]; [<reflink idref="bib22" id="ref154">22</reflink>]). In addition, our results are consistent with previous studies that show that vocabulary is significantly and strongly correlated with phonological awareness in children with DHH but is not related in children with TH ([<reflink idref="bib20" id="ref155">20</reflink>], [<reflink idref="bib21" id="ref156">21</reflink>], [<reflink idref="bib54" id="ref157">54</reflink>]). However, in this study, cognitive factors contributing to Korean word reading by Korean children with DHH appear to be quite different from those found in literacy development in other languages, including English. In this study, syllable and phoneme awareness uniquely contributed to Hangul word-reading accuracy in children with DHH and in those with TH. However, Hangul word-reading fluency was uniquely explained by phonological awareness in children with DHH and by vocabulary and orthographic awareness in children with TH. Our findings suggest that less-skilled readers with DHH depend on sublexical information for Hangul word-reading fluency, while more skilled readers with TH used lexical information, as proposed by dual-route models (e.g. [<reflink idref="bib12" id="ref158">12</reflink>]; [<reflink idref="bib41" id="ref159">41</reflink>]). Our results highlight some of the language-specific proprieties in the reading process of Korean children with DHH.</p> <hd id="AN0154255353-11">Funding</hd> <p>This work was partially supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2020S1A5A2A03044034).</p> <hd id="AN0154255353-12">Conflicts of Interest</hd> <p>No conflicts of interest were reported.</p> <ref id="AN0154255353-13"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref7" type="bt">1</bibl> <bibtext> Antia, S., Lederberg, A. R., Easterbrooks, S., Schick, B., Branum-Martin, L., Connor, C. M., & Webb, M.-Y. (2020). Language and reading progress of young deaf and hard-of-hearing children. Journal of Deaf Studies and Deaf Education, 25 (3), 334 – 350. https://doi.org/10.1093/deafed/enz050 Google Scholar Crossref Search ADS PubMed WorldCat</bibtext> </blist> <blist> <bibl id="bib2" idref="ref1" type="bt">2</bibl> <bibtext> Archbold, S. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Correlates of Korean Hangul Reading in Children with Hearing Loss
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Park%2C+Soon-Gil%22">Park, Soon-Gil</searchLink><br /><searchLink fieldCode="AR" term="%22Ryu%2C+Sung-Yong%22">Ryu, Sung-Yong</searchLink><br /><searchLink fieldCode="AR" term="%22Cho%2C+Jeung-Ryeul%22">Cho, Jeung-Ryeul</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Deaf+Studies+and+Deaf+Education%22"><i>Journal of Deaf Studies and Deaf Education</i></searchLink>. Jan 2022 27(1):62-72.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://jdsde.oxfordjournals.org/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Written+Language%22">Written Language</searchLink><br /><searchLink fieldCode="DE" term="%22Hearing+Impairments%22">Hearing Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Vocabulary+Development%22">Vocabulary Development</searchLink><br /><searchLink fieldCode="DE" term="%22Phonological+Awareness%22">Phonological Awareness</searchLink><br /><searchLink fieldCode="DE" term="%22Orthographic+Symbols%22">Orthographic Symbols</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Deafness%22">Deafness</searchLink><br /><searchLink fieldCode="DE" term="%22Assistive+Technology%22">Assistive Technology</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22South+Korea%22">South Korea</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1093/deafed/enab035
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1081-4159
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: This study examined the associations of vocabulary and phonological and orthographic awareness with Hangul word reading in Korean children, aged between 7 and 10 years, who were deaf and hard of hearing (DHH) and children with typical hearing (TH). The participants were 24 children with hearing aids (HAs), 24 children with cochlear implants (CIs), and 24 TH children in Korea. The three groups were matched for chronological age, vocabulary age, and nonverbal intelligence. Results showed that there were no differences between children with CIs and those with HAs in reading fluency and cognitive skills, except word-reading accuracy, whereas children with CIs and HAs were delayed in all measures compared with their TH peers. Regression analyses showed that syllable and phoneme awareness uniquely explained word-reading accuracy in children with DHH and those with TH. However, word-reading fluency was uniquely explained by syllable awareness in the DHH children and by vocabulary and orthographic awareness in the TH children. These results suggest that DHH and TH children in Korea rely on phonological awareness for Korean word recognition. However, DHH and TH Korean children tend to use different strategies based on sublexical versus lexical information, respectively, to read Korean words fluently.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2021
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1319736
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1319736
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1093/deafed/enab035
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 62
    Subjects:
      – SubjectFull: Written Language
        Type: general
      – SubjectFull: Hearing Impairments
        Type: general
      – SubjectFull: Children
        Type: general
      – SubjectFull: Vocabulary Development
        Type: general
      – SubjectFull: Phonological Awareness
        Type: general
      – SubjectFull: Orthographic Symbols
        Type: general
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Deafness
        Type: general
      – SubjectFull: Assistive Technology
        Type: general
      – SubjectFull: South Korea
        Type: general
    Titles:
      – TitleFull: Correlates of Korean Hangul Reading in Children with Hearing Loss
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Park, Soon-Gil
      – PersonEntity:
          Name:
            NameFull: Ryu, Sung-Yong
      – PersonEntity:
          Name:
            NameFull: Cho, Jeung-Ryeul
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          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2022
          Identifiers:
            – Type: issn-print
              Value: 1081-4159
          Numbering:
            – Type: volume
              Value: 27
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Journal of Deaf Studies and Deaf Education
              Type: main
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