Understanding Cued Speech
What is Cued Speech?
Cued Speech is a manual system that is used all over the world to enable deaf children to accurately lipread and learn spoken languages.
It was created in America in 1968 and has been used successfully in the UK since 1970.
Cuers (people who cue) make the cues as they speak.
They use 8 handshapes:
In 4 places around the face:
Using 3 simple rules.
Cue-readers listen with their eyes, they face the cuer and watch:
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The shape of their hand
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Where the hand is placed
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The natural lip-patterns as they speak
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And they may listen to the voice if possible
Most hearing people learn how to cue in 6 to 10 hours, after that they must practice at becoming fluent.
Most cue-readers are deaf and are exposed to cueing when they are very young, they never have to ‘learn it’ because their brains just absorb the language that is being cued to them.
Some of them like to cue themselves when they speak, others don’t, although nearly everyone finds that if they are struggling to pronounce a word, cueing it helps them say it.
A deaf persons experience with the English Language
Pt. 3 A deaf person's experience with the English language pt3
Pt 1 - A deaf person's experience with the English language
Pt.4 A deaf person's experience with the English language pt4 (1)
Parents who use Cued Speech
Parents who use cued speech
Parents who use Cued Speech 2 – Learning to Cue
Parents who use Cued Speech 4 – Not only for deaf kids
Parents who use Cued Speech 3 – How Cueing works for us
Parents who use Cued Speech 5 – Communication Choices
Cued speech and the impact it can have on communication
A professional View:
Ruth Campbell, Ph.D. (Professor Emeritus, Department of Cognitive, Perceptual and Brain Sciences Division of Psychology and Language Sciences University College London) writes in her Foreword to the book, Cued Speech and Cued Language for Deaf and Hard of Hearing Children (edited by Carol J. La Sasso, Kelly Lamar Crain and Jacqueline Leybaert):
‘The importance of Cued Speech is that it opens up the world of spoken language to the deaf child in a clear and simple way, from the outset. This has, as Cornett envisioned, the potential to allow a form of the traditionally spoken language to develop naturally in a deaf child, via a communication modality that the child and the child’s caregiver can use easily, fluently, and collaboratively.
‘[Research] has shown conclusively that children exposed consistently to Cued Speech gained and maintained a head start over deaf children of similar intelligence and skill who did not have Cued Speech. Those who started using Cued Speech before school were even more likely to forge ahead, often with literacy levels and styles indistinguishable from hearing children. Because this understanding is sound-based it is uniquely beneficial for deaf children both pre- and post-cochlear implant.’
Research:
Cued Speech and the Development of Reading in English: Examining the Evidence
Beverly J. Trezek
The Journal of Deaf Studies and Deaf Education, Volume 22, Issue 4, 1 October 2017, Pages 349–364, https://doi.org/10.1093/deafed/enx026
Published: 06 June 2017
Deaf Choices UK is currently the only charity in the UK that gives training in Cued Speech and we are always happy to share more information about this amazing system. If you have any questions, feel free to contact us at info@deafchoicesuk.co.uk
We look forward to hearing from you.
FAQ
Research Papers
This is just a small collection of some of the research available surrounding Cued Speech and deafness.
Research about and including Cued Speech:
Cued Speech Evolving Evidence: 1969-2018
Stephanie J. Gardiner-Walsh, Karla Giese & Timothy P. Walsh
A Case Study of the Preventing Academic Failure. Orton-Gillingham Approach with Five Students who are Deaf or Hard of Hearing: Using the Mediating Tool of Cued Speech: Jennifer Lynn Montgomery. Full Text
Early years language and development in deaf children – a best evidence scoping review – Dr Sarah Collins (2017). Full text
Further supporting material regarding early language development can also be found here – National Sensory Impairment Partnership.
The relative contributions of speechreading and vocabulary to
deaf and hearing children’s reading ability – Fiona Elizabeth Kyle , Ruth Campbell, Maire´ad MacSweeney (2015). Full text >>
Early Communication Development of Children with
Auditory Brainstem Implants – Laurie S. Eisenberg*, Dianne Hammes Ganguly, Amy S. Martinez, Laurel M. Fisher, Margaret E. Winter, Jamie L. Glater, Debra K. Schrader, Janice Loggins, Eric P. Wilkinson and the Los Angeles Pediatric ABI Team (2018) Early Communication Development of Children with Auditory Brainstem Implants, Journal of Deaf Studies and Deaf Education
The Neural Basis of Speech Perception through Lipreading and Manual Cues: Evidence from Deaf Native Users of Cued Speech – Aparicio, M., Peigneux, P., Charlier, B., Balériaux, D., Kavec, M. and Leybaert, J. (2017) full text >>
A longitudinal study on auditory perception and speech intelligibility in deaf children implanted younger than 18 months in comparison to those implanted at later ages. – De Raeve, L., (2010) abstract >>
An Alternate Route for Preparing Deaf Children for BiBi Programs: The Home Language as LI and Cued Speech for Conveying Traditionally Spoken Languages – LaSasso, C. J., Metzger, M. A., (1998) abstract >>
An examination of Cued Speech as a tool for language, literacy, and bilingualism for children who are deaf or hard of hearing – Reynolds, S. E. (2007) full text >>
An investigation of speechreading with and without Cued Speech – Gregory, J. (1987). abstract>>
Analysis and synthesis of the three-dimensional movements of the head, face, and hand of a speaker using Cued Speech – Gibert, G., Bailly, G., Beautemps, D., and Elisei, F. (2005) abstract >>
Annotated Bibliography of Research on Cued Speech – Cornett, R. O., (1990) full text >>
Complete Signed and Cued French: An original signed language-Cued Speech Combination – Charlier, B., (1992) abstract >>
Cued Speech and Cochlear Implants: Powerful Partners – Smith, J., (2006) full text >>
Cued Speech and the Reception of Spoken Language – Nicholls, G. H., Ling Mcgill, D., (1982) abstract >>
Cued Speech for Enhancing Speech Perception and First Language Development of Children with Cochlear Implants – Leybaert, J., LaSasso, C. J., (2010) Full article >>
Cued Speech in the stimulation of communication: an advantage in cochlear implantation – Descourtieux, C., Groh, V., Rusterholtz, A., Simoulin, I., Busquet, D., (1999) abstract >>
Effects of English Cued Speech on Speech Processing and Literacy: A single case study – Bladel, J., Rees, R., (1989) abstract >>
Evaluating a virtual speech cuer – Gibert, G., Bailly G., Elisei, F., (2010) full text >>
From 1-word to 2-words with cochlear implant and cued speech: A case study – Moreno-Torres, I., Torres, S., (2008) abstract >>
Influence of communication mode on speech intelligibility and syntactic structure of sentences in profoundly hearing impaired French children implanted between 5 and 9 years of age. – Vieu, A., Mondain, M., Blanchard, K., Sillon, M., Reuillard-Artieres, F., Tobey, E., Uziel, A., Piron, J. P., (1998) abstract >>
Quantitative and Qualitative Evaluation of Lingu
istic Input Support to a Prelingually Deaf Child With Cued Speech: A Case Study – Torres S., Moreno-Torres, I., Santana, R., (2006) abstract >>
Reading and Reading-Related Skills in Children Using Cochlear Implants: Prospects for the Influence of Cued Speech – Bouton, S., Bertoncini, J., Serniclaes, W., Cole, P., (2011) abstract >>
Rhyme Generation in Deaf Students: The Effect of Exposure to Cued Speech – LaSasso, C., Crain, K. L., Leybaert, J., (2003) abstract >>
The Role of Cued Speech in the Development of Spanish Prepositions – Santana Hernandez, R., Torres-Monreal, S., Garcia Orza, J., (2003) abstract >>
The role of lip-reading and Cued Speech in the processing of phonological information in French-educated deaf children. – Alegria, J., Charlier, B., Mattys, S., (1999) abstract >>
Use of Internal Speech in Reading by Hearing and HearingImpaired Students in Oral, Total Communication, and CS Programs – Wandel, J. E., (1990) full text >>
Variability in deaf children’s spelling: the effect of language experience – Leybaert, J. & Lechat, J. (2001). abstract>>
Visual Speech in the Head: The Effect of Cued-Speech on Rhyming, Remembering, and Spelling – Leybaert, J., Charlier, B., (2001) abstract >>
What can be expected from a late cochlear implantation? – Kos, M., Deriaz, M., Guyot, J., Pelizzone, M., (2009) abstract >>
Auditory Neuropathy Research:
Auditory neuropathy/dyssynchrony – Its diagnosis and management – Berlin, C. I., Morlet, T., Hood, L. J., (2003) abstract >>
Auditory Neuropathy/Dys-Synchrony: After the Diagnosis, then what? – Berlin, C. I., Li, L., Hood, L. J., Morlet, T., Rose, K., Brashears, S., (2003) abstract >>
Deafblind Research:
Analytic Study of the Tadoma Method: Improving Performance Through the Use of Supplementary Tactual Displays – Reed, C. M., Rabinowitz, W. M., Durlach, N. I., Delhorne, L. A., Braida, L. D., Pemberton, J. C., Mulcahey, B. D., Washington, D. L., (1992) abstract >>
Tactual Cued Speech as a Supplement to Speechreading – Delhorne, L. A., Besing, J. M., Durlach, N. I., Reed, C. M., (1998) full text >>
Articles
Myths and Half-Truths – Setting the record straight about Cued Speech – Written by Anne Worsfold and Cate Calder of the CSAUK, for publication the Magazine of BATOD in March 2016.
Cued Speech – research and evidence 40 years on – An article written by Anne Worsfold of the Cued Speech Association UK on the progression of CS research since its introduction to UK four decades ago. This article was published by BATOD in September 2015.
Cued Speech – Advantages for literacy – Anne Worsfold article published in BATOD Magazine in March 2014.
Letter to the Editor – Executive Director Anne Worsfold writes a response to an article in the BATOD Magazine, giving her opinion and the backup of research to a previously published piece. This letter was published in August 2012.
Seeing the Sound – Nicholas Orpin, BATOD Magazine, May 2012.
Complete Bilingualism – How full access to both British Sign Language (BSL) and English could be achieved. Written in March 2012 by the Cued Speech Association UK.
Access to Fluent Language – an article by Anne Worsfold for BATOD Magazine, March 2012.
The Advantages of Cued Speech – by Anne Worsfold, Executive Director of the CSAUK, and published in the BATOD Magazine in May 2011.
Teachers Assistants and Support – an article about the roll of classroom assistants in deaf education written by Cued Speech user, Nicholas Orpin, father of a deaf daughter. This was published in BATOD Magazine in December 2010.
The Phoneme Machine – BATOD Magazine article by Chris Griffifths, published in the January 2009 edition.
Access to Phonics and Literacy – First published in the Magazine of the British Association of Teachers of the Deaf (BATOD) in 2009. Over the years Teachers of the Deaf have tried to give their pupils full literacy – but with varied success. What do children need in order to become literate?
Language and literacy through Cued Speech – This article was originally written for the CICS (Cochlear Implanted Children’s Support) Group newsletter, March, 2008 issue.
Talk to your baby leaflet – A new resource published in January 2008: Talk To Your Baby – For parents and carers of children who are deaf. This leaflet has been jointly produced by the Cued Speech Association and the The National Literacy Trust (NLT) , an independent charity that works to change lives through literacy. It was created as part of NLT’s Talk To Your Baby campaign, which aims to encourage parents and carers to talk more to children from birth to three.
Cued Speech in Manchester Schools – An article written for the BAToD Magazine following a workshop about Cued Speech at the BAToD Conference on the 8th March 2008. Written by Teachers of the Deaf Tina Kirwin and Alison Paton.
Developing language – Will Collinson’s mother Sarah details his transition from profoundly deaf baby to
confident seven-year old, with the same advantages and opportunities of other children of his age. By sheer determination and hard work, Will and his parents have ensured that his language development has progressed from BSL to Cued Speech to spoken English, full literacy and now to bilingualism (in English and BSL). Published in BAToD Magazine May 2007.
From BSL; to BSL and Cued Speech; to BSL, Cued Speech and spoken English; and on to full literacy and full bilingualism: Will’s story. BATOD Magazine, February 2007
Report by Cate Calder and Gill Banham – The use of Cued Speech and synthetic phonics to support literacy skills at the ‘Exeter Royal Academy for Deaf Education’ (ERADE)
Literacy, Synthetic Phonics and Cued Speech – An article by Anne Worsfold, Executive Director, Cued Speech Association UK. She highlights the fact that, unlike most deaf children, those brought up with Cued Speech are just as able to benefit from synthetic phonics as hearing children. But what is synthetic phonics? And how can it be used with deaf children? This article explains how Cued Speech can help and also gives an update of work with students and teachers at the Exeter Royal Academy for Deaf Education (ERADE). Published in our Winter 2007 Newsletter.
Delayed language is not inevitable! Editorial – Personal thoughts from Anne Worsfold, published in our Winter 2006 Newsletter.
Bilingualism – two different models – Anne Worsfold, Executive Director, Cued Speech Association UK. ‘Few can argue with the aims of sign bilingualism. What better than to have a deaf young person leaving the education system fully fluent in BSL and English? But how can this be achieved?’ Published in BAToD Magazine March 2006.
Inclusion facilitated by visual access to spoken English – Anne Worsfold, Executive Director, Cued Speech Association UK describes some of the many advantages to accessing education through a Cued Speech Transliterator. Because it gives complete and unambiguous access to spoken English, deaf children brought up with Cued Speech have English language development which echoes that of hearing children. They achieve reading scores which equal hearing children and can develop an internal phonological model of spoken language, including good rhyming skills, which enables them to learn to read using the same techniques as hearing children. In addition, case studies suggest that Cued Speech is a great help with speech and enables deaf children familiar with it to more easily lipread those who do not cue. Published in BAToD Magazine January 2006.
Cued Speech for hearing children with language disorders – ‘Cueing with language disordered children – 15 years on.’ An article by Ann Clarke, Speech and Language Therapist, Thornfield House School, Belfast. Published in our Autumn 2005 Newsletter.
Complete access to spoken language – Anne Worsfold explains about the value of cued speech and how it helped her sons with early access to language. Published in BAToD magazine September 2005.
The Importance of Thinking Words – ‘This paper is based on a single, simple assertion. Only if in face-to-face communication, as a result of that communication, a child consistently thinks English words, will that child learn English rapidly and efficiently. This is true whether the child has an auditory deficit or not.’ Dr. R. Orin Cornett, October 8, 1993.
Cued Speech, cochlear implants and astonishing literacy levels – A parent’s story of a profoundly deaf three year old.
Article by Tracey Orpin for NDCS – Access to communication in English for deaf people. Written by the UK Council for deafness. Click here >>
Growing up with Cued Speech – a case study by Rachel Towsend, written for the NDCS in 2009/10.
True bilingualism – An article, written in December 2005 by Cate Calder, who has worked in the field of deafness, primarily interpreting, for 15 years. Cate now works part-time as the Educational Development Officer for the Cued Speech Association. She takes a look at how deaf children could become truly bilingual.
Cued English at the Exeter Royal Academy for Deaf Education – An article written by Cate Calder for the BAToD Magazine May 2008 issue. How much can late and limited exposure to Cued Speech be of bebefit to signing deaf students?
Cued Speech – Why do we leave it so neglected? – An article by Ron Hilton, a deafened adult, for the National Association of Deafened People magazine in September 2005 on the difficulties of lipreading. He says that ‘For a lot of lip readers, something to provide a few more clues would be very welcome.’ Cued Speech can solve the problem.
Cueing with language disordered children – 15 years on – Ann Clarke, Speech and Language Therapist, Thornfield House School, Belfast. Published in our Autumn 2005 Newsletter.
Cochlear implantation and Cued Speech internationally – Anne Worsfold, Executive Director, Cued Speech Association UK. ‘How can we ensure that implanted children reach their potential? Research and case studies from Europe and America suggest that the early and constant use of Cued Speech by family members and professionals can significantly improve the children’s ability to benefit from the implant.’ Published in BAToD Magazine March 2005.
A View From Two Decades – Jane Smith, Communication Specialist, Montgomery County MD Schools, USA. Published in our Summer 2004 Newsletter.
How Cued English Impacts Learning to read and Write English for Deaf/Hard of Hearing Students – Karen Stene Doenges – 2003.
Cued Speech in Spain – From La Palabra Complementada [LPC or Cued Speech] to the Modelo Oral
Complementada (MOC) – Santiago Torres (Honorary Professor, University of Malaga) and María José Ruiz Casas (Head of Speech Therapy, MOC Services, University of Malaga). Successful use of Cued Speech within an educational model which uses Cued Speech to complement oral practices.
FIAPAS PRIZE 2002 – Modelo Oral Complementado (Complemented Oral Model) – Summary of the Investigation by Santiago Torres Monreal and Group in Investigative Psycholinguistics, and María José Ruiz and Group in Intervention in Hearing Deficiencies.
Memory or memories: how can the child accumulate linguistic information…and use it – Brigitte Charlier – 3rd European LPC congress, Bruxelles 2-3 February 2002.
LPC research – LPC’s impact on the development of deaf children: The deaf child’s discovery of spoken language – Text by Nadine Cochard (Paediatric Unity of cochlea implants – CHU/CESDA Toulouse).
Sustaining an effective sign bilingual (BSL/English) environment in the family setting of a pre-school profoundly deaf child: a case for using Cued Speech? An article written from both a parents and teachers views, written by Sarah Collinson and Paul Gogue, and first published in the BATOD Magazine in April 2002.
The ‘Dumbing Down’ of Language – Sarina Roffe – and article for the NCSA – 2001.
Our success with Cued Speech and Auditory Neuropathy – a case study by Deanne and Judd Grafe.
Cued Speech – a case study – by Anne Worsfold – October 2000.
Adapting Cued Speech to Additional Languages – Dr. Orin Cornett – for the NCSA journal in 1994.
Research into profoundly deaf children’s English language comprehension and expression – Marilyn Peterson article from 1991.
Use of Internal Speech in Reading by Hearing and Hearing-Impaired Students in Oral, Total Communication, and CS Programs – Jean E Wandel, unpublished doctorate dissertation in 1989/90
Highlights from ‘Cued Speech and Cued Language for Deaf and Hard of Hearing Children’, LaSasso et al, 2010, Plural Publishing, San Diago CA.
Nature of Cued Speech and Cued Language Statement:
While Cued Speech is an effective tool for visually clarifying an auditory message and can improve a child’s ability to interpret auditory information received through hearing aids or a cochlear implant, cueing can provide a complete representation of a spoken language regardless of how much a person can or cannot hear (Fleetwood and Metzger, 1997), and it would appear that in at least one case, cueing can even disambiguate phonemic properties of a tonal language such as Thai (Tammasaeng, 1986). It has been shown that deaf cuers of English process much of the linguistic message in a fashion similar to hearing speakers of English, but the visual nature of cueing allows deaf native cuers to process the phonology of English in a way that is unique to them (Koo, 2003).
Research:
Fleetwood and Metzger (1997) studied the distinctive features of spoken and cued messages, and concluded that the acoustic properties of the spoken message (for those who can hear it) may at times provide information that supports the visual properties of a cued message, or may at times provide confounding information. The authors conclude that, while Cued Speech was intended by its inventor to be accompanied by an audible spoken message, there is reason to believe that this acoustic information may not be necessary for an individual to receive the full linguistic information conveyed via cueing.
Tammasaeng (1986) investigated the effect of Cued Speech on the tonal perception of the Thai language for deaf children in Thailand. Students came from a program using speech with signs, and from a program using signs with fingerspelling, but no speech. All students were taught lipreading skills and Cued Speech for one semester, and were given a test to discriminate pairs of Thai words that differ by tone only. Performance on the test did not vary by program, but did vary by mode of communication, that is the students scored an average of 49.5% with speech alone and an average of 86.2% with the addition of cues. When separating the two groups, the children exposed to speech and then taught to cue scored an average of 96.9%, while the students not exposed to speech and then taught to cue scored an average of 82.6%. The results show that Cued Speech can clarify the tonal characteristics of such a language.
Koo (2003) studied the relative contributions of manual and mouth-shape information to the comprehension of a cued message. Koo found that, for a native cuer, a cued message is not 50% handshape (or placement) and 50% mouthshape (or mouth movement), but that cuers use a combination of these incoming signals, with relative weighting of importance. In another study, Koo investigated cuers’ ability to use affixes (e.g., word endings), and found that some deaf cuers more consistently apply typical English word endings to psuedowords, suggesting that these cuers have an intrinsic linguistic ability to generate rules regarding nonsense words in the same way that they would apply to real English words.
Cued Speech and Speechreading / Lipreading Statement:
Deaf cuers are able to perceive and comprehend far more information presented to them via cueing than via speechreading alone (Ling & Clarke, 1975; Clarke & Ling, 1976; Nicholls & Ling, 1982; Gregory, 1987), and there appears to be no support for the opinion that cueing provides a ‘crutch’ for speechreading, preventing a person from being able to speechread without cues (Ling & Clarke, 1975).
Research:
Ling and Clarke (1975) conducted one of the earliest studies of speechreading ability with Cued Speech. They presented phrases and isolated words, slowly and at a regular speed, via speech alone and via cueing. The children in their study received inconsistent access to cueing and were cued to during in-class instructional times only, and several of the children had already been placed in oral programs, but were considered unable to learn in that setting. Nonetheless, Ling and Clarke found an increase in the amount of information the children could perceive, recode, and recall when presented via cueing, as opposed to speech alone.
Clarke and Ling (1976) conducted a follow-up to their 1975 study, and reported that, after one additional year of classroom exposure to Cued Speech, the children’s responses gave “a clear indication that cueing facilitated speechreading for sentences, phrases, and words.” (p. 30). The authors further stated that “audition [hearing the speech] played no role in speech perception with our subjects” (p. 32), suggesting again that access to ‘spoken’ language via cueing is not dependent upon a person hearing speech.
Nicholls and Ling (1982) studied deaf cueing children’s ability to understand speech under seven conditions: 1) audition alone, 2) lipreading alone, 3) audition + lipreading, 4) manual cues alone, 5) audition + manual cues, 6) lipreading + manual cues (i.e., cueing) and 7) audition + cueing. The children were able to recognize over 95% of key words in sentences and over 80% of syllables when the materials were cued to them, higher than in any other condition, with or without audition. This study also supports the idea that, while audition can be very helpful in the reception of a cued message, it is not strictly necessary.
Gregory (1987) investigated the speechreading ability of cuers by testing them with and without the addition of cues. Cuers correctly identified almost twice as many single words presented via cues than via speechreading alone. Gregory also found that single words beginning with vowels were more difficult to identify for these cuers than were single words beginning with consonants.
Cued Speech and Cochlear Implants Statement:
While observational reports from parents and teachers are quite encouraging, research regarding the benefits of Cued Speech specifically in regard to cochlear implants is still minimal. Osberger (1997) reported results of an FDA (United States Food and Drug Administration) clinical trial on the efficacy of cochlear implants for language development in young children, in which children raised with Cued Speech were included as a discrete group. Results from the clinical trial suggested that exposure to Cued Speech provided a benefit pre- and post-implant, as compared to the other groups of children. Vieu, Mondain, Blanchard, Sillon, Reuillard-Artieres, Tobey, Uziel and Piron (1998) studied Cued Speech, Oral, and Signing groups of children at annual intervals post-implantation and found that, while all three groups made progress in speech intelligibility and spoken language ability, the Cued Speech group generally outperformed the other two groups of children.
Descourtieux, Groh, Rusterholz, Simoulin and Busquet (1999) discussed a series of case studies of cueing children fitted with cochlear implants that, when considered in sum, suggest that early and consistent access to Cued Speech pre-implantation provides a superior foundation for the acquisition of spoken language after implantation. Cochard, Calmels, Pavia, Landron, Jusson, Honegger and Fraysse (2003) did investigated several auditory, communication, and family-related factors implicated in the development of deaf children who receive cochlear implants, and found many benefits associated with early and clear exposure to Cued Speech.
Research:
Osberger (1997) reported results of an FDA clinical trial, in which 151 profoundly deaf children were followed pre- and post-implantation. The children represented a somewhat homogenous group, in that they all were profoundly, bilaterally (most prelingually) deaf, did not benefit from hearing aids, did not show evidence of mental retardation, and came from homes with spoken English as the primary language. It is important to note that the majority (64%) of the children were implanted by the age of 5 years. The children were categorized as Oral, Cued Speech, or Total Communication. The children raised with Cued Speech represented 13% of the sample, which is a relatively large group.
The efficacy of the cochlear implant was determined by children’s awareness of sound (speech and environment) and language development. Therefore, it was necessary to test language abilities and to group children according to communication mode (language access). The Glendonald Auditory Screening Procedure (GASP) and the Early Speech Perception Test (ESP) were used to determine language comprehension. The Cued Speech group’s performance (both pre- and post-implantation) was similar to (though slightly higher than) the Oral group, and significantly higher than the Total Communication group. It is important to note that the range of scores for the Cued Speech group was smaller than that of the Oral group, possibly suggesting that Cued Speech was a more significant factor for this group; the Oral group having higher and lower scores, suggesting other variables were significant (depending on the child).
Vieu, et al. (1998) investigated speech production of 12 implanted children between the ages of 5 and 9 years old, with an average age of implantation of 7 years, 2 months. This study examined not only pronunciation of single words, but also syntax (grammatical accuracy) of sentences and stages of sentence patterns (language level). Speech intelligibility (words) was tested before implantation, and again at 1, 2, and 3 years post-implantation, by showing children pictures of common objects and having them verbally name the objects (1, 2, and 3 syllable words). Sentence syntax was tested at 1, 2, and 3 years post-implant, by presenting spoken sentences to the children and having them repeat them back completely. Language level was tested at 3 years post-implant, by showing pictures to the children, having them tell stories based on the pictures, and analyzing the accuracy and complexity of the responses.
Results indicated that all children improved their speech production and spoken syntax after implantation, and continued to improve over time (3 years). Specifically, results indicated that the Cued Speech group demonstrated more advanced syntax than the oral and signing groups, and that the Cued Speech and Oral groups both outperformed the signing group in word intelligibility and language complexity by the end of 3 years.
Descourtieux, et al. (1999), in an attempt to address the issue of whether, “…Cued Speech, which stimulates the visual channel, [would] cease to be useful, perhaps even be contraindicated in the long habilitative process both pre- and post-implant” (p.206), offered a glimpse into the early communication development of four children who received cochlear implants and who were raised with Cued Speech. The authors do not provide specific measures to illustrate receptive or expressive gains experienced by the children in the case studies, but they point out that the common feature of these cases is that the children received a clear visual representation of spoken language prior to implantation, and that their subsequent success with acoustic speech reception must be due, in part, to the visual-acoustic bridge provided by Cued Speech.
Cochard, et al. (2003) investigated factors influencing the communication and language development of implanted children, including the role of exposure to Cued Speech. The authors report data on 53 children, who were followed for a number of years in order to document their development. The children were tested regarding auditory discrimination, speech comprehension, spoken intelligibility, and language development.
An important aspect of this study is that the children were separated into three “profiles”, depending on their language development progress in the first three years after implantation (i.e. Profile 1: children whose progress is fast and continuous; Profile 2: children whose progress is slower, likely due to being implanted at a later age; and Profile 3: children whose progress is halted, likely due to other family or health factors.) Analyses including all 3 profiles indicate that all children improved in their ability to perceive spoken words and in their own speech intelligibility over time. However, for comparisons of the children’s development, only those children who fit the first two profiles are included, and these children are further separated into signing, oral, and Cued Speech groups.
Major findings are summarized thus:
Regarding the children’s perception of words in open and closed lists, the Cued Speech group outperformed the signing and oral groups at all three time intervals (i.e. 1, 3, and 5 years after implantation). Regarding the children’s speech intelligibility, all children were similar at one year after implantation, but the Cued Speech group outperformed the signing and oral groups at 3 years and 5 years after implantation.
Comparisons of language development were carried out using data from 19 children to whom the authors had consistent access for at least 4 years. Major findings are summarized thus: Neither age at implantation nor age at the beginning of auditive education appeared to be significant factors of comparison for these groups. This is likely due the children being similar in these regards. A significant difference, however, can be seen regarding a child’s ability to benefit from hearing aids prior to implantation. Children who experienced benefit from hearing aids prior to implantation were all found in Profile 1 (progress was fast and continuous) and children who did not benefit from hearing aids prior to implantation were all found in Profile 2 (progress was evident, but slower). Also, most of the children in Profile 1 came from families that reported being comfortable and capable with their communication mode (whether signing, oral, or Cued Speech), and most of the children in Profile 2 came from families that reported being frustrated with their comfort and capabilities. Interestingly, most families in Profile 1 used either oral communication or Cued Speech, whereas most families in Profile 2 used signs with speech.
The authors examined factors related to parents’ and families’ use of Cued Speech with their children, and results suggest very strongly the importance of early and consistent use of Cued Speech at home and at school. The authors found that parents who attend formal training enjoy more success with Cued Speech, but that the amount of time spent cueing is a more important factor than the actual type of instruction received. Truly, all families in Profile 1 reported using Cued Speech intensively or regularly, whereas all of the families in Profile 2 reported using Cued Speech regularly, moderately, weakly, or not at all. It is important to note that families in Profile 2 do indeed report success with Cued Speech and/or with the child’s cochlear implant, but at a level somewhat lower than the families in Profile 1.
In addition to the aforementioned research currently available, Leybaert (2003) has reported on a series of studies in progress or recently submitted for publication, that look into the contributions of cueing for interpretation of new or degraded auditory input provided by cochlear implants. Preliminary data from de Gestas and Leybaert (in Leybaert, 2003) indicate that, among children receiving cochlear implants, the children with early and consistent exposure to cueing at home and at school, attain rhyme judgment abilities at the expected age, whereas the implanted children who do not cue are slightly delayed in this developmental milestone.
Cued Speech and Language Development / Language Processing Statement:
Deaf children of hearing parents who cue their native spoken language have been found to develop that language according to the same milestones as hearing peers (Kipila, 1985; Anthony, Moseley, & Williams-Scott, 1991; Metzger, 1994). Hearing parents can learn to cue at a rate and accuracy level sufficient to deliver linguistically complex information to their deaf children within 2-3 months of learning the system (Torres, Moreno-Torres, & Santana, 2006). Deaf children exposed to multiple languages by fluent models of those languages can develop both languages and become bilingual in a fashion similar to hearing children (Earl, 2006). Cueing provides children with access to complete language, including such function words as prepositions, often missed by deaf children from other communication backgrounds (Santana, R., Torres, S., & Garcia, J. (2003). Indeed, deaf children whose parents and teachers cue (and/or who work with skilled transliterators) have been found to develop the written forms of spoken languages in ways similar to hearing children of hearing parents (Cornett, 1990; Leybaert & Alegria, 1993; Leybaert, Alegria, & Foncke, 1983; Perier, Charlier, Hage, & Alegria, 1988).
Research:
Kipila (1985) conducted a case study of the expressive and receptive cueing of a 5 year, 4 month old deaf child, and found many morphological structures used with 100% accuracy, including: regular and irregular past, plurals, possessives, and irregular third-person. Structures that Kipila found to be present but at less than 100% accuracy included: articles, contractible copula, present progressive, and regular third person. Many of these have not yet been reached in the 5th year of normal language development.
Quenin (1993) examined the effect of Cued Speech on deaf college students’ ability to repeat word-for-word what a speaker has said to them. She timed the participant’s responses, to keep track of speed as well as accuracy. The participants’ reception of connected speech was more accurate and more efficient with cues than without (less errors, and twice as fast). These findings suggest not only the benefit of cueing for receptive language, but specifically the ability of cuers to process ongoing connected discourse.
Metzger (1994) conducted a follow-up study with Kipila’s (1985) participant at the age of 11 years. Six years after the original case study, Metzger chose to focus on three structures noted by Kipila at 100% accuracy (regular and irregular past tense, and plurals) and three structures noted by Kipila at less than 100% accuracy (the contractible copula, present progressive, and articles). Metzger found all six structures demonstrated at 100% accuracy, suggesting the developmental nature of cued language development similar to the developmental nature of spoken language development.
Anthony, Moseley, and Williams-Scott (1991) conducted a case study of the expressive language ability of one child with a severe-to profound hearing loss who was exposed to Cued Speech from the age of 18 months. At the age of 3 years, 10 months, the child was videotaped in interactions with mother, father, and teacher. Language samples revealed evidence of language milestones, including: expressively-cued mean length of utterance (MLU), use of appropriate morphemes, question and negation forms, lexical categories, and turn-taking. The researchers found the participant’s morphological, lexical, and pragmatic development to be within normal limits for age level.
Torres, Moreno-Torres, and Santana (2006) conducted a case study in Spain involving a prelingually profoundly deaf child, her hearing mother, and a speech-language therapist with 10 years’ Cued Speech experience. The girl was identified as deaf at 12 months, and wore bilateral hearing aids until the age of 17 months, at which point she received a cochlear implant. She was exposed to Cued Speech beginning at the age of 14 months. Within 3 months of learning to cue (by the beginning of the case study), the mother was able to match the therapist’s level of cueing (e.g. mean length of utterance, variety and complexity of language forms). Both adults cued 62-65% of language-bearing utterances, and 83% of all words spoken. The child’s cued language models provided her access to linguistically rich messages, including nouns, verbs, grammatical structures, and pragmatics. The researchers concluded that the child was provided rich linguistic input via Cued Speech, that a parent can learn to cue and become a sufficiently competent cuer and language model in a short period of time, and that a deaf child can attend to cued as well as oral/aural messages for the purpose of language development.#
Earl (2006) documented the bilingual development of a ten month old girl with auditory dys-synchrony over a period of 8 months. The girl was exposed to cued Dutch by her hearing mother and cued Spanish by her hearing father. Findings include that, although the girl received fluctuating and inconsistent access to sound and auditory speech information, she demonstrated age appropriate receptive language development in both Dutch and Spanish, and demonstrated comprehension of cued messages in both language whether accompanied by speech or not. The girl’s expressive language (primarily spoken) was observed to be approximately 6 months delayed in both Spanish and Dutch, and the researcher speculated that additional disabilities associated with the girl’s birth may be contributing factors to this.
Santana, Torres, and Garcia (2003), aiming to shed light on deaf children’s development of specific linguistic concepts, conducted a study of the acquisition and use of Spanish prepositions by deaf children in Spain form oral, signing, and Cued Speech backgrounds. The researchers chose prepositions due to their important role in the comprehension of spoken language. The results show that the different systems of communication contribute, to different degrees, to the acquisition of Spanish prepositions, with the best results being obtained with Cued Speech. In the study, 35 children with prelingual profound sensorineural bilateral hearing loss who could read at a measured age equivalent of at least 8 years were grouped according to whether they had been consistently exposed (for at least the last 3 consecutive years) to oral, signed, or cued communication. The children were presented with a task booklet made of sheets with simple sentences from which the preposition had been replaced by a blank and four prepositions from which to choose a response. Each sentence was accompanied by a drawing to help clarify the meaning of the sentence. Results indicated no significant difference between the Cued Speech group and a hearing control group. These scores were higher than those seen in both the oral and signing groups. The authors conclude that exposure to cued language supplies information about the prepositions of spoken language to deaf children commensurate with that supplied to hearing children by speech.
Cued Speech and Phonics / Spelling Statement:
Deaf children with early and consistent exposure to cueing develop a phonological representation of words in their language, and can learn phonics generalizations for spelling in the same way as hearing children who speak the language (Alegria, Dejean, Capouillez & Leybaert, 1990; Leybaert & Charlier, 1996; Leybaert & Lechat, 2001).
Research:
Alegria, Dejean, Capouillez, & Leybaert (1990) compared hearing students and deaf cuers on the ability to identify new words in print. The students were first given a pre-test to determine words familiar and unfamiliar to them, and then they participated in mini-lessons in which they learned new vocabulary words, presented in cued French and accompanied by pictures instead of written words. After each lesson, the children were shown the drawings again and were given a multiple-choice test, consisting of both familiar and unfamiliar words. For each picture, one written word was the correct choice, two written words visually similar to the correct choice when speechread, and one written word was unrelated. In order for children to choose the correct word, they would have to disregard the both choices that look the same on the mouth and choose the one that is exactly the same when cued. There was a significant increase in correct responses for the new words, even though the children only had exposure to cued representations of the words, and no exposure to the printed word. These findings suggest that exposure to Cued Speech can provide children with the phonological representations of words, and the ability to develop their own vocabularies based on words’ phonological structure.
Leybaert and Charlier (1996) compared the phonics abilities of hearing students, deaf students who were exposed to Cued Speech at home and at school, those who were exposed to Cued Speech at school, using a generative spelling task. The students were shown simple pictures and were asked to spell the words represented. The deaf students exposed to Cued Speech at home plus at school, like the hearing students, exhibited error patterns in which the majority of errors were phonologically accurate (i.e., could be pronounced like the correctly spelled word). This was in sharp contrast to the students who were exposed to Cued Speech at only at school only, whose errors were almost equally phonologically accurate and phonologically inaccurate. These findings strongly argue for the use of Cued Speech at home plus at school for the development of cued language.
Leybaert and Lechat (2001) conducted a study of prelingually, profoundly deaf children’s spelling skills, in order to determine whether a deaf child’s accuracy in the use of phonics knowledge is affected by: (a) the nature of linguistic experience; (b) the age at which language exposure began; or (c) an interaction of the two factors. Signing children and cueing children were given picture and/or short sentences and asked to write a missing (but familiar) word. Specific phonics rules were investigated, to determine the accuracy of children’s spelling based on phonics. Both groups of signing children (those exposed to sign and/or a signed language at school and/or at home) provided more phonologically inaccurate spelling errors than phonologically accurate ones. The children exposed to cueing at home and at school provided more phonologically accurate spellings, and showed differences in spelling based on phonics generalizations, suggesting the importance of early acquisition of a language that has the phonological structure for the development of accurate phonics representations for spelling
Cued Speech and Memory for Reading Statement:
Deaf children with early and consistent exposure to cueing at home and at school demonstrate word coding, memory, and reading abilities similar to hearing peers, and superior to deaf children from other communication backgrounds (Leybaert & Charlier, 1996; Wandel, 1989; Ketchum, 2001) AND superior to children exposed to cueing only at school (Leybaert & Charlier, 1996).
Research:
Leybaert and Charlier (1996) compared deaf children raised orally, those raised with cueing at home and at school, and those raised with cueing only at school on their use of phonological representations (the way a word is “said”) for remembering a series of words. Picture stimuli were used to avoid the possibility of giving the children pronunciation clues based on spelling. The three groups were asked to recall series of pictures representing words in two sets of conditions: 1) rhyming vs. non-rhyming and 2) one-syllable vs. multiple syllables. The hearing children and the children who were exposed to cueing both at home and at school were able to recall more words than the oral group, and showed a difference in their ability to remember words based on word length and on phonological similarity (it’s harder to remember a list of words if they rhyme, and it’s harder to remember a list of long words than short words) suggesting that the children exposed to Cued Speech both at home and at school process the phonological structure of spoken words in much the same way as hearing children.
Ketchum (2001) studied the working memory capacity of deaf individuals from signing backgrounds and cueing backgrounds, as well as that of a group of hearing controls, to investigate the type of phonological coding that deaf and hearing cuers of English use for short-term retention of serial-order information. The study explored the recall of participants when presented with cued and printed word stimuli in conditions of oral and cued articulatory suppression. Ketchum found that deaf cuers use internal speech recoding similar to hearing individuals in working memory tasks, and do not show reduced working memory capacity relative to hearing individuals.
Wandel (1989) matched groups of deaf elementary school students by communication mode (Oral, TC, and Cued Speech) and compared them to a hearing control group matched for age, gender, and cognitive ability. Results indicated that the TC sub-groups had the lowest measured achievement on the tasks and the lowest internal speech recoding ability. There was no significant difference in reading achievement between the hearing and Cued Speech-profound groups. There was a relationship between internal speech recoding and reading comprehension for the deaf subjects in her study, and it seems that cuers use internal speech better than users of MCE systems.
Cued Speech and Phonological Representations for Reading Statement:
Individuals with early and consistent exposure to cueing in childhood demonstrate an awareness of phonology and reading comprehension commensurate with hearing peers (Coryell, 2001; LaSasso, Crain, & Leybaert, 2003). Children exposed to cued French demonstrate rhyme judgment and rhyme generation abilities similar to hearing peers, (Charlier & Leybaert, 2000), as do children exposed to cued American English (Crain, 2003).
Research:
Charlier and Leybaert (2000) studied the generative rhyming abilities of deaf children exposed to signing at school or at school plus at home, and deaf children exposed to cueing at school or at school plus at home. The children were asked to think of and write down words to rhyme with either printed words or the words indicated by pictures. Target words were separated into two groups: 1) easier words, in which correct rhyming answers are spelled alike, and 2) more difficult words in which correct rhyming answers may or may not be spelled alike. The group of children exposed to Cued Speech both at home and at school performed similarly to the hearing control group, outperforming all of the other groups.
Coryell (2001) investigated the correlation between verbal sequential processing abilities and reading abilities of deaf participants from signing and cueing backgrounds, compared to a hearing control group. Participants were tested with measures of verbal sequential processing, passage reading comprehension, and intellect. The deaf participants who used sign communication showed comparable intellect, yet scored lower than the cueing participants and the hearing controls, both on measures of verbal sequential processing and measured reading comprehension. Coryell hypothesized that the signers’ over-reliance on top-down reading processes may contribute to a lesser ability to take advantage of verbal sequencing for reading comprehension.
LaSasso, Crain, & Leybaert (2003) compared the rhyme generation abilities of hearing young adults to young adults with severe to profound deafness from 1) cueing backgrounds and 2) non-cueing backgrounds. Rhyming accuracy was better for orthographically-and-phonologically consistent words than for orthographically-and-phonologically inconsistent words. The performance of the deaf participants from cueing backgrounds did not differ significantly from that of the hearing participants. However, the performance of the non-cueing group was well below that of the hearing group. Hearing and cueing participants produced more orthographically different responses (e.g., love and of) while participants from the non-cueing group produced more responses that are orthographically similar (e.g., love and glove), indicating that the hearing and cueing groups rely more on phonology and the non-cueing group more on spelling to generate rhymes. Between-group comparisons reading comprehension scores indicated comparable measured reading achievement for the three groups, but within-group correlations between reading score and proportion of orthographically different responses indicated a correlation between measured reading achievement and rhyming ability. These findings point to the connection between phonological awareness and reading achievement.
Crain (2003) compared the effect of exposure to cued American English by comparing the generative rhyming abilities and reading comprehension of 10-14 year old deaf children from oral and cueing English-language backgrounds. He found that although the oral group had higher levels of hearing and better ratings of speech intelligibility than the cueing group, the cueing group had superior phonological awareness (PA) and higher measured reading comprehension, despite having more profound degrees of deafness. Additionally, speech intelligibility and degree of deafness correlated to PA for the oral group (i.e., the lower the speech intelligibility, the lower the PA; the less hearing, the lower the PA), but this was not true of the cueing group. This suggests that exposure to cued American English provides children with an internal representation of English that is sufficient to aid in their normal reading development, and that need not be affected by degree of deafness or speech capabilities.
Research References:
Alegria, J., Charlier, B., & Mattys, S. (1999). The role of lip-reading and Cued Speech in the processing of phonological information in French-educated deaf children. European Journal of Cognitive Psychology, 11, 451-452.
Alegria, J., Dejean, K., Capouillez, J., & Leybaert, J. (1990). Role played by Cued Speech in the identification of written words encountered for the first time by deaf children. Cued Speech Journal, 4, 4-9.
Anthony, C., Moseley, M., & Williams-Scott, B. (1991). Language expressed through Cued Speech: A preschool case study. Paper presented at the American Speech and Hearing Association, Atlanta, GA. Nov. 1991.
Charlier, B. & Leybaert, J. (2000). The rhyming skills of deaf children educated with phonetically augmented lipreading. Quarterly Journal of Experimental Psychology, 53A, 349-375.
Clarke, B. & Ling, D. (1976). The effects of using Cued Speech: A follow-up study. The Volta Review, 78, 23-34.
Cochard, N., Calmels, M., Pavia, G., Landron, C., Husson, H., Honegger,A., & Fraysse, B. (2003). L’impact du LPC sur l’évolution des enfants implantés. Unité Pédiatrique d’Implantation Cochléaire. Downloaded 1/3/06 from http://www.alpc.asso.fr/rech01-a.htm
Coryell, H. (2001). Verbal sequential processing skills and reading ability in deaf individuals using Cued Speech and signed communication. Unpublished Doctoral dissertation, Gallaudet University, Washington, DC.
Crain, K. (2003). The development of phonological awareness in moderately-to-profoundly deaf developing readers: The effect of exposure to cued American English. Unpublished Doctoral Dissertation. Gallaudet University, Washington, DC.
Descourtieux, C., Groh, V., Rusterholtz, A., Simoulin, I., & Busquet, D. (1999). Cued Speech in the stimulation of communication: An advantage in cochlear implantation. International Journal of Pediatric Otorhinolaryngology, 47, 205-207.
Earl, P. (2006). Communication Behaviors of a Young Child with Auditory Dys-Synchrony: Seeing Cued Dutch and Cued Spanish. Unpublished Doctoral Dissertation. University of Cincinnati, Cincinnatti, OH.
Fleetwood, E. & Metzger, M. (1997). Does Cued Speech entail speech? An analysis of cued and spoken information in terms of distinctive features. Unpublished manuscript.
Gregory, J. (1987). An investigation of speechreading with and without Cued Speech. American Annals of the Deaf, 132 (6), 393-398.
Ketchum, K. (2001). Implications of working memory strategies in deaf native cuers, hearing cuers, and hearing non-cuers. Unpublished doctoral dissertation. Gallaudet University, Washington, DC.
Kipila, B. (1985). Analysis of an oral language sample from a prelingually deaf child’s Cued Speech: A case study. Cued Speech Annual, 1, 46-59.
Koo, D. (2003). On the nature of phonological representations and processing strategies in deaf cuers of English. Unpublished Doctoral Dissertation. The University of Rochester, Rochester, NY.
LaSasso, C., Crain, K. & Leybaert, J. (2003). Rhyme generation in deaf adults: The effect of exposure to Cued Speech. Journal of Deaf Studies and Deaf Education, 8 (3), 250-270.
Leybaert, J. (2003). Phonological Representations in Profoundly Deaf Children with a Cochlear Implant: Possible Benefits from Exposure to Cued Speech. Presentation given October 12, 2003 at Gallaudet University: Washington, DC.
Leybaert, J. & Charlier, B. (1996). Visual speech in the head: The effect of Cued Speech on rhyming, remembering, and spelling. Journal of Deaf Studies and Deaf Education, 1, 234-248.
Leybaert, J. & Lechat, J. (2001). Variability in deaf children’s spelling: the effect of language experience. Journal of Educational Psychology, 93, 554-562.
Ling, D. & Clarke, B. (1975). Cued Speech: An Evaluative Study. American Annals of the Deaf, 120 (5), 480-488.
Metzger, M. (1994). Involvement strategies in cued English discourse: Soundless expressive phonology. Unpublished manuscript, Georgetown University, Washington DC.
Nicholls, G. & Ling, D. (1982). Cued Speech and the reception of spoken language. Journal of Speech and Hearing Research, 25, 262-269.
Osberger, M. (1997). Current issues in cochlear implants in children. The Hearing Review, 4 (10), 28-31.
Quenin, C. (1992). Tracking of connected discourse by deaf college students who use Cued Speech. Unpublished Doctoral Dissertation. The Pennsylvania State University.
Santana, R., Torres, S., & Garcia, J. (2003). The role of Cued Speech in the development of Spanish prepositions. American Annals of the Deaf, 148, 323-332.
Tammasaeng, M. (1985). The effects of cued speech upon tonal perception of the Thai language by hearing impaired children. Unpublished Doctoral Dissertation. Gallaudet University, Washington, DC.
Torres, S., Moreno-Torres, I., & Santana, R. (2006). Quantitative and qualitative evaluation of linguistic input support to a prelingually deaf child with Cued Speech: A case study. Journal of Deaf Studies and Deaf Education, 11, 38-448.
Vieu, A., Mondain, M., Blanchard, K., Sillon, M., Reuillard-Artieres, F., Tobey, E., Uziel, A., & Piron, J. (1998). Influence of communication mode on speech intelligibility and syntactic structure of sentences in profoundly hearing impaired French children implanted between 5 and 9 years of age. International Journal of Otorhinolaryngology, 44, 15-22.
Wandel, J. (1989). Use of internal speech in reading by hearing and hearing-impaired students in oral, total communication and Cued Speech programs. Unpublished doctoral dissertation, Teachers College, Columbia University, New York, NY.
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