International Journal of Pediatric Otorhinolaryngology, 26 (1993) 209-223 0 1993 Elsevier Scientific Publishers Ireland Ltd. All rights reserved. 0165-5876/93/$06.00

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PEDOT 00881

Review Article

The optimization of hearing-impaired children’s speechreading

Paul Arnold

Department of Psychology, University of Manchester, Manchester Ml3 9PL (UK)

(Received 28 May 1992)

(Revised version received 14 September 1992)

(Accepted 20 September 1992)

Key words: Speechreading; Hearing-impaired; Deafness

Abstract

As more hearing-impaired and deaf children are mainstreamed into regular schools and as age related hearing loss in advanced countries become more prevalent, so the need for optimal methods to teach speechreading increases. The numbers of children and adults who would benefit from improved methods of teaching speechreading must be considerable. No new methods of teaching speechreading have been developed since 1938. Speechreading is a skill that does not require complex technology, although it does augment the effectiveness of hearing aids. Increased knowledge of this skill would have great benefits in psychological, social and economic terms. Some relevant experimental psychological literature and the views of educators are discussed with the goal of contributing to the optimization of hearing-impaired children’s speechreading.

Introduction

Normally hearing individuals spontaneously process lip and other facial move- ments involved in speech production, as an integral part of their speech perception.

Correspondence to: Dr. Paul Arnold, Department of Psychology, University of Machester, Manchester Ml3 9PL, UK.

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When a person’s auditory system is damaged there is an urgent need to develop this natural, and largely unconscious, speechreading ability. An increased ability to read lip and face movement sequences can augment the effectiveness of hearing aids. In this way the visual system can assist the damaged auditory system in the perception of speech and other sounds. How can this ability be optimized to help hearing- impaired and deaf children’s comprehension and production of speech? I wish to argue that speechreading should be taught to hearing-impaired and deaf children and that new and optimal methods should be developed, based on knowledge from experimental psychology.

Speechreading is not taught to hearing-impaired children in Britain

One paradox is that speechreading is taught to adults who have lost part of their hearing, usually as a consequence of ageing, but not to hearing-impaired and deaf school children. Two literatures have developed, a larger one concerned with teaching adults in speechreading classes and a very much smaller one on children’s speechreading. It is important to maintain a clear distinction between teaching speechreading to adults and to children, partly as one school of thought represented by Montgomery and Demorest [37] concludes that ‘Our feeling is that speech- reading really is an independent trait (probably “hardened” and untrainable in the adult)‘.

You may remember that in Lewis Carroll’s Alice in Wonderland the Cheshire Cat fades away and all that was left of him was his grin. Just the opposite seems to have happened in the recent history of hearing-impaired education. Today the human voice, and the structures such as the larynx, tongue and velum, all solidly remain. As do listening skills. In contrast the visible lip movements and all of the expressive movements of the speakers face, the ‘grin’, has vanished as mysteriously as the Cheshire cat.

Markides [31] writes that ‘As far as can be ascertained no formal teaching of speechreading to hearing-impaired children takes place in the United Kingdom. Speechreading ability among these children develops incidentally and within the nor- mal process of communication’. He notes that the situation is quite different for hearing-impaired adults where speechreading instruction plays a very important part in their aural rehabilitation. It is interesting to speculate why this surprising state of affairs has come about. Has the teaching of speechreading to children been the vic- tim of a combined and sustained opposition by some Pure Oralists and also by some advocates of British, and American, Sign Language?

A naive observer might think that a hearing-impaired or deaf child should be assisted to develop every potential communication skill to help them understand other people’s speech and to produce good speech of their own. Indeed this was the stated aim of the Total Communication movement which predominated in many American, and some British, schools for the deaf and hearing-impaired in the 1970s.

A practical educational consideration is how teachers of mainstream classes with hearing impaired students can optimally communicate with these students. Speechreading would appear to have an important role. What practical advice can

be given to these reguIar classroom teachers about speechreading? Can speech- reading be used with those of profoundly deaf children who remain in special schools?

The opposition to teaching speechreading to children

Some writers are opposed to the teaching of speechreading to hearing-impaired chiIdren. Pollack [42] was one of the first educationalists, in the era of transistor based hearing-aids, explicitly to oppose the teaching of speechreading. Clark‘s book [4] is also a recent source of the arguments against teaching speechreading to hearing-impaired children. Pollack 142) justified her view in a discussion of the human visual system in her statement that ‘There can be no compromise. Once em- phasis is placed on looking there will be divided attention and the unimpaired modality - vision - will be victorious.’ The hope of Pollack and Clark is that modern hearing-aids will optimize the child’s residual hearing and so lead to fluent speech. Clark makes it clear that ‘an auditory oral approach does not deny the hearing-impaired child the opportunity to lipread, but it does not place emphasis on visual cues , . ,’ In particular one should not deliberately draw attention to the lips. A teacher should not point to the area of the lips and ask the child to ‘watch’, instead they should ask the pupil to ‘listen’. Lip movements should not be exaggerated. Hearing-impaired toddlers should not even be put in high chairs as this may lead, Clark believes, to an over emphasis on vision.

Vision is, for Pollack and Clark, an enemy and not a potential ally. The visual system will, they fear, lure the hearing-impaired child away from the crucial and fun- damental task of listening. If the child’s attention is divided between listening and looking (at lip movements), looking will triumph at the expense of fluent and natural speech.

The position of the advocates of American and British Sign Language and Bil- ingualism (in the sense that the term is used by Harlan Lane) is less clear. Whilst they are agreed that deaf people shoutd learn to read and write, it is less apparent if a consensus exists that it is important to encourage speech by deaf children. How far reaching is their Bilingualism, with respect to speech?

The case for teaching speechreading to children

The case for teaching speechreading to deaf and hearing-impaired children is based on the assumption that the more information about the spoken message the child has the easier it will be for them to comprehend the message. Oralists have not always been opposed to teaching speechreading. Earlier Oral& such as Alexander Graham Bell [l] and Ewing and Ewing [IX], in Britain, were in favour of speechreading, and the deliberate involvement of the visual system. Bell urged that the deaf child’s visual system should be used and ‘educated’. Ewing and Ewing did, however, require ‘Speech readiness before any formal lessons in speechreading or speech’. Then ‘Gradually a deaf child must come to know the power of his own voice

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to win attention; he must be lead to watch for speech and to make a beginning in speechreading. From all of this will spring, sooner or later, his first spontaneous word or words’. Ewing and Ewing [19], in the context of teaching speechreading to deafened adults wrote ‘Do not hesitate to use a suitable hearing aid and lipread at the same time. The one helps the other in a wonderful way’.

Do hearing people naturally lipread in everyday life? It would be mistaken to regard speechreading as an artificial and prosthetic pro-

cess, as normally hearing people use this ability in everyday life. We (if we are hear- ing or partially-hearing) can carry out a simple experiment to give a rough idea of our own speechreading skills. If you turn down the sound on your television and ‘listen’ to the news. You will probably find that you are, in this situation, not very good at speechreading at all. Of course this experiment is rather severe in that you received no sound, to help you to lipread. This discouraging experience should not, however, lead to the conclusion that hearing people do not spontaneously lipread in everyday life. Some psychological experiments suggests that we do.

Cotton [5] had a person sit in a sound proof room, so that their face could be seen through a thick glass window. The speakers voice was transmitted via a microphone and loudspeaker to the audience outside. The person’s speech was distorted by ad- ding a loud buzzing noise. Then the lighting was varied. When the light was turned off and the audience could not see the persons face, they could only understand an occasional word or two. Yet when the light was switched back on so that the per- son’s face (and lips) could be seen, their speech could be understood perfectly well by the listening audience. We can conclude that seeing the lips did help the understanding of speech.

More recently McGurk and MacDonald [35] wrote their paper ‘Hearing Lips and Seeing Voices’. They videoed a speaker saying the sound ‘ga-ga’, but then replaced the soundtrack with someone saying ‘ba-ba’. When the listeners, in the experiment, closed their eyes they did, of course, hear ‘ba-ba’. But what happened when they saw and listened to video where the persons lips ‘said’ ‘ga-ga’, but sounded like ‘ba-ba’? The listeners’ eyes suggested ‘ga-ga’ but their ears heard ‘ba-ba’ - or did they? In fact the listener heard something quite different to either of these. Their illusory perception was that the speaker was saying ‘gab-ga’ or ‘bag-ba’, a novel mixture of the two. The two contradictory stimuli were combining before the listener was con- scious of either of them. Cotton’s work together with that of McGurk and Mac- Donald shows that adult hearing people do naturally lipread in everyday life. Is this also true of hearing children?

Dodd [6] investigated the speechreading skills of 3- to 36-month-old normally hearing children and found that the ability to attend to lipread information is present soon after birth. The infants were aware of the special relationship between speech sounds and lip movements. The infant’s babbling can be modified by stimulation which includes lipread cues, but not by a purely auditory input, nor by purely social stimulation. By the time they reach 19 to 36 months they can lipread familiar words. Dodd has found that auditory and visual (lipread) speech perception abilities develop together.

In fact the relationship between heard and seen speech is unique, Dodd concludes.

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This provides strong evidence that lipread and heard speech are processed in a code insensitive to input modality.

Mogford [36] has reviewed the literature on speechreading in the prelingually deaf and concluded that ‘a developmental account of the different components of the skill is needed but is currently lacking’.

Is Pollack and Clark’s anxiety about divided attention justified? Adults who lose their hearing, usually in later life, are often taught to lipread.

Courses are available in most large cities. Of course these adults usually have a good grasp of English, which they can use to improve their speechreading skills. No one has expressed anxiety about their ‘limited capacity’ or attention span. There is research which answers the question of divided attention. The first is on the hearing- impaired and the second on the normally hearing. Pollack claims support from a study by Gaeth [21]. In fact, Gaeth used printed material in his experiments on audio-visual processing in deaf education and not lip or speech movement sequences. Goetzinger [23] places Gaeth’s contribution in context and shows that the experimental work in general supports a bimodal approach and not a unisensory one. Also Treisman and Davies [45] describe two experiments which show that the limits of divided attention are reduced when stimuli are presented simultaneously to ear and eye rather than both to the ears or both to the eyes. Readers who wish to pursue this issue further should read the contributions in Dodd and Campbell [7].

Experimental investigations

The experimental literature is reviewed in the volume by Dodd and Campbell [7]. The present paper is not a systematic literature review but selects work on the criterion of its potential relevance to the optimization of children’s speechreading. The main problem for the speechreader is to construct the speaker’s full message from the lip movements which represent only fragments of the message. Campbell [3] states that ‘the skill of lipreading is essentially one of interpreting the superficial, kinetic, aspects of lipmovement in terms of a deeper dynamic form’.

Campbell [3] summaries the few speech sounds that can be seen on the lips. Those consonants which are made with the lips together (lb/, /rn’ and lpi) can be discriminated from those which are not. The sounds If/ and Iv/ can be identified as are the two pronunciations of ‘th’ as in thought and this. But, of course, sound made further back in the mouth cannot be easily seen. The vowels Ii:/, la:/ and ILKI are usually easier to see. The distinctions between some vowels and consonants are less clear, so for instance the consonants /l/ and /r/ look like the vowel /u/. These dif- ficulties are found in the laboratory but, of course, in real life speech is both con- nected and continuous. Conversations also occur in concrete social and physical situations. Some pairs of words, however, are very easily confused when lipread, for example red and green are very difficult to distinguish, as are baby and paper.

The speechreader must then recreate the speaker’s intended message from the little information he or she can ‘read’ from the face and lips. This is the essence of the problem.

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Early experimental investigations Kitson [28] used a tachistoscope to present stimuli briefly to determine the rela-

tion of synthetic and analytic types of perception to speechreading ability. He described the analytic reader who grasps the material bit by bit and then puts it together and the synthetic reader who organizes the material at once into meaningful wholes while paying special attention to details. He used a test indicative of synthetic ability and compared the results with those of a lipreading test and found correla- tions between 0.6 and 0.7. Pintner [41] found a zero correlation between speechreading and his Non-Language (intelligence) Test, although he believed that a better test of speechreading ability might reveal a correlation.

The contribution of Heider and Heider Heider and Heider’s main findings [24] were that the rank order of children’s

speechreading performance remained constant over periods of several years; that great individual differences exist in children of the same age which cannot be due to differences in the length of training; a correlation of 0.54 between speechreading and educational achievement; and a positive correlation between the ability to follow a rhythm in dancing or gymnastics and speechreading.

The contribution of N.P. Erber A considerable contribution has been made by Erber at the Central Institute for

the Deaf [8-171. Erber [12] reviewed lipreading research from the perspective of educating deaf children and gave a rationale for the continued study of the visual perception of speech. He urges that teachers should aim to maximize the visual intel- ligibility of a message, they should employ frequently used words of two or more syllables, and rely on short, declarative sentences without unusual syntactic form. However, they must also expand the oral language competence of pupils by familiarizing them with complex structures which they may not understand. Difficult articulatory features should be placed in the context of familiar sentences. The following factors should be controlled by the teacher to enhance communication through lipreading: vocabulary and syntax; oral-facial characteristics of the speaker; the acoustic and optical environments of the classroom; methods for providing practice in speech-perception skills; and strategies that can be employed when communication difficulties arise.

Erber [ 131 confirmed that combined auditory-visual perception is superior to perception through either audition or vision alone.

Erber [14] proposed a lipreading skills matrix by which all communication by lipreading can be specified in terms of the word and sentence stimuli that a hearing- impaired child is able to detect, discriminate, recognize, or comprehend. Adequate performance is considered to be required for success at the next highest level. He claims that this matrix is useful for guiding teaching and suggests test materials based upon it.

Erber [17] varied the optical cues for visual and for auditory-visual (A-V) speech perception by placing a sheet of rough-surfaced Plexiglass between the talker and lipreader and systematically changing the distance between the Plexiglass and the talker. This procedure is analogous to masking or filtering in the acoustic domain.

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Under extremely poor optical conditions, A-V scores reach a plateau, which represents auditory perception without meaningful optical cues for speech. He con- cludes that optical distortion has potential as an auditory training technique to shift attention to non-dominant acoustic cues during A-V perception of speech. Erber [16] notes that short sentences tend to be easier to lipread than long ones, but then longer sentences are more complex in structure. Many hearing impaired children appear to have the least difficulty with sentences which have the form, subject-verb- object, but this may the product of the fact that this is introduced early in their education. He concludes by urging cooperation between researchers, clinicians and teachers to maximize the effectiveness of future technical achievements. The paper indicates the daunting nature of the difficulties in teaching speechreading to those with no residual hearing.

The contribution of D. W. Massaro Massaro [32] investigated hearing children’s perception of visual and auditory

speech. His results were well described by a fuzzy logical model of perception, which assumes that the perceiver integrates continuous and independent sources of infor- mation and determines the relative goodness of match to prototype definitions stored in memory. Massaro et al. [34] examined the developmental changes in visual and auditory contributions to speech perception. They found that children are poorer lipreaders than adults. They also found a positive correlation between lipreading ability and the size of the visual contribution to bimodal speech percep- tion. These results contradicted the categorical perception of speech. They claim that a fuzzy logical model of speech perception provides a good description of the results. Massaro justifies his use of fuzzy logic (Ref. 33, pp. 17-26).

Massaro [33] in a series of experiments elaborates his views further. His discussion of lifespan changes in speech perception is of particular interest. Massaro devised experiments to assess the evaluation and integration of audible and visible speech across a range of ages. He concludes (p. 235) that ‘There were significant differences in the information value of audible and visible speech as a function of age, but no difference in information processing. Acquisition of the visible speech distinctions occurs gradually across development, as does the acquisition of audible distinctions. Experience with speech enhances the quality of the information but does not appear to influence how the information is evaluated, integrated and utilized for decision.’ To this he adds a cautionary note that ‘differences in information processing might eventually be found when additional speech contrasts, experimental tasks, and theoretical analyses are used’.

The contribution of L. Gailey Gailey [22] notes in the introduction to her work that ‘no psychological

characteristic has yet been identified which is correlated with lip-reading ability’. Gailey outlined an information processing-based model, the central proposition of which is that speechreading comprises two types of process: firstly, the visual analysis of the perceptual input and, secondly, the integration of the results of this analysis with other sources of linguistic and non-linguistic information. The results of her two experiments produced results consistent with her model of lipreading.

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From the data it emerges that visual analysis is an important part of lipreading all types of stimuli. It can in some circumstances dominate the influence of the problem- solving process, for example in very favorable face viewing conditions. Her data also show the problem-solving process in operation for appropriate stimuli, such as those with some syntactic structure, a semantic or pragmatic context, or a degree of familiarity or frequency. There is no evidence to suggest that either of these processes should be further subdivided, although the possibility remains that if the range of stimuli were extended to include a conversation then other processes might emerge. Gailey makes suggestions as to how her findings might be extended.

Swedish work There has also been some recent work on speechreading in Sweden. Lyxell and

Riinnberg [29] examined two properties of visual feature extraction, of visual word decoding and visual word discrimination, and how these two were related to sentence-based speechreading. Samuelsson and Ronnberg [43] argue that the script property is particularly important for speechreading, where lip movements alone cannot transmit a verbal message. Schank and Abelson [44] stated that each script consists of information about a particular topic, or set of actions within a certain situation. The script has an hierarchical structure, which encompasses script, scene and action levels. The script level summarizes the general situation (e.g. a visit to a restaurant) and is divided into several scenes (e.g. reservation, ordering). Finally, the action level consists of possible specific actions (e.g. requesting a table, asking for something that is missing).

Their results did not support the idea of a single optimal level of abstraction. It appears that different contexts activate the internal script structures that are com- patible. The authors conclude that it seems reasonable to argue that the compatibili- ty effect reflects the existence and priming of sequential links between concepts within each level of abstraction. The findings also indicate that the directions of in- ferences are asymmetric. Low-level context ‘jogs inferences’ that make it possible to add information from superordinate levels with the entire script, because people are likely to encompass subordinate low level information in one basic scene. It is possi- ble that the basic concepts represent the level of abstraction at which they prefer to think or to describe scripted information, and so basic concepts do not encourage further low-level inferencing. It would be interesting to extend the work on script activation in speechreading to children.

Faces, voices and speech reading Blaney and Winograd [2] examined the development of hearing children’s memory

for faces. They found that recognition memory improved with age, from 5 to 10 years. They hypothesize that memory for faces is an increasing function of the number of features encoded. Mann et al. [30] examined encoding and subsequent recognition of unfamiliar voices in hearing children, from 6 to 16, and in adults. Per- formance improved sharply between ages 6 and 10, with the IO-year-olds approach- ing the adult levels. The course of development closely matches the ability to encode and recognize unfamiliar faces. They discuss parallels between voice recognition and face recognition. It would be interesting to include the development of speechreading in a study of the development of voice and face recognition.

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Reading and speech reading Williams [46] explored the relationship between reading and speechreading to find

whether hearing readers and speechreaders use similar strategies to comprehend ver- bal messages. Good speechreaders and poor readers were given a filmed speech- reading test and a test of their ability to comprehend printed material presented one word at a time. They study showed a significant relationship between reading and speechreading ability. Good readers may be either good or poor speechreaders, but poor readers are more likely to be poor than good speechreaders. A word-by-word strategy appears to be characteristic of both poor readers and poor speechreaders. Good readers and speechreaders use a combination of visual and linguistic cues.

How can hearing-impaired children be taught to lipread?

Moores (Ref. 38, p. 240) wrote that ‘Speechreading ability is an invaluable tool for any deaf individual. Why processes of developing speechreading - and speech - have received so little genuine attention in the past 50 years from both oralists and combined oral-manual proponents must remain a mystery.’ He continues, ‘Par- ticularly disheartening is the fact that, despite the ascendancy of the oral method for most of the twentieth century, there have been so few advances in methods of developing speech, speechreading and listening skills. Educators of the deaf continue to draw on the legacy of work done 30 or more years ago. The field cries out for theoretical and applied investigations . . .’

A similar conclusion is drawn by French-St. George and Stoker [20] who write that ‘We are left with gaping holes in our knowledge about how speechreading may be taught’ and that ‘In spite of nearly five centuries of experience in providing educa- tion and rehabilitation to hearing-impaired individuals, our knowledge remains perilously thin. We cannot say we are close to a comprehensive understanding of the speechreading process - particularly in reference to our understanding of the parts of the visual signal that are crucial for understanding, how to teach speechreading, the role of context, and the value of multimodal stimulation’. The older methods used to teach adults were often ‘bottom-up’ techniques, analogous to the phonetic methods in the teaching of reading.

Speechreading instruction for children today

Yoshinaga-Itano [47] has reviewed the available methods of speechreading in- struction for children and advocates a wholistic approach. She begins with the state- ment that ‘So little is systematized about speechreading instruction that few have written on this topic’. She stresses the similarities between speechreading and reading comprehension strategies. It is known that word-by-word reading is characteristic of both poor hearing readers and poor speechreaders [46]. Parasnis and Samar [40] advise the teacher to first focus on context and meaning and only then to draw the child’s attention to the visual characteristics of individual phonemes. Yoshinaga- Itano supports the ‘top-down’ and interactive approaches, against the ‘bottom-up’ strategies advocated by the early teachers of speechreading.

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Yoshinaga-Itano lists the objectives and principles of the holistic approach as follows. Increase the child’s ability to evaluate speechreading skills in a variety of communicative situations. Also to increase their knowledge of the speechreading process; their ability to generate strategies to facilitate more successful communica- tion; to increase confidence by providing situations that ensure a high probability of success; increase their tolerance of communicative situations that have a high degree of frustration; increase their ability to generate personal goals for improving speechreading; and increase the child’s motivation to improve speechreading abilities. This holistic approach is claimed to be both strategy and skill based.

There is an interesting discussion of the role of cueing systems and speechreading. The author writes: ‘In summary, Cued Speech has been shown to improve the visual reception of phonemes, words, syllables and sentences, particularly for poor speechreaders with profound hearing impairment. However, Cued Speech users do not appear to demonstrate significantly better speechreading performance than hearing-impaired children who do not use cues.’

The urgent need for a new method

Markides [31] observed ten British adult speechreading classes and concluded that ‘Most of the lessons observed were carefully prepared and competently carried out. The procedures followed, however, were stereotyped and lacking in imagination. This must not be seen as a direct criticism of the professionals involved since most of them were enthusiastic and highly proficient people with long experience in the field.’ To return to the school situation, it may also be inappropriate to use materials developed for adults with children of various ages. Materials must be age-appro- priate. There is, however, no scientific evidence to discourage the teaching of speechreading to hearing-impaired and deaf children. The renewed interest in the psychology and teaching of speechreading is encouraging. The problem remains, however, of turning these general insights into practical and robust methods to develop good speech in both mainstream and special school settings.

Teaching methods used with adults

Jeffers and Barley [25] critically summarize the development of methods which have been, and still are, used with adults. In the 1870s speechreading began to be seen as a skill separate from the teaching of articulation to deaf children. Jeffers and Barley discuss the confusions that existed in the in the field of speechreading at the end of the last century. There was a confusion between expression and reception, and between speech and speechreading which has never, they claim, been eradicated. They conclude that ‘In retrospect it appears there were three major errors in think- ing. The first was the assumption that the student must know how the sounds are formed. While such knowledge may be of use to the person who is learning to talk, it has scant relevance with respect to understanding what someone else is saying. The second and perhaps major error was the implicit assumption that skill in speech- reading could be developed sound by sound, i.e. through a cumulative knowledge

of the lip movements or articulatory positions. It was assumed that all speech sounds were visible, at least to some degree’. The third confusion concerned the use of mirrors.

Edward B. Nitchie was the first to realize that part to whole methods were not effective. Nitchie [39] wrote ‘The modern method of teaching a child to read is to begin with words and sentences: i.e., with ideas and not with the alphabet. So the most approved method of teaching speechreading to adults begins with a training of the mind to grasp ideas.’ Nitchie’s fundamental ideas were derived from Alex- ander Graham Bell’s wife, who was a skilled speech reader and who had stated that speechreading is the systematized result of practice in selecting the right word from a large assortment of possible words presented to the eye, and in the power of grasp- ing the meaning of what is said as a whole, from possibly a few words, or from parts of those words recognized here and there. Speechreading, was for her, essentially an intellectual exercise, where ‘the mechanical part performed by the eye . . is entirely subsidiary’. Jeffers and Barley, while recognizing Nitchie’s contribution note that his materials did not follow his philosophy and consist of unrelated sentences and of short stories written for reading rather than conversation.

The Mueller- Walle Method In the Mueller-Walle Method speech sounds are categorized with respect to their

visible characteristics, and the lessons based upon a sound movement or a group of sound movements. Consonants are divided into Class I where the cavity of the mouth is closed and Class II where the cavity of the mouth is open. Within each category the sounds are described with respect to their appearance, e.g., lfl and lvl ‘the lower lip is placed against the upper teeth’. So the order of teaching is analytical and procedes from the part to the whole.

The Kinzie Method This method is of most interest in the present context as it was devized for children

rather than adults. The Kinzie sisters were the first to develop materials specifically for the preschool and primary age partially-hearing child [26,27]. In Grade I materi- als, formal and analytic knowledge of speech sounds or speechreading movements are not taught. Visual aids are used and the following typical exercises are used, to which the child responds by pointing.

Show me the baby. Show me the mother. Show me the baby’s mouth. Show me the mother’s shoe.

In Grade II there is still no formal explanation of speech reading movements, but the teacher directs the children’s attention to the formation of a particular sound or sounds. Each lesson consists of six parts: movement words, conversational exercise, rhyme, motor exercise, sentence drill and story exercise. In Grade III the pupil enters ‘formal, conscious speechreading instruction’.

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Jeffers and Barley praise the Kinzie’s contribution, especially in the first two school grades. It is only when the Kinzie’s introduce formal and conscious instruc- tion that the materials become stilted. Another criticism is their failure to coordinate vision and hearing in their teaching, as they stipulate that no voice should be used in speechreading teaching.

The Jena Method The Jena method differs from the Nitchie and Mueller-Walle methods in some im-

portant ways. First of all, the description and classification of consonant sounds is based on their mode of formation and not their appearance. They are classified with respect to whether the primary movement is of the lips, tongue, or tongue-soft palate. Also the pupil is expected to speak in unison with the instructor and imitate his or her lip and jaw movements and at the same time to concentrate on the kinaesthetic sensations. It has been called ‘The talking way to speechreading’.

The Morkovin-Moore Method This method was first developed in 1938. The units for instruction are filmed con-

versations such as might emerge from real life situations. The hearing-impaired per- son needs to develop situational insights, language proficiency, ability to piece together fragments of words, ability to substitute visual for auditory cues. This ‘cooperation of the senses’ is expressed by the writers as AVKR, which stands for auditory, visual, kinaesthetic, rhythmic sensory integration. There are considerable advantages to this method. The major adverse criticism made by Jeffers and Barley is to do with the teaching materials. The topics in the life situations are often too general to make it possible to anticipate the dialogue. Also ‘The movies are old, technically poor and the scenes are often contrived rather than natural’.

Towards new methods of teaching speechreading

A reading of the literature shows that much is already known about the nature of speechreading and how to teach it. Many of the problems in learning to speechread fluently are similar to the problems in learning to be a mature reader. At least six areas require development and coordination.

There is a need for a developmental cognitive theory of the processes involved in children’s speechreading at various ages, with a range of hearing losses. Mogford’s conclusion [36] that ‘a developmental account of the different components of the skill is needed . . .’ remains true to today. Gailey’s work [22] provides the foundation for such an account. Her suggestion that speechreading within conversations may involve different processes is, potentially, a most valuable contribution. The aim of teaching speechreading is to help the child to converse, and conversation will in turn develop their comprehension of speech and their speechreading.

The large and consistent individual differences in speechreading ability first noted by Heider and Heider [24] suggest that individual children may develop different strategies to deal with the uncertainty inherent in speechreading. It is important to establish the nature and range of such differences in school populations.

The problem of making interesting teaching materials which will have an optimal

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effect on learning to speechread will also have to be addressed. The technology that has become available since 1938 is obviously of great potential value. Material can now be videoed, with a particular age and ability range and population in mind. Per- sonal computers are now widely available in the classroom. Materials of the kind pioneered by the Kinzie’s could be developed and enhanced using these new techni- ques. The new technology could be of great help to teachers of mainstream classes. In practice it would be difficult for a teacher to give speechreading lessons to the relatively small number of hearing-impaired children, but the teacher could assist these children to use programs to teach themselves aspects of speechreading.

Yoshinaga-Itano [47] summarizes the objectives and principles of her holistic teaching approach as follows. Increase the child’s ability to evaluate their own speechreading skills in different situations; their knowledge of the speechreading process; their ability to generate strategies to facilitate communication; provide situations that ensure a high probability of success which will increase their con- fidence in speechreading. It is also important to increase the child’s tolerance for communicative situations that have a high degree of frustration; increase the child’s ability to generate personal goals for improving speechreading; and to increase their motivation to improve speechreading abilities. Perhaps computers could assist in at- taining some of these goals.

Some of these aims, for example the need to encourage the children to generate strategies and personal goals and to increase their motivation, are easier to hope for than to obtain. In general, however, Yoshinaga-Itano’s teaching goals would be facilitated by an increased knowledge of the processes involved in learning to speechread.

The best of the work by the Kinzie’s should also be retained in essence and developed.

The research into face processing may, in the long term (see Ref. 48); Blaney and Winograd [2]; and Mann et al. [30], provide insights into speechreading. The lips are, perhaps, the most active and informative part of the human face. Indeed the term ‘speechreading’ implies that the entire face and not only the lips are involved. Face recognition, residual speech and speechreading ability develop side by side, and it is possible that these developments interact spontaneously and can be augmented by teaching. The work of Williams [46] on reading and speechreading possibly sug- gests that the avoidance of word-by-word (analytic) speechreading could be assisted by encouraging good synthetic reading habits by hearing-impaired students. Printed English, in extreme contrast to speechreading, contains a high degree of redundancy. Possibly the teachers should attempt to strive to integrate the growth of the process- ing of speechreading, together with listening skills (if there is sufficient residual hear- ing), facial expression and reading.

The terms speechreading and lipreading have been used as synonyms throughout this paper, as they are in most of the recent literature. In the United States speech- reading has come to be preferred and in Britain lipreading has generally been retain- ed. It may be that it would be more meaningful to use the term lipreading for those who have, or had, residual hearing (the partially hearing and the deafened hearing) and the term speechreading for the profoundly deaf who must acquire their knowledge of speech largely from the visible movements of speech.

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It is also likely that the hearing-impaired who have some useful residual hearing and the profoundly and prelingually deaf will require different materials and methods.

In conclusion, there are good reasons for teaching hearing-impaired and deaf children to speechread and a strong case for optimizing their speechreading skills.

Finally, the deliberate and conscious encouragement of speechreading can often go together with the use of hearing aids, which are themselves likely to become more effective in the near future.

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