TY - JOUR
AU - Finley,, Alayna
AB - Abstract The purpose of this study was to examine the effectiveness of a technology-based intervention (LanguageLinks: Syntax Assessment and Intervention®; Laureate Learning Systems, Inc., 2013) to improve reading comprehension for d/Deaf and hard of hearing (DHH) elementary students. The intervention was a self-paced, interactive program designed to scaffold learning of morphosyntax structures. Participants included 37 DHH students with moderate to profound hearing levels, 7–12 years of age, in Grades 2–6. Assessment data were collected pre- and post- an 8-week intervention using a randomized control trial methodology. Findings indicate the intervention did not appear to be effective in improving performance, and 17 out of 36 morphosyntax structures were found difficult to comprehend for participants in the treatment group. These difficult structures included aspects of pronominalization, the verbal system, and number in nouns. Results are compared to previous research, with recommendations for future areas of research related to increasing knowledge of morphosyntax for learners who are DHH. Improving literacy skills for struggling readers is a vital need in the field of education as a whole but is particularly crucial for learners who are d/Deaf or hard of hearing (DHH). The reading age/level of students who are DHH falls below their chronological age (Mitchell & Karchmer, 2006) to the extent that many struggle with learning to read (Luckner & Handley, 2008). Some students who are DHH lag behind classroom peers in reading comprehension and may gain only one third of the progress during a school year as compared to their classroom peers (Kyle & Cain, 2015). The purpose of the present study was to examine the effectiveness of an intervention to improve reading comprehension skills for elementary students who are DHH using a randomized control trial (RCT) methodology. Those learners who are developing literacy skills at a slower rate than their classroom peers will be referred to as “struggling readers” (i.e., the subgroup of DHH students who struggle with literacy skills). This distinction is posited because many learners who are DHH do not struggle to read and are therefore not included within this definition. The gap between chronological age and reading age may be particularly problematic as students transition from the primary grades (kindergarten through third grade; ages 5–8 years) to the intermediate grades (fourth through sixth grade; ages 9–12 years) when texts become more cognitively and linguistically demanding (Paul & Lee, 2010). Morphosyntax and Reading Comprehension Vocabulary, alphabetic knowledge, and phonological awareness are often the focus of instruction with learners who are DHH (Easterbrooks & Baker, 2002; Luckner & Urbach, 2012). Yet nearly 50 years of research reveals grammar comprehension as a barrier to literacy skills for some learners who are DHH in intermediate grades and beyond (see Berent, 1996 or Cannon & Kirby, 2013 for a review). A learner’s overall literacy development is correlated with their acquisition of functional English grammar skills, particularly for learners who are DHH (Kelly, 1996; Quigley & King, 1980). The functional rules that govern linguistic units in English include morphosyntax, which combines syntax (rules for forming sentences) and morphology (rules for forming vocabulary; Ewoldt, 1990). Morphosyntax plays a vital role in a learner’s linguistic comprehension skills. Research has shown that the understanding of syntax is dependent on an individual’s prior knowledge of the vocabulary used in texts (Cannon, Hubley, Milhoff, & Mazlouman, 2016; Kelly, 1996). For a learner, a tacit understanding of semantic–syntactic features used in a sentence precedes accurate grammar comprehension (White, 2002). For instance, auxiliary verbs are used with the main verb to express an action or state, as in the following example, where a continuous action is expressed in the sentence “The dog is eating.” The combination of the auxiliary verb (“is”) and the main verb (“eat”) represents the action of eating as being currently in progress. Similarly, accurate interpretation of a sentence is more likely when conventions around using syntactic features of a verb (or any other grammatical feature) are internalized, regardless of word placement. Research indicates that some readers who are DHH appear to use shallow processing when reading English print (i.e., not focusing on morphosyntactic structures within phrases and sentences) if they do not have proficient grammar and vocabulary skills (Coulter & Goodluck, 2015), leading to an overall lack of comprehension of written text (Cannon et al., 2016). Kyle (2015) describes a model of deaf learners’ reading development, which provides a framework for understanding the reading process for DHH struggling readers. The model proposes that linguistic comprehension includes both lexical (vocabulary) and grammatical (syntax) knowledge and that lexicon-decoding ability is predicted by phonemic awareness and speech reading skills (Kyle, 2015). The breadth of a learner’s lexicon can mediate phonological awareness and comprehension skills for DHH and hearing students (Dillon, de Jong, & Pisoni, 2012). Both lexical and grammatical knowledge are predictors of reading comprehension, and reading progress is predicted by English vocabulary knowledge (Barajas, González-Cuenca, & Carrero, 2016; Harris, Terlektsi, & Kyle, 2017). This reciprocal relationship (Mayne, Yoshinaga-Itano, Sedey, & Carey, 1998; Prezbindowski & Lederberg, 2003) requires not only effective decoding skills, but also automaticity of grammatical knowledge for comprehension (Coulter & Goodluck, 2015; Snyder & Downey, 1991). It is suggested that automaticity in reading skills reduces the cognitive processing load, which in turn increases reading comprehension for DHH learners (Kelly, 1996). Additionally, increasing automaticity in the comprehension of individual syntactic characteristics of written text such as object-relative clauses or passive voice sentences (Breadmore, Krott, & Olson, 2014; Traxler, Corina, Morford, Hafer, & Hoversten, 2014) promotes overall synthesis, which has also been shown to increase reading comprehension (Luckner & Urbach, 2012; Luckner & Handley, 2008; Luckner, Sebald, Cooney, Young, & Muir, 2005). Across nearly 50 years of research, the morphosyntactic structures that have been problematic for many learners who are DHH include the following: (a) the verbal system (i.e., tense agreement, auxiliaries, and verbal morphology in a passive voice; modals; copula); (b) pronominalization (i.e., using pronouns instead of a noun or noun phrase); (c) complementation (i.e., completing the meaning of a verb); and (d) relativization (i.e., forming a relative clause; Cannon et al., 2016; Cannon & Kirby, 2013; Quigley, Montanelli, & Wilbur, 1976; Quigley, Wilbur, Montanelli, Power, & Steinkamp, 1976). Increasing struggling readers’ acquisition of these morphosyntax structures may benefit literacy development, and interventions that focus on building this knowledge may improve reading skills. Use of Interventions to Improve Morphosyntax Acquisition Increasing comprehension for DHH learners who struggle with reading may be accomplished by using interventions that focus on linguistic comprehension skills and the scaffolding of lexical and grammatical knowledge. Current approaches used for literacy interventions, in general, tend to focus on increasing top-down skills (vocabulary, world knowledge, and inferencing) rather than bottom-up skills (syntactic knowledge and phonological awareness; Kyle & Cain, 2015; Miller, Kargin, & Guldenoglu, 2013). This may be problematic for learners who are DHH and use American Sign Language (ASL), as research has consistently found that proficiency in ASL skills leads to increased reading comprehension skills, but only when learners are provided with explicit instruction and strategies that connect ASL to English print (Kyle & Cain, 2015; Padden & Ramsey, 2000). Therefore, focusing on ASL bottom-up skills and how they can be used to increase knowledge of English print may be vital for students who use ASL, or another language other than English. This finding highlights the need for improvement of bottom-up skills in order to synthesize deep structure knowledge of not only vocabulary but also morphosyntactic and phonological knowledge (Chomsky, 1969; Cannon et al., 2016). DHH readers may also use strategies (or be taught strategies) that may be insufficient for linguistic comprehension. For example, the key word strategy (Al-Hilawani, 2003; Domínguez, Carrillo, González, & Alegria, 2016) consists of identifying some frequent content words and ignoring the function words (i.e., closed set of words that express grammatical relationships: determiners, conjunctions, prepositions, pronouns, auxiliary verbs, modals, and quantifiers) in text, which can impede comprehension (Domínguez et al., 2016). When provided with a semantic task of determining the missing word in a sentence (The storm released a ______), participants chose foils (rains, thunders, wind) over the correct response (catastrophe) due to ignoring the grammatical functions of the article (a) and/or the plural form of the verbs (rains, thunders; Domínguez, 2010; Domínguez, Carrillo, Del Mar Pé Rez, & Alegría, 2014). With these barriers to grammatical understanding and reading comprehension in mind, interventions that focus on increasing automaticity of top-down skills (e.g., word-level decoding and prior/background knowledge) are not sufficient because the synergy of bottom-up and top-down skills appears necessary for struggling readers who are DHH. Figure 1 Open in new tabDownload slide LanguageLinks modules and levels (Cannon & Kirby, 2013; Laureate Learning Systems, Inc., 2013). Figure 1 Open in new tabDownload slide LanguageLinks modules and levels (Cannon & Kirby, 2013; Laureate Learning Systems, Inc., 2013). Technology-based Interventions Increasing reading comprehension for learners who are DHH and are struggling readers may be accomplished by using interventions that focus on increasing linguistic comprehension through scaffolding to build automaticity of skills. One avenue to building automaticity is technology-based interventions, a recommended practice for learners who are DHH (National Agenda, 2005). Technology-based interventions may be beneficial because they can (a) include visual information in an interactive format, (b) increase motivation to complete academic tasks (Dangsaart, Naruedomkul, Cercone, & Sirinaovakul, 2008; Massaro & Light, 2004), (c) aid in recall and retention of subject matter (Paivio, 1991, 2006), (d) increase student achievement and positive attitudes (Kulik, 1994; Sivin-Kachala, 1998), and (e) reduce the cognitive load in processing information (Bavelier, Newport, Hall, Supalla, & Boutla, 2008). With the above-mentioned barriers to grammatical understanding and reading comprehension in mind, interventions that focus on increasing automaticity of sentence-level text, with varying grammatical features, hold the potential to be beneficial for DHH students who are struggling readers. Computer-based literacy interventions for DHH learners Literacy interventions examined with DHH learners that are computer-based have provided variable evidence of effects on reading vocabulary and comprehension skills. A few previous studies have examined the format (e.g., print only, print and picture, print and sign language) presented via computerized programs for learners who are DHH (Gentry, Chinn, & Moulton, 2004/2005; Mich, Pianta, & Mann, 2013). Results indicate benefits of combined approaches such as combined print and picture conditions (Gentry et al., 2004/2005; Mich et al., 2013) and active interaction with the content (Barker, 2003; Wang & Paul, 2011). Barker (2003) used computerized “talking heads” to significantly increase receptive vocabulary by 81 words in only two and a half hours of exposure to the intervention. Reitsma (2009) utilized a video to receptively and expressively match printed words to drawings and/or sign language in an array of three choices for eleven 6 to 9-year-old, Dutch participants. Results indicated that drawings were most effective in increasing word identification, spelling, and reading comprehension. Wang and Paul (2011) examined 22 DHH students between 7 and 11 years of age using an intervention that focused on multiple literacy variables across 20 target words, including word identification, word knowledge, and story comprehension. The intervention used (a) videos of stories with captioning; (b) a hypertext book; (c) interactive games, (d) story maps, (e) clip art in ASL, Signed Exact English (SEE), and Cued Speech; and (f) graphic organizers. Results indicated an increase in word identification and story comprehension, but only for two out of the three studies conducted. Holmer, Heiman, and Rudner (2017) found that no significant effect of a computerized intervention that utilized sign language could be established on either word reading or reading comprehension. No significant effects of three variables, (a) sign language phonological awareness, (b) sign language comprehension, and (c) non-linguistic working memory, were found in the study. Examining these studies gives us some information about possible components of effective literacy interventions for learners who are DHH, although the results varied. These may include presenting content with (a) captions, (b) print and pictures, and (c) active interaction to increase word identification, word knowledge, and reading comprehension. Therefore, the use of these components in a technology-based intervention has the potential to increase motivation, recall, and retention of word identification and reading comprehension. LanguageLinks: syntax assessment and intervention LanguageLinks: Syntax Assessment and Intervention® software program (LL) by Laureate Learning Systems, Inc. utilizes captions, prints, and pictures through interactive videos and feedback. The program is designed to increase comprehension of morphosyntax at the sentence level, as well as word knowledge utilized within the grammatical structures, including pronouns, verbs, and nouns. LL is a self-paced, interactive program that advances learners through the program as they master 36 structures across 6 modules within 6 levels (see Figure 1). This multimedia-based intervention can be used to identify the morphosyntax structures that learners may struggle to acquire, based on the frequency and duration of their attempts to progress through the modules and levels of the program (Wilson, Fox, & Pascoe, 2011). Previous research evaluating the LL intervention includes two studies (Cannon, Easterbrooks, Gagne, & Beal-Alvarez, 2011; Gillam, Crofford, Gale, & Hoffman, 2001). Gillam et al. (2001) examined the LL program with four participants, ages 6–7 years, with specific learning disabilities. Participants used the program for over 90 min per day for 4 weeks. Language samples were collected weekly along with a pre-post measure of the Oral and Written Language Scales (OWLS). Significant increases in language ability were documented from the OWLS scores, and the language samples were evaluated using pre- and post-mean length of utterance scores. Results revealed an increased use of morphemes and reduced grammatical errors. Cannon and colleagues (2011) investigated if use of the LL program for 9 weeks would influence the reading comprehension of morphosyntax structures (determiners, tense, and complementizers). Participants included 26 students who were DHH, ages 5–12 years, who used ASL and attended an urban day school for the deaf. The use of the LL program resulted in statistically significant growth in participants’ comprehension of morphosyntax structures, with an average increase of 0.4 modules per day based on two hierarchical linear modeling growth curve analyses. The results indicated that participants’ reading scores were statistically significant predictors of their rate of progress on the LL program modules. When examining pre- and post-intervention assessment scores, the authors found a statistically significant difference between the scores on the pre-test syntax subtest (M = 10.884, SD = 5.778) and the post-test syntax subtest (M = 12.769, SD = 4.966), t (25) = −2.394, p > .05. The results of this study indicated that the LL program may be a promising intervention for increasing learners’ reading comprehension of morphosyntax concepts. Cannon and Kirby (2013) conducted further analyses of the Cannon et al., (2011) LL program data, which revealed that many of the DHH participants struggled to read seven morphosyntax structures: (a) regular noun singular/plural, (b) accusative first- and second-person singular, (c) noun/verb agreement copular “be,” (d) accusative third-person number/gender, (e) locative pronominals; (f) auxiliary “be”/regular past “-ed,” and (g) prenominal determiners plural. Considering only two of the three studies focusing on LL included participants who are DHH, all had small sample sizes and restricted age ranges, and no studies included a control group for comparison; we do not know if the increases were due to the LL or simply an increase over time. The present study examined the effectiveness of the LL program in improving the reading comprehension of morphosyntax structures and reading vocabulary over an 8-week period for elementary students who are DHH using an RCT methodology. The research questions for this study were the following: (a) Does the use of the LL program, for 15 min a day, five times per week over 8 weeks, increase reading comprehension of morphosyntax structures and word knowledge for DHH elementary students?; (b) Which structures (i.e., LL modules) did participants have the most difficulty completing?; and (3) What were the teacher and student evaluations of the LL program? Method Participants Participants from Grades 2 to 6 and ages 7–12 years were recruited from three school districts near large urban centers in two Canadian provinces. The age range was selected based on previous research (Cannon & Kirby, 2013; Cannon et al., 2011; Cannon & Hubley, 2014; Cannon et al., 2016) indicating appropriate ages for the intervention and control software programs. Therefore, the age range targeted learners who were capable of independent reading activities, but may be struggling with reading comprehension. The inclusion criteria required participants to: (a) be in Grades 2–6, ages 7–12 years; (b) have hearing levels from moderate to profound; (c) be able to read independently; (d) receive resource or small group instruction from a teacher of the DHH (TDHH) for literacy instruction, and thus may benefit from the intervention/assessment; and (e) be able to work independently on a computer for 15 continuous min. Sample Description A total of 37 elementary school students (21 boys, 16 girls) who are DHH participated in the current study. The participants ranged in age from 7 to 12 years (M = 9.4, SD = 1.36) and were in Grades 2–6 from two schools for the d/Deaf (89.5%) and one pull-out, resource classroom in a public-school system (10.5%) across eight TDHH. Hearing levels ranged from moderate to profound, and various forms of hearing and assistive technology were utilized (e.g., hearing aids, cochlear implants, FM systems). Reading levels ranged from below kindergarten level to Grade 5 level, according to teacher reports. Participants were randomly assigned to either the intervention group (n = 20) or the control group (n = 17) within each setting. Participant demographic information, provided by the participant’s teacher and/or parent, is reported by group (i.e., intervention, control) in Table 1. Table 1 Detailed summary of sample characteristics Demographics . Intervention group, n = 20 . Control group, n = 17 . Sex  Boys 14 (70.0%) 7 (41.2%)  Girls 6 (30.0%) 10 (58.8%) Age M = 9.3 (SD = 1.21), 7–11 years M = 9.5 (SD = 1.55), 7–12 years Grade  2 3 (15.0%) 5 (29.4%)  3 6 (30.0%) 4 (23.5%)  4 5 (25.0%) 4 (23.5%)  5 4 (20.0%) 2 (11.8%)  6 2 (10.0%) 2 (11.8%) Reading level  Below kindergarten 1 (5.0%) 0 (0.0%)  Kindergarten 2 (10.0%) 2 (11.8%)  Grade 1 2 (10.0%) 6 (35.3%)  Grade 2 5 (25.0%) 3 (17.6%)  Grade 3 7 (35.0%) 2 (11.8%)  Grade 4 3 (15.0%) 2 (11.8%)  Grade 5 0 (0.0%) 1 (5.9%)  Missing 0 (0.0%) 1 (5.9%) Level of hearing loss  Mild 0 (0.0%) 0 (0.0%)  Moderate 2 (10.0%) 1 (5.9%)  Severe 2 (10.0%) 2 (11.8%)  Profound 16 (80.0%) 12 (70.6%)  Missing 0 (0.0%) 2 (11.8%) Type of amplification  None 3 (15.0%) 3 (17.6%)  HA only 4 (20.0%) 5 (29.4%)  CI only 5 (25.0%) 4 (23.5%)  Both HA and CI 5 (25.0%) 1 (5.9%)  HA, CI, and FM 3 (15.0%) 1 (5.9%)  Missing 0 (0.0%) 3 (17.6%) Mode of communication  Listening & spoken language 1 (5.0%) 1 (5.9%)  Sign language 4 (20.0%) 6 (35.3%)  Both 15 (75.0%) 10 (58.8%) Language used at home  ASL 3 (15.0%) 5 (29.4%)  English only 8 (40.0%) 6 (35.3%)  ASL and English 3 (15.0%) 2 (11.8%)  English + another language 3 (15.0%) 0 (0.0%)  Eng., ASL + another language 2 (10.0%) 0 (0.0%)  Another language 1 (5.0%) 1 (5.9%)  Missing 0 (0.0%) 3 (17.6%) Parental hearing status  Both parents are Hearing 19 (95.0%) 11 (64.7%)  Only father is DHH 0 (0.0%) 0 (0.0%)  Only mother is DHH 0 (0.0%) 1 (5.9%)  Both parents are DHH 1 (5.0%) 2 (11.8%)  Missing 0 (0.0%) 3 (17.6%) Diagnosed disability? (e.g., autism spectrum disorder; attention deficit hyperactivity disorder; mild intellectual disability; syndromes)  Yes 6 (30.0%) 2 (11.8%)  No 14 (70.0%) 15 (88.2%) Demographics . Intervention group, n = 20 . Control group, n = 17 . Sex  Boys 14 (70.0%) 7 (41.2%)  Girls 6 (30.0%) 10 (58.8%) Age M = 9.3 (SD = 1.21), 7–11 years M = 9.5 (SD = 1.55), 7–12 years Grade  2 3 (15.0%) 5 (29.4%)  3 6 (30.0%) 4 (23.5%)  4 5 (25.0%) 4 (23.5%)  5 4 (20.0%) 2 (11.8%)  6 2 (10.0%) 2 (11.8%) Reading level  Below kindergarten 1 (5.0%) 0 (0.0%)  Kindergarten 2 (10.0%) 2 (11.8%)  Grade 1 2 (10.0%) 6 (35.3%)  Grade 2 5 (25.0%) 3 (17.6%)  Grade 3 7 (35.0%) 2 (11.8%)  Grade 4 3 (15.0%) 2 (11.8%)  Grade 5 0 (0.0%) 1 (5.9%)  Missing 0 (0.0%) 1 (5.9%) Level of hearing loss  Mild 0 (0.0%) 0 (0.0%)  Moderate 2 (10.0%) 1 (5.9%)  Severe 2 (10.0%) 2 (11.8%)  Profound 16 (80.0%) 12 (70.6%)  Missing 0 (0.0%) 2 (11.8%) Type of amplification  None 3 (15.0%) 3 (17.6%)  HA only 4 (20.0%) 5 (29.4%)  CI only 5 (25.0%) 4 (23.5%)  Both HA and CI 5 (25.0%) 1 (5.9%)  HA, CI, and FM 3 (15.0%) 1 (5.9%)  Missing 0 (0.0%) 3 (17.6%) Mode of communication  Listening & spoken language 1 (5.0%) 1 (5.9%)  Sign language 4 (20.0%) 6 (35.3%)  Both 15 (75.0%) 10 (58.8%) Language used at home  ASL 3 (15.0%) 5 (29.4%)  English only 8 (40.0%) 6 (35.3%)  ASL and English 3 (15.0%) 2 (11.8%)  English + another language 3 (15.0%) 0 (0.0%)  Eng., ASL + another language 2 (10.0%) 0 (0.0%)  Another language 1 (5.0%) 1 (5.9%)  Missing 0 (0.0%) 3 (17.6%) Parental hearing status  Both parents are Hearing 19 (95.0%) 11 (64.7%)  Only father is DHH 0 (0.0%) 0 (0.0%)  Only mother is DHH 0 (0.0%) 1 (5.9%)  Both parents are DHH 1 (5.0%) 2 (11.8%)  Missing 0 (0.0%) 3 (17.6%) Diagnosed disability? (e.g., autism spectrum disorder; attention deficit hyperactivity disorder; mild intellectual disability; syndromes)  Yes 6 (30.0%) 2 (11.8%)  No 14 (70.0%) 15 (88.2%) Note. HA = hearing aids only; CI = cochlear implants CI; ASL = American Sign Language; DHH = deaf and hard of hearing. Open in new tab Table 1 Detailed summary of sample characteristics Demographics . Intervention group, n = 20 . Control group, n = 17 . Sex  Boys 14 (70.0%) 7 (41.2%)  Girls 6 (30.0%) 10 (58.8%) Age M = 9.3 (SD = 1.21), 7–11 years M = 9.5 (SD = 1.55), 7–12 years Grade  2 3 (15.0%) 5 (29.4%)  3 6 (30.0%) 4 (23.5%)  4 5 (25.0%) 4 (23.5%)  5 4 (20.0%) 2 (11.8%)  6 2 (10.0%) 2 (11.8%) Reading level  Below kindergarten 1 (5.0%) 0 (0.0%)  Kindergarten 2 (10.0%) 2 (11.8%)  Grade 1 2 (10.0%) 6 (35.3%)  Grade 2 5 (25.0%) 3 (17.6%)  Grade 3 7 (35.0%) 2 (11.8%)  Grade 4 3 (15.0%) 2 (11.8%)  Grade 5 0 (0.0%) 1 (5.9%)  Missing 0 (0.0%) 1 (5.9%) Level of hearing loss  Mild 0 (0.0%) 0 (0.0%)  Moderate 2 (10.0%) 1 (5.9%)  Severe 2 (10.0%) 2 (11.8%)  Profound 16 (80.0%) 12 (70.6%)  Missing 0 (0.0%) 2 (11.8%) Type of amplification  None 3 (15.0%) 3 (17.6%)  HA only 4 (20.0%) 5 (29.4%)  CI only 5 (25.0%) 4 (23.5%)  Both HA and CI 5 (25.0%) 1 (5.9%)  HA, CI, and FM 3 (15.0%) 1 (5.9%)  Missing 0 (0.0%) 3 (17.6%) Mode of communication  Listening & spoken language 1 (5.0%) 1 (5.9%)  Sign language 4 (20.0%) 6 (35.3%)  Both 15 (75.0%) 10 (58.8%) Language used at home  ASL 3 (15.0%) 5 (29.4%)  English only 8 (40.0%) 6 (35.3%)  ASL and English 3 (15.0%) 2 (11.8%)  English + another language 3 (15.0%) 0 (0.0%)  Eng., ASL + another language 2 (10.0%) 0 (0.0%)  Another language 1 (5.0%) 1 (5.9%)  Missing 0 (0.0%) 3 (17.6%) Parental hearing status  Both parents are Hearing 19 (95.0%) 11 (64.7%)  Only father is DHH 0 (0.0%) 0 (0.0%)  Only mother is DHH 0 (0.0%) 1 (5.9%)  Both parents are DHH 1 (5.0%) 2 (11.8%)  Missing 0 (0.0%) 3 (17.6%) Diagnosed disability? (e.g., autism spectrum disorder; attention deficit hyperactivity disorder; mild intellectual disability; syndromes)  Yes 6 (30.0%) 2 (11.8%)  No 14 (70.0%) 15 (88.2%) Demographics . Intervention group, n = 20 . Control group, n = 17 . Sex  Boys 14 (70.0%) 7 (41.2%)  Girls 6 (30.0%) 10 (58.8%) Age M = 9.3 (SD = 1.21), 7–11 years M = 9.5 (SD = 1.55), 7–12 years Grade  2 3 (15.0%) 5 (29.4%)  3 6 (30.0%) 4 (23.5%)  4 5 (25.0%) 4 (23.5%)  5 4 (20.0%) 2 (11.8%)  6 2 (10.0%) 2 (11.8%) Reading level  Below kindergarten 1 (5.0%) 0 (0.0%)  Kindergarten 2 (10.0%) 2 (11.8%)  Grade 1 2 (10.0%) 6 (35.3%)  Grade 2 5 (25.0%) 3 (17.6%)  Grade 3 7 (35.0%) 2 (11.8%)  Grade 4 3 (15.0%) 2 (11.8%)  Grade 5 0 (0.0%) 1 (5.9%)  Missing 0 (0.0%) 1 (5.9%) Level of hearing loss  Mild 0 (0.0%) 0 (0.0%)  Moderate 2 (10.0%) 1 (5.9%)  Severe 2 (10.0%) 2 (11.8%)  Profound 16 (80.0%) 12 (70.6%)  Missing 0 (0.0%) 2 (11.8%) Type of amplification  None 3 (15.0%) 3 (17.6%)  HA only 4 (20.0%) 5 (29.4%)  CI only 5 (25.0%) 4 (23.5%)  Both HA and CI 5 (25.0%) 1 (5.9%)  HA, CI, and FM 3 (15.0%) 1 (5.9%)  Missing 0 (0.0%) 3 (17.6%) Mode of communication  Listening & spoken language 1 (5.0%) 1 (5.9%)  Sign language 4 (20.0%) 6 (35.3%)  Both 15 (75.0%) 10 (58.8%) Language used at home  ASL 3 (15.0%) 5 (29.4%)  English only 8 (40.0%) 6 (35.3%)  ASL and English 3 (15.0%) 2 (11.8%)  English + another language 3 (15.0%) 0 (0.0%)  Eng., ASL + another language 2 (10.0%) 0 (0.0%)  Another language 1 (5.0%) 1 (5.9%)  Missing 0 (0.0%) 3 (17.6%) Parental hearing status  Both parents are Hearing 19 (95.0%) 11 (64.7%)  Only father is DHH 0 (0.0%) 0 (0.0%)  Only mother is DHH 0 (0.0%) 1 (5.9%)  Both parents are DHH 1 (5.0%) 2 (11.8%)  Missing 0 (0.0%) 3 (17.6%) Diagnosed disability? (e.g., autism spectrum disorder; attention deficit hyperactivity disorder; mild intellectual disability; syndromes)  Yes 6 (30.0%) 2 (11.8%)  No 14 (70.0%) 15 (88.2%) Note. HA = hearing aids only; CI = cochlear implants CI; ASL = American Sign Language; DHH = deaf and hard of hearing. Open in new tab Design An RCT methodology was used to answer the first research question by examining intervention effects for students in the intervention group (using the LL program) versus those in the control group (who used a web-based math program). Thus, the independent variable had two levels: (1) the LL program and (2) the control (IXL Math web-based; IXL Learning Inc., n.d.) program. Participants were randomly assigned to either the intervention or control group through an online random number generator matched to an alphabetical list of participant names. The dependent variables were the pre- and post-assessments of comprehension of morphosyntax structures and reading vocabulary given to all participants. To examine the second research question, participant data on the modules from the LL program reports were collected during the intervention phase of the study. Individual progression through the modules was examined to determine the structures that participants had the most difficulty comprehending. Difficulty was defined as requiring more than three sessions/days to reach mastery criterion and advance to the next level (Cannon & Kirby, 2013). The third research question was addressed using feedback obtained from teachers and students participating in the study. Assessments The current study used the following pre- and post-intervention assessments: the Comprehension of Written Grammar (CWG; Easterbrooks, 2010), Rhode Island Test of Language Structure (RITLS; Engen & Engen, 1983), a modified version of the Peabody Picture Vocabulary Test (PPVT-IV; Dunn & Dunn, 2007), and two subtests of the Woodcock Johnson (WJ-III; Woodcock, 2001): Word Identification (WJ-III-WI) and Passage Comprehension (WJ-III-PC). Comprehension of written grammar The CWG (Easterbrooks, 2010) is a test of 26 English language structures designed to document DHH learners’ ability to read and comprehend sentences written in targeted grammatical contexts. Each grammatical structure is tested using two separate items within the test, resulting in a 52-item assessment with no basal or ceiling. Each test item (sentence) is presented with three pictures containing characteristics requiring comprehension of the sentence’s morphosyntax. The examinee is instructed to silently read each sentence and then point to one of the three illustrations that best corresponds to the grammatical meaning (Cannon & Hubley, 2014). The CWG includes a reading vocabulary pre-test as well as the main test. Although the main test items contain high frequency words (e.g., Mom, baby, girl, boy), the pre-test measures knowledge of, and reviews with the students, 14 specific, printed words (e.g., dentist, doll, football, police) used in the main test in order to control for possible confounding effects of lexical knowledge on test scores. Administration of the CWG test takes an average of 15–20 min, and the estimated age range of suitability is 7–12 years. Scores on the main test range from 0 to 52, with higher scores indicating better CWG. Rhode island test of language structure The RITLS (Engen & Engen, 1983) assesses the comprehension of syntax for hearing and DHH learners. The 100-item RITLS test assesses 20 grammatical structures. After the stimulus sentence has been presented by the examiner “through-the-air” (i.e., through spoken English, ASL, or a combination), the participant points to one of three pictures that best corresponds to the meaning of the sentence. In this study, the RITLS was administered in signed and/or spoken language, depending on the participant’s preferred mode of communication and language preference. Four of the DHH participants chose administration in spoken English and 16 chose administration in ASL. It is important to note that, although the RITLS was designed for learners who are DHH, there are no directions or guidelines provided in the manual regarding administration of the RITLS using ASL. English to ASL translation requires some degree of subjectivity and varies across contexts and people. For this reason, and for the purpose of consistency in the research study, an ASL version of the RITLS items was developed. As there is no one way to sign or translate an English sentence to ASL, the decision was made to develop a video with ASL versions of all of the items from the RITLS. This provided consistency of administration across participants and administrators and attempted to control for variation in sign choice, syntactic placement of signs, and nonverbal cues. In the process of adapting the test to ASL, we used ASL syntax while making best attempts to stay true to the English syntactic function of each sentence in a way that still “made sense” in ASL. For example, in the use of English passive clauses, we needed to “set the stage” where we used ASL, but the components of the sentence were introduced as they were in English. A sentence containing a passive (nonreversible) structure (e.g., The man was bitten by the dog.) would be glossed (written in English) as “MAN 1-CL dog-BIT-man D-O-G.” In this simple sentence example, the man was given an arbitrary location in the signing space using a classifier (1-CL; handshape used to represent a noun or verb and add information such as location, action, size, shape, or manner). The use of the directional verb “bit” started from an unnamed subject’s location (later named as the dog) and moved towards the man. The subject “dog” appeared last. By setting up the object/subject locations and clearly depicting the directional verb “bit,” the syntactic function of the English sentence could be transferred to ASL in a way that was comprehensible. Similar methods were used in complex sentences, but more emphasis was placed on subject and object location with the use of gaze and body shifting, as well as reduplication of subject–object references (using classifiers, pronouns, and signs). For example, relative clauses (medial; e.g., The boy who is talking to the man is sitting in the car.) were represented as “BOY PRO-3index(boy) CHAT PRO-3index(man) MAN PRO-3index(boy) SIT CAR PRO-3index(car).” The use of signing space, specifically setting up referents in designated locations and clear use of directional verbs, allowed passive clauses and relative clauses to function in ASL. Body and gaze shifting were also used to clarify subject and object referents and movement. Even if the subject was introduced last, space was “held” for the subject, and gaze or body shifting helped clarify who was doing what, or what was being done to whom. We read through the RITLS, discussed the ASL transliteration and English syntactic goals for each item, and digitally recorded the test items being signed by a graduate research assistant (GRA) who is Deaf and proficient in ASL. The GRA consulted with two local Deaf post-secondary instructors of ASL from an independent institution, who viewed the recordings and provided feedback and editorial comments. Feedback was then incorporated into the digital recordings by the GRA and approved by the first author. The final version was then previewed by a Deaf research associate from an independent university, who had over 20 years of experience in the field of Deaf Education and an interest in linguistics. Scores on the RITLS range from 0 to 100, with higher scores indicating knowledge of more complex syntax structures in through-the-air (i.e., through spoken English, ASL, or a combination) language. Peabody picture vocabulary test-IV A modified version of the PPVT-IV (Dunn & Dunn, 2007) was selected for this study as a measure of reading vocabulary knowledge. PPVT-IV scores from this modified version in previous studies are significantly related to reading ability and memory tests with participants who are DHH (Convertino, Borgna, Marschark, & Durkin, 2014; Sarchet et al., 2014). The PPVT-IV assesses through-the-air (i.e., through spoken English, ASL, or a combination) receptive vocabulary. Sarchet et al. (2014) developed a print version of the PPVT for learners who are DHH presenting the stimulus word in written form, thus assessing participant’s ability to read a printed word and match to a corresponding picture (reading vocabulary). After participants were presented with the stimulus word, they were asked to point to one of four illustrations that presented the best correspondence to the word’s meaning. Scores on the PPVT-IV range from 0 to 228, with higher scores indicating knowledge of more vocabulary. Woodcock johnson test of achievement-III Two subtests of the WJ-III (Woodcock, 2001) were used for this study, the WJ-III-WI and WJ-III-PC. The WJ-III-WI subtest contains 76 items and assesses learners’ ability to recognize written words and letters. Initial items required the participant to identify individual written letters using verbal or signed language. Sign equivalents for each word were available and accepted by the examiner for participants who used ASL. Subsequent items required participants to identify words of increasing difficulty by reading aloud or using ASL. The basal level was established when a participant correctly identified six consecutive items and the ceiling level was reached when a participant incorrectly identified six consecutive items. This subtest was selected as a measure of word identification. Scores on the WJ-III-WI ranged from 0 to 76, with higher scores indicating the ability to identify more complex words in print. The second subtest was the WJ-III-PC; with 47 items assessing learners’ comprehension of written text. Initial items required the participant to match a rebus (picture symbol) to an actual picture. Subsequent items required participants to select which of three pictures best matched a short sentence. The majority of items required participants to finish an incomplete sentence by supplying a missing word to phrases of increasing complexity. This subtest was selected as a measure of reading comprehension. Scores on the WJ-III-PC ranged from 0 to 47, with higher scores indicating comprehension of more complex passages. Social validity questionnaire A social validity questionnaire served as an informal and subjective evaluation (Wolf, 1978) of the practicality of using the LL intervention in a classroom setting. Following the completion of the post-assessments, the participating teachers and students were asked to complete the questionnaires. There were separate teacher and student questionnaires for the intervention group, and completion was voluntary. Teacher questionnaire The teacher questionnaire consisted of three open-ended and two multiple-choice questions about the following: (a) the ease of using the LL program, (b) their perception of the students’ reaction to using LL, (c) whether the teacher would use LL in their future teaching, (d) how motivating LL appeared to participants during the study, and (e) any comments regarding the software. Student questionnaire The student questionnaire consisted of five questions to be rated on a Likert-type response format ranging from 1 (strongly agree) to 5 (strongly disagree). The students were asked to rate the LL program based on the following: (a) their enjoyment, (b) how much they learned using the program, (c) if the program was fun, (d) if they would use it at home, and (e) if they would recommend it to others. Table 2 Comparison of LanguageLinks (treatment) and IXL Math Program (control) groups across assessments Measure . ANCOVA result (controlling for pre-intervention score) . Pre/post-intervention score relationshipa . LL group post-intervention raw score, mean (SD) . Control group post-intervention raw score, mean (SD) . CWG F(1,33) = 0.82, p = .37, partial eta-squared = .024 .792 36.1 (8.50) 31.3 (10.46) RITLS F(1,32) = 2.32, p = .14, partial eta-squared = .067 .760 90.6 (5.04) 87.8 (7.49) WJ-III-PC F(1,32) = 0.58, p = .45, partial eta-squared = .018 .656 16.9 (3.75) 15.7 (5.35) PPVT-IV F(1,33) = 0.12, p = .73, partial eta-squared = .004 .839 85.1 (27.85) 69.88 (42.97) WJ-III-WI F(1,32) = 2.04, p = .16, partial eta-squared = .060 .929 36.1 (6.93) 32.3 (10.79) Measure . ANCOVA result (controlling for pre-intervention score) . Pre/post-intervention score relationshipa . LL group post-intervention raw score, mean (SD) . Control group post-intervention raw score, mean (SD) . CWG F(1,33) = 0.82, p = .37, partial eta-squared = .024 .792 36.1 (8.50) 31.3 (10.46) RITLS F(1,32) = 2.32, p = .14, partial eta-squared = .067 .760 90.6 (5.04) 87.8 (7.49) WJ-III-PC F(1,32) = 0.58, p = .45, partial eta-squared = .018 .656 16.9 (3.75) 15.7 (5.35) PPVT-IV F(1,33) = 0.12, p = .73, partial eta-squared = .004 .839 85.1 (27.85) 69.88 (42.97) WJ-III-WI F(1,32) = 2.04, p = .16, partial eta-squared = .060 .929 36.1 (6.93) 32.3 (10.79) Note. ANCOVA = analysis of covariance; CWG = Comprehension of Written Grammar test; RITLS = Rhode Island Test of Language Structure; WJ-III-PC = Woodcock Johnson III-Passage Comprehension; PPVT-IV = Peabody Picture Vocabulary Test; WJ-III-WI = Woodcock Johnson III-Word Identification; SD = standard deviation. aPartial eta-squared. Open in new tab Table 2 Comparison of LanguageLinks (treatment) and IXL Math Program (control) groups across assessments Measure . ANCOVA result (controlling for pre-intervention score) . Pre/post-intervention score relationshipa . LL group post-intervention raw score, mean (SD) . Control group post-intervention raw score, mean (SD) . CWG F(1,33) = 0.82, p = .37, partial eta-squared = .024 .792 36.1 (8.50) 31.3 (10.46) RITLS F(1,32) = 2.32, p = .14, partial eta-squared = .067 .760 90.6 (5.04) 87.8 (7.49) WJ-III-PC F(1,32) = 0.58, p = .45, partial eta-squared = .018 .656 16.9 (3.75) 15.7 (5.35) PPVT-IV F(1,33) = 0.12, p = .73, partial eta-squared = .004 .839 85.1 (27.85) 69.88 (42.97) WJ-III-WI F(1,32) = 2.04, p = .16, partial eta-squared = .060 .929 36.1 (6.93) 32.3 (10.79) Measure . ANCOVA result (controlling for pre-intervention score) . Pre/post-intervention score relationshipa . LL group post-intervention raw score, mean (SD) . Control group post-intervention raw score, mean (SD) . CWG F(1,33) = 0.82, p = .37, partial eta-squared = .024 .792 36.1 (8.50) 31.3 (10.46) RITLS F(1,32) = 2.32, p = .14, partial eta-squared = .067 .760 90.6 (5.04) 87.8 (7.49) WJ-III-PC F(1,32) = 0.58, p = .45, partial eta-squared = .018 .656 16.9 (3.75) 15.7 (5.35) PPVT-IV F(1,33) = 0.12, p = .73, partial eta-squared = .004 .839 85.1 (27.85) 69.88 (42.97) WJ-III-WI F(1,32) = 2.04, p = .16, partial eta-squared = .060 .929 36.1 (6.93) 32.3 (10.79) Note. ANCOVA = analysis of covariance; CWG = Comprehension of Written Grammar test; RITLS = Rhode Island Test of Language Structure; WJ-III-PC = Woodcock Johnson III-Passage Comprehension; PPVT-IV = Peabody Picture Vocabulary Test; WJ-III-WI = Woodcock Johnson III-Word Identification; SD = standard deviation. aPartial eta-squared. Open in new tab Table 3 Results of 2 (time) × 2 (group) ANOVAs on assessments Measure . Main effect for time . Main effect for group . Group × time interaction . CWG Wilks’ Lambda = 0.59, F(1,34) = 23.3, p < .001, partial eta-squared = .407 F(1,34) = 1.94, p = .17, partial eta-squared = .054 Wilks’ Lambda = 0.99, F(1,34) = 0.45, p = .51, partial eta-squared = .013 RITLS Wilks’ Lambda = 0.68, F(1,33) = 15.48, p < .001, partial eta-squared = .319 F(1,33) = 0.93, p = .34, partial eta-squared = .027 Wilks’ Lambda = 0.99, F(1,33) = 0.42, p = .52, partial eta-squared = .013 WJ-III-PC Wilks’ Lambda = 0.71, F(1,33) = 13.77, p < .01, partial eta-squared = .294 F(1,33) = 1.43, p = .24, partial eta-squared = .041 Wilks’ Lambda = 0.99, F(1,33) = 0.52, p = .48, partial eta-squared =.015 PPVT-IV Wilks’ Lambda = 0.72, F(1,34) = 13.02, p < .01, partial eta-squared = .277 F(1,34) = 1.67, p = .21, partial eta-squared = .047 Wilks’ Lambda = 1.00, F(1,34) = 0.01, p = .92, partial eta-squared < .001 WJ-III-WI Wilks’ Lambda = 0.96, F(1,33) = 1.28, p = .27, partial eta-squared = .037 F(1,33) = 1.18, p = .28, partial eta-squared = .047 Wilks’ Lambda = 0.96, F(1,33) = 1.28, p = .27, partial eta-squared = .035 Measure . Main effect for time . Main effect for group . Group × time interaction . CWG Wilks’ Lambda = 0.59, F(1,34) = 23.3, p < .001, partial eta-squared = .407 F(1,34) = 1.94, p = .17, partial eta-squared = .054 Wilks’ Lambda = 0.99, F(1,34) = 0.45, p = .51, partial eta-squared = .013 RITLS Wilks’ Lambda = 0.68, F(1,33) = 15.48, p < .001, partial eta-squared = .319 F(1,33) = 0.93, p = .34, partial eta-squared = .027 Wilks’ Lambda = 0.99, F(1,33) = 0.42, p = .52, partial eta-squared = .013 WJ-III-PC Wilks’ Lambda = 0.71, F(1,33) = 13.77, p < .01, partial eta-squared = .294 F(1,33) = 1.43, p = .24, partial eta-squared = .041 Wilks’ Lambda = 0.99, F(1,33) = 0.52, p = .48, partial eta-squared =.015 PPVT-IV Wilks’ Lambda = 0.72, F(1,34) = 13.02, p < .01, partial eta-squared = .277 F(1,34) = 1.67, p = .21, partial eta-squared = .047 Wilks’ Lambda = 1.00, F(1,34) = 0.01, p = .92, partial eta-squared < .001 WJ-III-WI Wilks’ Lambda = 0.96, F(1,33) = 1.28, p = .27, partial eta-squared = .037 F(1,33) = 1.18, p = .28, partial eta-squared = .047 Wilks’ Lambda = 0.96, F(1,33) = 1.28, p = .27, partial eta-squared = .035 Note. CWG = Comprehension of Written Grammar test; RITLS = Rhode Island Test of Language Structure; WJ-III-PC = Woodcock Johnson III – Passage Comprehension; PPVT-IV = Peabody Picture Vocabulary Test; WJ-III-WI = Woodcock Johnson III – Word Identification; SD = standard deviation. Significant results are in bold. Open in new tab Table 3 Results of 2 (time) × 2 (group) ANOVAs on assessments Measure . Main effect for time . Main effect for group . Group × time interaction . CWG Wilks’ Lambda = 0.59, F(1,34) = 23.3, p < .001, partial eta-squared = .407 F(1,34) = 1.94, p = .17, partial eta-squared = .054 Wilks’ Lambda = 0.99, F(1,34) = 0.45, p = .51, partial eta-squared = .013 RITLS Wilks’ Lambda = 0.68, F(1,33) = 15.48, p < .001, partial eta-squared = .319 F(1,33) = 0.93, p = .34, partial eta-squared = .027 Wilks’ Lambda = 0.99, F(1,33) = 0.42, p = .52, partial eta-squared = .013 WJ-III-PC Wilks’ Lambda = 0.71, F(1,33) = 13.77, p < .01, partial eta-squared = .294 F(1,33) = 1.43, p = .24, partial eta-squared = .041 Wilks’ Lambda = 0.99, F(1,33) = 0.52, p = .48, partial eta-squared =.015 PPVT-IV Wilks’ Lambda = 0.72, F(1,34) = 13.02, p < .01, partial eta-squared = .277 F(1,34) = 1.67, p = .21, partial eta-squared = .047 Wilks’ Lambda = 1.00, F(1,34) = 0.01, p = .92, partial eta-squared < .001 WJ-III-WI Wilks’ Lambda = 0.96, F(1,33) = 1.28, p = .27, partial eta-squared = .037 F(1,33) = 1.18, p = .28, partial eta-squared = .047 Wilks’ Lambda = 0.96, F(1,33) = 1.28, p = .27, partial eta-squared = .035 Measure . Main effect for time . Main effect for group . Group × time interaction . CWG Wilks’ Lambda = 0.59, F(1,34) = 23.3, p < .001, partial eta-squared = .407 F(1,34) = 1.94, p = .17, partial eta-squared = .054 Wilks’ Lambda = 0.99, F(1,34) = 0.45, p = .51, partial eta-squared = .013 RITLS Wilks’ Lambda = 0.68, F(1,33) = 15.48, p < .001, partial eta-squared = .319 F(1,33) = 0.93, p = .34, partial eta-squared = .027 Wilks’ Lambda = 0.99, F(1,33) = 0.42, p = .52, partial eta-squared = .013 WJ-III-PC Wilks’ Lambda = 0.71, F(1,33) = 13.77, p < .01, partial eta-squared = .294 F(1,33) = 1.43, p = .24, partial eta-squared = .041 Wilks’ Lambda = 0.99, F(1,33) = 0.52, p = .48, partial eta-squared =.015 PPVT-IV Wilks’ Lambda = 0.72, F(1,34) = 13.02, p < .01, partial eta-squared = .277 F(1,34) = 1.67, p = .21, partial eta-squared = .047 Wilks’ Lambda = 1.00, F(1,34) = 0.01, p = .92, partial eta-squared < .001 WJ-III-WI Wilks’ Lambda = 0.96, F(1,33) = 1.28, p = .27, partial eta-squared = .037 F(1,33) = 1.18, p = .28, partial eta-squared = .047 Wilks’ Lambda = 0.96, F(1,33) = 1.28, p = .27, partial eta-squared = .035 Note. CWG = Comprehension of Written Grammar test; RITLS = Rhode Island Test of Language Structure; WJ-III-PC = Woodcock Johnson III – Passage Comprehension; PPVT-IV = Peabody Picture Vocabulary Test; WJ-III-WI = Woodcock Johnson III – Word Identification; SD = standard deviation. Significant results are in bold. Open in new tab Procedures Four GRAs served as test administrators for this study alongside the principal researcher (first author). Teachers received training from the GRAs and/or the principal investigator, and received procedural and participant checklists because they administered the intervention and control procedures on a daily basis for the study. A blank section for notes was provided along with the checklists so anecdotal, procedural, and logistic information could be noted during the intervention phase of the study. These checklists provided documentation of participation during the intervention and control group sessions and were monitored weekly by the research team. The GRA also took anecdotal notes regarding teacher and participant comments when they monitored 20% of the intervention sessions for procedural fidelity. The examiners administered the CWG, RITLS, modified version of the PPVT-IV, WJ-III-WI, and WJ-III-PC subtests to all participants at two points in time: (a) at baseline before beginning the intervention and (b) at the end of the intervention period, which was approximately eight weeks later. The timeframe of 8 weeks was chosen to allow enough time for participants in the intervention and control groups to make progress on and/or complete the 36 modules of the LL program. This was based on an average length (i.e., 8.75) of the previous studies reviewed, because LL does not recommend a specific timeframe for completion of the modules. Assessments were individually administered in a separate room in the participants’ respective schools; in one case, however, the RITLS was administered in a group with 17 participants in one setting for logistical reasons. Group administration changed the response recording format because the participants circled their response on an answer sheet, while monitored by the examiner and a classroom educational assistant. Tests were administered until the participant either reached the ceiling level (for the modified PPVT-IV, WJ-III-WI, and WJ-III-PC) or until all test items were completed (for the CWG and RITLS). All examiners were proficient in the participants’ preferred mode of communication and language (listening and spoken language, ASL, and/or a combination of spoken and sign language). To prevent participant testing fatigue, baseline pre-testing and post-testing took place over two to three assessment sessions based on the participant age and school schedule. The same assessment procedures were followed each time. At least 20% of testing at each time point was observed and independently scored by two GRAs to ensure inter-rater reliability. Intervention group The intervention group used the LL software for 15 min every school day over an 8-week period. The volume for all computers was set to mute, and captions were provided on the screen for all dialog/directions because the purpose of this study was to examine participants’ reading comprehension of the morphosyntax structures in the LL program. All participants in the intervention group began LL at Module 1, Level 1 and progressed at their own pace through the six modules within the six different levels of the program (see Figure 1 for an example of the morphosyntax structures targeted in each level). The program is designed to provide scaffolded instruction of each structure in each module. Interactive activities probe the learner about their knowledge of the structures; if they score 80% or above, then the program moves them to the next module. If the learner scores below 80% on the first probe, then the program “teaches” them the structure by providing guided examples via interactive “games.” Following this guided practice, independent practice by the learner is probed and if they score above 80% they move to the next module; if not, they continue guided examples via differing interactive games until they reach the mastery criteria. The LL program provided reports of the percentage for each probe within each module. Control group For participants in the control group, the IXL Math program, on the IXL Learning, Inc. website was used during the time that the intervention group was using LL. IXL Math is an educational website through which students can independently practice math concepts. Students repetitively practiced number-based mathematical calculations, one concept at a time, leading to consistent progression, gaining rewards for correct answers, and instruction for incorrect answers. No word problems were presented and no print-based reading is necessary when using the program (other than instructions) so there is no reason to believe that use of the IXL Math program should impact reading comprehension of morphosyntax or vocabulary. Furthermore, use of an unrelated technology-based program meant that students in the two groups were treated similarly and the control group did not receive more classroom instruction than the intervention group. Table 4 Mean (standard deviation) assessment raw score performance . CWG . RITLS . WJ-III-PC . PPVT-IV . WJ-III-WI . Language Links (treatment)  Pre-intervention 32.0 (8.75) 87.3 (5.97) 15.6 (2.95) 76.1 (32.91) 35.1 (6.72)  Post-intervention 36.1 (8.50) 90.6 (5.04) 16.9 (3.75) 85.1 (27.85) 36.1 (6.93) IXL Math (control)  Pre-intervention 28.3 (9.90) 85.4 (10.89) 13.7 (4.17) 61.4 (38.13) 32.3 (11.76)  Post-intervention 31.3 (10.46) 87.8 (7.49) 15.7 (5.35) 69.9 (42.97) 32.3 (10.79) All participants (both groups)  Pre-intervention 30.3 (9.34) 86.5 (8.34) 14.7 (3.59) 69.6 (35.58) 33.9 (9.16)  Post-intervention 33.9 (9.58) 89.4 (6.27) 16.4 (4.48) 78.3 (35.7) 34.4 (8.85) . CWG . RITLS . WJ-III-PC . PPVT-IV . WJ-III-WI . Language Links (treatment)  Pre-intervention 32.0 (8.75) 87.3 (5.97) 15.6 (2.95) 76.1 (32.91) 35.1 (6.72)  Post-intervention 36.1 (8.50) 90.6 (5.04) 16.9 (3.75) 85.1 (27.85) 36.1 (6.93) IXL Math (control)  Pre-intervention 28.3 (9.90) 85.4 (10.89) 13.7 (4.17) 61.4 (38.13) 32.3 (11.76)  Post-intervention 31.3 (10.46) 87.8 (7.49) 15.7 (5.35) 69.9 (42.97) 32.3 (10.79) All participants (both groups)  Pre-intervention 30.3 (9.34) 86.5 (8.34) 14.7 (3.59) 69.6 (35.58) 33.9 (9.16)  Post-intervention 33.9 (9.58) 89.4 (6.27) 16.4 (4.48) 78.3 (35.7) 34.4 (8.85) Note: CWG = Comprehension of Written Grammar test; RITLS = Rhode Island Test of Language Structure; WJ-III-PC = Woodcock Johnson III-Passage Comprehension; PPVT-IV = Peabody Picture Vocabulary Test; WJ-III-WI = Woodcock Johnson III-Word Identification. Open in new tab Table 4 Mean (standard deviation) assessment raw score performance . CWG . RITLS . WJ-III-PC . PPVT-IV . WJ-III-WI . Language Links (treatment)  Pre-intervention 32.0 (8.75) 87.3 (5.97) 15.6 (2.95) 76.1 (32.91) 35.1 (6.72)  Post-intervention 36.1 (8.50) 90.6 (5.04) 16.9 (3.75) 85.1 (27.85) 36.1 (6.93) IXL Math (control)  Pre-intervention 28.3 (9.90) 85.4 (10.89) 13.7 (4.17) 61.4 (38.13) 32.3 (11.76)  Post-intervention 31.3 (10.46) 87.8 (7.49) 15.7 (5.35) 69.9 (42.97) 32.3 (10.79) All participants (both groups)  Pre-intervention 30.3 (9.34) 86.5 (8.34) 14.7 (3.59) 69.6 (35.58) 33.9 (9.16)  Post-intervention 33.9 (9.58) 89.4 (6.27) 16.4 (4.48) 78.3 (35.7) 34.4 (8.85) . CWG . RITLS . WJ-III-PC . PPVT-IV . WJ-III-WI . Language Links (treatment)  Pre-intervention 32.0 (8.75) 87.3 (5.97) 15.6 (2.95) 76.1 (32.91) 35.1 (6.72)  Post-intervention 36.1 (8.50) 90.6 (5.04) 16.9 (3.75) 85.1 (27.85) 36.1 (6.93) IXL Math (control)  Pre-intervention 28.3 (9.90) 85.4 (10.89) 13.7 (4.17) 61.4 (38.13) 32.3 (11.76)  Post-intervention 31.3 (10.46) 87.8 (7.49) 15.7 (5.35) 69.9 (42.97) 32.3 (10.79) All participants (both groups)  Pre-intervention 30.3 (9.34) 86.5 (8.34) 14.7 (3.59) 69.6 (35.58) 33.9 (9.16)  Post-intervention 33.9 (9.58) 89.4 (6.27) 16.4 (4.48) 78.3 (35.7) 34.4 (8.85) Note: CWG = Comprehension of Written Grammar test; RITLS = Rhode Island Test of Language Structure; WJ-III-PC = Woodcock Johnson III-Passage Comprehension; PPVT-IV = Peabody Picture Vocabulary Test; WJ-III-WI = Woodcock Johnson III-Word Identification. Open in new tab Analyses To answer the first research question, a series of one-way between group analyses of covariance (ANCOVAs) were conducted to determine if raw score performance on the assessments (CWG, RITLS, PPVT-IV, WJ-III-PC, and WJ-III-WI) were significantly different for participants in the treatment group (LL) than for participants in the control (IXL Math) group, after controlling for the respective pre-intervention score. Given the results of these analyses, follow-up 2 × 2 (group × time) mixed model analyses of variance (ANOVAs) were conducted to further understand the obtained results. These analyses permitted an examination of not only whether performance from pre- to post-intervention differed depending on group (LL vs. IXL Math) membership, but also whether the two groups differed overall and whether performance changed over time irrespective of group. In all analyses, partial eta-squared values are reported as measures of effect, with values <.01 being trivial, <.06 being small, <.14 being moderate, and >.14 being large (Richardson, 2011). Descriptive analyses were conducted to answer the second and third research questions. Individual progression through the modules was examined to determine the structures that participants had the most difficulty comprehending in print. Results Reliability and Fidelity of Assessments and Intervention Implementation Both reliability and fidelity checks were conducted during the assessment and intervention phases of the current study. Inter-rater reliability agreements were calculated using point-by-point agreement on 20% of the assessment sessions pre- and post-intervention, totalling 100%. Fidelity of implementation agreements were calculated by the percentages of steps implemented according to the checklist on 20% of the intervention sessions and also equaled 100%. Comparison of Intervention and Control Groups on Assessment Results A series of one-way between group ANCOVAs were conducted to determine if performance on the assessments (CWG, RITLS, PPVT-IV, WJ-III-PC, and WJ-III-WI) assessments post-intervention were significantly different for participants in the treatment group (LL) than for participants in the control (IXL Math) group, after controlling for the respective pre-intervention scores. These results showed that there were no significant differences between the LL and IXL Math intervention groups on any of the post-intervention scores (see Table 2). As a follow-up, a series of 2 × 2 ANOVAs were conducted across time (pre- to post-intervention) and group (LL and IXL Math) on the assessments to further understand the obtained results. Results are shown in Table 3. There were no significant main effects of group or group x time interactions for any of the assessments. With the exception of the WJ-III-WI, all of the assessments, however, showed large raw score improvements from pre-intervention test scores to post-intervention test scores, regardless of group membership (see Table 4). LL Morphosyntax Structures: Levels of Difficulty The descriptive analysis to answer the second research question revealed that from the intervention group at least one student experienced difficulty (i.e., they required more than three sessions to reach 80% mastery; see Table 5) with 17 out of the 36 modules (47%; see Table 5). There were seven modules on which at least 15% (n = 3) of students had difficulty. Five out of those seven modules were found to be difficult for DHH learners in previous studies. These seven were also found to be the most difficult for participants in the current study. Table 5 Most challenging LanguageLinks levels listed in increasing order of difficulty based on results LanguageLinks structures . Level.module . Grammar aspect . 1. Independent possessive first-person singular/plural 5.4 Pronominals 2. Independent possessive third-person number/gender 6.1 Pronominals 3. Accusative first- and second-person singular 1.4 Pronominals 4. Accusative first-person singular/plural 3.3 Pronominals 5. Accusative first-person plural and second person 4.2 Pronominals 6. Pronominal possessive first-person singular/plural 4.3 Pronominals 7. Negation 2.1 Verbal system 8. Nominative third-person number/gender 2.2 Pronominals 9. Negation 4.1 Verbal System 10. Genitive -s 6.5 Pronominals 11. Present passive 6.6 Verbal system 12. Auxiliary “be”/regular past “-ed” 2.5 Verbal system 13. Regular noun singular/plural 1.2 Noun, number 14. Locative pronominals 2.4 Pronominals 15. Future modal “will”/auxiliary “be/regular past “-ed” 5.2 Verbal system 16. Prenominal determiners plural 3.1 Noun, number 17. Accusative third-person number/gender 2.3 Pronominals LanguageLinks structures . Level.module . Grammar aspect . 1. Independent possessive first-person singular/plural 5.4 Pronominals 2. Independent possessive third-person number/gender 6.1 Pronominals 3. Accusative first- and second-person singular 1.4 Pronominals 4. Accusative first-person singular/plural 3.3 Pronominals 5. Accusative first-person plural and second person 4.2 Pronominals 6. Pronominal possessive first-person singular/plural 4.3 Pronominals 7. Negation 2.1 Verbal system 8. Nominative third-person number/gender 2.2 Pronominals 9. Negation 4.1 Verbal System 10. Genitive -s 6.5 Pronominals 11. Present passive 6.6 Verbal system 12. Auxiliary “be”/regular past “-ed” 2.5 Verbal system 13. Regular noun singular/plural 1.2 Noun, number 14. Locative pronominals 2.4 Pronominals 15. Future modal “will”/auxiliary “be/regular past “-ed” 5.2 Verbal system 16. Prenominal determiners plural 3.1 Noun, number 17. Accusative third-person number/gender 2.3 Pronominals Note. Italics indicates structures that 15% or more of participants had difficulty. Boldface indicates structures identified as difficult in previous studies. Open in new tab Table 5 Most challenging LanguageLinks levels listed in increasing order of difficulty based on results LanguageLinks structures . Level.module . Grammar aspect . 1. Independent possessive first-person singular/plural 5.4 Pronominals 2. Independent possessive third-person number/gender 6.1 Pronominals 3. Accusative first- and second-person singular 1.4 Pronominals 4. Accusative first-person singular/plural 3.3 Pronominals 5. Accusative first-person plural and second person 4.2 Pronominals 6. Pronominal possessive first-person singular/plural 4.3 Pronominals 7. Negation 2.1 Verbal system 8. Nominative third-person number/gender 2.2 Pronominals 9. Negation 4.1 Verbal System 10. Genitive -s 6.5 Pronominals 11. Present passive 6.6 Verbal system 12. Auxiliary “be”/regular past “-ed” 2.5 Verbal system 13. Regular noun singular/plural 1.2 Noun, number 14. Locative pronominals 2.4 Pronominals 15. Future modal “will”/auxiliary “be/regular past “-ed” 5.2 Verbal system 16. Prenominal determiners plural 3.1 Noun, number 17. Accusative third-person number/gender 2.3 Pronominals LanguageLinks structures . Level.module . Grammar aspect . 1. Independent possessive first-person singular/plural 5.4 Pronominals 2. Independent possessive third-person number/gender 6.1 Pronominals 3. Accusative first- and second-person singular 1.4 Pronominals 4. Accusative first-person singular/plural 3.3 Pronominals 5. Accusative first-person plural and second person 4.2 Pronominals 6. Pronominal possessive first-person singular/plural 4.3 Pronominals 7. Negation 2.1 Verbal system 8. Nominative third-person number/gender 2.2 Pronominals 9. Negation 4.1 Verbal System 10. Genitive -s 6.5 Pronominals 11. Present passive 6.6 Verbal system 12. Auxiliary “be”/regular past “-ed” 2.5 Verbal system 13. Regular noun singular/plural 1.2 Noun, number 14. Locative pronominals 2.4 Pronominals 15. Future modal “will”/auxiliary “be/regular past “-ed” 5.2 Verbal system 16. Prenominal determiners plural 3.1 Noun, number 17. Accusative third-person number/gender 2.3 Pronominals Note. Italics indicates structures that 15% or more of participants had difficulty. Boldface indicates structures identified as difficult in previous studies. Open in new tab Table 6 Teacher participant social validity questionnaire responses Teacher participants . The ease of using the LL program . Perception of the students’ reaction to using the LL program . Whether the teacher would use LL in their future teaching . How motivating LL appeared to participants during the study . Comments regarding the LL program . 1 Somewhat confusing in the beginning Negatively - students complained that the program was boring Not sure Looks very old and plain; the cartoons were not interesting to kids; the feedback was not clear I can see using it with a reading group (all together on the smartboard) or to fine-tune readers. But our classes have so many levels - struggling readers - it would be a challenge 2 Easy because it was set up in advance Neutral - they loved going to the computers … but became frustrated when the questions were similar Unknown Same as other direct instruction of language skills used in the past No response 3 It is easy to follow Positively - was motivating to continue lessons Probably yes - after each lesson on a specific grammar rule, for example noun/ verb agreement It will help me to prepare language lessons - then have students do the activity on the computer of what they were already taught previously Teacher participants . The ease of using the LL program . Perception of the students’ reaction to using the LL program . Whether the teacher would use LL in their future teaching . How motivating LL appeared to participants during the study . Comments regarding the LL program . 1 Somewhat confusing in the beginning Negatively - students complained that the program was boring Not sure Looks very old and plain; the cartoons were not interesting to kids; the feedback was not clear I can see using it with a reading group (all together on the smartboard) or to fine-tune readers. But our classes have so many levels - struggling readers - it would be a challenge 2 Easy because it was set up in advance Neutral - they loved going to the computers … but became frustrated when the questions were similar Unknown Same as other direct instruction of language skills used in the past No response 3 It is easy to follow Positively - was motivating to continue lessons Probably yes - after each lesson on a specific grammar rule, for example noun/ verb agreement It will help me to prepare language lessons - then have students do the activity on the computer of what they were already taught previously Note. LL = LanguageLinks: Syntax Assessment and Intervention® software program. Open in new tab Table 6 Teacher participant social validity questionnaire responses Teacher participants . The ease of using the LL program . Perception of the students’ reaction to using the LL program . Whether the teacher would use LL in their future teaching . How motivating LL appeared to participants during the study . Comments regarding the LL program . 1 Somewhat confusing in the beginning Negatively - students complained that the program was boring Not sure Looks very old and plain; the cartoons were not interesting to kids; the feedback was not clear I can see using it with a reading group (all together on the smartboard) or to fine-tune readers. But our classes have so many levels - struggling readers - it would be a challenge 2 Easy because it was set up in advance Neutral - they loved going to the computers … but became frustrated when the questions were similar Unknown Same as other direct instruction of language skills used in the past No response 3 It is easy to follow Positively - was motivating to continue lessons Probably yes - after each lesson on a specific grammar rule, for example noun/ verb agreement It will help me to prepare language lessons - then have students do the activity on the computer of what they were already taught previously Teacher participants . The ease of using the LL program . Perception of the students’ reaction to using the LL program . Whether the teacher would use LL in their future teaching . How motivating LL appeared to participants during the study . Comments regarding the LL program . 1 Somewhat confusing in the beginning Negatively - students complained that the program was boring Not sure Looks very old and plain; the cartoons were not interesting to kids; the feedback was not clear I can see using it with a reading group (all together on the smartboard) or to fine-tune readers. But our classes have so many levels - struggling readers - it would be a challenge 2 Easy because it was set up in advance Neutral - they loved going to the computers … but became frustrated when the questions were similar Unknown Same as other direct instruction of language skills used in the past No response 3 It is easy to follow Positively - was motivating to continue lessons Probably yes - after each lesson on a specific grammar rule, for example noun/ verb agreement It will help me to prepare language lessons - then have students do the activity on the computer of what they were already taught previously Note. LL = LanguageLinks: Syntax Assessment and Intervention® software program. Open in new tab Teacher and Student Social Validity Questionnaires Teacher and student social validity questionnaires were completed by 3 out of the 8 (38%) teachers participating in the study (see Table 6) and 14 out of 20 (70%) student participants in the intervention group (see Table 7). The return rate of the social validity questionnaires by teachers and students was low in part because it was not a requirement and the post-intervention time period was followed by a holiday break from the school year. Analysis of the teacher questionnaires revealed the following: (a) all responding participants felt the LL program was easy for their students to use; (b) the teachers reported mixed results from students’ reactions to using LL, some were actively engaged while others were frustrated and bored; (c) only Participant 3 stated they would use LL in their future teaching; (d) mixed results about how motivating LL appeared to participants during the study, with some students motivated to complete all levels and others not interested in progressing through the program; and (e) teachers commented that LL needs to be updated and some aspects were aimed at younger learners than the students in their class. Analyses of the student questionnaires revealed the majority strongly agreed or agreed that they (a) enjoyed using LL (78.6%), (b) that they learned something while using the program (64.3%), and (c) that the program was fun (71.4%). Only 28.6% of the students strongly agreed or agreed that they would use LL at home; 21.4% were unsure and 50% strongly disagreed or disagreed. Half of the students strongly agreed or agreed they would recommend LL to others. Discussion The three research questions for this study examined whether LL, a technology-based intervention, could increase reading comprehension of morphosyntax structures. The first was to evaluate whether the LL program would increase reading comprehension of morphosyntax structures and word knowledge for elementary students who are DHH and struggling readers. The second research question was to investigate which LL structures posed greater difficulty for the students as they advanced through the program. Finally, the third research question examined teacher and student feedback on the use of the LL program. Effectiveness of LL With respect to the first research question, we did not find that use of the LL program, for 15 min a day, five times per week for 8 weeks, increased comprehension of morphosyntax structures or word knowledge for elementary students who are DHH relative to a control group that used the IXL Math program for the same period. Rather, we found a significant increase in scores over the time period in both groups for all of the assessments except the WJ-III-WI. These findings suggest that the CWG, RITLS, WJ-III-PC, and the modified PPVT-IV may be sensitive to growth in reading comprehension of grammar and vocabulary over time but that the LL program was not responsible for that improvement. That is, classroom instruction, or other factors, may have caused an increase in performance given that the control participants also showed increased scores. Overall, our findings raise questions about the effectiveness of using the LL program independently for improving grammar or vocabulary skills related to reading comprehension. Our results are contrary to previous findings using the LL program (Cannon et al., 2011; Gillam et al., 2001). Previous research reported improvements in performance (e.g., increased language ability and reading comprehension of morphosyntax structures) after use of the LL program despite differences in the particular age ranges of the child participants, intervention period, degree of exposure to the LL program, and the particular variables and measures used. However, neither previous study included a control group. Thus, interpretations of these earlier findings need to be viewed with caution. Like the present study, most assessment scores increased post-intervention. However, without the inclusion of a control group, one cannot state definitively that the LL program was responsible for the increase. Improvements seen in earlier studies could have been due to other factors, such as classroom instruction. Table 7 Results of student social validity questionnaires Responses, n = 14 . I enjoyed using the LL program . I learned a lot using the LL program . The LL program was fun . I would use the LL program at home . I would recommend the LL program to others . Strongly agree 7 (50%) 9 (64.3%) 8 (57.1%) 2 (14.3%) 6 (42.9%) Agree 4 (28.6%) 0 (0%) 2 (14.3%) 2 (14.3%) 1 (7.1%) Unsure 2 (14.3%) 4 (28.6%) 3 (21.4%) 3 (21.4%) 4 (28.6%) Disagree 0 (0%) 0 (0%) 0 (0%) 1 (7.1%) 0 (0%) Strongly disagree 1 (7.1%) 1 (7.1%) 1 (7.1%) 6 (42.9%) 3 (21.4%) Responses, n = 14 . I enjoyed using the LL program . I learned a lot using the LL program . The LL program was fun . I would use the LL program at home . I would recommend the LL program to others . Strongly agree 7 (50%) 9 (64.3%) 8 (57.1%) 2 (14.3%) 6 (42.9%) Agree 4 (28.6%) 0 (0%) 2 (14.3%) 2 (14.3%) 1 (7.1%) Unsure 2 (14.3%) 4 (28.6%) 3 (21.4%) 3 (21.4%) 4 (28.6%) Disagree 0 (0%) 0 (0%) 0 (0%) 1 (7.1%) 0 (0%) Strongly disagree 1 (7.1%) 1 (7.1%) 1 (7.1%) 6 (42.9%) 3 (21.4%) Note. LL = LanguageLinks: Syntax Assessment and Intervention® software program. Open in new tab Table 7 Results of student social validity questionnaires Responses, n = 14 . I enjoyed using the LL program . I learned a lot using the LL program . The LL program was fun . I would use the LL program at home . I would recommend the LL program to others . Strongly agree 7 (50%) 9 (64.3%) 8 (57.1%) 2 (14.3%) 6 (42.9%) Agree 4 (28.6%) 0 (0%) 2 (14.3%) 2 (14.3%) 1 (7.1%) Unsure 2 (14.3%) 4 (28.6%) 3 (21.4%) 3 (21.4%) 4 (28.6%) Disagree 0 (0%) 0 (0%) 0 (0%) 1 (7.1%) 0 (0%) Strongly disagree 1 (7.1%) 1 (7.1%) 1 (7.1%) 6 (42.9%) 3 (21.4%) Responses, n = 14 . I enjoyed using the LL program . I learned a lot using the LL program . The LL program was fun . I would use the LL program at home . I would recommend the LL program to others . Strongly agree 7 (50%) 9 (64.3%) 8 (57.1%) 2 (14.3%) 6 (42.9%) Agree 4 (28.6%) 0 (0%) 2 (14.3%) 2 (14.3%) 1 (7.1%) Unsure 2 (14.3%) 4 (28.6%) 3 (21.4%) 3 (21.4%) 4 (28.6%) Disagree 0 (0%) 0 (0%) 0 (0%) 1 (7.1%) 0 (0%) Strongly disagree 1 (7.1%) 1 (7.1%) 1 (7.1%) 6 (42.9%) 3 (21.4%) Note. LL = LanguageLinks: Syntax Assessment and Intervention® software program. Open in new tab Morphosyntax structures The descriptive analysis to answer the second research question indicated weaknesses in participants’ reading knowledge of morphosyntax structures when completing modules within the LL program. The morphosyntax concepts that required more than three sessions to reach mastery are listed in order of least to greatest difficulty in Table 5. The second column in Table 5 notes the level and module where each structure was taught in the LL program and highlights the variability of order of difficulty compared to the sequential order of the modules and levels (see Figure 1). This finding shows that, for the participants in the current study, the sequence of levels was not scaffolded for their mastery, as described by the LL program. Examining Table 5 indicates 10 of the 17 structures found to be most difficult consisted of morphosyntax structures related to pronominalization (aspects of pronoun use). Previous research with participants who are DHH examined pronominalization (Wilbur, Montanelli, & Quigley, 1976) and found that possessive pronouns and reflexives were the most difficult for the participants. This contradicts the current findings, with locative pronominals listed as more difficult than possessive, and reflexive not found to be difficult for participants. Wilbur et al. (1976) noted that 540 DHH participants appeared to comprehend pronouns on an individual basis, rather than mastering a category (person, number, case). Explicit, targeted instruction on pronominal structures may be needed for mastery. Participants in the treatment group also struggled to complete five levels of LL related to the verbal system. Previous research with participants who are DHH found auxiliary “be” is challenging in both reading comprehension (Cannon et al., 2016; Cannon & Kirby, 2013) as well as cloze sentence tasks (Quigley et al., 1976b), along with other aspects of the verbal system, including the agreement of number and tense. This was also the case for the current study, with 2 out of 5 levels of difficulty related to the auxiliary “be” aspect of the verbal system. Previous research with participants who are DHH showed tense markers (e.g., past tense, -ed) and determiners (e.g., a, the, every) were challenging in story re-tell tasks, completing cloze sentence tasks, and using a technology-based intervention (Barajas et al., 2016; Cannon et al., 2011; Guo, Spencer, & Tomblin, 2013; Power & Quigley, 1973; Quigley, Montanelli, Wilbur, 1976). Finally, participants also had difficulty with number in nouns, particularly with plural concepts; no previous research has focused specifically on this aspect of morphosyntax with students who are DHH. Based on current and previous results, targeted focus on pronominalization, the verbal system, and possibly number in nouns should be included in language and literacy instruction for struggling readers who are DHH. Teacher and Student Evaluations of LL The descriptive analysis of the teacher and student questionnaires raised other concerns about the LL program. Teacher Participant 3 saw the potential in utilizing the LL program to supplement instruction, but this was not shared by the other two teacher participants. The lack of responses was a limitation for the teacher post-study evaluations, however. Analysis of the student questionnaires revealed participants were generally positive in terms of enjoyment of the program, that it was fun, and that they learned something using the program, but they were far less likely to use LL at home and only half would recommend the program to others. Although they reported positive attitudes towards the LL program, throughout the study the GRAs and researchers noted anecdotal reports of frustration with the program from students and teachers due to its “outdated” nature, referring to the slow speed of progression between items and its antiquated graphics. An updated, web-based version of the program, along with an explicit description of the rationale for using LL, may alter teacher and student perceptions of the software program. Recommendations As this technology-based intervention was not found to be effective in the current study, we recommend investigating interventions and materials that may increase comprehension of pronominalization, aspects of the verbal system, and plural nouns. Recommended best practices for morphosyntax instruction consists of using a visual representation of grammatical structures to increase “uptake” by learners (Easterbrooks & Baker, 2002). This can include the use of signs, key symbols, icons, patterns, and color coding to represent the various grammatical structures and increase recall and retention of how their placement and use can change the meaning of a sentence (Paivio 1991, 2006). Visual representation can also reduce the cognitive load in processing information (Bavelier et al., 2008) because learners begin to see patterns in the English code, aiding in comprehension. Scaffolding instruction in a developmental order and using metalinguistic representations of grammar structures through visual representation (Easterbrooks & Baker, 2002; Moats, 1994) can be combined with other research-based strategies, such as examples/nonexamples (Cannon, Fredrick, & Easterbrooks, 2010), or using visuals that represent the meaning of phrases and allow for phrase combining (Easterbrooks & Baker, 2002). Study Strengths and Limitations Strengths The current study had several strengths both in the methodological design and assessment adaptations. The first was the use of a control group with an RCT methodology, considering the dearth of RCT intervention studies available in the field of research on students who are DHH. A larger sample size was also used than previous studies examining the LL program. The development of an ASL version of the RITLS was another strength of this study because it provided consistency across research sites and assessors (the research team is willing to share these materials with schools or researchers by contacting the lead author). The collection of social validity data, although a low return rate, is a strength of the focus on research to practice in the current research findings. Limitations The findings should be interpreted with a degree of caution as the sample showed large variability in scores across participants. Another limitation included the lack of data collection regarding classroom instruction of morphosyntax in answering the first research question. The low return rate on the social validity questionnaires by student and particularly teacher participants was also a limitation in answering the third research question. Future studies should require completion of social validity post-study feedback to provide further insights into challenges within intervention research. Future Research and Directions Future research should investigate interventions and strategies to increase the morphosyntax structures noted in the current findings and other more advanced grammar structures (e.g., final and medial relative clauses, irregular plural nouns, dative movement) to continue to scaffold skills for increased literacy comprehension. Nearly 10 years ago, Trezek, Wang, and Paul (2011) called for further investigation into interventions that could improve syntactic knowledge; we have attempted to heed this call and encourage others to do the same. Given the rapid development of technological advances in recent years, it is important to select technology-based interventions that can capture students’ attention and adequately reflect the processing speed that many have become accustomed to in the 21st century. Future research should collect additional data to help determine whether classroom instruction paired with supplemental, technology-based activities is more effective in increasing comprehension of morphosyntax structures for DHH elementary students than using technology-based interventions independently. In conclusion, the present study revealed that DHH elementary students who used the LL program did not show significantly higher increases in performance over an 8-week period from baseline to post-test, as compared with a control group (where participants used a math website-based program). Descriptive analysis of individual performance revealed 17 morphosyntax structures that DHH learners in the intervention group had difficulty comprehending. Implications and recommendations for practice include metalinguistic, visual representation of concepts that connect meaning to print, leading to increased retention, motivation, and achievement. Funding The Social Sciences and Humanities Research Council of Canada (SSHRC) Insight Grant (grant number F13-05050). Conflicts of Interest No conflicts of interest were reported. References Al-Hilawani , Y. A. ( 2003 ). Clinical examination of three methods of teaching reading comprehension to deaf and hard-of-hearing students: From research to classroom applications . Journal of Deaf Studies and Deaf Education , 8 ( 2 ), 146 – 156 . doi: 10.1093/deafed/eng001 Google Scholar Crossref Search ADS PubMed WorldCat Crossref Barajas , C. , González-Cuenca , A. M. , & Carrero , F. ( 2016 ). Comprehension of texts by deaf elementary school students: The role of grammatical understanding . Research in Developmental Disabilities , 59 , 8 – 23 . doi: 10.1016/j.ridd.2016.07.005 Google Scholar Crossref Search ADS PubMed WorldCat Crossref Barker , L. J. ( 2003 ). Computer-assisted vocabulary acquisition: The CSLU vocabulary tutor in oral-deaf education . 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TI - A Technology-based Intervention to Increase Reading Comprehension of Morphosyntax Structures
JF - The Journal of Deaf Studies and Deaf Education
DO - 10.1093/deafed/enz029
DA - 2020-01-03
UR - https://www.deepdyve.com/lp/oxford-university-press/a-technology-based-intervention-to-increase-reading-comprehension-of-UzEjtdQHvd
SP - 126
VL - 25
IS - 1
DP - DeepDyve
ER -