LSHSS
Research Article
Interactive Storybook Reading Instruction
for Preschoolers Who Are Deaf and
Hard of Hearing: A Multiple Probe
Across Behaviors Analysis
Jessica W. Trussell,a Janna Hasko,b Joy Kane,c Brittany Amari,a and Alison Brusehabera
Purpose: Interactive storybook reading (ISR) improves the
picture labeling vocabulary of children who are deaf and
hard of hearing (DHH). Vocabulary knowledge consistently
predicts the later reading achievement of children who are
DHH. In this study, ISR was modified to include teaching
word meanings along with the vocabulary picture label.
Method: A multiple probe across behaviors single-case
experimental design was implemented to determine the
effects of ISR with word meaning instruction on picture
labeling and word meaning knowledge of 6 preschoolers
who are DHH and use spoken English. The student and
teacher participants engaged in ISR for 15–20 min a day,
4 days a week for 3 weeks.
E
arly vocabulary knowledge is a predictor of later
reading ability for students who are deaf and hard
of hearing (DHH; Kyle & Harris, 2010). Some
young children who are DHH have more difficulty acquir-
ing new vocabulary knowledge and decreased opportu-
nities to learn new words (Trezek, Wang, & Paul, 2011).
Undoubtedly, teachers and parents need to pay attention
to vocabulary learning for this population. Several litera-
ture reviews examined research conducted with students
who are DHH regarding the component areas of reading
(see reviews of vocabulary: Luckner & Cooke, 2010; reading
comprehension: Luckner & Handley, 2008; fluency: Luckner
& Urbach, 2011; morphology: Trussell & Easterbrooks,
a
National Technical Institute for the Deaf, Rochester Institute of
Technology, NY
b 2010; Messier & Wood, 2015) that measured vocabulary
Disability and Psychoeducational Studies, University of Arizona,
Tucson
c
Idaho Educational Services for the Deaf and Blind, Meridian
Correspondence to Jessica W. Trussell: jwtnmp@rit.edu
Editor-in-Chief: Julie Barkmeier-Kraemer
Editor: Patricia Brooks
Received August 24, 2017
Revision received December 18, 2017
Accepted March 20, 2018
https://doi.org/10.1044/2018_LSHSS-17-0085
922 Language, Speech, and Hearing Services in Schools • Vol. 49 • 922–937 • October 2018 • Copyright © 2018 American Speech-Language-Hearing Association
Results: A functional relation was established between ISR
and the increase in the preschoolers’ word labeling and
meaning knowledge. The preschoolers’ word knowledge
was generalized and was maintained over time.
Conclusions: ISR may be an effective vocabulary labeling
and word meaning instructional strategy for young children
who are DHH and use spoken English. Teachers and related
service providers who work with this population may want
to implement ISR with word meaning in 1-to-1 or small
groups to individualize the target vocabulary and maximize
the benefit. Future researchers should replicate this to
expand its generalizability to other subpopulations of
children who are DHH.
2016; grapheme–phoneme correspondence: Tucci, Trussell,
& Easterbrooks, 2014). These reviews noted that vocabu-
lary is the most heavily examined reading component.
This finding seemed promising until the definition of vocab-
ulary and the outcomes of these studies are looked at more
carefully.
Vocabulary is a repository of words and their mean-
ings that students use to plan expressive language, under-
stand receptive language, and comprehend written text
(Moats, 2005). Luckner and Cooke (2010) discovered that,
of 41 vocabulary studies with students who are DHH, only
10 were intervention studies. Even fewer addressed learn-
ing new words as well as their meanings (2/10; Paatsch,
Blamey, Sarant, & Bow, 2006; Robbins & Hatcher, 1981).
Since Luckner and Cooke, there have been three additional
intervention studies (Bowers & Schwarz, 2013; Dimling,
comprehension.
Of these five studies, four studies (Dimling, 2010;
Messier & Wood, 2015; Paatsch et al., 2006; Robbins &
Hatcher, 1981) included DHH students as old as 8–12 years
old. Although intervention for older DHH students is impor-
tant, vocabulary knowledge predicts DHH children’s later
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
reading achievement (Harris, Terlektsi, & Kyle, 2017; Kyle
& Harris, 2006; Kyle & Harris, 2010). With this in mind,
vocabulary interventions should occur earlier rather than
later (Meinzen-Derr, Wiley, Grether, & Choo, 2011).
Furthermore, Dimling (2010), Paatsch et al. (2006), and
Robbins and Hatcher (1981) used very limited words for
instruction (Dolch words: Dimling, 2010; monosyllabic
consonant–vowel–consonant words: Paatsch et al., 2006;
taught three unknown words: Robbins & Hatcher, 1981).
Some final limitations to these studies were limiting instruc-
tion to three words a week (Dimling, 2010), providing
instruction that was not interactive (Messier & Wood, 2015),
not requiring an expressive linguistic response to demon-
strating vocabulary understanding (Bowers & Schwarz, 2013),
and implementing the intervention using a researcher (Bowers
& Schwarz, 2013; Robbins & Hatcher, 1981) instead of a
teacher of the DHH (TODHH). Having teachers imple-
ment the study rather than researchers maximizes ecological
validity or the likelihood that the research can be imple-
mented in real classroom settings with fidelity (Kratochwill,
1978).
The purpose of this study was to address some of
the limitations of previous studies regarding instruction
on vocabulary meaning with young DHH students. We
implemented a modified interactive storybook reading
(ISR) intervention. We provided instruction including five
words (three nouns, one adjective, and one verb) a week,
provided interactive instruction by the classroom TODHH,
and required the preschool-age student participants who
were DHH to express a definition to measure their under-
standing. When looking at the vocabulary intervention
literature with young students who are DHH, ISR and dia-
logic reading seem to be common intervention methods
implemented to increase picture labeling abilities among
this group.
ISR and Students Who Are DHH
ISR instruction is grounded in the theory that chil-
dren learn language through practicing language and
gaining feedback about language from adults, who are
scaffolding the interactions carefully (Bandura, 1977;
Vygotsky, 1978). ISR was derived from dialogic reading
(Whitehurst et al., 1988). During dialogic reading, the
adult asks the child questions about the pictures or story
using the book as a shared referent. There are two levels
of dialogic reading. The first level of dialogic reading was
developed to increase the vocabulary skills of 2- to 3-year-
old children; the second level was designed to increase
the vocabulary and language skills of 4- to 5-year-old chil-
dren. The first level of dialogic reading, developed for
younger children, focuses on asking wh-questions to label
pictures in the books. Once the children have learned the
vocabulary related to the book, the adult can ask open-
ended questions about the book. The second level of dia-
logic reading, developed for preschool- or school-age
children, focuses on developing language and vocabulary
connected to the book. First, the adult reads the book to
the child. Then, each time the adult asks the child a ques-
tion related to the pictures or story, the PEER cycle is
followed (P = Prompt, E = Evaluate, E = Expand, R =
Reprompt; Whitehurst & Arnold, 1994). Prompt is the first
step in the cycle. The adult prompts the child using one
of five question types also known as CROWD questions,
because the first letter of each question type is noted in the
acronym. “C” indicates a completion question (The ____ is
flying.), “R” indicates a recall question (Where did Peter
Pan come from?), “O” indicates an open-ended question
(Why do you think she is surprised?), “W” indicates a wh-
question (What is the captain standing on?), and “D” in-
dicates a distancing question (What kinds of boats have
you been on?). Next, the adult evaluates and expands the
child’s response (Yes! That is a ship. That is a wooden
ship.). Last, the adult reprompts the child (What is the
captain standing on?). The end goal of dialogic reading is
for the child to be able to retell the story independently
(Zevenbergen & Whitehurst, 2003).
ISR deviates from dialogic reading in that ISR com-
bines the two levels of dialogic reading. ISR intends to
address the gaps in vocabulary knowledge of some children
who are DHH while at the same time providing a chal-
lenge. During ISR, the adult asks CROWD questions
using the PEER cycle, and the adult focuses on what is
happening in the pictures rather than the story. The pur-
pose of the interaction is to develop targeted vocabulary
for the story. For example, a recall question in ISR would
be related to the events depicted rather than what is hap-
pening in the text of the storyline.
Dialogic reading and ISR have been implemented
with students who were DHH in preschool through second
grade with a positive influence for picture labeling (Fung,
Chow, & McBride-Chang, 2005; Trussell & Easterbrooks,
2014; Trussell, Hasko, Kane, & Cascioli, 2017). Fung and
colleagues (2005) compared dialogic reading, shared reading,
and a “business-as-usual” condition using a quasi-experimental
design with kindergarten and first- and second-grade stu-
dents who were DHH (N = 28) matched on age and hear-
ing ability. The student participants and their parents used
spoken language. The parents implemented dialogic read-
ing using scripted CROWD questions and picture prompts
during the storybook reading sessions. Upon conclusion
of the study, the students who were in the dialogic reading
condition gained more picture vocabulary than the student
participants in the other two conditions. Furthermore,
Trussell and Easterbrooks (2014) implemented ISR with
five students who were DHH in preschool, kindergarten,
and first grades using a multiple probe across behaviors
single-case experimental design (SCED). The student par-
ticipants used speech-supported sign language (speaking and
signing at the same time using American Sign Language
signs following English grammar). The researcher imple-
mented ISR using scripted CROWD question prompts and
picture prompts during the ISR instructional sessions. A
functional relation was established between ISR and the
picture labeling growth of the student participants who were
DHH. In 2017, Trussell and colleagues replicated the
Trussell et al.: Interactive Storybook Reading 923
previous study with two preschool classrooms. One class-
room served students who were DHH and used spoken lan-
guage, and one served students who were DHH and used
speech-supported sign language. In the replication study,
TODHHs implemented ISR using scripted CROWD ques-
tion prompts and followed the PEER cycle. The TODHHs
did not use picture vocabulary prompts during the ISR
instructional sessions. A functional relation was established
between ISR using the PEER cycle and picture vocabulary
labeling. Implementing the PEER cycle may negate the
need for picture vocabulary prompts during the instructional
sessions because the PEER cycle doubles the number of
student responses elicited during ISR.
Although the previously discussed studies indicate
that ISR may be effective to increase the picture labeling
of students who are DHH, the studies do have limitations.
Trussell and Easterbrooks (2014) and Fung et al. (2005)
do not mention using the PEER sequence during instruc-
tion. Furthermore, both studies used picture prompts during
instruction. Trussell et al. (2017) addressed the limitations
of Trussell and Easterbrooks (2014) and Fung et al. by in-
cluding the PEER sequence and not using picture prompts
during instruction. However, none of the studies reviewed
included a generalization measure or went beyond picture
labeling to address the second part of the definition of
vocabulary—word meaning. Because ISR is developmen-
tally appropriate for young students who are DHH (Aram
& Biron, 2004) and appears to improve the picture labeling
of this group (Fung et al., 2005; Trussell & Easterbrooks,
2014; Trussell et al., 2017), we offer that ISR may be an
effective strategy to teach new words and their meanings in
the context of a storybook.
In the current study, we modified ISR to include teach-
ing the meaning of the target vocabulary as well as the picture
label. The vocabulary meaning portion of the intervention
was added by asking questions such as “What does family
mean?”, then following the PEER cycle to provide a kid-
friendly definition, and, finally, reprompting the child to
elicit the definition given by the TODHH.
The purpose of this study was to extend the findings
and address the limitations of previous research (Fung
et al., 2005; Trussell & Easterbrooks, 2014; Trussell et al.,
2017) to determine what effect ISR with word meaning
instruction has on preschoolers’ ability to learn new words
and their meanings. The research questions were as fol-
lows: What effect does ISR with word meaning instruction
have on the vocabulary knowledge of preschoolers who
are DHH? Will the knowledge generalize to other pictures?
Will the knowledge maintain over time?
Method
Participants and Setting
Six preschool students who are DHH and one TODHH
were included in the study. The student participants used
spoken English, were found eligible for special education ser-
vices under the category of deaf or hard of hearing according
924 Language, Speech, and Hearing Services in Schools • Vol. 49 • 922–937 • October 2018
to the Individuals with Disabilities Education Act (2004),
had a vocabulary goal on their Individualized Education
Program indicating a need for specially designed vocabu-
lary instruction, and attended a half-day preschool pro-
gram. All of the student participants were in their second
year of preschool (see Table 1 for further description of
the student participants). The teacher participant was
a certified teacher with 2 years of teaching experience
and 10 years of experience as a paraeducator in the
same program.
The preschool classroom was located in a public
school in the northwest portion of the United States. Dur-
ing the assessment probe sessions, the teacher worked with
each student participant individually. They sat at a small
table with the laptop between them. The student partici-
pants could clearly see the TODHH’s face. ISR took place
in the preschool classroom in a small group setting of six
student participants. The student participants sat in chairs
in a semicircle setup with the teacher participant across
them. The teacher participant used a sound-field FM system
during ISR instruction. The FM system was not used dur-
ing assessment probe sessions because the student participants
did not have personal FM systems. The student participants
could clearly see the TODHH’s face and the book.
Materials
Books
The books met the following criteria: aligned with
the teacher participant’s unit-based curriculum (Trussell &
Easterbrooks, 2014), contained many illustrations with
few words on the page and a simple plot (Zevenbergen &
Whitehurst, 2003), and were readily available children’s
books. The three books were Hansel and Gretel retold by
Ronne Randall during Week 1 (Book 1), Puss in Boots by
Lisa Findlay during Week 2 (Book 2), and Peter Pan re-
told by Carol Ottolenghi during Week 3 (Book 3). Before
instruction, the books were given a letter and taught in
random order determined by random.org. Books 1, 2, and
3, as detailed above, were implemented with all student
participants.
Technology
The primary author designed PowerPoint presenta-
tions containing pictures of the target vocabulary from the
books. In addition, the primary author designed generali-
zation PowerPoint presentations containing black and
white line drawings from the clipart. The primary author
shared the material via cloud storage. The teacher partic-
ipant recorded all sessions using the digital camera inte-
grated into her laptop.
Research Design
A multiprobe across behaviors SCED (Gast &
Ledford, 2014) was utilized to determine the effect of
ISR with word meaning instruction on student participants’
picture labeling and word meaning knowledge. Multiprobe
 Table 1. Participant demographics.
Participant Agea Gender Amp 4-Hz unaided PTA (L/R) (dB)
Cynthia 5;5 F 2 HA
Gadina 5;7 F 2 HA
Kaliyah 5;8 F 2 HA
Lashya 4;10 F CI
Parlan 4;5 M None
Zachariah 5;10 M CI
Note. Amp = amplification; PTA = pure-tone average; L = left; R = right; Comm = communication; F = female;
HA = hearing aid; CI = cochlear implant; M = male.
a
Age expressed in years;months.
across behaviors design is useful to answer demonstrative-
type research questions where the skill or behavior (vocabu-
lary knowledge) may not be unlearned in a short period
(3–4 weeks). Multiple probe across behaviors SCED stud-
ies demonstrate experimental control when the following
requirements are met: (a) a minimum of three tiers (i.e., sets
of target vocabulary with three nouns, one adjective, and
one verb; Trussell & Easterbrooks, 2014; Trussell et al., 2017)
that are similar yet functionally independent are identified,
(b) condition change criteria (i.e., stability of behavior in
baseline phase and increasing tread in intervention phases)
are selected, (c) the dependent variable is measured repeat-
edly and simultaneously, (d) changes in the dependent
variable coincide with the introduction of the independent
variable, and (e) consistent behavior change occurs every
time the independent variable is introduced for a minimum
of three different and temporally related time points (Gast &
Ledford, 2014). Furthermore, this design type mirrors the in-
dividualized nature of special education (Horner et al., 2005).
In addition, all students receive instruction, and instruction is
not concluded until some level of mastery is reached (Gast
& Ledford, 2014). This study had four phases across the
three behaviors or sets of vocabulary words and definitions.
Intervention
Independent Variable
The teacher participant implemented ISR for 15–
20 min a day, 4 days a week for approximately 3 weeks.
The teacher participant used the book as a shared referent
with the students and did not read the book. The text in
the book could be seen by the teacher and student partici-
pants during instruction. The teacher participant followed
the PEER cycle by asking the CROWD questions about
the book’s pictures. Here are two examples from this study:
(a) Teacher (prompt): “Who is standing on the ship?”
Student: “Captain.”
Teacher (evaluation and expansion): “Yes, the
captain is standing on the ship.”
Teacher (reprompt): “Who is standing on the ship?”
Student: “Captain is on the ship.”
(b) Teacher (prompt): “What does captain mean?”
Student: “Boss.”
Comm mode Language at home
23/4 Speech English
46/48 Speech Spanish
60/55 Speech English
74/CI Speech English
5/65 Speech English
CI/15 Speech English
Teacher (evaluation and expansion): “Almost right,
captain means the boss of a ship.”
Teacher (reprompt): “What does captain mean?”
During the first or second session for each book,
the student participants did not know the answers to the
book. In these cases, the teacher participant answers the
questions and provides a reprompt:
Teacher (prompt): “Who is standing on the ship?”
Student: (No response)
Teacher (evaluation and expansion): “The captain.
The captain is standing on the ship.”
Teacher (reprompt): “Who is standing on the ship?”
The teacher participant used paperback books and
did not show the student participants the PowerPoint slides
during ISR.
Dependent Variable
The dependent variable was correctly labeling the
picture (retrieved from the book) of the target vocabulary
as well as explaining what the word meant. The vocabulary
pictures were displayed on a laptop using PowerPoint soft-
ware. The PowerPoint slides were white with a single-color
picture from the book (Sarchet et al., 2014; Trussell et al.,
2017). The dependent variable was scored in two parts, label-
ing and definition. For labeling, the student participant
could receive a “1” (knew) or “0” (did not know). For the
definition, the student participant could receive a “0” (did
not know),”1” (knew the definition partially; e.g., family
means connected), or “2” (knew the definition; e.g., family
means people who are connected; Dimling, 2010). The stu-
dent participants were given one opportunity to provide
the label and the definition. They could earn 3 points per
word, equaling 15 points overall.
Procedure
Recruitment
The primary author had professional connections
with the state’s deaf education outreach program; therefore,
the teacher and student participants were a convenience
sample based on these connections. The primary author
obtained institutional review board approval as well as
Trussell et al.: Interactive Storybook Reading 925
recruited and obtained consent from the teacher participant.
The teacher participant gave letters to the parents of those
students who qualified for the study. One hundred percent
of the parents granted permission for their children to
participate in the study. Finally, the teacher participant
gained assent from each student participant at the begin-
ning of each assessment probe and ISR session by asking
a version of the following questions: “Do you want to
look at some pictures? Do you want to talk about the pic-
tures in this book?”
Professional Development for Traditional ISR
The initial professional development regarding ISR
without word meaning instruction was conducted during
the summer before the study. The primary author conducted
two 4-hr sessions for TODHHs on how to implement tradi-
tional ISR. During the first session, the primary author
explained how to choose books and target vocabulary, write
CROWD questions, and conduct the PEER cycle. During
the second session, the teacher participants role-played ISR
with each other and received feedback from the primary
author. The role-play sessions were recorded, and the pri-
mary author applied a fidelity checklist (see Figure 1 for an
example). The primary author reviewed the results from
the checklist and provided actionable feedback to the teacher
participant. The teacher participant began implementing
traditional ISR in the fall. Near the end of the fall semester,
the teacher participant approached the primary author
Figure 1. A portion of the procedural fidelity data collection tool.
926 Language, Speech, and Hearing Services in Schools • Vol. 49 • 922–937 • October 2018
about adding the word meaning to the ISR instruction.
The primary author searched the literature base to deter-
mine if ISR including word meaning instruction had been
done. No studies were located. The primary author and
teacher participant decided to modify ISR to include
word meaning instruction.
Professional Development for ISR With
Word Meaning Instruction
The primary author and teacher participant met four
times for 2 hr via videoconferencing technology. During
the first session, the two chose books and potential target
vocabulary. During the second session, the primary author,
the teacher participant, and a third veteran TODHH met
to determine how word meaning instruction would be
added to ISR without modifying it greatly. The three indi-
viduals came to an agreement to add the question “What
does (insert target vocabulary here) mean?” and follow
the PEER cycle to reinforce the meaning for each target
vocabulary. During the third session, the teacher partici-
pant role-played ISR with word meaning with the third
teacher, and the session was recorded. The primary author
conducted procedural fidelity (see Figure 1) and provided
feedback. During the last session, the teacher participant
role-played a final session and achieved 92% (Kennedy,
2005; Trussell et al., 2017) procedural fidelity. The teacher
participant was prepared to implement ISR with word
meaning component in her classroom.
Vocabulary Targets
Before implementing the ISR instruction, the teacher
participant and primary author chose books that aligned
with the curriculum. After the books were chosen, the
teacher participant and primary author chose 10 poten-
tial vocabulary words from each book. Kid-friendly defini-
tions for the potential vocabulary (Beck, McKeown, &
Kucan, 2006) were cross-referenced from two online, read-
ily available dictionaries from Merriam-Webster (www.
learnersdictionary.com [developed for students who are
English language learners] and www.wordcentral.com
[developed for students]). The potential vocabulary and
definitions were also reviewed and approved by the teacher
participant and the preschool program’s lead TODHH
with 10 years of teaching experience. The student partici-
pants were pretested on the 30 potential vocabulary words.
The words and meanings that most of the students did
not know were chosen as target vocabulary for the study.
The final list of targets and their definitions are presented
in Table 2. The teacher participant and other related service
providers (e.g., speech-language therapists, physical thera-
pists, and paraprofessionals) agreed not to instruct the
target vocabulary labels or meanings during any time out-
side the modified ISR instruction.
ISR With Word Meaning Scripts
A graduate research assistant (GRA) drafted poten-
tial CROWD question prompts to elicit the target vocabu-
lary and work meanings. The primary author ensured
each word and meaning was targeted four to five times in
each book and that a variety of CROWD question types
were drafted. The primary author and teacher participant
revised and approved the scripted CROWD questions for
Books 1–3 (see Figure 1 for an example of the script).
conclusion of this research study: strongly agree–5–4–3–2–
1–strongly disagree) and two open-ended questions (e.g.,
DHH children differ greatly from one another. Do you see
this strategy as appropriate for all children or for only
some and why?). The teacher participant’s response to the
survey are detailed in the Results section.
Procedural Fidelity and Interrater
Reliability Data Collection
The probe assessment and intervention instructional
sessions were digitally recorded to collect procedural fidel-
ity and interrater reliability (see Figure 1 for an example
of the fidelity data sheet). Before the study, the primary
author randomly chose 50% of the assessment and instruc-
tional sessions to collect procedural fidelity. The primary
author numbered the sessions and entered them into www.
random.org by phase. The chosen sessions were equally
spaced throughout baseline, intervention, and maintenance
phases.
Fidelity and Reliability Training
The primary author trained the fourth and fifth au-
thors (GRAs) how to rate the intervention sessions using
practice videos developed from ISR trainings for teachers.
The GRAs coded one assessment probe and intervention
session from the first week to determine if they were rating
similarly. The primary author compared their ratings and
clarified the evaluation part of PEER. The GRAs coded
a second assessment probe and intervention session, and
their ratings were compared. The reliability between the
GRAs was 96% for assessment sessions and 98% for in-
tervention sessions. This met the preestablished criteria
of 95% to continue collecting procedural fidelity and
reliability.

Social Validity Data Collection Preassessment

At the conclusion of the study, the primary author The student participants were pretested on 30 po-
emailed the teacher participant a researcher-created social tential vocabulary words, 10 from each book. Words
validity survey. The survey included five Likert-style state- and their meanings that were unfamiliar to most of the
ments (e.g., I will implement this intervention after the students were chosen for instruction. ISR was implemented

Table 2. Target vocabulary words and definitions.

Book Word Word meaning

Hansel and Gretel Family A group of people who are related to each other
Worried Feeling or showing fear because you think that something bad happened or might happen
Trunk The thick part of the tree growing out of the ground
Wake up To stop sleeping
Evil Very bad
Puss in Boots Sack A bag made of paper, plastic, or cloth
Carriage Has four wheels and is pulled by horses
Field An open area of land without trees or houses
Scared Feeling afraid or nervous
Hold To keep something in your hands or arms
Peter Pan Captain The boss of a ship
Leave To go away quickly
Plank A thick piece of heavy wood
Fairy A made-up small person with magic powers and wings
Surprised Feeling when something unexpected happens

Trussell et al.: Interactive Storybook Reading 927

with three books; each book had five target vocabulary
words (three nouns, one adjective, and one verb; Trussell
& Easterbrooks, 2014; Trussell et al., 2017) and their
definitions.
Baseline
During the baseline phase, each student participant
worked with the teacher participant individually during
probe assessment sessions. First, the teacher participant
asked for the picture label. The teacher participant showed
the student participant the slide of the picture vocabulary
on a laptop and asked “What is that?” The student partici-
pant was allowed 5 s to respond. The teacher participant
wrote a “1” (knew) or “0” (did not know) to indicate if
the student labeled the picture correctly. The student par-
ticipants’ articulation errors were not considered if the
teacher participant could understand the student partici-
pant. Then, the teacher participant checked for the
meaning by asking “What does that mean?” The student
participant was allowed 8 s to respond. After the student
participant did or did not respond, the teacher partici-
pant recorded a “0” (did not know),”1” (knew the defi-
nition partially; e.g., family means connected), or “2”
(knew the definition; e.g., family means people who are
connected; Dimling, 2010). If the student participant
responded incorrectly or did not respond, the teacher
participant moved on to the next picture. The student
participants were given one opportunity to provide the la-
bel and the definition. The teacher participant did not
provide feedback about the accuracy of the student par-
ticipants’ responses but provided only general feedback
on effort, such as “You really tried hard today! Thank
you!” The number of vocabulary targets assessed in each
session varied from 5 to 15 depending on which books
were being probed at the time.
Baseline for each set of target vocabulary was estab-
lished through a stable data path (i.e., minimum variabil-
ity in the data path with no trend or slope; Kazdin, 2011).
Once baseline was established for Book 1, intervention
was initiated. Books 2 and 3’s baseline data were collected
through probes. Baseline data for Books 2 and 3 were estab-
lished through a minimum of five probes, with three of
those probes occurring consecutively before intervention
with stable data path (Kazdin, 2011).
Intervention
During the intervention phase, individual assessment
sessions occurred before instruction each day, and the pro-
cedure just described was followed. The procedure for ISR
instruction during the intervention phase is the same as
described under the previous section labeled Independent
Variable. Mastery criteria for phase change were a mini-
mum of five data points demonstrating an increasing trend
in the phase. If the student participant persisted for eight
sessions without reaching mastery criteria, the student par-
ticipant would move on to the next book (Gast & Ledford,
2014). The next phase was generalization.
928 Language, Speech, and Hearing Services in Schools • Vol. 49 • 922–937 • October 2018
Generalization
A generalization probe session occurred after mas-
tery criteria were met for each intervention phase. The gen-
eralization probe consisted of a black-and-white line clipart
drawing of the target vocabulary from the recently con-
cluded intervention phase. The black-and-white drawing
was not from the books. The teacher participant fol-
lowed the same assessment procedures as described during
baseline.
Maintenance
Maintenance data were collected four and eight ses-
sions after the generalization data were collected. During
those weeks, none of the target vocabulary was instructed.
During the maintenance probe, the teacher participant
followed the same procedures as described during baseline.
The maintenance probe consisted of the same pictures that
were used during baseline and intervention (i.e., the pic-
ture of the target vocabulary from the book).
Fidelity and Reliability
Assessment Sessions
The fourth author collected procedural fidelity on
50% of the probe assessment sessions. For procedural fidel-
ity, the following teacher participant behaviors were noted:
asking for assent, saying the scripted prompt for each
picture, providing no feedback to the student participant
about each item, and delivering general praise for effort
to conclude the session. Furthermore, the fourth author
watched 50% of the assessment sessions and marked the
student participants’ responses. The teacher followed the
assessment protocol 97% of the time on average (range =
75%–100%). The teacher and fourth author agreed on the
score (0 or 1 for labeling and 0, 1, or 2 for the definition)
for the students’ responses 94% of the time on average
(range = 70%–100%). The fifth author watched 30% of
the assessment videos included in the 50% of videos watched
by the fourth author. The same behaviors were noted.
Point-by-point agreement was calculated (i.e., Agreements/
Agreements + Disagreements × 100; Kazdin, 2011). For
the assessment sessions, interrater reliability average was
91.7% (range = 80%–100%). Most disagreement among
the teacher participant and fourth and fifth authors was
scoring the word meanings (0 = did not know, 1 = partially
knew, and 2 = knew). With that being said, agreement was
still in the acceptable range.
Intervention Sessions
The fourth author watched 50% of the intervention
sessions and recorded if the teacher participant asked the
scripted questions and followed the PEER cycle. During
procedural fidelity and reliability for the intervention
sessions, we measured the following teacher behaviors:
(a) asking for assent, (b) saying question prompt as scripted,
(c) evaluating the students’ responses (defined as saying
similar words or phrases—“Yes!”, “Right!”, “Good”, “Let’s
try/look again”, and/or “No”—or a head shake or head
nod paired with an appropriate facial expression; Trussell
et al., 2017), (d) expanding the student response (defined
as rephrasing and adding one piece of information to the
student participant’s response), and (e) reprompting the stu-
dent participants using the scripted question (see Figure 1
for the procedural fidelity checklist). At times, the student
participants did not respond to the scripted questions. We
noted a nonresponse as “NR” (no response) and did not in-
clude evaluation as part of that PEER cycle opportunity.
For the intervention sessions, the teacher participant asked
the scripted questions 91% of the time on average (range =
82%–98%) and completed the PEER sequence 81% of
the time on average (range = 65%–88%; prompt = 91%,
evaluation = 91%, expansion = 79%, reprompt = 62%).
The teacher participant most often did not ask the reprompt
at the end of the PEER sequence when the student partici-
pants were able to answer the first prompt accurately. To
determine interrater reliability, the fifth author watched
30% of 50% of the intervention videos. Point-by-point
agreement was calculated. For the intervention sessions,
interrater reliability average was 97% (range = 96%–98%).
Results
Student participants’ data are presented in Figures 2
and 3. All student participants’ names are pseudonyms.
Data for Session 6 are missing for all student participants
because of a school holiday. All other missing data points
indicate student participant absences. Because of timing,
maintenance data for Book 1 were taken at 2 and 4 weeks
out; however, maintenance data for Books 2 and 3 were
taken early because the school year ended. Data were ana-
lyzed at the individual level for the following features: sta-
bility (50% on either side of the mean; Kazdin, 2011), level
(mean of the data in a phase), trend (direction the data
path is displaying), immediacy of effect (the last data point
in the baseline phase compared with the first data point in
the intervention phase), consistency (data paths look simi-
lar within phases [comparing baseline to baseline] and
across phases [baseline to intervention of one tier compared
with baseline to intervention of another tier]; Gast &
Ledford, 2014), and percentage of nonoverlapping data
(percentage of data points that do not overlap when com-
paring baseline with intervention phases; Kratochwill
et al., 2013). The student participants’ performance on
word meaning is indicated by a circle, and word labeling
is indicated by a triangle.
Word Meaning
As seen in Figures 2–4, the student participants had
stable baseline data paths before interventions for Books
1–3 with the exception of Parlan for Book 1. However,
Parlan’s baseline data path for Book 1 was stable before
intervention. All of the student participants’ data paths
demonstrated a change in level from baseline to interven-
tion for each book. Similarly, all of the students’ data
paths trended upward during the intervention phases for
all the books. The only exception was Kaliyah. Kaliyah’s
data path during intervention instruction for Book 3 did
not demonstrate a trend but did indicate a change in level
from baseline to intervention phase of Book 3. In regard
to immediacy of effect, Cynthia’s data paths demonstrated
immediacy of effect of the intervention instruction for all
three books. Kaliyah, Lashya, and Zachariah’s data paths
indicated immediacy of effect of the intervention instruc-
tion for Books 1 and 2. Parlan’s data paths showed an im-
mediacy of effect of the intervention instruction for Book 3
only. Gadina’s data paths did not indicate an immediacy
of effect for the intervention instruction. Generally, all
of the student participants’ data paths were consistent be-
tween phases with the exception of Parlan and Zack’s base-
line data paths in Books 1 and 2, respectively. Five student
participants’ data paths were consistent across phases for
Books 1–3 with the exception of Kaliyah’s data path from
baseline to intervention phase for Book 2. All of the stu-
dent participants were able to generalize the word meaning
knowledge they gained during intervention instruction.
All of the student participants remembered what they
learned during intervention. There are no generalization or
maintenance data for Gadina. She was absent on those ses-
sions. Overall gains for word definitions before and after
intervention instruction can be found in Figure 5. All
of the student participants had less than 20% average
word meaning before instruction, and all of them gained
a minimum of three times their previous knowledge after
intervention instruction began, from 0% to more than 90%
word meaning knowledge on average.
Word Labeling
Word labeling results are indicated by a triangle in
Figures 2–4. All of the student participants’ baseline data
paths exhibit stability before intervention instruction began
with the exception of Kaliyah for Book 1. Her baseline
data path increases slightly before baseline. Most of the
student participants’ data paths demonstrated a change in
level from the baseline to intervention phase for all books.
Parlan’s data path did not demonstrate a change in level
from baseline to intervention for Book 1. Similarly, Lashya’s
data path did not demonstrate a change in level for Book 2.
Five of the six student participants’ data paths during the
intervention phase for all the books demonstrated an increas-
ing trend. On the other hand, Gadina’s data path during
the intervention phase for Book 3 was variable. For Books 1
and 3, all of the student participants’ data paths indicated
immediacy of effect of the intervention instruction on word
labeling with the exception of Gadina for Book 1. For
Book 2, Lashya was the only student participant whose data
path indicated an immediacy of effect of the intervention in-
struction. In regard to consistency between phases, Cynthia
and Zachariah’s data paths during the baseline phase for
Book 2 had a higher mean than their other baselines. Parlan
had more variability in his baseline and intervention data
paths for Book 1 when compared with Books 2 and 3. In
regard to consistency across phases, the student participants’
Trussell et al.: Interactive Storybook Reading 929
 Figure 2. Cynthia and Gadina’s graphs. BL = baseline; Int. = intervention; G = generalization; M = maintenance.

data paths demonstrated consistency across phases with the
exception of Parlan discussed previously. All of the stu-
dent participants remembered and were able to generalize the
word labels they learned during intervention. Overall gains
for word labeling before and after intervention instruction
can be found in Figure 5. Similar to the word meaning pre-
average and postaverage, five of the students (Cynthia,
Gadina, Kaliyah, Lashya, and Parlan) learned three times
the number of word labels they knew before intervention
instruction. Zachariah learned about double the number of
word labels he knew before intervention instruction.
Social Validity
The teacher participant strongly agreed that ISR
with word meaning instruction benefited her students, but
she mentioned that she thought ISR word meaning instruc-
tion “was only helpful if the students already understand
standard classroom routines.” She agreed strongly that
the intervention itself was easy to teach and sustainable.
When asked what she would change, the teacher partici-
pant would like to find a way to make the script easier to
use. She had to flip a book page and a script page. Then,
she had to look down at her script before speaking. She
reported this process as being “cumbersome.”
Discussion
The purpose of the current study was to determine
what effect ISR with word meaning instruction had on the
vocabulary knowledge of preschoolers who are DHH and

930 Language, Speech, and Hearing Services in Schools • Vol. 49 • 922–937 • October 2018
 Figure 3. Kaliyah and Lashya’s graphs. BL = baseline; Int. = intervention; G = generalization; M = maintenance.
use spoken English. We implemented a multiple probe
across behaviors SCED study to answer the first research
question: What effect does ISR with word meaning instruc-
tion have on the vocabulary knowledge of preschoolers
who are DHH? When looking at the graphs for the student
participants, a functional relation was established between
ISR with word meaning instruction and the student par-
ticipants’ ability to express a definition. For Cynthia, the
mean change across conditions was higher than the mean
change within conditions for all three books. This was repli-
cated by Gadina, Kaliyah, Lashya, Parlan, and Zachariah.
Furthermore, all the students’ data paths trended upward
during instruction (Gast & Ledford, 2014). The incon-
sistency among the students regarding the immediacy of
effect of the intervention weakens the functional relation
and requires further discussion (Kratochwill et al., 2013).
These findings support previous research (Fung et al., 2005;
Mueller & Hurtig, 2009; Trussell & Easterbrooks, 2014;
Trussell et al., 2017) demonstrating that ISR promotes
picture vocabulary learning in young children who are
DHH. In addition, this finding extends previous research
to indicate that ISR with word meaning instruction can
promote word definition knowledge in preschool children
who are DHH and use spoken English.
The secondary research questions (Will the knowl-
edge generalize to other pictures? Will the knowledge main-
tain over time?) were answered through probe sessions after
the conclusion of the intervention. The student partici-
pants were able to generalize the vocabulary knowledge
they gained from color pictures that were taken from
the books to black-and-white line drawings. In addition, the
student participants maintained what they learned over
Trussell et al.: Interactive Storybook Reading 931
 Figure 4. Parlan and Zachariah’s graphs. BL = baseline; Int. = intervention; G = generalization; M = maintenance.

time. These findings indicate that ISR with word meaning
instruction may have a lasting effect on the vocabulary
knowledge of children who are DHH and use spoken
English. Furthermore, the preschoolers may be able to
take what they learn in ISR and apply it to novel mate-
rials without explicit instruction on how to generalize
information.
The initial point for discussion is the measure used in
the current study. Preschool state standards (Idaho State
Department of Education, 2012; New Jersey State Depart-
ment of Education, 2014; New York State Department
of Education, 2011; Ohio State Department of Education,
n.d.) suggest that expressing the meaning of unknown
words in the context of a storybook is a benchmark for
emergent readers. As is common with standards, there is
little guidance on what this benchmark looks like in the
classroom. Although we interpreted this standard to include
providing a kid-friendly definition, there are other devel-
opmentally appropriate ways to measure word meaning
with young children. One way would be to notice the
child using the new word correctly in a different context.
In addition, the teacher or parent could ask the child
a question or a series of questions about the word that
would indicate comprehension such as “Can you tell me
about a time you have been scared?” Although the stu-
dent participants in this study could recite the definition
taught during the intervention, this finding must be inter-
preted with caution. These student participants may merely
have been memorizing the definition and would not have
been able to apply the meaning to other contexts outside
this ISR interaction.
The lack of immediacy of effect and the low percent-
age of nonoverlapping data for Book 2 require further
investigation. When looking at the data paths, the student

932 Language, Speech, and Hearing Services in Schools • Vol. 49 • 922–937 • October 2018
 Figure 5. The average of the last three data points in baseline phases compared with the average of the last three
data points in intervention phases for all the books, separated by student.
participants knew more of the target vocabulary words
during the baseline phase of Book 2 when compared with
the baseline phases for Books 1 and 3. Several of the stu-
dent participants knew the target words scared, field, and
carriage before instruction. Not only did they label scared,
many of them could partially define scared. In addition,
the teacher participant reported that the picture of field
was confusing. For example, Parlan could label and define
“field” during the intervention sessions when the picture
was in context. Yet, when only the portion of the picture
from the book was presented, he struggled to label “field.”
The pictures used for assessment were not vetted by the
TODHH. Perhaps, we should have replaced the picture
when the TODHH noticed Parlan’s confusion. However,
it is difficult to determine what is confusing for the stu-
dent participants and what is generalizing information
from instruction to assessment. Although the books were
implemented in random order, the difference in perfor-
mance for Book 2 could be due to the fact that it was im-
plemented in the middle. In the current study, we were
attempting to implement larger group instruction (six stu-
dents and one teacher) to fit the established routines of
the preschool classroom. In a similar classroom situation,
teachers may consider taking the opportunity to teach a
Tier 2 (Beck & McKeown, 2007) vocabulary word (e.g.,
teaching terrified instead of scared) to increase the breadth
and depth of students’ vocabulary knowledge. Another
alternative would be one-to-one or small groups of two or
three students engaging in ISR with the teacher. Smaller
groups or individual sessions might be more effective. If
the groups were smaller or one-to-one, the teacher could
tailor the target vocabulary to each student’s needs and
learning speed. Conducting ISR with word meaning
instruction in one-to-one sessions may lend better to the
therapeutic or itinerant TODHH model. Speech-language
pathologists and itinerant TODHHs tend to work with
children who are DHH in one-to-one settings or very
small groups (no more than two students). ISR with word
meaning instruction may be more effective if delivered in
smaller settings that are not always feasible for a preschool
classroom with one teacher and many students.
When looking at the data paths for Book 3, the stu-
dent participants learned the words and definitions more
quickly than those for Books 1 and 2. This finding con-
firms previous findings (Trussell & Easterbrooks, 2014;
Trussell et al., 2017) that it takes a few weeks for students
to become familiar with the ISR instruction itself and the
expectations during ISR. These student participants have
been participating in ISR with their teacher throughout
the year to learn picture labels; however, this was the first
time the student participants were expected to learn more
than only the picture label. After Books 1 and 2, the stu-
dent participants are familiar with the instruction itself and
may be better able to predict what is going to occur during
instructional sessions.
When taking a closer look at the data for Books 1–3,
the student participants were generally more successful
learning the noun labels and definitions when compared
with the verbs and adjectives. The only exception was the
adjective mentioned above—scared. Learning nouns more
easily is consistent with language acquisition norms for
hearing children (MacNamara, 1972) and supports the qual-
itative similarity hypothesis (Paul, Wang, Trezek, & Luckner,
2009), which proposes that children who are DHH learn
literacy skills in a similar developmental pattern as hearing
children.
Trussell et al.: Interactive Storybook Reading 933
 Gadina and Parlan appeared to benefit less from the
ISR instruction when compared with the other students.
In both cases, these student participants had different
demographics and backgrounds than the other students.
Parlan is younger than the other children, and Gadina
had frequent absences as well as a second language in the
home. Furthermore, Gadina was given a secondary diag-
nosis of intellectual disability after the conclusion of the
intervention instruction. When looking at the preaverage
and postaverage in Figure 5, it appears that ISR with word
meaning instruction does not overcome the Matthew effect.
Cynthia and Zachariah who started the intervention in-
struction with more knowledge also ended the intervention
instruction with more knowledge. Perhaps, ISR with word
meaning instruction is not the most effective instructional
strategy for those students who are DHH and use two or
more languages or have other diagnoses. A second explana-
tion is the implementation fidelity average for the PEER
sequence. Although this study had a similar implementation
fidelity for the PEER sequence as past studies (Trussell
et al., 2017), the TODHH most often forgot to reprompt
the student participants with the question again. This de-
creased the intensity of the ISR instruction and may have
had an effect on Gadina and Parlan’s performance. When
deciding the type of vocabulary instruction to use in the
classroom, TODHHs may consider modifying the ISR with
word meaning instruction for pacing, group instruction size,
intensity, or duration.
The procedural fidelity averages were high in this study.
The teacher participant was able to adhere to the plan of
instruction and most often forgot to reprompt the student
participants. It must be noted that the teacher participant
was already implementing ISR using the PEER cycle and
CROWD question prompts in her classroom before the
study. We added the word meaning component because the
teacher participant wondered if she could use ISR to teach
word definitions. Her previous experience with ISR may
have been critical to her ability to implement the instruction
with such high fidelity. In addition, the fourth author was
collecting data on her procedural fidelity and reporting the
information to the primary author. If the teacher partici-
pant fell below 80% fidelity for two consecutive sessions,
the primary author would provide feedback and coaching.
Initial professional development, but more importantly,
ongoing professional development, appears to be important
when the goal is to implement ISR with fidelity (Guskey &
Yoon, 2009). When beginning ISR with word meaning
instruction, teachers should seek training as well as have
a fellow teacher or an administrator conduct fidelity
checks.
Because of the fact that the researchers were not in
the classroom every day at all times, there is a small chance
that the preschoolers may have learned the vocabulary
words and their meanings from other instruction. However,
the students’ data paths indicated that the students were
learning the words from the ISR with word meaning instruc-
tion. This type of threat to validity is always a concern
when conducting studies in schools. However, conducting
934 Language, Speech, and Hearing Services in Schools • Vol. 49 • 922–937 • October 2018
research in ecologically valid settings (e.g., classrooms,
school therapy settings; Gast & Ledford, 2014) is important
to determine if the instruction can be carried out in the
classroom by a teacher as it was designed by the researcher.
The implications of this study begin in the classroom.
The importance of vocabulary knowledge to reading is
well documented (Harris, Terlektsi, & Kyle, 2017; Kyle &
Harris, 2006, 2010, 2011). TODHHs are required to imple-
ment evidence-based vocabulary strategy practices (Every
Student Succeeds Act, 2015). This study provides emergent
evidence for using ISR with word meaning instruction to
teach vocabulary words and definitions to preschool chil-
dren students who are DHH and use spoken English. In
addition, we designed this study to address a gap in the
vocabulary strategies research addressing word meaning
knowledge of students who are DHH. When the goal is to
teach picture labeling with a kid-friendly definition, ISR
with word meaning instruction has an emergent evidence
base to support its use in the DHH preschool classroom
that focuses on the development of spoken English.
The findings of this study are significant to the field
of special education because they further build the knowl-
edge base surrounding effective vocabulary instruction strate-
gies. The most consistent predictor of later reading success
for children who are DHH is vocabulary knowledge (Harris,
Terlektsi, & Kyle, 2017). With this in mind, researchers
and teachers need to work together to determine the most
efficient and effective ways to increase the size of the vo-
cabularies of young children who are DHH. In addition,
the student participants’ data paths indicate that ISR with
word meaning may be more effective in one-to-one settings or
smaller groups. Potentially, speech-language pathologists
or itinerant TODHHs could implement ISR with word
meaning instruction. Similar to TODHHs, speech-language
pathologists who work in schools are required to deliver
evidence-based practices. ISR may be one to consider.
Limitations and Future Research
The first limitation of this study was the small sam-
ple size. The sample size was appropriate for an SCED.
However, the findings may not be generalizable to students
or settings that are different from those represented in the
current study. In addition, group design studies with a large
enough sample population to ensure power is the gold stan-
dard for determining the effectiveness of an instructional
strategy (Institute of Educational Sciences, 2014). Future
researchers should consider implementing ISR with word
meaning instruction with a larger number of preschoolers
who are DHH and use spoken English using a randomized
controlled trial design. When considering scaling up to a
larger sample size, there are several findings from this study
that future researchers should take into account. We in-
cluded extensive teacher training (8 hr). That amount of
teacher training may not be feasible in a large-scale study.
In addition, our assessment fidelity was at 94% on average
with a small number of students. When introducing more
students, teachers, and variability, it may be difficult for
teachers to use the measurement system (0 = did not know,
1 = partially knew, and 2 = knew) we used herein reliably.
Furthermore, future researchers should replicate this study
with additional subpopulations of students who are DHH.
These subpopulations may include students who are DHH
and use American Sign Language or some combination of
spoken English and sign language.
The second limitation of this study was the manner
in which word meaning was defined and measured. Herein,
we used kid-friendly definitions to teach the meaning as
well as measure if the students knew the meaning, although
teaching kid-friendly definitions is a recommended practice
for instructing unfamiliar vocabulary (Beck et al., 2006).
Reciting definitions may not be the most authentic way
to measure if a student understands what a word means.
Future researchers may want to consider teaching all as-
pects of a word (e.g., meaning [multiple if needed], exam-
ples, nonexamples, synonyms, antonyms; Easterbrooks
& Beal-Alvarez, 2013) and measuring comprehension by
eliciting a sentence or phrase using the vocabulary word
to measure if the student knows what the word means as
well as the picture label (Dimling, 2010) or prompting the
students’ use of the word in authentic contexts.
The third limitation of this study was that mainte-
nance data were not collected properly for Book 3 because
school came to an end. However, predicting the students’
maintenance outcomes using the data from Books 1 and 2,
one may project that the students would remember the
words and meanings from Book 3 for at least 4 weeks post-
instruction. At the same time, further data collection on
maintenance would be helpful to investigate if ISR with
word meaning lends to sustainable vocabulary knowledge.
Future researchers may want to collect maintenance data
at 6 and 8 weeks postintervention to see how the students’
new vocabulary knowledge changes over time.
Fourth, each book was used in multiple sessions
limiting our ability to determine if ISR with word mean-
ing instruction, repeated experiences with the book and
words, or the combination of both caused the change in
the students’ behavior. Future researchers may implement
ISR with word meaning instruction using a different book
for each session. Designing the study with many different
books may show if ISR with word meaning instruction
has the same or different effect on students’ vocabulary
knowledge. In addition, the social validity findings are
most likely biased. The teacher participant and primary
author had a working relationship, and it was impossible
for the teacher participant to answer the survey anony-
mously. In the future, researchers could collect social valid-
ity from the student participants or attempt to find a way
not to introduce bias.
Similar to previous studies (Trussell & Easterbrooks,
2014; Trussell et al., 2017), some student participants’
baseline data paths demonstrated variability. The teacher
participant was instructed not to give praise or reinforce-
ment on the basis of performance during assessment sessions,
and this may explain the variability. The student partici-
pants may not have been completely sure of their answers.
Without reinforcement, they responded inconsistently.
Implementing planned praise as part of the assessment
procedure (Gast & Ledford, 2014) may lead the students
to more consistent responding.
Conclusion
Previous ISR intervention studies (Trussell &
Easterbrooks, 2014; Trussell et al., 2017) have mentioned
that measuring only picture vocabulary labeling and not
vocabulary comprehension was a limitation to their stu-
dies. The current study aimed to address that limitation.
A functional relation was established between ISR with
word meaning instruction and the students’ ability to label
a picture and give a kid-friendly definition. In addition,
the student participants were able to maintain what they
learned and generalize the knowledge to different pic-
tures. ISR appears to be a dynamic instructional strategy
that can help TODHHs meet various goals in their class-
rooms (e.g., picture labeling or word definitions). Future re-
searchers may want to implement the strategy with larger
groups of children who are DHH and determine a more
authentic manner to measure vocabulary comprehension
in this population.
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