Making Grammar Visible: Strategies for Teaching English Grammar to Children with Hearing Loss

As an SLP working with children who use cochlear implants, hearing aids, and BAHA devices in an Auditory-Oral program, I have an excellent opportunity to integrate grammar instruction with auditory skill development, vocabulary building, speech production, and reading comprehension.

One important consideration: Children who are deaf or hard of hearing often hear the main words in a sentence but miss the small grammatical elements that change its meaning. These include articles, auxiliary verbs, pronouns, prepositions, and word endings.

For example:

• The boy is running.
• The boy was running.
• The boys are running.

These sentences sound similar, but their grammatical differences carry important information.

Here is how I would organize grammar instruction in my speech therapy program.

1. Teach grammar in a developmental sequence

I would divide the grammar curriculum into six levels. Students should progress according to their individual language abilities rather than their chronological age or grade.

Level	Grammar concept	Examples
1. Basic sentences	Subject + verb + object	The girl eats an apple.
2. Pronouns	He, she, they, it, his, her	She is reading.
3. Verbs and tenses	Present, past, future	He plays. He played. He will play.
4. Grammatical markers	Articles, plurals, possessives	A dog, two dogs, the dog's ball.
5. Sentence expansion	Adjectives, adverbs, prepositions	The little boy runs quickly.
6. Complex sentences	Conjunctions and clauses	I stayed inside because it was raining.

I would also introduce questions and negative sentences throughout the curriculum.

2. Use visual grammar instruction

This is one strategy I would prioritize for my students. Children with hearing loss may have difficulty detecting short, unstressed grammatical words through listening alone. Instead of simply explaining grammar verbally, make grammar visible!

A. Color-coded sentence building

Assign a consistent color to each grammatical component. For example:

Grammar component	Color	Example
Who? (Subject)	Blue	The boy
Does what? (Verb)	Red	is eating
What? (Object)	Green	an apple
Where?	Orange	in the kitchen
When?	Purple	in the morning

Start with three visual cards:

🔵 THE BOY + 🔴 IS EATING + 🟢 AN APPLE

Then gradually expand:

🔵 THE BOY + 🔴 IS EATING + 🟢 AN APPLE + 🟠 IN THE KITCHEN.

Have students:

1. Look at the picture.
2. Identify who is in the picture.
3. Identify what the person is doing.
4. Select the appropriate words.
5. Arrange the cards.
6. Read the completed sentence.
7. Repeat the sentence while listening to their own production.

This activity addresses grammar, auditory memory, vocabulary, sequencing, and sentence formulation simultaneously.

3. Teach one grammatical concept at a time

I would avoid introducing too many grammatical rules during one session.

Instead, select one target and provide repeated exposure.

Here are the concepts I would prioritize.

A. Articles: A, AN, THE

Teach:

• A dog.
• An apple.
• The dog is sleeping.
• The apple is red.

Activities:

• Choose between A and AN.
• Complete sentences.
• Describe pictures.
• Identify the correct sentence.
• Listen and point to the correct picture.

For older students, explain that we use “a/an” when introducing something singular and nonspecific, and “the” when referring to something specific or already known.

B. Pronouns: HE, SHE, THEY, IT

4. Teach pronouns using pictures of people performing familiar activities.

Examples:

• He is reading.
• She is riding a bicycle.
• They are playing soccer.
• It is sleeping.

Activities:

• Match the pronoun to the picture.
• Replace the noun with a pronoun.
• Complete sentences.
• Describe what people are doing.

An important step is teaching students to understand that pronouns replace nouns. For example:

The girl is running.

She is running.

C. Verb tenses: PRESENT, PAST, FUTURE

  

6. Use a visual timeline.

Yesterday	Today	Tomorrow
PLAYED	PLAYING / PLAYS	WILL PLAY
WALKED	WALKS	WILL WALK
JUMPED	JUMPS	WILL JUMP

Activities:

• What did you do yesterday?
• What are you doing today?
• What will you do tomorrow?

Teach regular and irregular past tense separately.

Examples:

Regular:

• Walk → walked
• Jump → jumped
• Play → played

Irregular:

• Go → went
• Eat → ate
• See → saw
• Run → ran

Important for DHH students: Make verb endings audible and visible. Emphasize the grammatical ending without exaggerating speech unnaturally. For example:

WALK → WALKED

Show the written words, highlight the ending, and provide opportunities for auditory discrimination.

D. Plurals and possessives

Teach:

• One cat / two cats.
• One book / three books.
• The boy's backpack.
• The girl's shoes.

Activities:

• Sort singular and plural pictures.
• Add the missing ending.
• Identify whether the sentence refers to one or more objects.
• Describe pictures using complete sentences.

Pay particular attention to the /s/, /z/, and /ɪz/ plural endings because they can be difficult for children with hearing loss to perceive and produce.

E. Prepositions

 

7. Teach spatial relationships using real objects.

Prioritize:

• In
• On
• Under
• Behind
• In front of
• Between
• Next to

Have students manipulate objects and describe their positions. For example:

"The teddy bear is under the table."

Then ask the student to follow an auditory direction:

"Put the teddy bear behind the chair."

This combines receptive language, auditory comprehension, and expressive grammar.

4. Use sentence expansion techniques

This is particularly useful for students who speak in short sentences.

Start with the child's spontaneous production and gradually expand it. For example:

Student: "Dog running."

SLP: "The dog is running."

Student: "The dog is running."

SLP: "The big dog is running."

SLP: "The big dog is running in the park."

You can use three levels:

Level	Sentence
Beginning	Dog runs.
Intermediate	The dog is running.
Advanced	The brown dog is running in the park.

Use expansions and grammatical recasts rather than correcting every error directly. For example:

Student: "He go school."

SLP: "Yes! He goes to school."

This provides a correct grammatical model without interrupting communication.

5. Incorporate grammar into auditory training

This is where your grammar program becomes particularly valuable for children with hearing aids and cochlear implants. Grammar instruction should not be exclusively visual or exclusively auditory.

I recommend a combination of:

Listen → Identify → Understand → Repeat → Produce → Generalize.

For example, when teaching present progressive:

1. Show a picture of a girl eating.
2. Say: "The girl is eating."
3. Ask the student to identify the person.
4. Ask: "What is she doing?"
5. Present two sentences:
• The girl is eating.
• The girl is sleeping.
6. Ask the student to identify the sentence they heard.
7. Have the student formulate their own sentence.
8. Remove the picture and see whether the student can understand the sentence through listening alone, when appropriate for their auditory access.

Remember to check hearing technology, HAT/FM access, background noise, and the student's ability to perceive the specific grammatical markers being targeted.

6. Use books to teach grammar

I particularly recommend repeated reading of picture books. Choose a book with predictable sentence structures and many opportunities to practice the same grammatical concept. For example, when teaching past tense:

Read a story and identify actions:

• The boy walked.
• The girl jumped.
• The dog played.
• The baby slept.

During the first reading, emphasize comprehension.

During the second reading, emphasize verbs.

During the third reading, encourage students to formulate sentences independently.

You can also create your own grammar books using simple illustrations and repetitive sentence patterns. Research supports combining repeated storybook reading with structured instruction for teaching vocabulary and morphosyntax to children who are DHH.

7. My recommended structure for a 30-minute grammar session

I would organize individual or small-group sessions as follows:

Time	Activity	Purpose
3 minutes	Auditory warm-up	Listen for target grammatical words.
5 minutes	Introduce grammar concept	Explain using pictures and examples.
7 minutes	Visual sentence building	Arrange words into grammatically correct sentences.
5 minutes	Listening activity	Identify differences between sentences.
7 minutes	Expressive language	Describe pictures or formulate sentences.
3 minutes	Generalization	Use the target grammar in conversation.

For students who need more support, provide sentence frames, picture choices, and verbal models. Gradually fade these supports.

8. How I would differentiate instruction

I would develop three levels of grammar activities.

Level	Student profile	Instructional approach
Beginner	Uses single words or short phrases	Picture matching, sentence frames, basic subject + verb combinations.
Intermediate	Uses simple sentences but omits grammatical markers	Explicit grammar instruction, color-coded sentences, verb tense practice, expansions.
Advanced	Uses sentences but struggles with complex grammar	Conjunctions, irregular verbs, complex sentences, narratives, and grammatical self-correction.

For multilingual students, particularly those whose home language is Spanish, remember that grammatical structures do not always correspond directly between English and Spanish. Consider the student's language exposure and language-specific differences before identifying an error as a disorder.

9. Resources I recommend for your professional practice

These are particularly relevant to your population:

-> 1. ASHA – Language and Communication of Deaf and Hard of Hearing Children

Provides guidance on language development, communication approaches, and individual differences among children with hearing loss.

->2. ASHA – Spoken Language Disorders

Provides practical intervention approaches for morphology, syntax, sentence formulation, and language development in school-age children.

->3. Research published in 2025: Language Interventions for School-Aged Children Who Are d/Deaf and Hard of Hearing

A particularly interesting systematic review and meta-analysis. It included 14 studies involving 794 children. The researchers found positive intervention effects, including a substantial effect on morphosyntactic knowledge.

10. My biggest recommendation: Create your own DHH Grammar Curriculum

Rather than using conventional grammar worksheets designed for hearing children, I would create a visual and auditory grammar curriculum specifically designed for elementary-school children with hearing loss. I envision a printable workbook organized into the following units:

Unit	Grammar workbook content
1	Building Basic Sentences
2	Nouns and Pronouns
3	Action Words and Verb Tenses
4	Is / Are / Was / Were
5	Articles: A / An / The
6	Singular and Plural Nouns
7	Possessive Nouns
8	Prepositions
9	Adjectives and Adverbs
10	Questions and Negatives
11	Conjunctions: And / But / Because
12	Sentence Expansion and Storytelling

Each lesson could include:

• Colorful illustrations.
• Simple explanations of grammatical rules.
• Visual sentence-building cards.
• Auditory discrimination exercises.
• Listening comprehension activities.
• Fill-in-the-blank exercises.
• Sentence formulation activities.
• Opportunities for spontaneous speech.
• Short progress-monitoring activities.

I would also include a special feature for my students with cochlear implants and hearing aids: auditory listening activities that contrast grammatical endings and short function words.

This would make the workbook more than a traditional grammar book. It would become a combined grammar, listening, and spoken-language intervention resource.