How do children with hearing loss progress in group flute lessons compared to their normally hearing peers? A preliminary study

Abstract

Music education for individuals with hearing loss has a long history, yet it is not comprehensively understood how children with hearing loss progress in mainstream instrumental music settings. The present study addressed this by assessing the progress of eight flute students, four with hearing loss who wore hearing aids and four with normal hearing, over 9 months of group lessons. Results showed that children with hearing loss achieved equivalent levels of musical skill to their peers with normal hearing when undertaking the same training. This suggests that children with hearing loss can participate in instrumental music lessons on the same basis as their typically hearing peers. Furthermore, they can do this by playing instruments that require careful attention to pitch and tone, such as the flute, rather than being limited to instruments of fixed pitch such as percussion or piano.

Keywords

music education hearing loss flute lessons hearing aid inter-rater reliability

Music education for individuals with hearing loss has a considerable history, as evidenced by the addition of music education to the curricula of Schools of the Deaf in the late nineteenth century (Hennessy, 1893; Redfield, 1927; Sheldon, 1997). Whilst early research focused on identifying effective methods for music instruction (Redfield, 1927; Wecker, 1939) research undertaken more recently has sought to identify the contributions of music education in improving general speech and language outcomes (Burns, 1965; Darrow, 1985) and contributing to the holistic development of the individual (Burdett, 2012; Jahns, 2001; May, 1961; Redfield, 1927; Walczyk, 1993).

One of the earliest documented examples of music education with a Deaf individual was published in 1848, when W.W. Turner presented the case of Augusta, a former pupil of the American Asylum for the Education of the Deaf and Dumb. Despite losing her hearing at 18 months and being educated in American Sign Language, Augusta expressed an interest in learning to play the piano (Turner & Bartlett, 1848). Turner openly reported his doubt of her ability, but was so surprised upon hearing her play that he wrote to her teacher, Professor D. E. Bartlett, seeking further information. This correspondence revealed that despite providing Augusta’s piano, her father had never intended for her to play it; the family friend who first started to teach Augusta had done so with significant doubt about her ability to progress, and Bartlett himself had taken Augusta on as a pupil harbouring reservations (Turner & Bartlett, 1848). Despite this, Augusta achieved skills well beyond anyone’s expectations, prompting educators of the Deaf to consider the possible benefits of music education for individuals with hearing loss and document teaching methods to help them progress (Turner & Bartlett, 1848).

Over the next 100 years, music education became more common in Schools for the Deaf (Hennessy, 1893; Redfield, 1927; Sheldon, 1997), with both the New York Institution for the Deaf and the Illinois School for the Deaf offering successful band programmes (Redfield, 1927; Sheldon, 1997). Experiments were also conducted to see if children with hearing loss could appreciate music and express themselves through music in similar ways to typically hearing children (Wecker, 1939). Reported teaching methods at this time linked music to marching, placing an emphasis on feeling rather than hearing (Redfield, 1927; Wecker, 1939), and alluded to the influence of varying degrees of hearing loss on instrument choice (Redfield, 1927). Findings revealed that children with hearing loss could clap the beat of amplified music, copy rhythmic patterns, and sing back various pitches (Wecker, 1939), while adolescents could play brass instruments in ensembles with great success when taught using appropriate methods (Redfield, 1927).

Whilst early research focused on the intrinsic outcomes of music education for children with hearing loss, such as the acquisition of musical skills, more recent research has investigated instrumental effects such as contributions to general speech and behavioural outcomes (Burns, 1965; Darrow, 1985). Music performance requires a combination of sensory (auditory, visual and tactile) and cognitive (top-down) processing skills, making it more than a solely auditory pursuit, and therefore accessible to individuals with hearing loss (Fulford et al., 2011; Gouge, 1990; Turner & Bartlett, 1848; Walczyk, 1993). Children with hearing loss are capable of feeling and reproducing rhythm (Jahns, 2001; May, 1961; Schraer-Joiner & Chen-Hafteck, 2009; Wecker, 1939), can learn to read music notation and perform successfully on instruments of fixed pitch such as percussion and piano (Comeau et al., 2017; May, 1961; Walczyk, 1993), and can attain similar levels of singing accuracy to their typically hearing peers (Yang et al., 2019). Young children actively engage in singing, demonstrate creativity, and show a desire to master musical skills (Chen-Hafteck & Schraer-Joiner, 2011; Schraer-Joiner, Chen-Hafteck, 2009). Importantly, musical participation provides enjoyment, a sense of achievement, and social connections with peers for children and young adults with hearing loss (Burdett, 2012; Jahns, 2001; May, 1961; Redfield, 1927; Walczyk, 1993).

Research investigating stakeholder perspectives (children and parents) reveals that children with hearing loss show similar levels of musical engagement and enjoyment to their normally hearing peers (Chen-Hafteck & Schraer-Joiner, 2011; Jorgensen & Walker, 2019; Looi et al., 2019). Parents do not view hearing loss as a contraindication to musical involvement (Looi et al., 2019), and children’s levels of musical training are not influenced by the degree of their hearing loss (Jorgensen & Walker, 2019). Interviews with students who have hearing loss reveal that musical participation is a positive experience, allowing them to gain a sense of musical enjoyment, accomplishment, and group membership from playing their instruments (Burdett, 2012).

Technology has been a key driver in developing music programmes for those with hearing loss. While Redfield (1927) described a programme reliant solely on the residual hearing of each student, Wecker (1939) referred to the use of a microphone attached to headphones, which allowed students to control the volume individually. Later, curriculum guides and other inclusive education resources discussed the use of hearing aids (Robbins & Robbins, 1980) and Frequency Modulation systems (Atterbury, 1990) in the music classroom. While the main aim of audiological intervention in children with hearing loss is to provide them with access to speech, hearing aid technology has now advanced to a point where it can also provide access to music (see Doherty et al., 2023 for a comprehensive review).

Despite the growth of research in this area, little is known concerning the musical development of children with hearing loss compared to their typically hearing peers. Studies have been conducted using instruments of fixed pitch, such as piano (Comeau et al., 2017; Walczyk, 1993), by assessing singing accuracy (Yang et al., 2019), and by observing preschool children’s levels of engagement in music lessons (Chen-Hafteck & Schraer-Joiner, 2011); however, research has not yet considered performance on instruments that require careful attention to tuning and tone, such as the flute. This preliminary study addresses these gaps in the literature by exploring how children with hearing loss, who wore hearing aids, progressed in group flute lessons compared to their normally hearing peers over the course of a school year.

Method

This article presents quantitative data collected as part of a larger exploratory mixed-methods preliminary study. This study was a joint venture between The University of Queensland and Hear and Say, a not-for-profit organisation that provides auditory-verbal therapy to children with hearing loss. This portion of the study aimed to investigate the benefits and challenges of music education for children with hearing loss by exploring the following research question through a post-positivist theoretical lens: How do children with hearing loss progress in flute lessons compared to their normally hearing peers?

Ethical approval was granted by The University of Queensland’s Human Research Ethics Committee (approval number 2017000998). This was then subsequently endorsed by Hear and Say’s own Research and Ethical Advisory Committee.

Participants

Two groups of children were recruited from a clinical research database via a Gatekeeper. The test group (n = 4) had hearing loss, wore bilateral hearing aids, and had participated in auditory-verbal therapy during their early childhood (age range 6.33–8.58 years, mean age 7.44). Details of their hearing losses and audiologic histories are provided in Table 1. The control group (n = 4) had normal hearing, no significant otologic history, and was recruited from a school hearing screen database (age range 7.25–8.17, mean age 7.71). The children in both groups attended local primary schools. Prior to the study, one child in the control group and two children in the test group had participated in 1 year of piano lessons. All other children had no previous musical training aside from weekly classroom music lessons at school.

Table 1.

Hearing History and Technology Summary for All Children with Hearing Loss.

Participant	Hearing status and history
HL1	Hearing Loss:	An essentially mild sensorineural hearing loss bilaterally
	Age at Diagnosis:	Approximately 12 months
	Hearing Aids:	Bilateral with FM (single boot, right ear)
HL2	Hearing Loss:	Right ear: Essentially a moderate rising to mild sensorineural hearing loss Left ear: A severe rising to moderately severe mixed hearing loss Ongoing fluctuation, particularly in left ear, as a result of middle ear dysfunction
	Age at Diagnosis:	Approximately 36 months
	Hearing Aids:	Bilateral with FM (bilateral boots)
HL3	Hearing Loss:	Right ear: Essentially a moderate to moderately severe sensorineural hearing loss Left ear: Essentially a mild to moderate sensorineural hearing loss
	Age at Diagnosis:	Soon after birth
	Hearing Aids:	Bilateral
HL4	Hearing Loss:	Symmetrical, mild to moderate, sensorineural hearing loss
	Age at Diagnosis:	Soon after birth
	Hearing Aids:	Bilateral with FM (single boot, alternating ears)

Flute lessons

The children in both the test and control groups participated in weekly group flute lessons during school terms for one school year. Lessons typically began with a warm-up activity and homework from the previous week. This was followed by a mix of pitch, rhythm and music reading activities, refinement of existing skills and repertoire, learning new skills, and incorporating new skills into new repertoire. Lessons concluded with the completion of student learning journals, and the cleaning and packing away of flutes.

Repertoire consisted of solos and duets that could be played with or without accompaniment. The students were all provided with CDs of their flute repertoire early in the year to assist with familiarisation and home practice. In order to focus on technique, the students were initially taught to play repertoire using stick notation and then progressed to reading full notation throughout the year.

Musical assessment protocols

Aural assessment

Prior to commencing their flute lessons, all participants underwent a basic assessment of their pitch and rhythm skills. Facing away from the examiner, each child was asked to clap the rhythm of a two-bar passage after hearing it clapped twice by the examiner (×5) and sing a short melodic phrase after hearing it played twice on the piano, assessing melody only (×5). These tasks were modified from the Australian Music Examinations Board (AMEB, 2002) Preliminary Syllabus. The same tasks were then repeated at the conclusion of flute tuition and recordings from both assessment points were assessed by three blinded examiners using set grading criteria. To remove the variable of singing, the children were also asked to listen to a set of intervals played melodically (×5) and state whether the second note was higher or lower than the first. These intervals ranged in size from minor seconds to major thirds. This assessment was also completed both before and after flute tuition. As the answers were dichotomous, it was graded by the researchers.

Flute performance assessment

At the conclusion of flute tuition both groups of children underwent a flute performance assessment to measure their progress in flute playing. Performance pieces were recorded during flute lessons, while scales and sight-reading were recorded individually. Each participant was asked to:

1. Perform three contrasting pieces:

Skip to my Lou (Cacavas, 1973)—unaccompanied

Elizabethan Song (North, 2013)—accompanied

Ah, Poor Bird (Bolkovac & Johnson, 1996, arranged by Author 1)—both unaccompanied and accompanied

2. Play C major, F major and G major scales, one octave from memory

3. Perform two simple sight-reading exercises

Stick notation

Standard notation

These were assessed by the same blinded examiners as the aural tasks, again using set grading criteria.

Validation of assessment materials

Measurement tools needed to be created for the quantitative measures in this study. We therefore used common examination formats from the AMEB (2017), the Associated Board of the Royal Schools of Music (ABRSM, 2017) and Trinity College London (2016) to template the content of the flute performance assessment.

Functional grading criteria were also required to give the blinded examiners a set framework for judging the achievements of each student. A seven-point grading system was adopted for this purpose because of its common use in universities throughout Australia. This makes it familiar to all Australian tertiary trained musicians, including potential examiners. Criteria were then adapted from the examination criteria provided by the ABRSM (2017).

Given that the grading criteria were adapted for this project, it was necessary to assess their validity before commencing the study. While we recognise that there are many elements in validation (Sireci, 2011), domain relevance and domain representation were considered paramount for this study. Because both domain relevance and domain representation can be established by asking the opinions of experts in the area (Sireci, 2011), this was achieved via an online survey of music teachers undertaken in January and February 2018. This established that both the assessment tasks and grading criteria were fit for purpose.

Data preparation and grading

The musical assessments were all recorded in MP3 format using an Oppo R9s Plus mobile phone. Once complete, these recordings were transferred to a desk top computer and edited as required using Audacity (version 2.1.2). Editing de-identified participants and removed any comments that might influence the examiners. This was done using cuts only. The edited files were then exported as 16-bit WAV files.

The de-identified recordings were provided to three blinded examiners on a USB flash drive, along with paper instructions and grading sheets. These examiners were all experienced flute specialists, with extensive resumés covering both performance and education. Examiners were blinded to both group and time of assessment. They were instructed to grade each recording against the criteria provided.

Data analysis

Given the limited sample sizes in this study, each child’s results were examined both individually and within their respective groups.

Single subject analyses

All data were initially mapped descriptively in Microsoft Excel. This process was based on average grades awarded by the three examiners and aimed to give an overall impression of the data and identify potentially significant elements.

The flute performance data were then analysed using Singlims_ES software (Crawford et al., 2010). Singlims_ES applies a classical significance test (two-tailed used) to compare the result of a single case to a control sample. It also provides a point and interval estimate of the abnormality of the case’s result, as well as a point estimate and 95% confidence interval of the effect size for the difference between the case’s score and the control sample (Crawford et al., 2010). These analyses were completed with each group acting as a control for the other. The results of the four children with normal hearing were combined into a control group and the individual results of each child with hearing loss were compared to that group control set one at a time. The groups were then swapped around and the individual results of each child with normal hearing were compared to the aggregated results of the group with hearing loss. These analyses were completed for both the overall results from each assessment task (e.g. scales or Elizabethan Song) and the overall grades awarded for individual performance elements such as tone and articulation, using means of the grades awarded by the three examiners.

Group comparisons

Group comparisons for the pitch and rhythm components of the aural assessment were conducted using repeated measures ANOVA in IBM SPSS Statistics (version 25, 64-bit edition for Windows). While these analyses were limited by the small sample size, ANOVA was preferable to non-parametric tests, as it improved the statistical power slightly by including all eight participants in each analysis, while also exploring main and interaction effects. This was deemed suitable, as these analyses were intended to provide objective support to descriptive observations rather than draw concrete inferences from the data.

Group comparisons for the flute performance assessments were completed using both independent sample t-tests and the Mann–Whitney U, allowing us to compare the output of both parametric and non-parametric measures. Unlike the single subject analyses, which were conducted solely on mean grades awarded by the three examiners, group comparisons were conducted using both the grades awarded by each individual examiner and their aggregated means. This allowed us to identify any discrepancies in grading between examiners that may have affected the overall results.

Inter-rater reliability

Inter-rater reliability between the three examiners was explored descriptively by looking at the overall results assigned by each examiner for each assessment item. Because these were overall results, it was not appropriate to expect absolute agreement between examiners. Instead, the percentage of times that all examiners’ aggregated results fell within 15% of the maximum grade for that assessment item was calculated, as this was the equivalent of approximately one nominal grade. These measures were then converted into an overall percentage of agreement within 15% to assess inter-rater reliability on a macro level.

As there were no precedents for these inter-rater reliability calculations, we adopted Landis and Koch’s (1977) concept of separating the results into 20% bands and then conservatively renamed some categories to produce the following degrees of agreeance:

0% to 20% = poor agreement

21% to 40% = slight agreement

41% to 60% = moderate agreement

61% to 80% = substantial agreement

81% to 100% = excellent agreement

These definitions were deemed suitable because they also align with the recommendations of Multon and Coleman (2018), who define good inter-rater reliability as a percentage agreement of 70% or more.

Results

Aural assessments

Individual results

Descriptively, the individual and group results from the aural assessment tasks showed similar patterns in performance across both groups. All children held relatively stable throughout the year in their performance on the pitch task. The group with normal hearing performed slightly better overall than the group with hearing loss, but individual results varied greatly across both groups (see Figure 1).

Figure 1.

(a) Results of the pitch task for each child before and after flute tuition. (b) Results of the rhythm task for each child before and after flute tuition. (c) Results of the melodic contour task for each child before and after flute tuition.

Both groups also demonstrated better rhythmic skills than they did pitch skills at both assessment points. Performance among both groups on the rhythm task also became more consistent throughout the year, as demonstrated by smaller standard deviations in the end-of-year assessment sessions. Despite some individual variation, the group with normal hearing again held relatively stable in their results on the rhythm task, while the group with hearing loss generally showed improvement in their skills over the course of flute tuition (see Figure 1).

Results for the melodic contour task revealed that half of the children with hearing loss and half of the children with normal hearing were already comfortable detecting and labelling melodic contour prior to commencing flute lessons. Of the four students who made errors at the beginning of the year, three (two with hearing loss and one with normal hearing) achieved perfect scores in their end-of-year assessment sessions, while one child with normal hearing held steady at 60% correct. One participant with normal hearing also showed a slight decline in their result throughout the year; however, this difference reflected an error on only one of the five tasks. Overall, the contour task showed that both groups performed at equivalent levels at the beginning of the year. At the end of the year, the group with hearing loss recognised and labelled melodic contour more consistently (see Figure 1).

Group analyses

Group comparisons for the aural assessments (pitch and rhythm) were conducted using repeated measures ANOVA. No significant main or interaction effects were detected for either the pitch or rhythm task. This result held regardless of whether the analysis was completed using the individual results awarded by each examiner, or an overall mean. This supported the descriptive results, which showed that, although one examiner marked a bit more conservatively than the others in the pitch task, the examiners were generally in agreeance with the trajectory of results and levels of performance between the beginning and end of the year.

Flute performance assessment

Single subject analyses

Analyses of the overall results in the flute performance assessment revealed that three children with hearing loss (HL2, HL3, and HL4) performed on par with the normally hearing control group, with no statistically significant differences noted in any individual assessment task or in their overall flute performance results (see Table 2).

Table 2.

Single Subject Statistics Comparing the Overall Flute Performance Results Across Both Groups Using Singlims_ES.

	Child	Child’s overall flute performance result	Control Sample			Significance test (2-tailed) on difference between case’s score and control sample
	Child	Child’s overall flute performance result	n	Mean	SD	t	p
Hearing loss group	HL1	154	4	121.33	11.86	2.46	.09
	HL2	107.33	4	121.33	11.86	−1.06	.37
	HL3	118.33	4	121.33	11.86	−0.23	.84
	HL4	125.33	4	121.33	11.86	0.30	.78
Normally hearing group	NH1	121.33	4	126.25	19.93	−0.22	.84
	NH2	136.33	4	126.25	19.93	0.45	.68
	NH3	107.33	4	126.25	19.93	−0.85	.46
	NH4	120.33	4	126.25	19.93	−0.27	.81

HL1’s results in her flute performance assessment revealed some differences in performance when compared to her typically hearing peers. Analyses revealed no significant differences for scales, sight-reading, Skip to my Lou, Elizabethan Song, or Ah, Poor Bird (unaccompanied) when compared to the normally hearing control group. However, HL1’s result for Ah, Poor Bird (accompanied) was significantly different to the results of the normally hearing control group (p = .05), with a grade that was 3.53 standard deviations higher than the control mean. When all of the individual assessments were combined to provide an overall result, the difference between HL1’s result and the normally hearing control group was not statistically significant (see Table 2).

When analysed by skill (tone, articulation etc.) HL2, HL3, and HL4’s results all showed that the skills they demonstrated in their flute performance pieces were on par with those of the normally hearing control group. No statistically significant differences were noted in the aggregated results for any of their individual skills.

HL1’s results revealed that her skills were generally on par with her typically hearing peers. However, analyses did reveal that her tone was significantly better than that of the normally hearing control group (p = .02), with a result that was 4.8 standard deviations higher than the control group mean.

When the individual results for each participant with normal hearing were compared to the group results of the participants with hearing loss, analyses revealed that they all performed on par with the group who had hearing loss in all measures.

Group analyses

Group results for the flute performance assessment were analysed using both the Mann-Whitney U test and independent samples t-tests. This revealed no significant differences in achievement between the hearing loss and normally hearing groups on any assessment item (e.g. scales and Elizabethan Song) in the end-of-year flute performance assessment (see Table 3). This result held regardless of whether the tests were conducted based on the grades awarded by each individual examiner or mean results across all three examiners. Analyses were also conducted on aggregated results for individual skills (tone, articulation, etc.), with these also revealing no significant differences between the hearing loss and normally hearing groups (see Table 3).

Table 3.

Mean Results For Each Group With the Results of Independent Samples t-tests and Mann–Whitney U Comparisons.

		HL group mean	NH group mean	Markedout of	IS t-testp	Mann–Whitney U p
Scales		13	13.5	21	.768	.886
Sight Reading		9.25	9.42	14	.891	1.000
Performance Pieces (by piece)	Skip to my Lou	27.59	23.17	42	.321	.343
	Elizabethan Song	25.5	28.75	42	.311	.343
	Ah Poor Bird (unacc)	25.58	23.67	42	.528	1.000
	Ah Poor Bird (acc)	25.33	22.83	42	.548	.886
Performance Pieces (by skill)	Tone	18.58	17.5	28	.522	.486
	Rhythm	17.25	16.83	28	.840	.886
	Pitch/Tuning	19.5	18.25	28	.486	.486
	Articulation	12.34	11.75	28	.825	1.000
	Expression	18.17	16.92	28	.556	.686
	Fluency	18.17	17.17	28	.636	.886
Flute Assessment Total		126.25	121.33	203	.686	.886

Practise and attendance data

All participants practised their flute playing at home throughout the year, however practice time varied significantly among participants. In Terms 1, 2, and 3, the typically hearing group practised more on average than their counterparts with hearing loss. This changed in Term 4, when practice increased significantly in the group with hearing loss.

Due to public holidays, the group with hearing loss had a total of 30 flute lessons scheduled over the course of the study, while the group with normal hearing had 32. Lesson attendance data revealed that all participants committed well to their flute lessons, attending between 81% and 97% of their scheduled lessons.

Inter-rater reliability

Inter-rater reliability between the examiners was assessed at both a micro and macro level. At a micro level, absolute agreement between examiners ranged from ‘slight’ to ‘substantial’. These rates improved when close agreement was assessed, ranging from ‘moderate’ to ‘excellent’.

Inter-rater reliability at a macro level was assessed by looking at the overall results assigned by each examiner for each assessment item and calculating the percentage of times that all three examiners aggregated results that fell within 15% of the maximum grade for that assessment item. Levels of inter-rater reliability at this level ranged from ‘slight’ to ‘excellent’ across the various assessment items. Although some differences in opinion were noted between examiners on individual assessment tasks, this averaged out when grades were combined into overall results, with the examiners showing 100% agreement within 15% of the total assessment grade for the overall flute performance assessment results.

Discussion

The results of this study show that children with hearing loss are capable of learning to play the flute and can progress at the same rate as their typically hearing peers when participating in group lessons. Group comparisons revealed no statistically significant differences between the groups for any assessment item, while single subject statistics only reached statistical significance for one child with hearing loss who outperformed her normally hearing peers in measures of tone quality, and in her performance of Ah Poor Bird (accompanied). The children in both groups also showed good levels of attendance and participated in home practise throughout the year.

Overall, this is in agreeance with the results of previous research, which shows that children with hearing loss exhibit high levels of engagement in music lessons and ensemble activities (Chen-Hafteck & Schraer-Joiner, 2011; Jorgensen & Walker, 2019; Redfield, 1927), and can acquire the same musical skills that would be expected in typically hearing populations (Burdett, 2012; Comeau et al., 2017; Redfield, 1927; Schraer-Joiner & Chen-Hafteck, 2009; Yang et al., 2019). However, the results of this study extend existing research by drawing direct comparisons between the skills of children with hearing loss and children with normal hearing while they learn to play the flute. This contrasts with previous research, which has focused predominantly on instruments of fixed pitch, such as piano (Comeau et al., 2017), more general early childhood musicianship training (Chen-Hafteck & Schraer-Joiner, 2011), and choir activities (Yang et al., 2019).

Flute playing places substantial demands on students’ coordination, proprioception and auditory skills, yet the students with hearing loss in this study showed that they could engage with their training on the same level as their typically hearing peers. This finding is significant. Traditionally, students with hearing loss have been directed towards instruments such as piano or percussion because their fixed nature allows them to be played effectively with less auditory input (Jahns, 2001; May, 1961; Turner & Bartlett, 1848; Walczyk, 1993). However, with modern hearing aid technology and inclusive teaching practices, such an approach is no longer the sole avenue for facilitating mainstream musical engagement for children who have hearing loss. This is not a new concept, just one that has lain dormant in the many decades since the highly acclaimed band programmes at the New York Institution for the Deaf and the Illinois School for the Deaf (Redfield, 1927; Sheldon, 1997). Students in those institutions played wind instruments with great success (Redfield, 1927; Sheldon, 1997) and gained significant enjoyment from their musical education (Redfield, 1927), suggesting that similar results to those observed in this study might have been possible for at least the past 90 years. This uncomfortable possibility is one that music educators should consider when addressing inclusion for children with hearing loss in musical training.

Further, the aural assessment results obtained by both groups showed no statistically significant differences between the children with hearing loss and their typically hearing peers. The children in both groups were stronger in their rhythm assessments than they were in their pitch assessments, with the rhythm tasks also yielding more consistent results across both groups. Significantly more individual variation was noted across both groups for the pitch tasks, with some children achieving consistently strong results and others finding the assessment challenging. However, when the variable of singing was removed, the group with hearing loss proved much more consistent in their ability to identify melodic contour at the end of the study than their normally hearing counterparts, with all students providing 100% correct responses.

Furthermore, despite the variation in performance, both within and between groups in the melodic contour and pitch tasks, all of the students ultimately performed at equivalent levels in their flute performance assessments. This questions the relationship between playing an instrument and the aural assessments routinely completed in music performance examinations (ABRSM, 2017; AMEB, 2017; Trinity College London, 2016) or used as tests of musical aptitude in school settings. Although some students in this study demonstrated difficulty with singing back melodic phrases or labelling melodic contour, that difficulty had little effect on their eventual flute performance ability when they experienced music in an applied context. All of the students in this study proved capable of learning and memorising scales, sight-reading in both stick and standard notation, and playing with piano accompaniment when they knew a piece well. This supports the idea that playing a musical instrument draws on a large variety of top-down and bottom-up skills from cognitive, motor, and sensory domains which interact differently based on the strengths and challenges of each individual and the task at hand (Fulford et al., 2011; Gouge, 1990; Turner & Bartlett, 1848; Walczyk, 1993). These children’s equivalent flute performance skills, regardless of aural assessment results or hearing status, demonstrate that there are many ways to engage with music and attain musical achievement. Further, they suggest that the ability to develop performance skills does not necessarily rely on high level aural abilities as measured by the basic assessments included in practical performance examinations or used in educational settings to predict musical aptitude. Instead, the results of this study suggest that personal motivation, cognitive understanding, encouragement from parents and teachers, and regular practice are capable of managing any ‘gaps’ in such skills, at least in the short term while those skills are developed.

The practice and attendance data from this study also highlights the importance of parental support in early musical development, regardless of hearing status. The parents of all children in this study showed significant commitment to their children’s flute lessons throughout the year by facilitating their attendance and supporting home practice. Consistent with the literature, degrees of home practice varied both between children and throughout the year but still remained a crucial element in each child’s musical development (Creech, 2010; Davidson et al., 1996; Hallam, 2011; McPherson & Davidson, 2002; McPherson & Renwick, 2001; Upitis et al., 2017). This was expected as parent support of both practice routines and methods is crucial in helping students use their practice time effectively to maximise progress (Creech, 2010; Davidson et al., 1996; McPherson & Davidson, 2002; McPherson & Renwick, 2001).

Finally, descriptive inter-rater reliability between the three blinded examiners who marked the assessment items in this study was good overall. Calculations on overall results revealed 100% agreement within 15% of the maximum possible result (the equivalent of approximately one nominal grade). This suggests that any variation between examiners on individual assessment tasks evened out when the tasks were combined into an overall measure of achievement. The group statistical comparisons further support this, showing the same results regardless of whether they were conducted based on the results assigned by each individual examiner, or aggregated means.

Conclusions and future directions

Overall, the results of this study suggest that children with hearing loss who wear hearing aids and attend mainstream schools are capable of learning to play the flute and can achieve the same performance standards in their first year of lessons as their typically hearing peers. Furthermore, all of the children in this study, regardless of hearing status or aural skills, were capable of learning to play the flute and developing musical understanding, suggesting that musical aptitude testing should not exclude any child from instrumental music lessons if that child is motivated to participate.

We recognise that this preliminary study was limited by small sample sizes, which required novel statistical methods to manage. It also focused specifically on children who were (re)habilitated using auditory-verbal therapy and used hearing aids to support their communication. Future research should aim to recruit larger sample sizes and include children with a range of device types who have experienced different (re)habilitation and use more varied communication styles (e.g. Auslan/BSL/ASL, in addition to spoken language). Future research may also include children with additional disabilities and consider tuition on a larger range of instruments, or using a larger range of musical training paradigms.

Supplemental Material

sj-pdf-1-pom-10.1177_03057356251325450 – Supplemental material for How do children with hearing loss progress in group flute lessons compared to their normally hearing peers? A preliminary study

Supplemental material, sj-pdf-1-pom-10.1177_03057356251325450 for How do children with hearing loss progress in group flute lessons compared to their normally hearing peers? A preliminary study by Eloise C Doherty, Margaret S Barrett and Wayne J Wilson in Psychology of Music

Footnotes

Acknowledgements

We gratefully acknowledge the children who participated in this study and their families. The time and effort they put into this project was substantial, and they were incredibly generous in all they shared. Thanks also goes to the staff at Hear and Say for their sustained support over the duration of the project.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by an Australian Government Research Training Program Scholarship. Significant in-kind funding in the form of teaching and research space was also provided by Hear and Say.

ORCID iDs

Eloise C Doherty

Margaret S Barrett

Wayne J Wilson

Supplemental material

Supplemental material for this article is available online.

References

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