Rapidly reading words on a page is a process most of us take for granted. When we were youngsters, we progressed from speaking our native language to reading and writing with relative ease. Yet, for some individuals, school entry marks the beginning of a long struggle in learning to read during which the ability to efficiently decode or "sound out" words in print is never really mastered.
Many interventions for children with reading disorder have been developed over the years, but one intervention that has attracted much recent attention is phonological awareness. Speech-language pathologists working with preschool and school-aged children are embracing phonological awareness intervention with enthusiasm. It holds the promise of significantly improving reading performance in children with reading disorder and promoting a smoother path to successful literacy acquisition for many young children at risk for reading failure.
Amidst the excitement of integrating phonological awareness into our clinical practices, it is important to take time to reflect upon the types of activities we include under the umbrella of phonological awareness and methods that may increase its effectiveness. Research demonstrating its benefits for children with spoken-language impairment provides clear directions for practice.
Phonological awareness—the explicit understanding of a word's sound structure—is critical for the efficient decoding of printed words and the ability to form connections between sounds and letters when spelling. The term "phonological awareness" began appearing in the research literature in the late 1970s and early 1980s. Rapid and remarkable growth during the 1990s in research demonstrating the importance of phonological awareness to the reading process has led to the wide adoption of the term in education and speech-language pathology clinical practices.
Phonological awareness is a multi-level skill and reflects how words can be broken down into smaller units in differing ways. Tasks that require children to segment words into syllables, (syllable-level tasks), identify or produce rhyming words (rhyme-level tasks), identify individual sounds in words, blend sounds to make words, or segment words into their individual sounds (phoneme-level tasks) are all examples of skills that are encompassed under phonological awareness. Measures of phonological awareness, particularly at the phoneme level, are powerful predictors of reading success and can predict early literacy performance more accurately than variables such as intelligence scores, vocabulary knowledge, and socioeconomic status.
My own strong interest in phonological awareness intervention was fuelled through witnessing the written-language difficulties that many children with speech and language impairment encounter. First as a clinician working with children in the schools and then as a researcher in a department of speech and language therapy, I have frequently observed the struggle of many of these children in learning to read. I noticed that some children I treated at 4 and 5 years of age reappeared on my assessment caseload at an older age due to poor written-language performance.
Research supports these clinical observations. Indeed, children with a history of speech-language impairment are 4–5 times more likely to have reading difficulties than children from the general population (see Catts et al.). These difficulties tend to be persistent in nature and not readily resolved by classroom instruction. Specific interventions are therefore needed to help many children with spoken-language impairment acquire efficient and fluent reading skills.
The SLP's Role
Speech-language pathology education and clinical experience develop expertise in normal and disordered phonological development that place SLPs in a unique position within the educational team. We have a knowledge base related to the structure of the speech-sound system, including how it develops, how it relates to orthographic symbols, and how awareness of it can be promoted. This knowledge, coupled with the fact that many of the young children we treat are at high risk for literacy problems, makes it vital that clinicians foster the skills necessary for the development of written language as well as spoken language in intervention programs.
Major advancements in defining SLPs' role in literacy development have been made in recent years. American and British associations of speech-language pathology, in particular, have clearly defined the critical role of SLPs in the prevention and treatment of written-language disorder. To indicate international support for the strong movement in literacy that ASHA has established, consider this statement in the British Speech Therapists' Professional Standards of Practice:
When providing therapy to children with spoken language disorder, the speech-language therapist will consider pre requisite written language skills and actual written language skills as part of the overall intervention programme. The discharge of a child who is speaking but not reading or writing or showing the pre requisite skills appropriate to age, cannot be seen as a successful discharge. (Communicating Quality-2, Royal College of Speech and Language Therapists, 1996, p. 192.)
The importance of treating underlying deficits for written-language development is highlighted in a longitudinal study. Stothard and colleagues indicated that children whose spoken-language difficulties were resolved by age 51/2 at a surface level (e.g., their speech-production difficulties were resolved, and they were therefore discharged from treatment) were found to have reading difficulties at age 15. It may be speculated that early speech-language intervention that included programs to build underlying skills for literacy (such as phonological awareness) may have prevented the persistent academic difficulties experienced by these adolescents.
Types of Activities
Attention has increasingly focused on the type of phonological awareness activities that should be included in interventions for children with speech and language impairment. Interventions employed by SLPs to resolve speech-error patterns or to improve oral-language skills frequently involve some level of phonological awareness or meta-linguistic knowledge.
For example, in treating children with speech difficulties, we may draw attention to sounds at the beginning, middle, or end position in words. We may ask children to listen carefully to an array of words that all start with the same sound, and rhymes are frequently introduced into intervention as practice for speech sounds in connected speech. Awareness of correct grammatical sentences and vocabulary are also important for reading development, and many clinical programs aimed at developing oral semantic and syntactic skills develop children's awareness of grammatically correct and semantically plausible sentences.
These types of indirect phonological awareness and meta-linguistic activities do not appear to be sufficient to have a significant impact on written-language development. Most studies that have reported poor phonological awareness and reading development in children with spoken-language impairment have included participants that have received lengthy and frequently intensive periods of speech-language pathology. Two factors may account for this finding: The nature and severity of children's spoken-language impairment may prevent the development of age-appropriate written-language skills; or the type of intervention provided, although effective in improving spoken language, is ineffective in developing underlying skills crucial for written language.
Recent research provides support for the second argument. The Gillon (2000) study suggested that speech and language treatment for children aged 51/2 –71/2 years that did not include intensive training in phonological awareness had little impact on enhancing early written-language development. Children who received this control treatment made significant improvements in speech production, but made remarkably little progress in their phonological awareness and written-language development over time (Gillon, 2002).
In sharp contrast, children with severe expressive phonological impairment and severe phonological awareness deficits responded quickly to an integrated phonological awareness intervention implemented by an SLP. Children who received this intervention showed significant gains in speech production, phonological awareness, reading, and spelling development. The majority of the children were reading at or above the expected level for their age 11 months post intervention.
Factors to Consider
SLPs need to pay careful attention to the clinical aspects of phonological awareness interventions included in research studies to ascertain what factors contribute to their success for children with spoken-language impairment. They should consider the following factors:
Type of Instruction
There are a wide variety of activities that may be included under the heading of phonological awareness, including commercial products specifically designed to enhance children's awareness of a word's sound structure. Clinicians need to consider carefully their choice of intervention activities.
Results from research studies support the value of focusing on phoneme-level activities and integrating speech-to-print tasks such as teaching the relationship between sound in words and letters in words with letter blocks. The results question the value of spending too much time on rhyme- and syllable-level activities for school-aged children, since skills at these levels may develop without intensive intervention. Syllable and rhyme knowledge may develop as a result of improving speech production or in response to general classroom instruction that includes rhyme activities. However, for children with spoken-language impairment who also have significant reading delay, skills at the phoneme level only appear to develop in response to specific intervention. Such intervention should include activities that require children to blend speech sounds together to form words and to segment words into their individual sounds.
The recent comprehensive meta-analysis of phonological awareness intervention by the American National Reading Panel (Ehri et al.) provided a range of excellent recommendations for clinical practice. However, caution in interpreting a few of these recommendations for children with spoken-language impairment may be necessary.
The report suggested that clinicians should provide instruction in phonological awareness for one phoneme skill at a time and work until mastery of this skill is achieved before introducing a new target. Very few studies in the National Reading Panel's analysis comprised children from clinical populations such as those with diagnosed speech and language disorders, and none of the studies included children with significant expressive phonological impairment. We know that, in treating children with severe speech disorder (of a linguistic nature), a phoneme-by-phoneme approach teaching to 90% mastery is an inefficient method. Rather, multiple phoneme approaches and cyclic approaches that do not rely on skill mastery of one phoneme before introducing new phoneme targets are more effective. Similarly, integrated approaches to phonological awareness intervention that involve a variety of phoneme-awareness-level tasks, articulation tasks, and letter-sound knowledge tasks may be both efficient and effective for children with spoken-language impairment who have a severe phonological awareness deficit.
Length of Training
A second finding from the National Reading Panel's analysis that should be interpreted cautiously in relation to children with spoken-language impairment is the recommended length of training time. The panel's meta-analysis suggested that as few as five hours of phoneme awareness training will have significant effects on reading, but the authors cautioned that individual abilities must be considered. This caution may be particularly valid for children with spoken-language impairment. Intervention that has shown transfer effect to the reading and spelling process for children with spoken-language impairment consisted of 20 hours of treatment administered in a relatively intensive manner (i.e., two one-hour individual sessions weekly with an SLP). Less intensive models of intervention or the use of teacher aides in program implementation may not produce the same results. Research is needed to investigate the efficiency of alternative models of service delivery specifically for children with spoken-language impairment.
Participants in research studies who have shown benefits from phonological awareness instruction have typically also received class programs that provided a language-rich environment to foster reading and spelling development. This may have helped the children consolidate and transfer their newly acquired skills to the reading and writing process through, for example, class language activities that promoted "invented spelling." It is important, therefore, for clinicians to consider phonological awareness intervention as one part of a much wider language program and work closely with teachers and reading specialists to ensure transfer of phoneme awareness knowledge to reading and spelling tasks.
Benefits from phonological awareness interventions have been demonstrated for children with differing types of spoken-language impairment. Preschool and school-aged children described as having a specific-language impairment, 3–5-year-old children with speech disorder, and school-aged children whose spoken-language impairment primarily involved expressive phonological difficulties have responded positively to phonological awareness intervention. Clinicians should be cautious in expecting similar results for children with other types of communication impairment (e.g., language comprehension difficulties resulting from traumatic brain injury).
Failure to Transfer Skills to the Reading Process
Not every child with spoken-language impairment who receives phonological awareness intervention becomes a successful reader. Research studies involving children at risk and children with spoken-language impairment frequently report that a small percentage failed to demonstrate the same positive transfer effects to reading that most children in the study demonstrated. Research has established methods for identifying children who may be most in need of phonological awareness training, but as yet has not established reliable predictors for the successful outcome of this intervention for children with spoken-language impairment. We need to be cautious, therefore, in our comments to teachers and parents regarding the potential of phonological awareness to prevent reading disorder for all children. Further research is needed to more fully understand the children for whom phonological awareness intervention is not effective in enhancing reading development.
Method of Analysis
It is important that SLPs choose appropriate methods of assessment and analysis to evaluate the effectiveness of phonological awareness intervention. For example, this intervention can also have a significant impact on improving children's early spelling development. A child who progresses from spelling the target word teeth as a single unrelated letter b, to spelling teeth as teth, in response to phonological awareness intervention, demonstrates improved performance. The attempt, however, is still incorrect, and simply scoring the response at a whole-word level will mask significant improvement in spelling development. Qualitative analysis, such as scoring the number of correct matches between sounds and letters in the word, will indicate the progress made in the child's spelling performance.
Professional Development Needs
The education that SLPs receive in speech and language acquisition and disorders provides an excellent basis for understanding phonological awareness. The wider perspective of speech and language development is crucial in realizing that phonological awareness is but one aspect of spoken language that is necessary for successful written-language development. In considering the broader picture of reading comprehension and writing, SLPs' knowledge of semantic, syntactic, morphological, and narrative spoken-language development is indeed valuable in assessment and intervention practices for written-language disorders.
However, in order to appropriately evaluate a child's phonological awareness development and plan well-structured interventions, SLPs must have the necessary theoretical background knowledge of the scientific research literature relevant to phonological awareness. Professional education programs in speech-language pathology and development courses for clinicians need to consider such topics as theoretical models of word recognition and spelling development. An appreciation of these models will help ensure that clinicians more fully understand how phonological awareness facilitates the process of reading and writing.
The ultimate goal of any phonological awareness intervention is not to improve a child's ability to identify sounds in words or to be successful at completing spoonerisms, but to enhance a child's literacy development. Understanding the manner in which explicit knowledge of the sound structure of a word can help a child decode a word efficiently, which in turn can help a child comprehend written text, will ensure that meaningful outcomes of phonological awareness interventions are achieved.
Essential to the assessment and intervention of any area of disordered language is detailed knowledge of what is considered to be typical development in children. Thus, SLPs must have knowledge of when and how children acquire phonological awareness skills and understand what factors contribute to this development. Consideration also needs to be given to understanding the development of phonological awareness in languages other than English and the effects of the language-learning environment on phonological awareness.
Knowledge of phonological awareness development in children with differing language-learning needs is also essential. Exciting developments in understanding and enhancing phonological awareness in children who are blind and using Braille as their reading medium, children with severe speech and physical impairments who use alternative communication systems, children with severe hearing loss, and children with Down syndrome are being reported in the literature. Knowledge of these developments will assist clinicians in modifying phonological awareness assessment and intervention strategies for their clients' differing learning needs.
Phonological awareness intervention is a new area of practice for many SLPs since clinical research studies directly involving children with speech-language impairments have only been published in recent years. Scientific disciplines such as speech-language pathology demand a research basis for intervention practices, and it is not surprising, therefore, that some issues related to the provision of phonological awareness intervention for children with spoken-language impairment still need to be addressed. Further research and attention to content development in professional educational programs will ensure that clinicians develop the expertise in phonological awareness that has the potential to make a significant difference in the lives of many young children.