Wednesday, December 14, 2011

Teaching Phoneme Awareness to Pre-literate Children with Speech Disorder: A Randomized Controlled Trial

Hesketh, A., Dima, E., and Nelson, V. (2007). Teaching phoneme awareness to pre-literate children with speech disorder: a randomized controlled trial.  International Journal of Language & Communication Disorders, 42(3), 251-271.
Role of phonological awareness in speech change is not understood.  Speech and language therapy often necessitate tasks that require an awareness of phonemes. Preschool children, largely preliterate, often have little PA and are therefore, are unable to segment or manipulate phonemes.

This study investigates the possibility of teaching PA skills to preliterate children with speech disorder.  Forty-two children (randomized controlled design) with speech disorders ages 4-4.5 years were placed in a PA or a language stimulation intervention.  Assessments measured alliteration awareness, phoneme isolation, word segmentation and phoneme addition or deletion (pre and posttests).

Results: more children improved in the PA group than the language stimulation group on three of four measures. On the two most advanced tasks, segmentation and manipulation, only a few children showed improvement. Phoneme isolation was significant for a majority of the children in the phonological awareness group.

Conclusions: Phoneme isolation is the most easily learned skill and appears relevant to speech and language therapy. Phoneme addition and deletion  and word segmentation were attainable only by a few older and more cognitively developed children. Isolation of initial consonants can be triggered at 4-4.5 years though meaningful activities, but phoneme manipulation tasks were beyond the cognitive ability of most pre-literate children.

As a group, children with speech disorders perform worse than their peers on PA tasks. Uncertainty remains re: its role in speech therapy and also its relationship to lexical phonological representations. Wood and Terrell (1998) found evidence for developing PA in preliterate children without intervention. 25% of participants (ages 3yr 10m - 4yr 11 m) could perform complex PA tasks including deletion. Hulme (2005) found that children (mean age 4 y 11 m) could segment initial and final phonemes from syllables despite no knowledge of letter-sound correspondence, but the ability was more noted in older children,; however, some typically developing children demonstrate PA before the age of 5 without literacy experiences.

Warrick et al, (1993) found that some children with speech and language disorders could develop PA before the age of 5. Laing and Espeland (2005) found evidence that instruction improved initial phoneme matching among 4 yr olds and Gillon (2005) provided instruction for children with speech disorders aged 3-5, noting improvement in phoneme matching beyond the level of typically developing peers in a control group. Treated children could not segment; however, they did well with phoneme isolation of the first sound in words.

Program: children in both groups had 20 min x 30 sessions, 2-3 times weekly with a researcher, resulting in approximately 10 weeks of intervention, carried out at home or school per parent choice. Children in the PA group began with syllable and rhyme awareness (clapping, blending, segmenting, completing, judging, matching) moving on to PA (consonants and picture links, initial sounds, final sounds, vowel sounds with picture links, identifying initial and final clusters).  The language stimulation program focused on listening comprehension, print awareness, expressing feelings, developing vocabulary and concept knowledge like days of week, seasons, transportation, etc.

Significance of outcomes based on comparing pre and posttests for improvement in alliteration awareness, isolation of phoneme, and segmentation tasks as well as improvement above chance for phoneme add/del, since participants were all at chance levels before the intervention.

Gillon (2005) found that children with speech disorders receiving intervention later developed phoneme and letter awareness at the same rate as typically developing children.

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