Summary        Sommaire        Text in French
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Phonological Awareness Training as an Indirect Therapy

for Phonological Disorders

 

Angela Hurd & Diana McQueen
University of Central England, Birmingham
Speech and Language Therapy Department
Glebefields Health Centre St Mark's Road
TIPTON
West Midlands
DY4 OUB
Tel. 0121 557 9681
Fax. 0121 557 0661

Sandwell, the area in which the study took place, is a typical inner city borough with attendant difficulties related to socioeconomics, education and health.

Statutory annual assessments in key curricular areas produce league tables which compare achievements in all schools in England and Wales. As an aside, the validity of such comparisons is questionable given the diversity of catchment areas for schools across the country. However, Sandwell’s almost permanent position at the bottom of the league tables, still gives cause for concern. Thus there was an ever increasing need to tackle the problem.

Given that many studies eg: Bradley and Bryant (1983) have shown that there is a link between Phonological Awareness and later literacy development, a programme to teach phonological awareness skills to children aged 3yrs:3m to 4yrs:2m was developed.

However, as practising Speech and Language Therapists, the focus of our interest was the children in the phonological awareness programme who had speech output problems.

The numbers of children presenting with speech output problems meant that resources were constantly stretched. There has been an ever increasing pressure to treat such children in groups so that larger numbers could be seen. Due to the high number of children on individual therapists’ case loads, some children were considered a very low priority. However, in the eyes of their nursery school teachers, they were in need of therapy and considered to be difficult to understand both by the staff and other children.

Looking at the literature, Webster and Plante (1992) concluded that "phonological awareness ability was associated with primary (overt) phonological ability" . They subsequently studied additional children with speech output difficulties and found that the phonologically impaired children as diagnosed by the Goldman – Fristoe Test of Articulation (1986) had concomitant deficits in phonological awareness". This led us to question whether working on phonological awareness could help us tackle output phonology difficulties.

Given that there did seem to be a link between phonological awareness and speech production, teachers in six nurseries were asked to identify those children they considered to be ‘unintelligible’. The definition was left to their own interpretation. From 160 children and six nurseries, 58 children were identified. All the children were assessed using the Edinburgh Articulation Test (Anthony, Bugle, Ingram 1971). This is a standardised assessment which provides a standard score and age equivalent of a child’s articulation at a single word level.

The Edinburgh Articulation Test allowed us to eliminate children who were within normal limits, according to their standard score, from the study.

24 children were found to have speech output problems.

34 were actually within normal limits. Of the trial 24 children, 12 were from the experimental nurseries and 12 from the control group nurseries. All were mono-lingual English speakers.

All the children were also assessed using the phonological awareness assessment (devised for the study). This consisted of a series of picture-based tests looking at a range of phonological awareness components (eg: rhyming, onsets and syllable awareness).

The children in the experimental group then received 16 weeks of the phonological awareness intervention programme. This consisted of activities designed to teach core skills of attention, listening and linguistic concepts initially and subsequently rhyme detection, onset, phoneme grapheme correspondence and syllable awareness skills.

Following the programme which was delivered by trained nursery staff, to groups on a daily basis, all the children were re-assessed using both measures.

It can be seen from table 1 that, using the Wilcoxon Test (one tailed), there was a statistically significant change for both groups in their Edinburgh Articulation Test scores.

 

Seen as a bar chart it is clear that there is a broadly similar configuration between both groups.

Looking at phonological awareness scores, a significant difference was found for the experimental group who received the intervention programme, but not for the control group.

This can also be represented in the form of a bar chart.

It can be seen that the children in the experimental group performed at a level significantly greater than the control group - even though the starting points were statistically similar.

A Spearmans Rank Order correlation was carried out to determine whether there was a statistically significant relationship between phonological awareness ability (as determined by the phonological awareness assessment) and output phonology (as determined by the Edinburgh Test of Articulation). No statistically significant relationship was found. In other words:

we found that phonological awareness ability was not a significant predictor of articulation age.

The results of this study show that there is a significant improvement in output phonology when phonological awareness is the focus of intervention. However, the control group also made significant improvement. The findings are interesting because they lead us to question the type of intervention children receive and how decisions are made about those who receive intervention and those who are left on review. It can be noted that, for example, some individual children did not improve their scores on the Edinburgh Articulation Test.

In fact four of the experimental and three of the control group had lower standard scores. On re-assessment the differentials were greater for subjects in the control group.

However, there was no statistically significant correlation between the Edinburgh Articulation Test

and the Phonological Awareness Assessment. This could be due to a number of factors. Similar findings were reported by Leitae, Hogben and Fletcher (1997). They also found no relationship between articulation score and phonological awareness, but they did subsequently identify subgroups of children.

Given that their articulation assessment also allowed only one snapshot of the child’s production, there is an issue of variability /consistency that needs to be addressed. By qualitatively analysing the speech output of their subjects they identified children who were delayed, deviant consistent or deviant inconsistent. Of these only the ‘deviant consistent’ group had poor phonological awareness skills. Perhaps there is some value then in evaluating the children in our study in more detail.

All the experimental group made significant gains following phonological awareness training, in contrast to the control group. However, we do not yet know whether those with output difficulties performed less well than the subjects in the larger study. Despite the improvements made we have reinforced our view that accurate and specific diagnosis, using a psycholinguistic model, should precede any blanket/enrichment programme. Returning to our original question, does phonological awareness training lead to an improvement in speech output - the answer is yes but the control group who had no intervention also made significant improvements in their speech output. We also need to consider the level of breakdown more closely to determine whether the child’s perceived articulation difficulties are of a phonetic nature. In our efforts to find quick solutions we may be applying treatments that are ineffective yet which consume valuable resources. This is a lesson for clinician and manager alike. Beware the quick fix!

 

References

Anthony A, Bogle D, Ingram T (1971); The Edinburgh Articulation Test. E and S Livingston, Edinburgh

Bradley L and Bryant P (1083); Categorising Sound and Learning to Read - A Casual Connection. Nature 301: 419-421

Catts H (1993); The Relationship Between Speech – Language Impairments and Reading Disabilities. Journal and Speech and Hearing Research; 36: 948 – 958

Leitao S, Hogben J and Fletcher J (1997) Phonological Processing Skills in Speech and

Language Impaired Children. European Journal & Disorders & Communication; 32: 73 – 93

Webster P and Plante A (1992). Effects of Phonological Impairment on Word, Syllable and Phoneme Segmentation and Reading. Language, Speech and Hearing Services in School

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