Targeting Speech Sound Disorder Through Phonological Awareness Intervention

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By: Yvonne Wren, PhD, CertMRCSLT, Senior Research Speech & Language Therapist, Frenchay Speech & Language Therapy Research Unit, Bristol, UK.

Introduction
Many approaches to intervention exist for speech sound disorder (SSD). One such approach is phonological awareness intervention. This article describes what we mean by phonological awareness and how it is used in intervention for children with SSD. In addition it refers to the evidence which supports the use of phonological awareness intervention with some types of children with SSD and concludes with a case study of a child who received input based phonological awareness intervention using clinician controlled computer software.

What is phonological awareness?
Phonological awareness is the ability to identify and manipulate sounds in spoken words and is widely recognised as a key skill required for developing literacy skills (Gillon, 2004; Wagner & Torgeson, 1987; Bradley & Bryant, 1983). It is also known that many children with SSD show difficulty in this area (Rvachew et al, 2003; Larivee and Catts, 1999; Webster and Plante, 1992). Moreover, if problems with speech and phonological awareness persist into the early school years, children are at much greater risk of low attainment in reading and spelling and more generally in terms of poor life outcomes (Nathan et al, 2004; Stothard et al, 1998).

Phonological awareness intervention for SSD
Unsurprisingly perhaps, phonological awareness activities are therefore frequently included within intervention programmes for children with speech sound disorder. In many ways this can be seen as an efficient therapy approach given its dual targeting of both speech production and pre-literacy skills. Whilst there are many approaches to intervention in current use with children with SSD, there have been a number of studies which have provided positive evidence to support phonological awareness intervention (Gillon, 2000, 2005; Denne et al, 2005; Hesketh et al, 2000). Indeed, in some studies, improvement in phonological awareness has been targeted in order to prepare the child for direct intervention on speech (Smith, Downs & Mogford Bevan, 1998) while in others, a change in phonological awareness skill has been the target outcome, on the basis that improvement to speech will automatically follow (Rvachew, Nowak & Cloutier, 2004).

Phonological awareness activities
So what is meant by phonological awareness? The term covers a range of abilities but central to all is the ability to consciously reflect using metalinguistic skill. The tasks which can be used to display, measure or develop phonological awareness skills then require more than memory or discrimination abilities. These skills are nevertheless pre-requisites to successful phonological awareness as without the ability to remember sounds or discriminate between them, it is difficult to reflect and manipulate them.

Specifically, phonological awareness tasks include segmentation, detection, generation, completion, deletion, reversal, blending, manipulation and matching activities. These might be carried out at a syllable, rhyme or phoneme level leading to a range of tasks such as:

  • syllable segmentation (splitting a word into syllables);
  • phoneme detection (identifying the first or last sound in a word);
  • rhyme generation (generating a list of rhymes for a given word);
  • word completion (for a given part word, adding the remaining phonemes to complete the word);
  • phoneme deletion (repeating a word with one or more phonemes deleted);
  • phoneme reversal (saying a word backwards);
  • phoneme blending (hearing a sequence of words and producing them as a whole word);
  • phoneme manipulation (repeating a word with one sound replaced by another);
  • alliteration matching (identifying words which start with the same sound).

While this is not an exhaustive list, it does give some idea of the nature of the tasks and the requirement to discriminate sounds and remember them whilst performing some sort of activity upon them.

Stackhouse and Wells Psycholinguistic Framework
Stackhouse and Wells (1997) in their Psycholinguistic Framework provided a hierarchy for many of these activities whereby tasks are broadly categorised into input (e.g. phoneme detection – where a child hears a stimulus and acts on it, usually without the need for spoken output) or output tasks (e.g. rhyme generation – where the child is required to produce speech as part of their response to the stimulus). These activities are combined with information from other speech processing tasks to provide an individual profile on a child’s abilities and identify areas which could be impacting upon their speech production. Their framework adds an extra element to the types of phonological awareness activities described above in that non-words are used to target a lower level of processing in which semantic representations and stored forms of words are not accessed. In this way, the child’s abilities in phonological awareness can be observed without reference to known words which may be stored incorrectly in the child’s internal lexicon.

Phonological awareness input tasks
Most phonological awareness tasks are input tasks in which responses can be made using pictures rather than words if necessary. Phoneme detection, for example, can be carried out using pictures to represent sounds (sound/symbol pictures) or letters to represent each of the phonemes included in the task so that when the child is presented with a spoken word and/or a picture, they can identify the initial consonant by means of pointing to the letter or sound/symbol picture. Similarly rhyme detection can be carried out by presenting two pictures to a child and asking them to say whether or not they rhyme. They could respond with a simple yes or no or alternatively they could point to a tick or a cross.

Case study
There is evidence to show that for some children, phonological awareness input tasks alone can bring about substantial change in a child’s speech sound system without the need for speech output activity. In other words, activities which require a child to listen and reflect on sounds in speech can be sufficient in some cases to prompt the child to reflect on their own speech and make the changes spontaneously without being required to practise speech sound production following any other type of program. One case study which describes this is Callum (Wren & Roulstone, 2009).
Callum was a child who presented with severe speech delay at age 6 years and one month. He had average non-verbal IQ and receptive language skills but achieved a standard score of 41 on the Goldman Fristoe Test of Articulation (2000), giving him a centile rating of 1.

He received 8 weeks of intervention using a software program which provided fully customised games for input based phonological awareness activities (Phoneme Factory Sound Sorter®). Each week he received thirty minutes of direct intervention using only the software program targeted to his specific pattern of errors from a speech-language pathologist. In addition, he received two further thirty minute sessions from an untrained volunteer who had observed the weekly SLP session. The games on the software were phoneme matching, phoneme detection, minimal pair detection, phoneme blending and rhyme awareness. All activities required a response using the computer software but did not require a verbal response.

At the end of the 8 week block of intervention, reassessment showed that Callum had made significant progress in his speech production. His standard score on the GFTA was now 80 giving him a centile rating of 11. These gains were sustained and indeed increased over the following three month non-intervention period: his standard score increased to 95 and his centile rating to 22.

Callum’s response to the phonological awareness intervention was successful because of a combination of two things. Firstly, phonological awareness intervention most suited his particular pattern of difficulties – i.e. an input based problem with regular speech processes. In addition, the delivery of the intervention was carried out using a computer to assist. Computers permit controlled and frequent opportunities for repetition, such as is usually required for intervention for SSD. Whilst it was clear from the findings of the larger study (Wren & Roulstone, 2008) that not all children responded so positively, analysis of the response to intervention within the group receiving phonological awareness therapy showed that where children’s type of SSD was phonological (rather than phonetic) in nature and they were stimulable for the target sounds, progress with phonological awareness alone was sufficient to produce long lasting change in their speech.

References
Bradley, L. & Bryant, P. (1983) Categorizing sounds and learning to read: A causal connection. Nature, 301, 419-421.

Denne, M., Langdown, N., Pring, T., & Roy, P. (2005). Treating children with expressive phonological disorders: Does phonological awareness therapy work in the clinic? International Journal of Language and Communication Disorders, 40(4), 493–504.

Gillon, G. (2000). The efficacy of phonological awareness intervention for children with spoken language impairments. Language, Speech, and Hearing Services in Schools, 31, 26–41.

Gillon, G, (2004) Phonological Awareness: from research to practice. New York: Guilford Press

Gillon, G. (2005). Facilitating phoneme awareness development in 3- and 4-year-old children with speech impairment. Language, Speech, and Hearing Services in Schools, 36, 308–324.

Hesketh, A., Adams, C., Nightingale, C., & Hall, R. (2000). Phonological awareness therapy and articulatory training approaches for children with phonological disorders: A comparative outcome study. International Journal of Language and
Communication Disorders, 35(3), 337–354.

Larivee, L. S. & Catts, H. W. (1999).Early reading achievement with expressive phonological disorders. American Journal of Speech–Language Pathology, 8, 118–128.

Nathan, L., Stackhouse, J., Goulandris, N., & Snowling, M. (2004). The development of early literacy skills among children with speech difficulties: A test of the “critical age hypothesis”. Journal of Speech, Language and Hearing Research, 47, 377-391.

Rvachew, S., Nowak, M., & Cloutier, G. A. (2004). Effect of phonemic perception training on the speech production and phonological awareness skills of children with expressive phonological delay. American Journal of Speech-Language Pathology,
13, 250–263.

Rvachew, S., Ohberg, A., Grawberg, M. & Heyding, J. (2003). Phonological awareness and phonemic perception in 4-year-old children with delayed expressive phonology skills. American Journal of Speech–Language Pathology, 12, 463–471.

Smith, J., Downs, M., & Mogford-Bevan, K. (1998). Can phonological awareness training facilitate minimal pair therapy? International Journal of Language and Communication Disorders, 33(Suppl.), 463–468.

Stothard, S.E., Snowling, M.J., Bishop, D.V.M., Chipchase, B. & Kaplan, C. (1998). Language impaired pre-schoolers: A follow-up into adolescence. Journal of Speech, Language and Hearing Research, 41, 407-418

Wagner, R.K. & Torgeson, J.K. (1987) The nature of phonological processing and its causal role in the acquisition of reading skills. Psychological Bulletin, 101, 192-212.

Webster, P. E., & Plante, A. S. (1992). Effects of phonological impairment on word, syllable, and phoneme segmentation and reading. Language, Speech, and Hearing Services in Schools, 23, 176–182

Wren, Y., & Roulstone, S. (2008). A comparison between computer and tabletop delivery of phonology therapy. International Journal of Speech-Language Pathology, 10(5), 346–363.

Wren, Y.E. & Roulstone, S.E. (2009) Software in treatment for children with specific speech disorders: case studies using Phoneme Factory. Poster presentation at ASHA conference, New Orleans, 2009.

This Month’s Featured Author: Yvonne Wren, PhD, CertMRCSLT

Yvonne Wren is a speech and language therapist working in Bristol, UK. Alongside running a small private practice, Yvonne is a senior research speech and language therapist at Frenchay Speech & Language Therapy Research Unit and a visiting research fellow at the University of the West of England. Her interests are primarily in the area of children’s speech sound development and disorder and also the use of technology in speech and language interventions. She has authored and co-authored a number of academic papers and is also the first author of the Phoneme Factory Phonology Screener ® and Phoneme Factory Sound Sorter.

Information on Phoneme Factory Sound Sorter®
Phonological awareness activities lend themselves to computerised tasks that can be made into games which appeal to children and can be carried out frequently and repetitively. Whilst a number of software programs exist, few are able to be customised to a child’s specific pattern of speech substitutions in the way that a speech language pathologist would tailor their intervention and materials. One such program which does allow such customisation is Phoneme Factory Sound Sorter®. Designed by speech-language pathologists and based on the Stackhouse and Wells Psycholinguistic Framework, this program contains 7 games targeting phoneme matching, phoneme detection, minimal pair identification, phoneme blending and rhyme awareness across a range of word types (single sounds, real word, non-word, words in sentences) and word positions (initial, final, medial). Moreover, 21 out of the 24 consonant phonemes in English (nasals are excluded) can be targeted or used as contrasts in all activities.

For more information on this program, contact Yvonne Wren, Yvonne.wren@speech-therapy.org.uk

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One Response to Targeting Speech Sound Disorder Through Phonological Awareness Intervention

  1. Wonderful article, Yvonne. Thanks for sharing.