Phonological Impairment

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Phonological Impairments Relation to
Phonological Awareness, Working Memory, and
Literacy Monica Gordon Pershey, Ed.D.,
CCC-SLP Department of Speech and
Hearing Cleveland State University Cleveland,
OH mgpershey_at_att.net Patricia A. Clickner, M.A.,
CCC-SLP Lorain County Board of Mental Retardation
and Developmental Disabilities Elyria,
OH pclickner_at_loraincountymrdd.org
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Background

• Developmental phonological impairment may arise
  from inadequate mental
• representations of speech sounds and/or
  difficulty accessing representations of speech
  sounds.
• Possibly 35 of children with phonological
  impairment evidence subsequent reading and
  spelling difficulties.
• Some children with phonological impairment may
  have difficulty acquiring phonological
• awareness, i.e., the metalinguistic ability to
  reflect upon and manipulate speech sounds.
• Phonological awareness bootstraps onto the
  childs speech system, with instabilities in the
  speech system potentially constraining
  phonological awareness. Strong and accurate
  internal phonological representations meaning
  accurate speech sound productions provoke the
  association of phoneme to grapheme, allowing
  reading and spelling to develop.
• The question remains whether it is weakness in
  phonological awareness alone that places children
  with phonological impairment at risk for reading
  and spelling difficulties. There is ample
  research evidence that a double deficit in two
  core processing deficits underlie reading
  disability (1) undeveloped phonological
  awareness and (2) inadequate rapid naming of
  visual symbols. For children with phonological
  impairment, a proposed double deficit would
  involve (1) a weakness in internally representing
  and/or accessing speech sounds that impacts upon
  phonological awareness and that coexists with (2)
  difficulty rapidly retrieving names for visual
  symbols.

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Background

• A Proposed Double Deficit for Children with
  Phonological Impairment
• Some children with phonological impairment may
  have comorbid deficits in verbal working memory
  that manifest as difficulties with short term
  storage and manipulation of information that is
  encountered as auditory and/or verbal input.
• Verbal working memory span allows phonological
  and/or orthographic information to be On Screen
  for a long enough period of time for
  manipulations to be performed. Rapid naming of
  colors, letters, or numbers demonstrates verbal
  working memory.
• Rapid naming of letters reveals additional,
  separate cognitive-linguistic processes critical
  for learning to read. Each time a letter is
  encountered, it must be matched to letter
  templates or prototypes stored in visual memory
  and then matched to its name. Trouble rapidly
  naming letters shows deficiencies related to (a)
  orthographic representations (i.e., difficulties
  with visual symbols that enter memory as icons
  which are then arbitrarily named and stored as
  semantic memory), and/or (b) adequate storage of
  visual information but inadequate semantic labels
  for the names of letters, and/or (c) interference
  from inadequate phonological representations,
  with instabilities in the speech system
  constraining knowledge of letter names and/or
  sounds. For children with phonological
  impairment, we must also rule out diminished
  naming speed that can be attributed to reduced
  articulatory proficiency.

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Purpose

• The purpose of this study was to explore
• whether children with phonological impairment
• would show associated deficits in speech
• motor control, phonological awareness, verbal
• working memory, reading, and spelling.
• This research explored whether deficits in
• phonological awareness and rapid naming
• converged in a sample of children with
• phonological impairment and determined the
  combined
• impact of this double deficit on reading and
  spelling.

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Research Questions

• Research Questions
• Group Comparisons
• Do children with phonological impairment evidence
  lower scores on tests of physiologically-based
  functions, namely suprasegmental quality of
  speech and oral motor control, than typically
  developing peers?
• Do children with phonological impairment evidence
  lower scores on cognitive-linguistic tasks that
  tax verbal working memory than typically
  developing peers?
• Do children with phonological impairment perform
  more poorly on rapid naming testing than
  typically developing peers?
• Do children with phonological impairment evidence
  lower scores on phonological awareness testing
  than typically developing peers?
• Do children with phonological impairment perform
  more poorly on reading testing than typically
  developing peers?
• Do children with phonological impairment perform
  more poorly on spelling testing than typically
  developing peers?

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Research Questions

• Research Questions
• Measures of Association Among Variables
• Are deficits in physiologically-based functions,
  namely suprasegmental quality of speech and oral
  motor control, related to the presence of
  phonological impairment?
• Are deficits in cognitive-linguistic tasks that
  tax verbal working memory related to the presence
  of phonological impairment?
• Are deficits in rapid naming associated with
  phonological impairment?
• Are deficits in phonological awareness associated
  with phonological impairment?
• Are deficits in reading associated with
  phonological impairment?
• Are deficits in spelling associated with
  phonological impairment?

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Methodology

• Participants
• Group 1 - 23 English-speaking children (12 in 1st
  grade, 8 in 2nd grade, 3 in 3rd grade) diagnosed
  with phonological impairment
• Group 2 - 23 phonologically unimpaired peers (12
  in 1st grade, 8 in 2nd grade, 3 in 3rd grade)
  matched for race, gender, age (range 6.4 - 9.1),
  grade level, free lunch status, and IQ (normal
  range)
• From 10 elementary schools in one Midwest county,
  median household income 60,000
• All Group 1 and 2 students had passing scores for
  hearing acuity Pure-tone air-conduction hearing
  screening at 20 db HL for 500, 1000, 2000, and
  4000 Hz
• Groups 1 and 2 are significantly different due to
  level of phonological impairment as assessed by
  the Goldman-Fristoe Test of Articulation-2
  (GFTA-2) (with findings used to compute
  Percentage of Consonants Correct) ANOVA F(1,
  44) 55.16, p lt.0001

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Methodology

• Methodology
• Three areas of capabilities were assessed for all
  participants.
• Administration of tests was conducted by the
  second author in randomized order over three
  individual testing sessions per child.
• Mean scores on all measures for groups 1 and 2
  were computed.
• Area 1 - Physiological factors
• To assess suprasegmental qualities of speech A
  brief conversational sample analyzed for each
  participant for presence/absence of adequate
  quality scored as 0" for normal, 1" for
  deviated 10 or less of the time, or 2" for
  deviated greater than 10 of the time
• To assess oral motor skills Zelvis Oral
  Peripheral Screening - scored as 1" for normal
  diadochokinetic rate or 2" for abnormally slowed
  diadochokinetic rate for each participant

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Methodology

• Area 2 - Cognitive-linguistic factors
• To assess verbal working memory The Clinical
  Evaluation of Language Fundamentals-3 (CELF-3)
  subtests for word forms (sentence recall allows
  child to generate needed syntax/grammar/morphology
  ), following directions, sentence repetition
  Standard scores obtained for each participant
• To assess rapid naming The Comprehensive Test
  of Phonological Processes (CTOPP) Rapid Naming
  Subtests - colors, digits, letters, and
  non-words Standard scores obtained for each
  participant
• To assess phonological awareness CTOPP
  (Composite of Elision, Blending, Sound Matching
  subtests) Standard scores obtained for each
  participant

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Methodology

• Area 3 - Reading and Spelling
• Reading and Spelling subtests from The Kaufman
  Test of Educational Achievement (K-TEA) brief
  form Standard scores obtained for each
  participant

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Results

• Group Comparisons
• Area 1
• Do children with phonological impairment evidence
  lower scores on tests of physiologically-based
  functions, namely suprasegmental quality of
  speech and oral motor control, than typically
  developing peers?
• Suprasegmental Quality
• The difference between groups is
  significant ANOVA F(1, 44) 7.48, p .009
• Oral Motor Control
• 22 of Group 1 children had abnormal
  diadochokinetic performance
• The difference between groups is
  significant ANOVA F(1, 44) 6.11, p .017

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Results

• Group Comparisons
• Area 2
• Do children with phonological impairment evidence
  lower scores on cognitive-linguistic tasks that
  tax verbal working memory than typically
  developing peers?
• CELF-3 Word Forms
• The difference between groups is not significant
  ANOVA F(1, 44) 3.67, p .062
• CELF-3 Direction Following
• The difference between groups is not significant
  ANOVA F(1, 44) 3.04, p .088
• CELF-3 Sentence Repetition
• The difference between groups is significant
  ANOVA F(1, 44) 5.55, p .023
• CTOPP Non-word Repetition
• The difference between groups is significant
  ANOVA F(1, 44) 10.39, p .002
• Do children with phonological impairment perform
  more poorly on rapid naming testing than
  typically developing peers?
• CTOPP Rapid Naming mean composite standard score
  Group 1 45th percentile average performance
  range

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Results

• Area 3
• Do children with phonological impairment perform
  more poorly on reading testing than typically
  developing peers?
• K-TEA Reading standard score Group 1 34th
  percentile lt 1 SD below normative mean
• Group 2 74th percentile lt 1 SD below normative
  mean
• The difference between groups is significant
  ANOVA F(1, 44) 31.72, p lt.0001
• Do children with phonological impairment perform
  more poorly on spelling testing than typically
  developing peers?
• K-TEA Spelling standard score Group 1 37th
  percentile lt 1 SD below normative mean
• Group 2 68th percentile lt 1 SD below normative
  mean
• The difference between groups is significant
  ANOVA F(1, 44) 9.84, p .003
• Just to be sure - How different are these two
  groups?
• A Multivariate Analysis of Variance (MANOVA)
  compared groups based on all variables combined -
  speech physiology, phonological awareness, verbal
  working memory, rapid naming, reading, spelling
• The difference between groups is significant
• MANOVA F(1, 44) 14.25, p lt.0001
• MANOVA compared groups based on two variables
  combined - reading and spelling
• The difference between groups is significant
• MANOVA F(1, 44) 15.58, p lt.0001

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Results

• Measures of Association Among Variables for
  Children with Phonological Impairment
• Phonological impairment was associated with
  deficits in oral motor control and working
  memory, including rapid naming, but not
  phonological awareness, reading, or spelling
• Pearson Product Moment Correlations of Mean
  Scores - Percentage of Consonants Correct
  correlated with Other Variables
• Are deficits in physiologically-based functions,
  namely suprasegmental quality of speech and oral
  motor control, related to the presence of
  phonological impairment?
• Suprasegmental Quality - No Correlation
• Oral Motor Control - Significant Correlation r
  -.597, p .003
• Lower Percentage of Consonants Correct scores
  were associated with higher (poorer)
  diadochokinetic scores, creating an inverse
  relationship
• Are deficits in cognitive-linguistic tasks that
  tax verbal working memory related to the presence
  of phonological impairment?
• CELF-3 Word Forms - Significant Correlation r
  .517, p .012
• CELF-3 Direction Following Significant
  Correlation r .612, p .002
• CELF-3 Sentence Repetition Significant
  Correlation r .464, p .026
• CTOPP Non-word Repetition - No Correlation

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Results

• Are deficits in rapid naming associated with
  phonological impairment?
• CTOPP Rapid Naming Composite - Significant
  Correlation
• r .405, p .05
• Are deficits in phonological awareness associated
  with phonological impairment?
• CTOPP Phonological Awareness Composite - No
  correlation
• Are deficits in reading associated with
  phonological impairment?
• K-TEA Reading - No correlation
• Are deficits in spelling associated with
  phonological impairment?
• K-TEA Spelling - No correlation

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Results

• Stepwise Regression Data
• Correlational data did not fully describe whether
  phonological impairment was associated with
  deficits in rapid naming
• (at p .05), phonological awareness, reading,
  and/or spelling
• Which test scores for children with phonological
  impairment accounted for variance in reading and
  spelling test scores?
• 41 of the variance in K-TEA Reading scores could
  be accounted for by performance on CTOPP
  Phonological Awareness Composite (p lt.001)
• 69 of the variance in K-TEA Reading scores
  could be accounted for by performance on CTOPP
  Phonological Awareness Composite and CTOPP Rapid
  Naming Composite scores as a combined independent
  variable (p lt.0001) Coefficient analysis PA at
  p lt.0001 RN at p .004 - indicates adequate
  stringency for each predictor variable
• 64 of the variance in K-TEA Spelling scores
  could be accounted for by performance on CTOPP
  Phonological Awareness Composite (p .008)
• 49 of the variance in K-TEA Spelling scores
  could be accounted for by performance on CTOPP
  Rapid Naming Composite (p .012)
• Need to finally reduce to explained/unexplained
  variance
• 66 of the variance in K-TEA Reading and Spelling
  scores as a combined dependent variable could be
  accounted for by performance on CTOPP
  Phonological Awareness Composite and CTOPP Rapid
  Naming Composite scores as a combined independent
  variable (p lt.0001) Coefficient analysis PA at
  p lt.0001 RN at p .009 - indicates adequate
  stringency for each predictor variable

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Conclusions

• The difference between children with phonological
  impairment and matched unimpaired children was
  significant for all measures except two verbal
  working memory tasks (not rapid naming).
• The presence of speech motor deficits was not
  ruled out. Phonological impairment correlated
  with poorer performance on speech motor tasks.
• Children with phonological impairment performed
  below the normative mean on tests of rapid
  naming, phonological awareness, reading, and
  spelling. Phonological impairment correlated with
  poorer performance on cognitive-linguistic tasks
  that tax verbal working memory and on rapid
  naming.
• Depressed rapid naming and phonological awareness
  coexisted as a double deficit in this sample of
  children with phonological impairment.
• Findings support prior research that children
  with reading deficits may have difficulties with
  verbal working memory.
• Findings support prior reports that children with
  phonological impairments may manifest deficits in
  verbal working memory, specifically rapid naming.

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Conclusions

• Practical Applications
• Speech disturbances which render a child
  difficult to understand should not be dismissed
  as developmental motor skill.
• For children with phonological impairment who
  have weak phonological awareness and rapid
  naming, the double deficit hypothesis is
  applicable internal representations of speech
  sounds must be continually monitored and
  reinforced.
• All children with phonological impairment should
  be assessed by a speech-language pathologist and
  a reading specialist for deficits in rapid
  naming, phonological awareness, reading, and
  spelling.
• Intensive speech, language, and literacy
  interventions should be applied for children with
  coexisting phonological impairment and verbal
  memory deficits.
• Future Research
• Can research distinguish when deficient rapid
  naming ability reflects difficulties with verbal
  memory AND/OR difficulties with speech motor
  control? Studies need to separate these
  performance components to isolate the memory vs
  motor aspects of rapid naming.
• Can research establish subtypes of phonological
  impairment, as in with verbal memory impairment,
  with speech motor impairment, or with both?
• Research is needed to explore any and all
  connections between phonological impairment and
  literacy acquisition.

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