From Phonological Therapy to Phonological Awareness

Joy Stackhouse, Ph.D.,1 Bill Wells, D.Phil.,1 Michelle Pascoe, M.Sc.,1 and Rachel Rees, M.Sc.2

ABSTRACT

Children with speech difficulties often have delayed phonological awareness development and associated literacy problems. Speech-language pathologists (S-LPs) typically use phonological and articulatory ap- proaches in their treatment of such children. However, it is unclear to what extent phonological awareness training, originally designed to promote literacy skills, might also improve children’s speech output. This article adopts a psycholinguistic approach to examine the nature and development of phonological awareness and to explore the relationship between phono- logical awareness training and phonological therapy. The role of phonolog- ical awareness in predicting literacy development in children is discussed, and principles for analyzing the psycholinguistic properties of therapy tasks are presented. Phonological awareness cannot be dealt with independently as it is an integral part of articulation and phonological intervention. Fur- ther, phonological awareness is a necessary “on-line” skill in the dynamic communication process between therapist and child. Failure to take this into account will result in inappropriately targeted therapy and pragmatic breakdown between the child and S-LP.

KEYWORDS: Phonological awareness: development and training, predicting literacy outcome, psycholinguistic perspective, task analysis, child/S-LP interaction

Learning Outcomes: As a result of this activity, the reader will be able to (1) discuss the concept of phonolog- ical awareness from a psycholinguistic perspective, (2) consider the speech processing skills necessary to complete a range of phonological awareness tasks, and (3) evaluate the role and design of phonological aware- ness activities within intervention programs for children with speech and literacy difficulties.

Updates in Phonological Intervention; Editors in Chief, Nancy Helm-Estabrooks, Sc.D., and Nan Bernstein Ratner, Ed.D.; Guest Editor, Shelley Velleman, Ph.D. Seminars in Speech and Language, volume 23, number 1, 2002. Address for correspondence and reprint requests: Professor Joy Stackhouse, Department of Human Communication Sci- ences, University of Sheffield, 31 Claremont Crescent, Sheffield, S10 2TA, United Kingdom. E-mail: [email protected]. 1Department of Human Communication Sciences, University of Sheffield, Sheffield, United Kingdom; and 2Department of Human Communication Science, University College London, London, United Kingdom. Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662. 0734–0478,p;2002,23;01,027,042,ftx,en;ssl00102x. 27 28 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 23, NUMBER 1 2002

Approaches to treating children with have to be able to divide the word into its seg- speech difficulties have been well documented ments before they can attach the appropriate by clinicians and linguists throughout the last letters. When reading an unfamiliar word, they century and have been subject to various fash- have to be able to decode the printed letters ions. These can be broadly divided into articu- back to segments and blend them together to latory or “traditional” approaches up until the form the word. Thus, it is not surprising that mid-1970s,1,2 then phonological approaches3,4 phonological awareness skill is associated with and currently psycholinguistic approaches.5,6 reading and spelling performance. From the 1970s, parallel research emerged, mainly through work by psychologists, on phonological awareness training as a means of HOW DOES PHONOLOGICAL improving the literacy skills of children with AWARENESS DEVELOP? specific reading difficulties (see Snowling7 for a review). Recently, researchers and practition- During the 1970s and 1980s, there was much ers have questioned how phonological aware- debate about whether phonological awareness ness training might be used in intervention for was a prerequisite or consequence of literacy 8 children with speech difficulties. It is certainly development (see Goswami and Bryant10 for a the case that children with persisting speech review). It is now clear that the relationship is a and language difficulties often have problems reciprocal one. Figure 1 shows that children’s with phonological awareness tasks and literacy phonological awareness develops along a con- development, but it is not clear how phonolog- tinuum of tacit to explicit awareness (see level ical awareness training might promote speech of awareness) and is the cumulative result of intelligibility as well as reading development. auditory, articulatory, and reading experience This article aims to explore the relation- (see feedback). Popular phonological awareness ship between phonological therapy for speech tasks are presented in a developmental progres- and phonological awareness training (“meta- sion from left to right (see level of analysis) and phonological” training) for literacy. It will are related to children’s increasing feedback ex- adopt a psycholinguistic perspective to define perience. The phonological awareness tasks be- phonological awareness and examine the ratio- come progressively more dependent on literacy nale behind intervention approaches for chil- experience to the right of the figure. Ortho- dren with speech and literacy difficulties. graphic experience shows the child how words are structured (e.g., word/syllable boundaries, vowels, clusters) and thus facilitates a more ex- WHAT IS PHONOLOGICAL plicit level of phonological awareness. AWARENESS? Figure 1 is also a reminder that phonolog- ical awareness requires speech processing skills, Phonological awareness has been defined as for example, input (auditory) and output (ar- the ability to reflect on and manipulate the ticulatory), as well as orthographic knowledge sound structure of an utterance as distinct from in order to develop satisfactorily. Stackhouse its meaning.9 Popular phonological awareness and Wells9 argue that phonological awareness tasks include rhyme, syllable and sound seg- tasks, although many and varied, are all depen- mentation, blending, and spoonerisms. Chil- dent on one or more aspects of speech process- dren need to develop this awareness in order to ing skills. They use a simple speech processing make sense of an alphabetic script, such as model to demonstrate this (see Fig. 2). English, when learning to read and to spell. This model assumes that the child receives For example, children have to learn that the information of different kinds (e.g., auditory, segments (the consonants and vowels) in a visual) about a spoken utterance or written word can be represented by a written form— form, remembers it, and stores it in a variety of letters. When spelling a new word, children lexical representations (a means for keeping in- PHONOLOGICAL THERAPY—PHONOLOGICAL AWARENESS/STACKHOUSE ET AL. 29

Figure 1 The development of phonological awareness skills. (From Stackhouse10b.) formation about words) within the lexicon (a ample, consider the processing demands made store of words), then selects and produces spo- by each of the following popular rhyme tasks: ken and written words. Stackhouse and Wells9 use this model to analyze “what do tests really A. Rhyme judgment of two spoken words (no test?” and show that even phonological aware- pictures). For example, do these rhyme: ness tasks grouped under the same name (e.g., ‘cat’/ ‘hat’; ‘cat’/ ‘shoe’? rhyme; blending; or spoonerisms) are not made B. Rhyme detection (no pictures). For exam- up of the same speech processing skills. For ex- ple, the clinician presents three finger pup- pets. Each one “says” a word. The child points to the two puppets that said the rhyming words in the following: ‘shell ’, ‘bell ’, ‘sea’; ‘bear’, ‘boy’, ‘chair’. C. Rhyme detection as in B, but this time pic- tures of the stimuli are presented that the clinician does not name. The child has to point to the two pictures that rhyme in the following: ‘spoon’, ‘moon’, ‘knife’; ‘house’, ‘horse’, ‘mouse’. D. Rhyme string production. For example, the child is asked to say as many words as she or he can that rhyme with (i) ‘cat’, (ii) ‘tea’,or (iii) ‘goat’.

The speech processing properties of these tasks can be identified by answering the fol- lowing three questions about each of them:

Figure 2 The basic structure of the speech process- ing system. (From Stackhouse and Wells.9) 1. Is this an input or output task? 30 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 23, NUMBER 1 2002

2. Does the child have lexical representations how they can tell us more about the integrity of a for the stimuli used in this task? child’s underlying speech processing system.The 3. Does the child have to access these lexical pattern of a child’s performance will indicate representations in order to complete the where difficulties are arising within his or her task? speech processing system. Thus, phonological awareness is not independent, as is often pre- Thus, task A is an input task (there need sented, but rather a product of a child’s speech not be a verbal response at all, merely a nod or processing skills. Any difficulty in the basic shake of the head). To judge whether or not speech processing system will result not only the two words rhyme, the child has to detect in spoken difficulties but also in problematic differences in the onsets and the commonality phonological awareness development, which in of the rhyme. Although the task involves “real” turn will affect literacy performance. words that the child knows, the child does not It is therefore not surprising that children have to access his or her representations to with speech and language difficulties often go complete the task; for example, the child does on to develop literacy problems. One of the not have to know the meaning of the word to greatest challenges for practitioners is to iden- be successful. Task B involves the same basic tify which children will and will not resolve speech processing skills as task A but adds a their spoken language difficulties in time for bigger memory load. Contrasting a child’s per- literacy to develop normally. Can phonological formance on tasks A and B reveals whether the awareness tasks help us to do this? child has difficulties with the concept of rhyme (i.e., if the child fails both tasks) or if the prob- lem is at the level of memory (if the child PHONOLOGICAL AWARENESS passes task A but not B). Task C is another AS A PREDICTOR OF LITERACY input task but this time the child has to access OUTCOME his or her representations in order to perform the task. The pictures have to be identified via A number of studies have attempted to identify the visual system in order to access the seman- predictors of literacy outcome in children with tic representation before the child can conjure speech and language difficulties. These studies up the spoken form of the words to reflect on have had interesting but conflicting results; their structure and make a decision about some report language skills, such as syntax11,12 which two rhyme. Task D is the only output and vocabulary,13 as the best predictor of liter- task. The child has to generate a novel response acy outcome, whereas others have emphasized in the form of a string of rhyming words. aspects of speech production more.14–16 Chil- There may be more than one strategy for doing dren with both speech and language problems this. One approach may be to generate a rhyme may be particularly at risk.17 However, what all string that has been stored in the lexicon. This these studies have in common is that phono- is more common with words that have a large logical awareness skills are difficult for children rhyme pool and are popular targets (e.g., ‘cat’). with speech, language, and literacy problems. However, the observation that children often A longitudinal study carried out by Stack- generate nonwords in their rhyme strings sug- house et al18 was designed to explore factors gests that there is an alternative strategy of fill- that put children at risk for persisting speech ing in the onset slot with random sounds or and literacy difficulties. Forty-seven children letters. If asked to generate real words only, with specific speech difficulties and their children then check their output against their matched controls were assessed at three points own representations and reject any nonwords. in time (TI, T2, and T3) at ages around 4;6 Examining phonological awareness tasks in (TI), 5;6 (T2), and 6;6 (T3). A range of speech this way is a reminder that activities with the and language tests were selected to investigate same name (e.g., rhyme) can make different pro- receptive and expressive language, speech in- cessing demands on a child. It also illustrates put skills, precision of lexical representations, PHONOLOGICAL THERAPY—PHONOLOGICAL AWARENESS/STACKHOUSE ET AL. 31 speech output skills; input and output phono- Perhaps the current popularity of rhyme logical awareness, and letter knowledge. tasks in teaching and therapy and the focus on At T3 (CA 6;6) the children with speech rhyme in national literacy strategies have posi- difficulties were divided into typical (i.e., tively influenced this result. In any case, the within the normal range) and delayed reader/ findings suggest that although persisting diffi- spellers and their concurrent and past speech culties with rhyme detection and/or produc- and language processing skills were exam- tion indicate a faulty speech processing system ined.19,20 The performance on the phonological and are likely to be associated with serious lit- awareness tasks presented a perhaps surprising eracy problems (e.g., the cases of Zoe pre- result. Although the children with speech diffi- sented by Stackhouse and Wells9,27 and Anna culties in general performed less well than their presented by Corrin28,29), the corollary of this controls on the rhyme detection and produc- is not true: being able to perform well on tion tasks administered, rhyme itself did not rhyme tasks does not guarantee good literacy feature as a predictor of literacy performance outcome. However, this does not mean that we because it did not differentiate between the should stop including rhyme tasks in our typical and the delayed reader/spellers. In fact, teaching and therapy programs. In fact, rhyme at T2 and T3 the delayed readers performed as is an inescapable part of phonological aware- well as the typical readers on rhyme tasks. It ness training and phonological therapy. was the phonological awareness tasks that tapped the level of the phoneme (rather than the syllable as in the case of rhyme) that were PHONOLOGICAL AWARENESS the best predictors. Performance on alliteration TRAINING fluency at T2 and on phoneme deletion and completion at T3 were more closely associated A number of studies have shown the benefit of with reading and spelling development. The phonological awareness training for literacy role of rhyme in literacy development is cer- development, particularly in word recognition tainly controversial. Some believe that it is cen- and spelling skills. One of the first empirical tral to literacy development,21,22 whereas others training studies was by Bradley and Bryant.30 have shown that it does not predict literacy They studied 65 children who were nonreaders outcome.23,24 The findings from such longitu- and below average on phonological awareness dinal studies suggest that practitioners should tasks when starting school. The group was di- be cautious about how they interpret children’s vided into experimental and control groups. At performance on rhyme tasks. Many of the the end of a 2-year period, during which 40 in- young normally developing children studied dividual teaching sessions were carried out, the could not perform rhyme tasks at around the group who had received sound categorization age of 4;6.25 Even so, these children still went training (including rhyme) was no different on to have normal literacy development. The from a control group who had received seman- opposite was also true. Some of the children tic categorization training. In contrast, the who developed literacy difficulties could per- children who had received sound categoriza- form the rhyme tasks perfectly well, for exam- tion training specifically linked to orthography ple, the cases of Luke presented by Nathan and (by plastic letters) were significantly better Simpson26 and Tom presented by Stack- than controls on reading and spelling mea- house.19 Nonetheless, both Luke and Tom sures. Similarly, Hatcher et al,31 working with struggled with sound segmentation and blend- 7-year-old children with reading delay, found ing tasks in spite of having normal hearing and that although training in phonological aware- nonverbal IQ. When asked to spell “camel” at 6 ness resulted in improved phonological aware- years of age, Luke said: ness skills, there was no carryover to reading performance. It was only the children who re- “I’m trying to sound out the letter, but I ceived both phonological awareness training can’t hear it.” and explicit reading instruction who made 32 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 23, NUMBER 1 2002

significantly more progress than controls on to point to “key” but mispronounces the word as reading and spelling measures at the end of the “tea,” then the adult will point to the picture of study. the tea. This confronts the child with a discrep- A robust finding from phonological ancy between the meaning intended and the awareness training studies is that the teaching meaning understood. In some cases, this con- of phonological awareness in isolation from frontation may merely confuse the child or lead the printed word will not necessarily promote the child to assign the fault of the communica- literacy development, particularly in children tion breakdown to the listener. However, chil- with difficulties.31,32 Letter knowledge is cen- dren with more advanced metalinguistic skills tral to the development of literacy33 and is a will reflect on their own speech production and significant predictor of reading and spelling will recognize the need to alter their pronun- skills.18,24 Thus, making explicit links between ciation to eliminate the ambiguity. Thus, a letters and sounds is essential when teach- metaphonological approach to therapy focuses ing.34,35 It allows children to “crack the code” on facilitating the child’s awareness of the na- when reading and spelling and facilitates func- ture and function of the speech sound contrasts tional alphabetic skills (for example, onset seg- and awareness of communicative effectiveness. mentation is essential for using dictionaries or The Metaphon program37 is a good exam- encyclopedias), all of which are essential for in- ple of a structured metaphonological approach dependent reading and writing. to therapy for speech difficulties. The program The invention of phonological awareness aims to provide children with information and the subsequent training packages was inde- about the sound system of their language and pendent of but parallel to work in clinical to enable them to bring about changes in their phonology and speech and language therapy speech output. Therapist and child share a focusing on children with speech and language vocabulary (a meta-language) about speech difficulties. Here the preoccupation was with “sounds” that is built up during the course of discovering “phonological” impairment as dis- therapy (e.g., “long” to talk about fricative tinct from articulatory difficulties, and a new sounds, ‘fffffffff ’, and “short” for plosive perspective on therapy emerged in the mid- sounds, /p/). Metaphon has two phases. Phase 1970s3 (see Hodson and Edwards4 for a review). I consists of games and activities that center on the sound system, and phase II gives opportu- nities for children to use their newly acquired knowledge in communicative settings. PHONOLOGICAL THERAPY The Metaphon program is described as moving beyond typical MMC therapy because In the 1970s a shift from articulatory ap- the child is provided with explicit information proaches to targeting phonological processes about the nature of the target contrasts and was seen as a more efficient way of carrying out about how such targets can be achieved.38 The therapy. Intervention focusing on phonological program has been positively evaluated as an “processes” (e.g., fronting, stopping) rather than effective therapy tool37,39,40 regardless of the se- sounds became the norm. Targeting the devel- verity and nature of the child’s difficulties.38,41 opment of phonological contrasts was regarded However, individual differences need to be con- as the primary therapy goal. Weiner36 used sidered when implementing such programs, meaningful minimal contrast (MMC) therapy which rest on assumptions about the child’s to reduce the frequency of three phonological motor and metaphonological phases of develop- simplifying processes in the speech of two chil- ment. First, a child can change his or her speech dren with phonological disability. MMC ther- production when confronted with the errors apy involves selecting pairs of words, where one only if she or he has enough articulatory ease to member of the pair corresponds to the child’s produce the target contrast.42 Second, success intended meaning (e.g., “key”) and the other is dependent on the child having sufficient corresponds to the child’s mispronunciation of phonological awareness skill to take advantage the word (e.g., “tea”). If the child asks an adult of this “meta” approach. Children who have lit- PHONOLOGICAL THERAPY—PHONOLOGICAL AWARENESS/STACKHOUSE ET AL. 33 tle awareness of the internal structure of words some children may benefit mainly from oppor- will be unlikely to benefit from an approach that tunities to explore the system of sound con- gives them information about the individual trasts whereas others may gain most from the phonemes in a word.43 It has also been ques- experience of recognizing, matching, and cate- tioned whether the extra information given re- gorizing sounds. A further subgroup may need garding properties of individual phonemes in to become aware of when and in what ways the shared vocabulary is really necessary. Per- their communication is inadequate; others may haps the success of the approach is embedded in benefit from opportunities to explore new ar- the MMC aspects themselves.44 ticulatory gestures. However, the original mo- Prescribed programs cannot be a panacea tivation behind programs such as Metaphon for all children with speech difficulties. This was to improve speech intelligibility and not group of children is heterogeneous, and individ- literacy, and therefore the links between the ual differences need to be taken into account phonological awareness activity and print are when planning therapy. Dodd and Bradford45 not necessarily made explicit. The potential of have emphasized that no single therapy ap- such approaches to enhance literacy as well as proach is appropriate for all children. There are speech production of school-age children is different types of underlying phonological dis- not fully realized or at least has not always orders, and these require the careful selection been an outcome measure. In the same way, the and sequencing of different treatments. Their effectiveness of phonological awareness train- study suggested that phonological contrast ther- ing packages for children with delayed reading apy may be most successful with children with development (e.g., see Hatcher49) has been consistent nondevelopmental phonological er- measured only in terms of literacy outcome rors; a core vocabulary approach is more suitable and not of speech and language gains.8 for children with inconsistent speech output, and a whole language approach is best for chil- dren with delayed phonological development. PHONOLOGICAL AWARENESS A further difficulty with prescribed pro- TRAINING AND PHONOLOGICAL grams is that they are not always able to deal THERAPY: A CONTINUUM? with atypical phonological processes that are more resistant to therapy than normal simpli- Within the last decade research papers have fying processes.46 Such difficulties may arise been published that address the issue of from pervasive speech processing problems whether phonological awareness training can comprising both phonological and motor diffi- be used to promote the speech skills of chil- culties that need to be targeted specifically in dren with speech and language difficulties. therapy. Psycholinguistic approaches focus on Studies have contrasted (e.g., Gillon and the relationship between overt speech and lan- Dodd50) or combined (e.g., Major and Bern- guage performance and underlying processing hardt,51 Wise et al52) phonological awareness skills.5,47 Individual differences are stressed. intervention with other types of more tradi- The discovery that different aspects of an indi- tional phonological or articulatory therapy for vidual child’s speech difficulty (e.g., voicing, children with speech and language difficulties. fronting, cluster reduction) may have their ori- However, there is a problem for studies com- gin at different levels of speech processing27,48 paring intervention approaches within phonol- suggests that children with specific and com- ogy, such as metaphonological versus phono- plex speech difficulties need an individually logical or articulatory approaches to speech designed therapy program. difficulties, in that virtually no approach to This does not reduce the contribution that therapy for speech difficulties is “meta-free.” metaphonological programs such as Metaphon Therapy activities targeting speech are on a have made to our resources for working with continuum from implicit to explicit phonolog- children with speech difficulties. Within the ical awareness (as presented in Fig. 1). For ex- Metaphon program, Dean et al38,39 acknowl- ample, activities from the Metaphon pro- edge individual differences, suggesting that gram37 address the more explicit end of the 34 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 23, NUMBER 1 2002

continuum, whereas other approaches such benefits of phonological awareness training. as MMC therapy36 incorporate phonological The same type of direct phonological instruc- awareness more implicitly. Studies to date tion that is appropriate in developing literacy have been contaminated to some extent by this skills is appropriate for children with phono- (e.g., see Dodd and Gillon,53 Hesketh and logical impairments. Adams54), which may explain some of the con- Intervention studies by Harbers et al57 and flicting findings. Hesketh et al58,59 have been more cautious in Gillon8 used a phonological awareness in- their interpretation of the benefits of phono- tervention approach with children (ages 5;6– logical awareness training for speech output 7;6) with spoken language impairments and performance. Harbers et al57 found that the rate matched controls. Children with spoken lan- and degree of change in phonological aware- guage impairment were allocated to three dif- ness did not always parallel production perfor- ferent treatment groups: (1) an integrated mance. Hesketh et al58,59 contrasted phonologi- phonological awareness program, (2) a “tradi- cal awareness therapy and articulatory training tional” program that focused on improving approaches for children (aged 3;6–5;0) with articulation and language skills, and (3) a min- phonological disorders. They found both types imal intervention control group. The phono- of therapy effective in enhancing phonological logical awareness tasks in this study aimed to awareness skills and speech output when con- improve children’s awareness of sound struc- trasted with speech and phonological awareness ture in spoken language and to develop explicit gains made in a control group of normally de- knowledge of the links between spoken word veloping children over the same period. How- forms and written representations, following ever, no effect of therapy type was found in this Hatcher et al31 (and see Gillon8 for other theo- study. Such comparisons of articulation versus retical foundations and a detailed description metaphonological therapies are problematic in of the intervention program). The traditional that “conventional” articulation therapy can therapy involved a phoneme-oriented, articu- often be seen to require and encourage meta- latory approach, and in some severe cases ac- phonological awareness, although to a lesser ex- tivities from the Nuffield Dyspraxia Program tent than the pure phonological awareness (NDP)55 were used. The NDP is a program of training condition. graded sessions to teach basic articulatory Clinicians tend to draw upon a range of placement and coordination of motor speech therapeutic approaches and combine these in sequences. Although no overt mention is made ways appropriate for individual children. Hes- of metaphonological awareness, the program keth et al58,59 acknowledge that therapists may can be used in this way.*,28,29,56 Gillon8 ac- find it difficult to make a clear distinction be- knowledged this in her study and noted that tween metaphonological and articulatory ap- most speech and language therapy activities proaches to therapy. Studies that combine incorporate phonological awareness to some rather than contrast therapy approaches include degree. The study found that children who re- those of Bowen and Cupples,60 who effectively ceived phonological awareness training ob- incorporated aspects of the metaphonological tained age-appropriate levels of literacy per- approach into a speech production program, formance, and in addition their speech and Smith et al,61 who combined phonological articulation improved. Gillon8 concluded that awareness training with a traditional articula- the presence of a severe phonological impair- tory approach in their treatment of children ment does not restrict a child’s access to the with persisting phonological difficulties. Smith et al61 divided their subjects (aged 5;8–8;2) ran- domly into two groups. Each group received a *The NDP is currently being revised by Pam Williams sequence of treatments interspersed with assess- from the Nuffield Hearing and Speech Centre in London. The new version will make more explicit how the materials ment. The intervention consisted of conven- can be used for input, output, and phonological awareness tional speech therapy, phonological awareness activities. Links with literacy are also strengthened. training, or no treatment. An eclectic approach PHONOLOGICAL THERAPY—PHONOLOGICAL AWARENESS/STACKHOUSE ET AL. 35 was used in the conventional treatment condi- from the wealth of resources the appropriate tion with a combination of articulation therapy tasks, in the right order, for an individual child. from the NDP55 and MMC therapy.36 Exam- Tasks selected may be useful only if they are well ples of tasks include minimal pair discrimina- matched to a child’s level of metaphonological tion, sorting of words by initial sounds, and awareness and intervention needs. Rees43 pre- minimal pair production. Again, it can be seen sents a procedure for doing this by addressing that although these tasks are broadly referred to the issue of “What do tasks really tap?” She as conventional therapy, they draw heavily on poses seven questions that need to be asked metaphonological skills. The authors concluded about a therapy activity in order to understand that phonological awareness training is a useful its psycholinguistic properties. Question 4 of addition when used together with more tradi- these relates to the metaphonological demands tional approaches to therapy. of a task and has four components: It has been difficult to disentangle phono- logical awareness from phonological therapy in some of the studies because they are both on a 1. Does the child have to reflect on his or her continuum of developing metaphonological speech production? skill. Phonological awareness training needs to 2. Does the child have to show awareness of run throughout an intervention program and the internal structure of phonological repre- should not be tagged on to therapy or pulled sentations or of spoken stimuli? out when the child is having literacy difficul- 3. If so, what kind of segmentation is required? ties. However, there is no one prescribed pro- 4. Does the child have to manipulate phono- gram for enhancing the phonological skills of logical units? children with speech and language difficulties. Rather, the threads of a therapy program need Try answering these questions with refer- to be knitted together for an individual child in ence to task A and task B in the following two order to take into account individual differ- therapy scenarios involving Jimmy and Suzie ences. To do this, a task analysis is needed to (taken from Rees43). Check your answers to ensure that therapy is being targeted appropri- the four questions for each task against the key ately. This includes establishing both the levels in Appendix 1. Decide which of the tasks (A or of speech processing involved in the tasks (as B) requires the child to be aware of how the in the preceding rhyme example) and the de- stimuli are segmented. gree of implicit and/or explicit phonological awareness required. Task A Jimmy is 8 years old and has been receiving in- dividual help with his speech for six months. TASK ANALYSIS The following task was presented to him: Materials: Tasks are not always what they appear. For ex- Five picture cards of simple words beginning ample, Rvachew’s62 study of speech perception with /t/: ‘tap’, ‘tea’, ‘talk’, ‘tall’ and ‘toast’ training was not explicitly called metaphono- Five picture cards of simple words beginning logical, but computer software was used to help with /k/: ‘king’, ‘kiss’, ‘key’, ‘kite’ and ‘kick’ the children to reflect on their speech produc- Two mailboxes, one labeled ‘t’ and one labeled tion. Similarly, Dent63 illustrates how electro- ‘k’ palatography—a computer-based system that Procedure: provides a visual display of tongue contact with The picture cards were shuffled and placed the roof of the mouth—can be used as a psy- picture side downwards on the table in front of cholinguistic tool in therapy to work simultane- Jimmy. Both mailboxes were within his reach. ously on phonological awareness and lexical He had to pick up each picture in turn, name it representations as well as on articulatory place- aloud, decide whether the word started with ment. The challenge for practitioners is to select /t/ or /k/, match this choice to the label on one 36 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 23, NUMBER 1 2002

of the boxes and mail the card in the appropri- involved onset/rime segmentation (e.g., t/ap; ate box. t/ea; t/all). It would have been impossible to do Feedback: the task without this skill, as Jimmy had to When Jimmy named the picture correctly and match this segmented consonant to a symbol chose the correct box the therapist rewarded on the mailbox. Moreover, some words had the him verbally. If he was not sure which box to competing consonant in coda (final) position, choose or started moving a picture towards the for example, ‘talk’; ‘kite’, which makes the task wrong box, the therapist asked him to say the more difficult. word again and asked him what sound the word To carry out task B successfully, Suzie starts with. If Jimmy was unable to respond, she could use the strategy of segmentation to re- repeated the first consonant and then asked him mind herself which consonant she should use. to choose one of the labels. If Jimmy was still However, segmentation is not necessary to unable to choose or chose incorrectly, the thera- complete the task. When Suzie was encour- pist repeated the consonant and pointed to the aged to use a different pronunciation, due to corresponding letter simultaneously and then the nature of the task, she could experiment asked him to mail the picture. with a “whole word” type of approach until she produced the correct pronunciation. Many Task B young children or older children with a speech Suzie is 4 years old and has been receiving in- delay have [t] and [k] in their repertoire of dividual help with her speech for five weeks. sounds but fail to use them contrastively to The following task was presented to her: convey meaning. Such children could easily ex- Materials: periment with different pronunciations of the Three picture cards of each of the following whole word until the therapist indicated that words (making twelve cards in total): ‘tea’, they had produced the correct label. ‘key’, ‘tap’, ‘cap’ Even though task A required Jimmy to One mailbox be aware of the internal structure of the words Procedure: he spoke, he did not have to manipulate these The picture cards were shuffled and placed structures by rearranging the phonological picture side up in front of Suzie. She had to units in any way by, for example, generating name each one in turn. After each one was phonologically similar words. If, however, he named the therapist picked up the appropriate had been given a follow-up task that involved card, asked Suzie whether it was the correct thinking of other words beginning with /t/ or one and, if it was, mailed it in the box. /k/, then either he would have to select such Feedback: words from a network of lexical representa- When Suzie named the picture correctly the tions organized appropriately and choose ones therapist picked the appropriate card and mailed that had different rimes (e.g., top;tool) or he it in the box. If Suzie looked at a picture and would need to use the mechanical slot filling named it using its minimal pair (e.g. looked at routine where /t/ and /k/ are joined to differ- the picture of ‘key’ and said “tea”), the therapist ent rimes and compared with the lexicon. Both picked up the picture of ‘tea’ and said, “this is strategies involve the manipulation of phono- what I heard” and encouraged her to change her logical units. pronunciation to match the word she had in- The purpose of questions 4a–d is to assess tended to say. If Suzie said “key” the therapist what metaphonological skills are required by picked up the picture of ‘key’ and said something tasks, irrespective of whether the tasks involve like “now I clearly heard that one” and mailed words the child already knows, new words for the picture in the box. the child, or nonwords. However, there is more to this task analysis skill than focusing on the Task A and task B both required the chil- content of an activity. It is equally important to dren to reflect on their speech. To carry out analyze the process of its presentation and the task A successfully, Jimmy had to segment the interaction between the child and the therapist first consonant from the rest of the word; this or teacher. PHONOLOGICAL THERAPY—PHONOLOGICAL AWARENESS/STACKHOUSE ET AL. 37

META-INTERACTION IN THERAPY 4. St: [p¯ɒts] (looking at therapist, then away) Phonological awareness training and phono- 5. Th: are they pots? (St looks to therapist logical therapy are normally discussed with ref- again) erence to single words in tabletop or laptop ac- 6. St: (shakes head) tivities. However, it is an obvious but not often 7. Th: let’s hear the sammy snake sound at stated fact that intervention targeted at chil- the beginning then dren’s speech difficulties is carried out through (.) spoken interactions between the child (alone or 8. Th: .h s:pot in a group) and the therapist or teacher. This is 9. St. [pɒt] the case whether or not the intervention is spe- cifically targeted at the correction or improve- ment of the child’s spoken output. It is there- In line 3, the therapist attempts to initiate a fore important to appreciate what pragmatic repair from Stuart by means of a request for resources the child might bring to the particular clarification. This does not take the form of an type of social interaction that is “speech ther- exact repetition of Stuart’s inaccurate produc- apy.” Most children with speech difficulties are tion, which lacked an initial fricative but re- pragmatically competent in many respects—for tained the unaspirated [p] from “spots.” Instead, instance, in turn-taking, establishing and devel- she produces, with rising intonation, an inaccu- oping a conversational topic, and, most impor- rate “redoing” of Stuart’s production, with aspi- tant for the therapy session, in engaging in re- rated initial plosive. This constitutes the thera- pair or correction behaviors. These pragmatic pist’s production as a different lexical item, skills are strengths that can be exploited in in- “pots,” because singleton voiceless plosives in tervention aimed at speech difficulties. stressed syllables are always aspirated in her ac- Although the child may be pragmatically cent of English. The therapist is thus using a competent, this does not mean that phonetic kind of MMC strategy: confronting Stuart with repair sequences in therapy sessions always pass the possibility that his original version of “spots” off without pragmatic misunderstandings. By in line 2 would be interpreted as “pots”—a dif- applying the methodology of conversation ferent lexical item. Although the therapist’s analysis, Gardner64–66 has highlighted how overriding aim is to induce a phonetic repair phonological awareness skills can affect the in- from Stuart (this is explicit in line 7), in line 4 teraction between therapist and child in the in- Stuart makes no attempt to modify the phonetic tervention session. The following extract is production from line 2. On the basis of this and from a therapy session with Stuart, a 4-year-old similar examples, Gardner argues that children boy who has speech difficulties that include the are most unlikely to interpret a clarification re- production of /s/ clusters in onset positions. quest of the type found in line 3 as a request for The therapist’s focus here is on the contrast be- phonetic repair. Unless the phonetic agenda is tween /sp/ and /p/. The target word, “spots,” is made explicit, the child will interpret repair ini- presented in picture form and modeled by the tiations as being about lexical, rather than pho- therapist (l). Stuart attempts to imitate it (2), netic, matters. Thus, here in line 4, by using his but his production is inaccurate. This gives rise own pronunciation of “spots,” Stuart is confirm- to the repair sequence presented below. ing that the word in question is indeed “spots,” not “pots.” It is only in lines 7 and 8 that the Stuart (St) and therapist (Th), second session. therapist asks explicitly for phonetic work from First presentation of /sp/ in ‘spots’ (picture of Stuart. Judging by Stuart’s response in line 9, spotty face) however, it appears that the therapist’s earlier strategy of invoking a lexical minimal pair 1. Th: s:pots “spots” “pots” has confused Stuart in his at- 2. St: [p¯ɒts] (looking at picture) tempt to address the pronunciation issue: he 3. Th: pots? now produces the target spot as “pot” (line 9), [pɒts]? with the aspirated plosive at onset. 38 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 23, NUMBER 1 2002

Drawing on Tarplee’s67,68 research on pic- has provided assessments that can tap the in- ture labeling sequences involving young chil- tegrity of a child’s speech processing system. It dren and adults, Gardner concludes that self- has made us question at what point and how our repair is a skill that is little required of young phonological intervention with a child moves children in their everyday interactions with from being implicit to explicit. It has reminded adults. Where repair is required of the child, it us of the importance of linking our therapy ac- is initially concerned with “factual” or lexical tivities with alphabetic knowledge if we want to matters. On the basis of her own analyses, work simultaneously on speech and literacy Gardner argues, “the child in therapy is having skills. It also allows us to identify with more ac- to cope with a blurring of the division between curacy children at risk for persisting spoken and phonetic and lexical repair.” This means that written language difficulties and may be used to the therapist has to do specific work to make predict not only literacy but also therapy out- the phonetic agenda explicit. Gardner observes come. It has been one of the biggest single fac- that phonetic repair sequences are more likely tors in bringing teachers and therapists together to be successful if, when redoing the child’s er- through a sharing of common terminology.70 roneous form, the therapist imitates it accu- A question of the 1990s was whether rately rather than producing an alternative but phonological awareness training could affect phonetically similar candidate word (such as speech as well as literacy development in chil- “pots” in the preceding extract). dren with speech and language problems. In This extract (see Stackhouse and Wells69 the new millennium perhaps the question is, for further examples and discussion) shows “how can we take into account all we have that the interactional structure of intervention learned through the phonological awareness sessions can have a huge impact on the sense experience of the last 20 or so years?” The main that the child makes of what the session is message seems to be that phonological aware- about, in speech processing terms; and so can ness is not a separate or new aspect of a child’s influence the success or otherwise of the inter- phonological therapy program, just as it is not vention. Popular therapy techniques, such as an independent skill in normally developing working with minimal pairs, may pose particu- children. Failure to attend to the complexities lar difficulties if the requirements are not made of phonological awareness can result in a explicit. Gardner66 concludes: breakdown in the therapy process. It is no longer possible to assume that the child has Therapists must be aware of the complexity sufficient metaphonological awareness to ben- of skills such as that labelled ‘metalinguistic efit from therapy programs; it needs to be awareness’ and the need to control the inter- tested. The impact of conversation analysis actional aspects of therapy as well as the cogni- studies in particular emphasizes a need for tive ones becomes clear. Specifically, for instance, therapists and teachers to heighten their own these findings bring requests for self-repair into awareness of the dynamic process involved question as techniques for gaining phonetic re- when interacting with a child. pair except as a carefully directed target behav- If phonological awareness is a product of a iour at a specific stage in therapy. child’s speech processing skills (e.g., input, output, and lexical representations), it follows that these underlying skills need to be specifi- CONCLUSION cally targeted for progress to be made. For example, articulatory skill is necessary for re- In the 1990s the two parallel developments of hearsing words for segmentation and spell- phonological therapy and phonological aware- ing.71 Children with the most severe problems ness training came together in both research and (verbal and/or cognitive) may not really benefit practice. 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