Marisha: Hello there, and welcome to the SLP Now podcast where we share practical therapy tips and ideas for busy speech language pathologists.

Marisha: Grab your favorite beverage and sit back as we dive into this week's episode.

Marisha: Hello there, and welcome to the SLP Now podcast. This month, Monica and I are talking about phonological awareness. It's something that a lot of SLP Now members have been asking about. They've been requesting activities and just asking about what that would look like in therapy.

Marisha: And then I also had a little experience that I wanted to share real quick before we dive into all of the nitty-gritty details that Monica did a fabulous job digging up and putting together for us. And so my first experience with phonological awareness was when I was working at a school and there was a student, he had a couple speech errors. We just had articulation goals. It was a student that I inherited, so I just started down that route. But after communicating with the teacher, I realized that there was a lot more going on. The student was really struggling with reading, among other things.

Marisha: So I started digging through the research, trying to figure out what my role would be and what I could do to better support. And there was one article that really stood out and got me excited, and it just made a lot of sense for this student. And this is just one article that I'm pulling out that just stood out to me, but we will go through a lot of different types of articles and research that has a higher quality of evidence, but this is just what got me started.

Marisha: But it was Guillen 2000. The article compared traditional articulation therapy to a phonological awareness intervention. Check out the article for the full details on their approach. But we will share some of the activities throughout the podcast today, just some ideas. What was really interesting was that these children with SLI who received phonological awareness intervention made significantly more gains in their phonological awareness ability and reading development, which makes sense because that's what they're targeting and they saw improvement, but it also improved the children's speech articulation.

Marisha: So they weren't doing direct speech activities. They were doing all of this phonological awareness, but they also saw an improvement in the speech articulation which was really interesting to me. And I was able to implement some of these approaches with this student, and I saw some similar approaches.

Marisha: But that was just my intro to it, and I'm really curious, Monica, to hear about what your experience was like because your school or district sets things up a little bit differently. [inaudible 00:03:03] you started with it and what have you seen?

Monica: I had preschool to junior high at one point, so I was kind of seeing the different spectrum of it.

Monica: So for my preschool students, we were just really using it a lot for that contrast for them to even hear the sound and do that auditory discrimination. And I was like, "This is really making a difference," so then I really looked into it, and I was like, "There is so much research behind this" because it's just one of those things where you're fresh out of grad school, and they might've touched on it, but then you look into it on your own and you're like, "Wow. I need to like really digest this."

Monica: So I started incorporating it and with my preschoolers because even if we weren't at a really high level, they could still do it receptively, so I feel like that was really great for them, and they felt great because they could be successful with something.

Monica: And then for my elementary students, it was a great way to be able to collaborate with the teachers. And so it was just kind of a natural way to do that, so that was really nice. And they were all just really happy that I was doing something with reading and speech as well because they saw the results. So I was like, "Well, if it's generalizing, there's a big light bulb right there."

Monica: And then for my junior high students, the ones that still kind of had residual speech sound errors, I found that doing those things really helped them, and it wasn't necessarily something that they had done, but just doing a lot of that and concentrating on that because they also were struggling readers as well. They were still going to get help with reading. So it was kind of like, "Maybe that's the missing piece for them to do that in speech as well."

Monica: So for one kid, he didn't have his R in, I think, it was seventh grade, but he had the motivation and he was like, "You know what? I want to get this." And I was like, "Well, we're going to get it" and building in some of those really helped him. I think it just felt like a new way for him to do speech because he had done speech for so long that I think it was just different, and so I got a little bit more buy-in.

Marisha: That is so interesting. I loved your range of experience with that too, and I think that'll resonate with people listening because we have SLPs working with all sorts of age groups, so that's awesome.

Marisha: And so what is phonological awareness, actually, because we've been sharing all of these cool little stories, but what is it? Phonological awareness is just your ability to, and I'm quoting, "identify and manipulate units of oral language," so words, syllables and onset and rime. so rimes is R-I-M-E-S, not like rhyming words. So the onset would be the beginning sound and then the rime would be the end sound.

Marisha: And then under that is also phonemic awareness. So that's your ability to manipulate individual sounds and words, and I feel like a lot of SLPs are probably doing a lot of phonological awareness, but you're just not calling it phonological awareness.

Monica: That's super interesting. And so what are some of the types of activities that we might be doing that fit under phonological overtness?

Monica: So some of the things could be syllable awareness, rime awareness and production, alliteration, onset and rime segmentation, initial and final sound segmentation, blending sounds into words, segmenting words into sounds, and then deleting and manipulating sounds.

Monica: And so we can do a quick example, so syllable awareness would be saying, "How many syllables are in awareness" and then they would get to clap them out.

Monica: Then rime awareness is that, "Do cat and dog rime," or for rime production, it would be, "What rimes with cat?"

Monica: And then for alliteration, it would just be saying words that start with the same sound.

Monica: Then onset rime segmentation would be splitting those words from the beginning sound and the end sound.

Monica: Initial and final sound segmentation is what it sounds like, is being able to segment those. All of that segmentation [inaudible 00:07:19].

Monica: And then blending sounds into words. So that's when we say, "C, A, T. What does that make?"

Monica: And it's so interesting. It feels like I've done some phonological awareness testing, and it's always fascinating that some of our students can't put that together. It seems like, "I'm giving you the answer," but, no. It's super interesting how that works.

Monica: And then the reverse of segmenting words into sounds like, "Tell me the sounds in 'cat' and then the student would have to do that."

Monica: And then the higher level with that is also deleting and manipulating sounds so, "Say 'cat' without the c-." That's how that works.

Monica: So why is all of this important? Why would we be targeting this with our students?

Marisha: It's important at every level, but I feel like maybe the most important is that early intervention where we can really make the biggest difference, especially with some kids who might come to us first just for speech because we all know that is definitely the case sometimes. But when I highlight how important it is for future reading skills and that we can incorporate it into things that we're already doing because I feel like sometimes, we hear like, "You need to do this. You need to do this. You need to do this," but you can incorporate it pretty quickly into something that you're already doing. So a quick phonological awareness check during an assessment and then when you're doing intervention with speech sound disorders, you can kind of put these into things that you're already doing.

Marisha: The kids who are at risk for dyslexia, we have so much overlap with kids who have speech sound disorders. So we're almost like the frontline of catching that and to be able to help with that intervention.

Monica: And it's not hard to incorporate. If we're doing articulation practice, we can do some of those. We can identify the syllables. We can identify the initial sound, the final sound. It's just a matter of knowing which questions to ask and could even have a little cheat sheet of like, "We're going to try this." And so it doesn't involve a lot of extra materials. We're just using words. And then we'll talk a little bit more about activities later, but I love that you pointed that out.

Marisha: I think that's important too is that it's you don't need extra materials or extra supplies. You can just kind of use what you already have.

Monica: Do we want to talk about who could benefit from this, or did you want to talk a little bit more about the importance?

Marisha: There are a couple articles that I looked at. So there was one by [inaudible 00:09:55] et al., and it said that children with a history of speech language impairment are four to five times more likely to have reading difficulties than children from the general education population, so that one definitely stood out to me.

Marisha: And then there is an article that I pulled a lot of this from. So it's from [inaudible 00:10:16] et al. which also includes Kelly Farquharson who is on Instagram, and she's classlab_FSU, and she has a lot on all sorts of things. But this article was exploring the overlap between dyslexia and speech sound disorder, speech sound production deficits. In that article, they just said one-quarter of kids with speech sound disorders who are receiving school-based speech therapy have decoding deficit. So I think she just really wanted to go over the importance that SLPs could play with the role they could play in schools and the best intervention is early.

Marisha: And then it kind of touched on that. It's our speech-only kids. They come in, and you think it's just a speech sound disorder, but I think we're now starting to realize that it's not ever just a speech sound disorder.

Marisha: And in our district, we're really trying to push for full assessments when they have that because you might have a kid who just has a lisp once in a blue moon, but most of the time, they're going to have a lot of other things that go along with that, and I think it's just the importance of also working with other members of the team, just to make sure things are covered. And if I get interns or CS and they'll be like, "Well, this kid just has a speech sound disorder. Do I need to do language testing too?" And I'm like, "Well, here's the thing" and then we kind of go into the importance of you have the opportunity to chat. You might as well just do it. If it's an extra hour or so of testing, you could make a difference in this kid's life for them to be able to get early intervention and to prevent reading difficulties that they have later on.

Monica: No, that can have a huge impact. If it's not super apparent right away, it will become very apparent. And if we lose that time, then that one hour, is it really that bad if we avoid that impact.

Marisha: And then in California, I think we'll talk about it a little bit later too, but in California, it's kind of a tricky area with our ED code. SLPs aren't covering reading skills. That's our other reading specialists, and we have RTI for that too in some districts. But a lot of times, they can't get that intervention until they're 1.5 standard deviations or 2 grade levels below or whatever the qualifier is. So that student might not get intervention until first or second grade which is too late. It's just kind of looking at the big picture sometimes helps to sacrifice that extra little bit of testing.

Monica: So who can benefit from this approach?

Marisha: Going through the research, all students can benefit. So I think all classrooms have it, but if we're looking at who needs that really targeted practice, it's the students that have these phonological awareness difficulties. That's really going to be some of the first indicators that they're going to have difficulty with future reading skills.

Monica: So it's students who have learning disabilities can benefit, students in early education settings, students with speech impairments would all benefit. There was even an article specifically mentioning apraxia. So it's all these different students can benefit it, and you can start as early as preschool.

Marisha: Did you want me to go through some of the articles that I found?

Monica: Maybe you pick one or two to talk about, and we can link in the show notes to the rest of the articles if people want to dig in more, but these are super interesting.

Marisha: Yeah. I, of course, went to the ASHA Evidence maps. It's the easiest place to go if you want a really good quality article. So I'm going to go over two more systematic review type ones.

Marisha: So the first one is a systematic review, and it's called, "The Effectiveness of Early Phonological Awareness Interventions for Students with Speech or Language Impairments." This one is by Otaiba et al. It's 2009. And so across eight studies, they just showed that phonological awareness training showed improvement in phonological skills kind of across the board. So that was awesome to see.

Marisha: And then the other one was [inaudible 00:14:42], and it was a Pearson EBP brief. And this one talked about how you can start as early as preschool and in those early years that you don't have to start with the super easy tasks where it's like, "Which one is a dog barking? Which one is a bell? Put sunset into sunset." You can start with the phoneme deletion. You can start with segmenting. You can start with blending. And that might not necessarily be for every student that we have. We [inaudible 00:15:12] different levels of support that we need to provide for students, but if they're able to and that seems like a good fit for your student, that you can start those as early as preschool.

Monica: That's awesome.

Monica: We have some additional articles that we'll share in the show notes related to the impact on articulation, but that was so cool how we can target, and it makes so much sense that targeting phonological awareness can impact articulation as well. Even if we don't do actual articulation practice, that's so interesting.

Monica: [inaudible 00:15:45] phonological patterns? What does the research show on that?

Marisha: We all know that if there is a phonological pattern in there, that there is going to be a weakness in their whole phonological system. So the research shows that if you do not target phonological awareness, it's not going to generalize to reading and writing skills.

Marisha: Also, if you don't dismiss the kids until you check for those phonological awareness skills because just because the speech sound errors are gone, it doesn't mean necessarily that their whole phonological system is intact. So that Guillen article that you were talking about, as well as the [inaudible 00:16:29] one, was just talking about how this phonological awareness training definitely improves their reading skills, but children who were in the control group... so it's children who received this controlled treatment made significant improvement, but made remarkably little progress in their phonological awareness and written language skills development over time.

Marisha: So I think it just kind of is highlighting the importance again of being able to just include those phonological awareness skills during the treatment.

Monica: That's super interesting, and the progress wasn't significantly slower by adding in the phonological awareness, just in terms of the progress on articulation. So there's not a huge... but we really want them to get their sounds and be able to graduate and all of that. Just targeting that helps the progress towards that, plus it looks at the whole child perspective. So I think I'm convinced.

Marisha: And we have all of the articles in the show notes if you want to dive in more.

Marisha: Thanks for listening to the SLP Now podcast. This podcast is part of a course offered for continuing education through Speech Therapy PD. So yes, you can earn ASHA CEUs for listening to this podcast.

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