Phonological Awareness Difficulties Research Articles

Exploring Challenges of Dyslexic Students Learning English as a Second Language: Reading Drama Script

This study aimed to explore the reading challenges faced by dyslexic students learning English as a second language and interventions to support their reading skills. A mixed research design (both qualitative and quantitative) was used. Data was collected through a questionnaire, semi-structured interview and observation. A judgmental sampling technique was employed to select dyslexic students and teachers at two public schools in Tiruvallur district. Twenty-six students with English dyslexia and two teachers were selected for this study. Data were collected through the use of schedule questionnaire, interview and classroom observation. Statistical package for social Science Software version 26 was employed to analyze quantitative data, whereas the thematic analysis method was used for interview and classroom observation data analysis. The findings of this study showed that students encounter difficulties in phonological awareness, decoding words, recognizing patterns and comprehension. Besides, the study revealed that employing a multisensory and structured approach to teaching, incorporating visual and auditory, are crucial strategies for enhancing students English reading skills. The research also explored that explicit reading instruction and assistive technology significantly improve students’ reading drama script skills. The findings also identified that early identification, targeted instruction and individualized support for dyslexic students are significant elements in progressing their English reading skills. However, the study also acknowledges the limitations and suggests future researchers investigate the impact of parental involvement on dyslexic students’ English reading drama script skills.

The Influence Of Phonological Awareness On Early Literacy Development

Phonological awareness, defined as the ability to recognize and manipulate the sounds of language, has been widely recognized as a critical factor in early literacy development. This article aims to explore the influence of phonological awareness on the acquisition of reading and writing skills during the early stages of education. The research examines the relationship between phonological awareness and various aspects of literacy, including decoding, spelling, and reading comprehension. Numerous studies have demonstrated a strong correlation between phonological awareness and early literacy outcomes. Children with well-developed phonological awareness skills exhibit better phonemic awareness, word recognition, and reading comprehension abilities. Conversely, deficits in phonological awareness often manifest as difficulties in decoding words, spelling, and overall reading proficiency. The article further investigates the instructional strategies and interventions that can enhance phonological awareness in young learners. Effective techniques, such as phonemic awareness exercises, explicit instruction, and multisensory approaches, are discussed. Additionally, the article highlights the significance of early identification and intervention for children at risk of phonological awareness difficulties. Understanding the impact of phonological awareness on early literacy development is crucial for educators, parents, and policymakers. By recognizing the importance of phonological awareness and implementing appropriate instructional practices, it is possible to foster strong foundations for reading and writing skills, ultimately supporting children's overall literacy achievement.

Difficulties in Phonological Awareness in Children and Adolescents with Developmental Language Disorder (DLD)

Phonological awareness in children with DLD can be affected in pre-school ages as well as in school ages. Through this quasi-experimental study, formed by a sample of 24 subjects, 12 of with belongs to the experimental group or DLD and 12 belongs to the comparative group or Typical Development (TD). It is intended to know if the phonological awareness in children with SLI is affected and if the results obtained by this group are lower than the comparative group. For this, the evaluation of phonological awareness has been carried out through the PECO test, in order to affirm or deny the hypothesis that children with DLD present specific difficulties in phonological awareness. The results obtained shows that after evaluating both groups, the average performance in the different tasks of the experimental group or DLD is lower than that obtained by the comparative group or with TD; considering a significantly lower result in tasks of identification of phonemes, syllable addiction and phoneme addiction. Therefore, the results of this study reaffirm what has been corroborated by previous studies, that children with DLD have difficulties in phonological awareness and hence the need to implement intervention programs on this to avoid difficulties in other areas such as reading and writing.

Informal preparation and years of experience: Key correlates of dyslexia knowledge among Massachusetts early elementary teachers.

Dyslexia is a neurobiological condition affecting phonological processing and characterized by reading and phonological awareness difficulties. We assessed correlations between dyslexia knowledge and five independent variables among early elementary teachers in Massachusetts. We designed a survey based on two published assessment tools and surveyed 92 early elementary teachers. Using univariate and multivariate linear regression models, we assessed the relationships among knowledge (dependent variable) and confidence, feelings of preparedness, years of teaching experience, informal education and professional development opportunities (independent variables). The mean knowledge score was 68 ± 14%; teachers performed best on questions about perceptions of dyslexia, classroom management/teaching strategies and some dyslexia characteristics. Informal education and years of teaching experience were consistently positively associated with knowledge. Formal training and professional development opportunities may need to focus more specifically on learning disabilities and dyslexia. Teachers should also have input on professional development needs. Our findings suggest a need for additional studies on strategies to improve educator knowledge of dyslexia and assess outcomes.

Efficacy of Berni: A software for preschoolers at risk of dyslexia

The signs of dyslexia can appear as early as preschool. Teachers need effective and efficient programmes to overcome the difficulties these children face, making use of the available resources. The purpose of this study was to design an educational software that would enable effective intervention to improve the early difficulties of children at risk of dyslexia, and that a preschool teacher could apply in the classroom in an inclusive manner. Hence, the software named Berni was designed as an early intervention measure to overcome difficulties in phonological awareness, verbal memory, alphabetic awareness, receptive language and print awareness. The sample included 43 preschoolers aged 4 and 5 years old from 7 schools in the Basque Country (Spain), who showed warning signs of dyslexia. To evaluate the software, half of the participants used the Berni software in their regular classroom and a pre-test/intervention/post-test design was used with a control group. The results showed that multimedia training with the Berni programme helped to overcome difficulties in the variables that better predict dyslexia: phonological awareness, rapid automatised naming and verbal memory. Furthermore, teachers and children consider the Berni software to be perceptible, operable and adequately developed. Teachers consider it to be appropriate to the curriculum, effective and conducive to learning. However, autonomous use, feedback and adaptation possibilities could be improved.

Learning by Doing Intervention: Addressing Phonological Difficulties of Children through Audiolingual Method and Total Physical Response

Phonological awareness is a critical skill that children must master during the early foundations of literacy. It is considered a highly accurate predictor of a child’s success in learning to read. However, at the expected age, there are cases in which children have not developed phonological awareness that consequently result in poor reading skills. This case study sought to determine the alphabet knowledge of two seven-year-old children and address their difficulties in phonological awareness through the alphabetic code. The researchers conducted ten sessions of phonological interventions to children with identified language learning difficulties in reading. The data analysis and collection process included curriculum document reviews, diagnostic assessments, phonological interventions, and evaluation. Diagnostic results indicated that the children have difficulties in letter recognition of Consonant-Vowel-Consonant (CVC) patterns, blending, and segmentation of phonemes. However, anchoring on the principles of learning-by-doing delivered through oral-situational as a core language approach, the interventions in this case study were found effective for phonics instruction. The audio-lingual method and the total physical response in learning phonics, or letter sounds, activated children’s basic phonological skills. Repetition, drilling, memorisation and performing language or vocabulary concepts using physical movement to react to verbal input can lessen the phonological difficulties of children. In light of the current global situation, no previous studies have applied a case study utilizing both audiolingualism and total physical response to address the phonological issues of non-readers. Hence, this study offers scientific and pedagogical implications.

Longitudinal Relationships Between Reading Abilities, Phonological Awareness, Language Abilities and Executive Functions: Comparison of Low Risk Preterm and Full-Term Children.

Different investigations have found that very or extremely (high risk) preterm children show global or specific difficulties in phonological awareness (PA) and reading abilities. Do low risk preterm children, however, exhibit this pattern? Phonological awareness has been considered an important predictor of literacy. Certain executive functions (EFs), and language abilities in turn, have been found to predict PA. The aims of this study are (1) to compare reading abilities of low risk preterm children of different gestational age (GA) groups to those of full-term children, (2) to compare the performance of low risk preterm children of different GA groups to that of full-term children in different EFs, language measures and PA, and (3) to perform a path analysis in order to test a longitudinal model of the relationships between EFs, language abilities, PA and reading. The participants were 108 low risk 4- year-old preterm children, classified into 3 groups of different GAs, and 34 full-term children. The children’s EFs (rapid automatized naming task (RAN), working memory, and inhibition) were assessed at 4 and 5 years of age. Vocabulary comprehension, morphosyntactic production and grammar reception were assessed when the children were 5 years of age, as well as phonemic awareness and syllabic awareness. Finally, reading abilities were assessed when the children were 9 years old. No significant difference between gestational age groups was found on any of the measures taken on EFs, language abilities, phonological awareness, or reading abilities. The path analysis model demonstrates the direct effect of working memory, certain linguistic skills governed by rules (grammar, morphology) and phonological awareness on reading abilities at 9 years of age. The model also shows the mediating role that PA has on the relationship between EFs and language abilities with reading abilities.

Potenziare l’abilità di consapevolezza fonologica: uno studio preliminare sull’efficacia di un percorso educativo attraverso l’utilizzo di tecnologie specifiche

Reading-writing learning is the result of the interaction between individual cognitive maturation and standard and informal educational experiences solicited by the environment. A relationship between phonologic awareness and reading-writing learning has been hypothesized; thus, it is important studying the development of the meta-phonologic abilities on nursery school children, to facilitate written language learning in the following primary school. The present study aimed at verifying the effectiveness of a phonological awareness abilities enhancing, by means of a structured software («En Plain») which allows training meta-phonological abilities by means of virtual reality. Within a first group of 32 aged 5 children, 20 of them, who showed higher phonological awareness difficulties, have been selected. Half of them (Experimental Group, EG) was submitted to the experimental training by means of «En Plein», while the others (Control Group, CG) were submitted to the standard educational activities. Data analysis revealed that, despite a significant improvement in both groups, only EG children showed higher levels of improvement, likely due to the specific structure of the educational training (explicit work on the meta-phonological abilities), as well as to the technology which improved children’s attention, facilitating learning process. Data suggested the usefulness of including a wider sample, to detect meta-phonological abilities learning critical issues at the beginning of schooling process, as well as prescribing specific empowering training of such abilities to reduce difficulties before structure the reading-writing learning process.

Effects of Orthographic, Morphological and Semantic Overlap on Short-Term Memory for Words in Typical and Atypical Development

ABSTRACTLittle is known about implicit morphological processing in typical and atypical readers. These studies investigate this using a probe detection task with lures sharing morphological, orthographic, or semantic overlap with the probe. Intermediate and advanced readers (reading ages = 9;1–12;9) perform more poorly when there is more linguistic overlap. Novice readers (reading ages = 5;7–8;0) were influenced only by orthographic overlap and not by semantics, indicating that use of orthographic processes typically precedes integration of semantic and morphological skills. Children with otitis media (repeated ear infections) had phonological awareness difficulties but performed age appropriately on the probe detection task, indicating that morphological processing is not constrained by phonology. In contrast, dyslexic children’s performance reflected a failure to remember distinctions between words sharing root morphemes. Dyslexic children are sensitive to morphology but may over-rely on root morphemes. This pattern differed from reading-ability-matched children and children with circumscribed phonological difficulties.

Identifying phonological awareness difficulties in preschool children with speech sound disorders

Phonological awareness is one type of phonological processing ability and is considered to be particularly important for early literacy development. Specific phonological awareness skills include syllable-level awareness, onset-rime awareness, and phonemic awareness. Children with speech sound disorders are at a high risk of difficulties with phonological awareness and literacy. There is a body of literature reporting both composite scores and task-specific phonological awareness scores from the assessment of children with typically developing speech and school-age children with speech sound disorders. In this study, we completed a systematic overview of the available literature regarding the assessment of phonological awareness in preschool-age children with speech sound disorders. A systematic search of literature databases yielded 777 articles which were screened. The full text of 30 articles was read and 12 articles met all specified criteria. Ten of the 12 articles reported composite scores for the phonological awareness of participants. The studies rarely reported the profile of specific phonological awareness skills. Of the final 12 articles, eight were case–control studies (Level III) and four were case-series or cross-sectional studies without a control reference (Level IV). There is a need for more research reporting task-specific phonological awareness abilities in preschool-age children with speech sound disorders in order to understand the relationship between specific skills and literacy development in this population.

Aberrant N400 responses to phonological overlap during rhyme judgements in children at risk for dyslexia

It is widely accepted that dyslexia is associated with difficulties in phonological awareness and that rhyme awareness in young children can predict later reading success. However, little is known regarding the underlying phonological mechanisms of rhyme awareness in dyslexia, as rhyme awareness is typically assessed using explicit behavioural measures that represent only the endpoint of processing and often lack phonological distracters. We examined event-related potentials (ERPs) in response to auditory word pairs that differed in phonological overlap during a rhyme judgement task given to 6-year-old beginning readers who were at risk for dyslexia (n=30) and typical-reading age-matched controls (n=29). ERPs were recorded in response to word pairs with various types of phonological overlap, including rhyming (e.g., wall-ball), non-rhyming overlapping (e.g., bell-ball) and non-rhyming unrelated (e.g., sock-ball) word pairs. Both groups of participants exhibited N400 responses for basic rhyme judgements vs. unrelated targets. In the typical-reading controls, the neural responses also differed between the rhyming targets and the non-rhyming overlapping targets, whereas neural responses to these targets were similar in the group of children at risk for dyslexia, indicating difficulties in their ability to process similar-sounding, non-rhyming targets. These findings suggest that typical-reading children solve the rhyme judgement task using a more analytical approach, whereas children who are at risk for dyslexia base their judgments on a comparison of overall sound similarity.

Consciência fonológica e a memória de trabalho de crianças com e sem dificuldades na alfabetização

To investigate phonological awareness and working memory skills as well as their influence on the literacy process in a group of intellectually normal children. Forty intellectually normal children (7.6-8.0 years) from the second and third grades of elementary school participated. Children were organized in two groups (20 children each): one with and another without literacy difficulties. These participants underwent RAVEN's intelligence quotient test, audiometric assessment, CONFIAS test of phonological awareness, written spelling task, and working memory test. Children in the alphabetic phase presented a good development of phonological awareness, and 85% of them showed a high-performance working memory. Children in the syllabic-alphabetic phase had changes in phonological awareness, and 91.6% of them showed an average working memory performance. The subjects at pre-syllabic and syllabic phases demonstrated more difficulties in phonological awareness than those at syllabic-alphabetic and had a poor working memory performance. Between-group differences were observed for CONFIAS and working memory tests (p<0.0001). There was also a significant correlation (r=0.78, p=0.01) between the skills of phonological awareness and working memory for the total sample of individuals. Based on these results, it was found that as phonological awareness and working memory levels increased, the literacy phase also advanced, therefore showing that these are directly proportional measures.

What Factors Place Children With Speech Sound Disorders at Risk for Reading Problems?

To identify weaknesses in print awareness and phonological processing that place children with speech sound disorders (SSDs) at increased risk for reading difficulties. Language, literacy, and phonological skills of 3 groups of preschool-age children were compared: a group of 68 children with SSDs, a group of 68 peers with normal speech matched on receptive vocabulary, and a group of 68 peers with normal speech and language. The SSD group demonstrated impairments in expressive phonological awareness (ts = 3.45 to 8.17, ps < .001, effect size [ES] = 0.51 to 1.04), receptive phonological awareness (zs = 2.26 to 5.21, ps ≤ .02, ES = 0.39 to 0.79), accessing phonological representations (zs = 3.34 to 5.83, ps < .001, ES = 0.59 to 0.91), quality of phonological representations (zs = 2.35 to 13.11, ps ≤ .02, ES = 0.44 to 1.56), and word reading (ts = 2.48 to 4.42, ps ≤ .01, ES = 0.22 to 0.54). Analyses of covariance found that lower performances of the SSD group on tests of phonological awareness and word reading could be explained by their weaknesses in quality and accessibility of phonological representations. The present study makes a significant theoretical contribution to the literature as the first study, to our knowledge, that has tested the hypothesis that weaknesses in representation-related phonological processing may underlie the difficulties in phonological awareness and reading that are demonstrated by children with SSDs.

The fragile nature of phonological awareness in children with specific language impairment: Evidence from literacy development

Previous studies have suggested that children with specific language impairment (SLI) risk encountering subsequent literacy difficulties, due to difficulties in phonological awareness (PA). This longitudinal study provides evidence in support of this view based on a group of 20 French-speaking children with SLI examined at the start of learning to read. It also investigates the specific difficulties in reading decoding, reading comprehension and spelling. The sample was tested on standardized measures of phonological awareness, nonverbal skills, morphosyntax, reading, and spelling. The assessment was performed twice separated by an interval of 30 months. At Time 2, the results indicated normal scores on phonological awareness. Despite this, the sample scored poorly on literacy tasks, and the majority exhibited particularly striking deficits on spelling. We argue that there is a reciprocal influence between the early PA deficit and the subsequent literacy development in children with SLI. The sample of the study presented normal PA skills after 2 or 3 years of schooling. Nonetheless, most of the participants experienced difficulties on the literacy tasks, thus proving that the acquired PA skills were fragile and not sufficiently developed to cope with tasks more complicated than typical PA tasks.

Desempenho de escolares em consciência fonológica, nomeação rápida, leitura e escrita

phonological awareness, rapid naming, reading and writing in students with learning difficulties of a municipal public school. to characterize and compare the performance of students from public schools with and without learning difficulties in phonological awareness, rapid naming, reading and writing. participants were 60 students from the 2nd to the 4th grades of municipal public schools divided into 6 groups. Each group was composed by 10 students, being 3 groups of students without learning difficulties and 3 groups with students with learning difficulties. As testing procedure phonological awareness, rapid automatized naming, oral reading and writing under dictation assessments were used. the results highlighted the better performance of students with no learning difficulties. Students with learning difficulties presented a higher ratios considering time/speed in rapid naming tasks and, consequently, lower production in activities of phonological awareness and reading and writing, when compared to students without learning difficulties. students with learning difficulties presented deficits when considering the relationship between naming and automatization skills, and among lexical access, visual discrimination, stimulus frequency use and competition in using less time for code naming, i.e. necessary for the phoneme-grapheme conversion process required in the reading and writing alphabetic system like the Portuguese language.

Zusammenhang zwischen phonologischer Bewusstheit und Verhaltensauffälligkeiten bei Kindern im Vorschulalter

Phonological awareness is a key precursor of reading and writing skills in preschool children. Many children with reading and spelling problems have comorbid disorders that have a negative impact on their development. Research to date has rarely focused on the interaction between behavioral problems and phonological awareness. The study investigates whether preschool children with difficulties in phonological awareness already show behavioral problems. Children (N = 188) were interviewed to assess their level of phonological awareness and teachers used the SDQ to rate their behavioral strengths and difficulties. Children with low levels of phonological awareness have more emotional problems, are more hyperactive, and have more problems with peers than children with higher levels of phonological awareness. No gender differences were found. The results indicate that already at preschool age children with low levels of phonological awareness show more behavioral problems than children with higher levels of phonological awareness. The results are comparable to those of school children who have writing and reading difficulties and behavioral problems.

Second Language Learning Difficulties in Chinese Children With Dyslexia: What Are the Reading-Related Cognitive Skills That Contribute to English and Chinese Word Reading?

This study examined the relations between reading-related cognitive skills and word reading development of Chinese children with dyslexia in their Chinese language (L1) and in English (L2). A total of 84 bilingual children—28 with dyslexia, 28 chronological age (CA) controls, and 28 reading-level (RL) controls—participated and were administered measures of word reading, rapid naming, visual-orthographic skills, and phonological and morphological awareness in both L1 and L2. Children with dyslexia showed weaker performance than CA controls in both languages and had more difficulties in phonological awareness in English but not in Chinese. In addition, reading-related cognitive skills in Chinese contributed significantly to the ability to read English words, suggesting cross-linguistic transfer from L1 to L2. Results found evidence for different phonological units of awareness related to the characteristics of the different languages being learned, supporting the psycholinguistic grain size and linguistic coding differences hypotheses.

Evidence for Functional Impairment but Not Structural Disease in Benign Rolandic Epilepsy

Is Rolandic Epilepsy Associated with Abnormal Findings on Cranial MRI? Boxerman JL, Hawash K, Bali B, Clarke T, Rogg J, Pal DK. Epilepsy Res. 2007;75( 2 – 3 ):180–185. Rolandic epilepsy (RE) is designated an idiopathic epilepsy syndrome, and hence no lesional abnormalities are expected on MRI exam. Recent reports suggest that MRI abnormalities are not only common, but may be specific for temporal lobe epilepsy, and lateralized to the side of EEG discharges. However, no controlled study has been performed to test the hypothesis of association between MRI abnormalities and Rolandic epilepsy. We performed an unmatched case-control study to test the hypothesis of association between MRI abnormalities and Rolandic epilepsy, using 25 typical RE cases and 25 children with migraine. Two independent examiners rated the MRIs for abnormalities. Examiners were blinded to the study hypothesis and identity of case and control exams. Fifty-two percent of RE exams contained at least one abnormality: peri/hippocampal abnormality (one case), non-localized congenital malformation (seven cases), subcortical parenchymal hyperintensities (two cases), periventricular parenchymal hyperintensities (one case), dilated perivascular spaces (six cases). There was no difference between the number or type of abnormalities in cases and controls. No type of abnormality lateralized to the hemisphere from which the EEG spikes emanated. The odds ratio of association between MRI abnormalities and RE was 0.87, 95% CI: 0.18–4.33 after adjusting for potential demographic and technical factors. We conclude that routine cranial MRI abnormalities are common in RE, but no more common than in controls, and not specific for RE. Memory and Phonological Awareness in Children with Benign Rolandic Epilepsy Compared to a Matched Control Group. Northcott E, Connolly AM, Berroya A, McIntyre J, Christie J, Taylor A, Bleasel AF, Lawson JA, Bye AM. Epilepsy Res. 2007;75(1):57–62. Purpose In a previous study we demonstrated children with Benign Rolandic Epilepsy have normal intelligence and language ability. However, difficulties in verbal and visual memory and aspects of phonological awareness were found compared to normative data. To address the methodological limitations related to the use of normative data, we compared the same cohort of children with Benign Rolandic Epilepsy to a matched control group. Method Controls ( n = 40) matched on age and gender to the Benign Rolandic Epilepsy cohort underwent neuropsychological assessment. The life functioning of the control group was assessed using a modified version of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). Results The study confirmed the previous findings of memory and phonological awareness difficulties. In addition, the children with Benign Rolandic Epilepsy had significantly lower IQ scores than the matched control group. Paired sample t-tests showed that on 8 of 11 QOLCE scales, children with Benign Rolandic Epilepsy were rated by parents as having poorer life functioning compared to matched controls, including lower parental ratings on the subscales of memory and language. Discussion Benign Rolandic Epilepsy has an excellent seizure prognosis, but this study further emphasizes potential cognitive difficulties. Using an age and gender matched control group, the previous findings of memory and phonological awareness difficulties were validated. These problems in cognition were also identified by parents of children with Benign Rolandic Epilepsy as problematic and impacting upon the child's quality of life.

Memory and phonological awareness in children with Benign Rolandic Epilepsy compared to a matched control group

In a previous study we demonstrated children with Benign Rolandic Epilepsy have normal intelligence and language ability. However, difficulties in verbal and visual memory and aspects of phonological awareness were found compared to normative data. To address the methodological limitations related to the use of normative data, we compared the same cohort of children with Benign Rolandic Epilepsy to a matched control group. Controls (n=40) matched on age and gender to the Benign Rolandic Epilepsy cohort underwent neuropsychological assessment. The life functioning of the control group was assessed using a modified version of the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). The study confirmed the previous findings of memory and phonological awareness difficulties. In addition, the children with Benign Rolandic Epilepsy had significantly lower IQ scores than the matched control group. Paired sample t-tests showed that on 8 of 11 QOLCE scales, children with Benign Rolandic Epilepsy were rated by parents as having poorer life functioning compared to matched controls, including lower parental ratings on the subscales of memory and language. Benign Rolandic Epilepsy has an excellent seizure prognosis, but this study further emphasizes potential cognitive difficulties. Using an age and gender matched control group, the previous findings of memory and phonological awareness difficulties were validated. These problems in cognition were also identified by parents of children with Benign Rolandic Epilepsy as problematic and impacting upon the child's quality of life.

Childhood Apraxia of Speech: Children at Risk for Persistent Reading and Spelling Disorder

This article discusses written language development in children with childhood apraxia of speech (CAS). Children with CAS are at risk for persistent reading and spelling disorder in addition to their spoken communication difficulties. The article highlights four factors that increase the risk of written language disorder in this population: (1) the nature of the speech disorder, (2) the presence of phonological awareness difficulties, (3) genetic risk factors, and (4) the negative impact of early reading difficulty on later written language development. The article suggests that traditional approaches used to target articulation in CAS may do little to develop skills that are critical to early literacy acquisition and stresses the importance of integrating speech, phonological awareness, and literacy goals for this population. Data presented from a pilot intervention study with three children with CAS aged 6 and 7 years highlight the potential benefit of an integrated phonological awareness approach to improve simultaneously speech, phonological awareness, and decoding ability. The need for further empirical evaluation of treatment approaches designed to improve the spoken and written language outcomes of children with CAS is emphasized.