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Purpose Children with dyslexia have speech production deficits in a variety of spoken language contexts. In this article, we discuss the nature of speech production errors in children with dyslexia, including those who have a history of speech sound disorder and those who do not, to familiarize speech-language pathologists with speech production–specific risk factors that may help predict or identify dyslexia in young children. Method In this tutorial, we discuss the role of a phonological deficit in children with dyslexia and how this may manifest as speech production errors, sometimes in conjunction with a speech sound disorder but sometimes not. We also briefly review other factors outside the realm of phonology that may alert the speech-language pathologist to possible dyslexia. Results Speech-language pathologists possess unique knowledge that directly contributes to the identification and remediation of children with dyslexia. We present several clinical recommendations related to speech production deficits in children with dyslexia. We also review what is known about how and when children with speech sound disorder are most at risk for dyslexia. Conclusion Speech-language pathologists have a unique opportunity to assist in the identification of young children who are at risk for dyslexia.
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LSHSS
Tutorial
Exploring the Overlap Between Dyslexia
and Speech Sound Production Deficits
Kathryn L. Cabbage,
a
Kelly Farquharson,
b
Jenya Iuzzini-Seigel,
c
Jennifer Zuk,
d,e
and Tiffany P. Hogan
d
Purpose: Children with dyslexia have speech production
deficits in a variety of spoken language contexts. In this
article, we discuss the nature of speech production errors
in children with dyslexia, including those who have a history
of speech sound disorder and those who do not, to familiarize
speech-language pathologists with speech production
specific risk factors that may help predict or identify dyslexia
in young children.
Method: In this tutorial, we discuss the role of a phonological
deficit in children with dyslexia and how this may manifest
as speech production errors, sometimes in conjunction with
a speech sound disorder but sometimes not. We also briefly
review other factors outside the realm of phonology that may
alert the speech-language pathologist to possible dyslexia.
Results: Speech-language pathologists possess unique
knowledge that directly contributes to the identification and
remediation of children with dyslexia. We present several
clinical recommendations related to speech production
deficits in children with dyslexia. We also review what is
known about how and when children with speech sound
disorder are most at risk for dyslexia.
Conclusion: Speech-language pathologists have a unique
opportunity to assist in the identification of young children
who are at risk for dyslexia.
Ben is in second grade and has always enjoyed school.
His teachers have consistently reported that he is
quite bright and engaged in the classroom setting.
His parents note that Ben has always enjoyed being read to
at home, but since late kindergarten he has resisted trying
to read on his own or aloud to mark off his assigned home
reading timefor school. They have talked with his teachers
about his resistance to read at home. Although his teachers
have noted that Ben tends to lag behind his peers in reading
skills, they have not been overly concerned because of his
classroom engagement. Ben was seen by a school-based
speech-language pathologist (SLP) from 3 to 6 years of age
for a speech sound disorder that significantly impacted his
overall speech intelligibility. At age 6, all error patterns had
remediated except for /r/ in all positions of words, so he
was discharged from therapy. Now in second grade, Bens
resistance to participating in reading activities in class and
at home has become increasingly worrisome. He was re-
cently referred for a special education evaluation to deter-
mine the presence of a reading disability. Results revealed
that Ben has relatively strong oral language comprehension
and expression but has weak phonological awareness and
significant difficulty in decoding words. The special educa-
tion team determined that Ben exhibits characteristics consis-
tent with a learning disability and are now recommending
intensive instruction to remediate Bens deficient word-
reading skills.
This true case example
1
is a common scenario regu-
larly played out in many educational settings. It often takes
23 years of a child failing to respond to reading instruction
before he or she is identified with dyslexia (often referred
to as a specific learning disability in school-based settings)
and can begin receiving much-needed individualized instruc-
tion to support reading acquisition. Ben exhibited early
1
Ben is a pseudonym.
a
Department of Communication Disorders, Brigham Young
University, Provo, UT
b
Department of Communication Sciences and Disorders, Emerson
College, Boston, MA
c
Department of Speech Pathology and Audiology, Marquette
University, Milwaukee, WI
d
Department of Communication Sciences and Disorders, MGH
Institute of Health Professions, Boston, MA
e
Program in Speech and Hearing Bioscience and Technology, Division
of Medical Sciences, Harvard University, Boston, MA
Correspondence to Kathryn L. Cabbage: kcabbage@byu.edu
Kelly Farquharson is now with the School of Communication Sciences
and Disorders, Florida State University, Tallahassee
Editor-in-Chief: Julie Barkmeier-Kraemer
Received January 8, 2018
Revision received April 22, 2018
Accepted July 13, 2018
https://doi.org/10.1044/2018_LSHSS-DYSLC-18-0008
Publisher Note: This article is part of the Clinical Forum: Dyslexia.
Disclosure: The authors have declared that no competing interests existed at the time
of publication.
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risk factors, such as a speech sound disorder, that placed
him at risk for reading difficulty long before he was strug-
gling with reading in the classroom. Children with dyslexia
are at risk for long-term educational and social-emotional
consequences, including poor self-esteem and poor self-
perception of social and academic competence (Polychroni,
Koukoura, & Anagnostou, 2006; Snowling, Muter, &
Carroll, 2007; Terras, Thompson, & Minnis, 2009). Conse-
quently, optimizing early identification of children with
dyslexia has been a central goal for educators and researchers
for decades. In this article, we highlight how SLPs are
uniquely suited to play a pivotal role in improving early
identification of children with dyslexia because of their ex-
pertise in speech and language and their interaction with
children before the start of formal reading instruction.
The SLPs Impact on Children With Dyslexia
Approximately 9% of school-age children in the
United States have dyslexia (Katusic, Colligan, Barbaresi,
Schaid, & Jacobsen, 2001; Pennington & Bishop, 2009).
Dyslexia is defined as a specific learning disability that is
characterized by difficulties in accurate and/or fluent word
recognition and by poor spelling and decoding abilities.
These difficulties typically result from a deficit in the pho-
nological component of language. Secondary consequences
may include problems in reading comprehensionand vo-
cabulary and background knowledge(Lyon, Shaywitz,
& Shaywitz, 2003, p. 2). At first glance, it may appear that
assessing and treating dyslexia may be outside the scope of
practice for SLPs and instead fall more fully under the
purview of a reading specialist or other educator. We,
too, believe that reading specialists and other educators are
key players for remediation of decoding and spelling skills
as children learn to read. It is crucial, however, to consider
the full scope of how dyslexia is characterized and recognize
the important role SLPs play in the prevention, identifica-
tion, and remediation of children with dyslexia.
Since 2001, it has been the position of the American
Speech-Language-Hearing Association (ASHA) that SLPs
play a critical and direct role in the development of literacy
for children and adolescents with communication dis-
orders(ASHA, 2001, p. 1). This role includes the identifi-
cation of children who are at risk for reading and writing
problems, such as dyslexia. As outlined in ASHAs position
statement, the connections between spoken and written
language are well established and spoken language provides
the foundation for the development of reading and writing
(ASHA, 2001, p. 1). Children with dyslexia commonly
have a history of poor oral language skills in early childhood
(Bishop & Adams, 1990; Magnusson & Nauclér, 1990;
Scarborough, 1990; Snowling & Melby-Lervåg, 2016). In
addition, weak word-reading skills have cascading influ-
ences on key language skills outside the phonological do-
main, such as the acquisition of vocabulary knowledge
and reading comprehension. This becomes particularly
evident around the third to fourth grades when students
make the well-known shift from learning to read to reading
to learn (Chall, 1983). As a result, children with dyslexia are
at particular risk for experiencing a detrimental Matthew
effect, a phenomenon wherein reading deficits impede a
childs ability to improve his or her language skill through
reading texts (Duff, Tomblin, & Catts, 2015; Stanovich,
1986). Furthermore, as reviewed by Adlof and Hogan
(2018), there is an established relationship between devel-
opmental language disorder (DLD) and dyslexia. DLD
is characterized by a deficit in any subcomponent of lan-
guage such as phonology, morphology, syntax, vocabulary,
and/or pragmatics (see Bishop, Snowling, Thompson,
Greenhalgh, & CATALISE2 Consortium, 2017, for a re-
view).Thus,childrenwithDLDareatsignificantriskfor
dyslexia if phonological weaknesses are part of their profile.
Importantly, however, some children with DLD do not show
phonological weaknesses and thus do not exhibit dyslexia
(Catts, Adlof, Hogan, & Weismer, 2005). We refer the
reader elsewhere for further discussion on the relationship
between dyslexia and oral language skills (Adlof & Hogan,
2018; Scarborough & Dobrich, 1990; Snowling, Bishop,
& Stothard, 2000; Storch & Whitehurst, 2002)
But what is the relation between dyslexia and speech
production, apart from language ability? Because dyslexia
involves a deficit in phonology, it is plausible that individ-
uals with dyslexia likewise show difficulty with speech pro-
duction in some capacity. Speech production is, after all,
heavily reliant on an intact phonological system. Indeed,
research shows that individuals with dyslexia exhibit a spec-
trum of speech production deficits, spanning the gamut
from more severe impairments that are properly character-
ized as a speech delay or speech sound disorder to subclinical
deficits involving word-specific errors, such as phonological
confusion during speech production (e.g., mispronouncing
animalas aminaland stethoscopeas steposcope
long after it is age appropriate).
The purpose of the current article is to review the
nature of speech production deficits in children with dys-
lexia, particularly as it relates to errors that may alert the
SLP to the risk for dyslexia in young children. We further
provide concrete recommendations that SLPs may readily
incorporate into clinical practice to more fully support the
identification and/or remediation of children with or at risk
for dyslexia. We believe a more complete understanding of
speech production skills and how they relate to dyslexia
will help SLPs more easily recognize their role in the pre-
vention, identification, and treatment of children with dys-
lexia. We first provide the reader with a brief review of the
role that phonology plays in dyslexia, including evidence
for a phonological deficit in children with dyslexia. Second,
we review speech production error patterns made by indi-
viduals with dyslexia, regardless of the presence or absence
of a speech sound disorder. Third, we review the relation
between speech sound disorder and dyslexia, particularly
as this pertains to identifying young children with speech
sound disorder who are most likely to develop dyslexia. Next,
we look beyond phonological deficits and discuss other
prominent theories of deficit for children with dyslexia that
may further assist SLPs in the identification and management
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of children with dyslexia. Finally, we provide concrete clini-
cal recommendations to help clinicians more confidently
apply the breadth of their knowledge to identify and remedi-
ate children with dyslexia.
The Role of Phonology in Children With Dyslexia
Dyslexia is a disorder that is primarily characterized
by deficits in the understanding and use of the phonologi-
cal system for literacy skills (e.g., decoding and encoding;
Lyon et al., 2003). The phonological deficit hypothesis
offers a long-standing explanation for the difficulties
most commonly experienced by children with dyslexia
(McCardle, Scarborough, & Catts, 2001; Stanovich & Siegel,
1994; Vellutino, Fletcher, Snowling, & Scanlon, 2004). The
classic manifestation of the phonological deficit in dyslexia
culminates as difficulty in mapping speech sounds onto let-
ters during the decoding process. Importantly, however,
individuals with dyslexia have difficulty with a number of
other phonologically based skills that provide further evidence
of a weak phonological system. One of the strongest indica-
tors of phonological weakness is poor phonological aware-
ness (Farquharson, Centanni, Franzluebbers, & Hogan,
2014; Swan & Goswami, 1997), referring to ones metalin-
guistic knowledge of the sound structure of language. Phono-
logical awareness can be reflected at the word and syllable
level (e.g., rhyming, syllable segmentation) or at the pho-
neme level, which include abilities such as phoneme blend-
ing (e.g., What word do these sounds make? /s/ /p/ /u/ /n/.)
or phoneme deletion (e.g., Say the word splitwithout /p/.)
Poor literacy outcomes have long been linked to children
with poor phonological awareness (Bruck, 1992; Wagner &
Torgesen, 1987). Importantly, even after learning to read,
individuals with dyslexia continue to show poor phonologi-
cal awareness, particularly for tasks that require phoneme-
level sensitivity (Pennington, Orden, Smith, Green, & Haith,
1990; Snowling, Nation, Moxham, Gallagher, & Frith, 1997;
Wilson & Lesaux, 2001).
In addition to known deficits in phonological aware-
ness, those with dyslexia commonly manifest other deficits
reflective of a weak phonological system, including poor
phonological memory (Brady, Shankweiler, & Mann,
1983), poor speech perception (Rosen, 2003), and poor
letter sound decoding skills (Stanovich & Siegel, 1994).
Taken together, children with dyslexia exhibit poor pho-
nological processing skills across the board (Lyon et al.,
2003; Snowling et al., 1997; Vellutino et al., 2004; Wagner
& Torgesen, 1987). As defined by Scarborough and Brady
(2002), phonological processing refers to the the forma-
tion, retention, and/or use of phonological codes or speech
whilespeaking, listening, remembering, learning, naming,
thinking, reading, or writing(p. 318). Although it is clear
that dyslexia manifests with deficits in phonology across a
variety of skills and tasks, the underlying mechanism(s) that
drives this deficit is still debated.
Long-standing research has reported that phonologi-
cal representations appear weak, underspecified, and/or
absent in children with dyslexia (Boada & Pennington, 2006;
Elbro & Jensen, 2005; Farquharson et al., 2014). These
abstract mental representations in the phonological system
are an important component of how we store information
about individual words in long-term memory (Goswami,
2000; Scarborough & Brady, 2002; Sutherland & Gillon,
2005). Such information may include the phonemes com-
prising the word, the stress pattern of the word, and/or any
other phonologically relevant information for a given word.
Phonological representations appear to be acquired and
refined over time as language develops (Scarborough &
Brady, 2002). Importantly, phonological representations
are not the only mental representation for words in long-term
memory. For example, a semanticrepresentation pro-
vides meaning of the word in the lexicon (Perfetti & Hart,
2002). For children with dyslexia, the creation of phonolog-
ical representations appears to be disrupted (Alt et al., 2017;
Brady et al., 1983; Melby-Lervåg & Lervåg, 2012; Swan &
Goswami, 1997). As children acquire new words, they must
rely on phonological working memory to create, retain, and
retrieve a phonological code that is not yet associated with
a semantic representation. This process of phonological
encoding has been an oft-reported deficit for children with
dyslexia (Brady et al., 1983; Elbro & Jensen, 2005; Swan &
Goswami, 1997), which likely has negative implications for
learning to read and produce complex words. For example,
this deficit may affect a childs ability to encode and re-
trieve challenging words in a science class, where vocabu-
lary is often complex.
Speech Production Error Patterns in Children
With Dyslexia
Because dyslexia is characterized by a core deficit in
phonology (Stanovich & Siegel, 1994; Vellutino et al., 2004),
it follows that individuals with dyslexia may produce errors
during speech production, an ability that relies heavily on
phonology. Indeed, the relation between spoken language
and dyslexia has been of interest for many years. As far
back as the early 20th century, it was noted that children
with word-reading deficits often presented with a history of
oral language problems early in childhood (Orton, 1925).
Numerous researchers have since corroborated this find-
ing and similarly reported that children with dyslexia com-
monly have a history of spoken languageor verbal
deficits (Gallagher, Frith, & Snowling, 2000; Lambrecht
Smith, Roberts, Locke, & Tozer, 2010; Scarborough &
Dobrich, 1990; Snowling, 1981). However, prior research
has not always been clear about what was meant by spo-
ken languageor verbaldeficits. It is possible this termi-
nology alternatively may have referred to deficits of speech
production (i.e., articulation), oral language, or both. Be-
low, we review literature that characterizes speech produc-
tion in both young children at risk for dyslexia as well as
older children and adults who have dyslexia.
In early development, young children with familial
risk for dyslexia have shown significantly poorer speech
production accuracy relative to children without familial
risk (Carroll, Mundy, & Cunningham, 2014; Carroll &
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Snowling, 2004; Elbro, Borstrom, & Petersen, 1998;
Scarborough, 1990). These studies have noted that even in
toddlerhood, children with familial risk of dyslexia who
eventually develop dyslexia produce more consonantal
errors (Lambrecht Smith et al., 2010; Scarborough, 1990)
and use slower speaking rates (Smith, Roberts, Smith,
Locke, & Bennett, 2006) than their peers at familial risk
for dyslexia who do not develop the disorder. Additional
speech production deficits have been implicated among
children, adolescents, and adults with dyslexia with respect
to phonetic accuracy during speech production (Bertucci,
Hook, Haynes, Macaruso, & Bickley, 2003; Catts, 1986,
1989; Catts, Fey, Zhang, & Tomblin, 2001), articulatory
speed (Duranovic & Sehic, 2013; Fawcett & Nicolson, 2002),
speaking rate (Catts, 1989), and speech motor planning/
programming (Peter, Lancaster, Vose, Middleton, &
Stoel-Gammon, 2017). Of note, the speech errors in those
with dyslexia are atypical and do not follow the pattern of
systematic misarticulations or distortions characteristic of a
clinically diagnosed speech sound disorder.
Catts (1986) sought to explicitly characterize speech
production patterns in children with dyslexia in the ab-
sence of a diagnosed speech sound disorder. He found that
children ages 12;7 to 15;9 (years;months) produced more
speech production errors than their peers during a picture-
naming task (e.g., rhinoceros, ambulance), when repeating
multisyllabic words (e.g., aluminum, sympathize), and when
repeating short phrases (e.g., the priest blessed the bread ).
These errors were characterized as word- or phrase-specific
misarticulations (e.g., saying amunium for aluminum), as
opposed to the systematic distortions typical of children
with speech sound disorder (e.g., /r/ is produced as /w/ in
all instances). Catts hypothesized that some of these errors
were the result of difficulty in encoding phonological infor-
mation (e.g., omitting phonemes, substituting the wrong
phoneme) but attributed other errors to the childrens diffi-
culty with accessing phonological memory because the chil-
dren were aware that the production they attempted was
not correct (e.g., laughing when a word came out incorrectly).
He concluded that children with dyslexia may have an ade-
quate phonological representation to recognize that what
they produced did not match the intended phonological tar-
get. This study replicated an earlier finding from Snowling
(1981) that showed that children with dyslexia produce
an increasing number of speech production errors or mis-
articulations, but only when words become more phono-
logically complex (e.g., producing consonant cluster vs.
singletons, producing words of increasing length). Impor-
tantly, both Catts (1986) and Snowling (1981) noted these
errors were not systematic distortions children were mak-
ing in their speech but rather occurred in specific words
and/or when the speech task became more challenging.
Speech Sound Disorder in Children With Dyslexia
Similar to children with dyslexia, a core deficit in the
phonological system has been implicated in children with
speech sound disorder (Anthony et al., 2011; Pennington &
Bishop, 2009; Sutherland & Gillon, 2007). Children with
speech sound disorder have a clinical delay or difference in
speech sound acquisition that cannot be explained by cog-
nitive, sensory, or structural deficits (Shriberg et al., 2010).
Speech production errors in speech sound disorder are
characterized by persistent and systematic deletion, sub-
stitution, and/or distortion of speech sounds resulting in
decreased intelligibility as compared to same-age peers
(Shriberg, Austin, Lewis, McSweeny, & Wilson, 1997). In
addition to their overt errors in speech production, children
with speech sound disorder have shown deficits for a vari-
ety of other phonological tasks, including phonological
awareness (Bird, Bishop, & Freeman, 1995; Carroll &
Snowling, 2004; Preston, Hull, & Edwards, 2013; Rvachew
& Grawburg, 2006), phonological memory (Couture &
McCauley, 2000; Farquharson, Hogan, & Bernthal, 2017;
Munson, Edwards, & Beckman, 2005), spelling (Bird et al.,
1995; Carroll & Snowling, 2004; Clarke-Klein & Hodson,
1995), and word reading itself (Apel & Lawrence, 2011;
Overby, Trainin, Smit, Bernthal, & Nelson, 2012). Impor-
tantly, children with speech sound disorder have been
shown to exhibit deficits in these tasks, even when control-
ling for their poor speech production accuracy (Anthony
et al., 2011; Rvachew, Ohberg, Grawburg, & Heyding,
2003; Sutherland & Gillon, 2005, 2007) and/or even after
their speech sound errors have been remediated (Raitano,
Pennington, Tunick, Boada, & Shriberg, 2004). This sug-
gests that phonological deficits impact an underlying level of
phonological representation that goes beyond their overt
speech production errors.
A large body of work has shown that children with
speech sound disorder are at increased risk for having diffi-
culty in learning to read (Anthony et al., 2011; Bird et al.,
1995; Carroll & Snowling, 2004; Hayiou-Thomas, Carroll,
Leavett, Hulme, & Snowling, 2017; Larivee & Catts, 1999;
Peterson, McGrath, Smith, & Pennington, 2007; Raitano
et al., 2004; Rvachew, 2007). Approximately 18% of pre-
school-age children with isolated speech sound disorder
(absent of a co-occuring language impairment) have read-
ing difficulty in mid-elementary school (Lewis, Freebairn,
& Taylor, 2000). In a separate line of work, an estimated
25% of school-age children with a family history of dys-
lexia have a history of speech sound disorder in early child-
hood (Pennington & Lefly, 2001). Thus, speech sound
disorder and dyslexia are highly comorbid.
The comorbidity of speech sound disorder and dys-
lexia is not well understood for several reasons. First, one
inherent challenge to studying these populations concerns
the ages at which symptoms of speech sound disorder and
dyslexia manifest. Children with speech sound disorder are
typically identified during the early preschool years due to
low intelligibility resultant from speech production errors.
Once these children are identified, an SLP begins targeting
the childs speech production errors in therapy, well before
reading instruction begins. It is not uncommon for many
of these children, with the provision of adequate speech
therapy, to resolve most of their overt speech errors by the
beginning of reading instruction in early elementary school
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(Baker & McLeod, 2011). Indeed, that is often a primary
goal of therapy: to remediate speech production errors be-
fore the start of formal education. It is during the early
elementary grades that reading deficits associated with dys-
lexia manifest for children who are failing to respond to
quality reading instruction. Thus, dyslexia is typically diag-
nosed in the early to mid-elementary grades. Just as chil-
dren with speech sound disorder are resolving their speech
production errors, those children with dyslexia are on the
cusp of being identified. As a child is undergoing evaluation
for dyslexia, knowing that he or she has a history of speech
sound disorder would provide useful diagnostic informa-
tion concerning that childs underlying phonological system.
Unfortunately, because of the age disparity between when
children with speech sound disorder and children with dys-
lexia are diagnosed and treated, it is common for a childs
history of speech sound disorder to be unknown to the per-
sonnel conducting the evaluation.
Second, as mentioned in the previous section, many
children with dyslexia have poor speech production as
compared to age-matched typically developing readers (e.g.,
Catts, 1989; Snowling, 1981; Snowling & Melby-Lervåg,
2016), particularly when words are long or phonologically
complex (Catts, 1989; Peter et al., 2017; Snowling, 1981).
The quantity of their errors, however, may not be sufficient
to warrant a clinical diagnosis of speech sound disorder,
and thus, these children may not be under the direct care of
an SLP. On the reverse side, some children with speech
sound disorder show poorer reading outcomes when com-
pared to their age-matched peers with typical speech pro-
duction, even though their weak literacy skills may not fully
qualify them for a formal diagnosis of dyslexia (Hayiou-
Thomas et al., 2017). These children may have related sub-
clinical deficits, such as poor phonological awareness, but
may not require intensive reading intervention (Overby et al.,
2012). This may place these children at increased risk for
reading comprehension deficits in the later grades subsequent
to their weak phonological skills. In both casessubclinical
speech production deficits in children with dyslexia and
subclinical reading deficits in children with speech sound dis-
orderthe potentially interesting overlap between these
two disorders is missed because the visibility of one deficit
may be more apparent than the other.
Third, the comorbidity between dyslexia and speech
sound disorder is often mediated by oral language skills
(see Pennington & Bishop, 2009). For example, in one
sample of children, 75% of preschool-age children with
speech sound disorder and language impairment developed
dyslexia (Lewis et al., 2000), and 18% of preschool-age
children with isolated speech sound disorder (absent of lan-
guage impairment) developed dyslexia. Similar converging
findings have led many to conclude that a speech sound
disorder alone is not necessary or sufficient to result in dys-
lexia in all children (Bishop & Adams, 1990; Larivee &
Catts, 1999; Nathan, Stackhouse, Goulandris, & Snowling,
2004; Pennington & Bishop. 2009; Raitano et al., 2004;
Snowling et al., 2000). We argue, based on literature dis-
cussed above, that although comorbid speech and language
impairments are a major risk factor for dyslexia, isolated
speech sound disorder also poses an increased risk for
dyslexia and should not be ignored (Hayiou-Thomas et al.,
2017; Lewis et al., 2011). Children with isolated speech
sound disorder are at risk for being overlooked for dyslexia
risk precisely because they do not have a co-occurring lan-
guage impairment that would otherwise alert the SLP to
further investigate reading skills.
Finally, characteristics of a childs speech sound dis-
orderseverity of the disorder, persistence of the disorder,
and errors associated with the disorderare linked to risk
for reading difficulties (Bird et al., 1995; Larivee & Catts,
1999; Preston et al., 2013; but see Shriberg et al., 2005). In
terms of severity, the more severe or persistent the speech
sound disorder, the more likely the child will have a read-
ing disability. This finding is highlighted in children with
childhood apraxia of speech, a speech sound disorder asso-
ciated with motor programming deficits and which tends
to show a poor response to treatment (Lewis, Freebairn,
Hansen, Iyengar, & Taylor, 2004). In terms of persistence,
children with speech sound disorder beyond the age of
6 years, regardless of initial severity (Hayiou-Thomas et al.,
2017), are at increased risk for reading difficulty (Nathan
et al., 2004; Raitano et al., 2004). Indeed, one of the most
significant risk factors for dyslexia in children with speech
sound disorder is whether or not they are still producing
speech production errors at the onset of reading instruction
(Bird et al., 1995; Hayiou-Thomas et al., 2017; Raitano
et al., 2004). In terms of error types, children who produce
atypical or unusual speech errors (e.g., nondevelopmental
phonological processes such as initial consonant deletion,
backing) are at greater risk for later reading difficulty as
compared to children who produce more typical speech er-
rors (Hayiou-Thomas et al., 2017; Preston et al., 2013).
Taken together, these findings help provide guidance for
SLPs regarding factors that increase the risk for dyslexia in
children with speech sound disorder.
Beyond the Phonological Deficit in Children
With Dyslexia
Although research suggests deficits in phonology play
a key role in dyslexia, we acknowledge that a phonological
deficit may not be the sole contributor to reading difficulty.
In a large population-based analysis of children with dys-
lexia, Pennington et al. (2012) investigated the roles of pho-
nological awareness, processing and/or naming speed, and
language as determinants for dyslexia. Specifically, they
tested whether a singular phonological deficit accounted for
dyslexia in some, most, or all cases of dyslexia. Using statis-
tical modeling, Pennington et al. (2012) concluded that it
was individual differences in children that determined whether
a singular deficit in phonological awareness or multiple
cognitive deficits (e.g., phonological awareness + language)
best accounted for a childs risk of dyslexia. That is, there
was not a definitive model of dyslexia that fit for all or even
the majority of children. Although these findings shed further
light on the complex nature of dyslexia in children, more
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research is necessary to further elucidate the contribution of
additional cognitive deficits such as naming/processing speed
or language to the presence or absence of dyslexia risk. In
related work, Pennington (2006) proposed that the multiple-
deficit hypothesis further helps explain the high incidence
of comorbidity among dyslexia and other disorders such as
speech sound disorder, DLD, or attention-deficit/hyperactivity
disorder. For speech sound disorder, Peterson, Pennington,
Shriberg, and Boada (2009) proposed that a multiple deficit
hypothesis provides the best explanation for when and how
speech sound disorder co-occurs with dyslexia. Similar to
the findings of Pennington et al. (2012), it appears that
phonological deficits may interact with other factors (e.g.,
nonverbal cognitive ability, phonological awareness, oral
language skill) to determine whether a child develops
dyslexia.
So, what are other factors that could potentially con-
tribute to a multiple-deficit view of dyslexia? Beyond the
key areas of deficit in the phonological domain, psycho-
linguistic components also play an important role, which
refer to the underlying factors that allow individuals to ac-
quire, use, and understand language. In a case study review,
Cabbage, Farquharson, and Hogan (2015) investigated two
such psycholinguistic factorsspeech perception and
working memoryto determine whether these constructs
were deficient for children with speech sound disorder
and/or dyslexia. They found that the underlying phono-
logical processing skills of children with speech sound
disorder with or without dyslexia are quite varied and
not necessarily predicted by overt speech production pat-
terns. That is, the children produced similar overt errors but
displayed distinct deficit profiles for the psycholinguistic
constructs of speech perception and working memory.
As reviewed in this article, those with dyslexia produce
increasing numbers of speech production errors as word
length and complexity increases. This occurs even in the ab-
sence of a co-occurring speech sound disorder. Although
underlying deficits in phonology may explain these errors,
it is possible that deficits in broader domains beyond the
speech mechanism, such as generalized deficits in motor skills,
may also play a role. Indeed, children with dyslexia have
clear deficits in gross motor skills (Fawcett & Nicolson,
1999; Ramus, 2003) and procedural learning (Nicolson &
Fawcett, 2011; Stoodley, Harrison, & Stein, 2006; Vicari,
Marotta, Menghini, Molinari, & Petrosini, 2003), neither of
which are easily explained by a singular deficit in phonology.
Motor deficits may appear as general deficit in motor coor-
dination or balance (Nicolson & Fawcett, 2011), whereas
deficits in procedural learning manifest as difficulty in ac-
quiring skills or behaviors without explicit teaching. In read-
ing instruction, generally students are exposed to systematic
instruction of the correspondence between speech sound to
letter mappings, and then knowing this basic information,
children figure outhow to read mostly on their own
(Share, 1995). Is it possible that children with dyslexia, be-
cause of a procedural learning deficit, have more difficulty
with the implicit learning required to master the reading
process? Procedural learning deficits have been implicated
for children with dyslexia and some children with speech
sound disorder (Peter et al., 2017), specifically those with
childhood apraxia of speech. Although an exhaustive re-
view of the literature in this area is beyond the scope of
this article, we nevertheless want to raise awareness to
other factors beyond phonology that may be associated with
dyslexia.
Clinical Implications
Taken together, the information above has substan-
tial clinical utility. In this section, we highlight specific
and practical ways SLPs can recognize and assist with
the prevention, identification, and remediation of chil-
dren with dyslexia in various clinical settings, including
schools and private practice. Pediatric SLPs, regardless of
clinical setting, are on the frontline for identifying pre-
school-age children who may be at risk for dyslexia and/or
assisting in the evaluation of older children who are
struggling with reading. In some cases, children exhibit
multiple risk factors that may alert the SLP to a childs
riskfordyslexia.Forexample,achildwhohasahistory
of significant developmental delays in addition to a signif-
icant speech sound disorder is likely to be already on
the SLPs radar as at risk for reading difficulty. In these
cases, the child is often receiving services from several
professionals on a multidisciplinary team and is thus be-
ing monitored across several disciplines, including academic
preparedness. But what about children who are receiving
primarily and, in some cases, only speech and/or language
services? In Figure 1, we offer an example of the referral
process for a kindergartener who is experiencing some diffi-
culties in learning letter names and sounds. In this example,
it is assumed that the referral is made to a student support
team and that the SLP would be a member of this team.
Case History
Dyslexia is a disorder that is neurobiological in ori-
gin and is highly inheritable in families (Yu, Zuk, & Gaab,
2018). Thus, children with a familial risk for dyslexia
have a higher likelihood of developing dyslexia (Astrom,
Wadsworth, & DeFries, 2007; Snowling & Melby-Lervåg,
2016). Relatedly, the prevalence of dyslexia is higher among
children with speech sound disorder who also have a family
history of dyslexia (Hayiou-Thomas et al., 2017). Thus, we
recommend that SLPs ensure that any case history or in-
take protocol includes an inquiry into the childsfamily
history of reading difficulty. Note that asking this question
may insinuate to parents that they have causedtheir
childs dyslexia. To alleviate this burden, SLPs can provide
information to parents on the neurobiological nature of
dyslexia.
Individuals with dyslexia, regardless of speech ther-
apy history, often have difficulty in producing words of
increasing length of phonological complexity (Catts, 1986;
Snowling, 1981). The SLP can raise awareness for this
difficulty by helping teachers and other practitioners
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watch for this marker in children. This does not suggest
that children are suspected of having dyslexia if they have
difficulty in producing complex or multisyllabic words; it
merely serves as an additional point of consideration for
children who may be at risk. Thus, it would be appro-
priate for a generalized developmental history question-
naire to include a question regarding whether a child has
difficulty in producing specific words, such as saying
steposcopefor stethoscope,etc., or notes any pronun-
ciation errors children make during assessment of classroom
tasks. Importantly, many young children make these types
of errors (e.g., saying pasghettifor spaghetti), but it is
the persistence of these errors that is the key to concern for
dyslexia.
Figure 1. Decision-making tree for a young child referred for academic difficulty in the classroom. Each question addresses a risk factor
associated with dyslexia and ultimately directs the student support team (multitier system of supports [MTSS] or equivalent) to recommended
outcomes; SLP = speech-language pathologist; RTI = response to intervention; PA = phonological awareness.
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Phonological Skills
An assessment of phonological awareness is essential
to fully examine a childs phonological system including a
full assessment of speech production error patterns and/or
phonological processes. Phonological awareness encom-
passes multiple skills that reflect an awareness of the sound
structure of language, including rhyming, blending, and
segmentation tasks (at both syllable and phoneme). There
are numerous commercial phonological awareness assess-
ments available to practitioners, but we believe that infor-
mal measures of phonological awareness can yield equally
useful information about a childs phonological awareness
skills. Magnusson and Nauclér (1990) reported that rhyming
skills and the ability to identify phonemes were the most
important metaphonological skills for a preschool-age child
to have, as these skills predicted reading and spelling abili-
ties in first grade. This was true even for children diagnosed
with a language disorder, as well as those with severe speech
sound disorder. As reported previously, tasks that require
phoneme-level sensitivity are particularly problematic for
children (and adults) with dyslexia (Pennington et al., 1990;
Snowling et al., 1997; Wilson & Lesaux, 2001). Thus, it is
important for any assessment of phonological awareness to
include tasks that assess phoneme-level sensitivity such as
phoneme blending and phoneme segmentation.
Given the phonological underpinnings of dyslexia, it
is critical to fully examine the breadth of phonological
skills in children who have speech sound disorder. Histori-
cally, we have classified children with speech sound disor-
der into those with articulation or phonological disorders,
with the assumption that there are divergent underlying
deficits for these populations. That is, articulation disor-
ders are assumed to be the result of a sensorimotor deficit
of some kind. By contrast, phonologically based speech
sound disorders are assumed to be the result of a deficit in
the underlying cognitive phonological representation for
the phonemes used in speech production and thus cannot
be explained by sensorimotor deficits. Although this distinc-
tion has been popular in the field for some time now, the di-
chotomization of these disorders may be more difficult to
distinguish clinically than previously assumed (Farquharson,
2015). As a result, we suggest a full examination of phono-
logical skills in all children with speech sound disorder, re-
gardless of suspected origin, to ascertain the functioning of
the underlying phonological system.
Importantly, when assessing phonological awareness
in children with speech sound disorder, it is critical to in-
clude receptive measures of phonological awareness in the
assessment to prevent the interference of the childs speech
sound production errors from masking true phonological
awareness skills. A child who has multiple phonological
process patterns, such as consonant cluster reduction or
fronting, may not be able to verbally demonstrate the breadth
of his or her phonological awareness skills if he or she is re-
quired to respond verbally. For example, the child may be
asked to produce a word with the same beginning sound as
spoon.The child may respond with /tar/. In this case, it is
unknown whether the child intended to say /star/, which
would be correct, or if the child intended another target
such as /kar/ or /tar/, both of which would be incorrect. In-
stead, the child may be shown three pictures (e.g., pig, ball,
star) and asked to point to the picture that begins with the
same sound as spoon.This example demonstrates the
complex nature of assessing phonological awareness in chil-
dren with speech sound disorder. When a childs speech
production errors are not accounted for in scoring, childrens
phonological awareness skills may be underestimated.
Thus, SLPs should be mindful of the childs speech produc-
tion error patterns when scoring expressive phonological
awareness measures.
Given that children with dyslexia, regardless of speech
sound disorder, have difficulty producing words of increasing
length and complexity, we recommend incorporating multi-
syllabic word production and/or nonword repetition to
assess speech production. Such a measure will also allow
for an examination of phonological memory and phonolog-
ical encoding skills, which are often weak in children with
dyslexia. Assessment tools that are used for differential di-
agnosis of children with childhood apraxia of speech often
include subtests of multisyllabic word production. Indeed,
the speech errors among those with dyslexia can appear
similar to those evidenced by individuals with childhood
apraxia of speech (Peter et al., 2017). Likewise, performance
on a nonword repetition task provides insight into phono-
logical processing and phonological encoding for increas-
ingly complex words. Children with weak phonological
systems produce more errors repeating nonwords than their
typically developing peers (Melby-Lervåg & Lervåg, 2012;
Munson et al., 2005).
Importantly, we recommend the assessment of pho-
nological processing skills both when the child is initially
assessed for services and when being discharged from speech
services. That is, even if a childs speech production errors
have fully corrected, there may be continuing deficits in
broader phonological skills, such as phonological awareness.
Therefore, a measure of phonological awareness is also rec-
ommended as part of exit testing. This does not mean, neces-
sarily, that a child with poor phonological awareness should
remain on the caseload of an SLP; rather, it means that the
SLP has an important role on the literacy team to advise
other team members for risk of dyslexia (ASHA, 2001).
Additional Considerations
It is within the scope of practice of the SLP to also
investigate a childs word-reading skills directly. Again,
commercial measures are useful for determining a childs
word reading ability in relation to age- and grade-matched
peers, but age-appropriate informal measures of word
reading also provide important insight into a childs decod-
ing abilities. By having a child read during a therapy activity,
the SLP may gather informal data regarding a childsword-
reading skill. For example, is the child using strategies that
are successful? Does it seem that weak decoding or low levels
of fluency are impacting the childs reading comprehension?
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It may be the case that a child acquires compensatory strat-
egies that aid in the development of a sight word vocabulary
(e.g., words such as saidand the), which does not require
systematic decoding. Thus, an assessment that more deeply
probes a childs ability to use decoding strategies to read
nonwords (e.g., fape, kneet) is critical to measure a childs
ability to apply phonics rules outside of any linguistic con-
text. Lastly, because phonological skills through reading
contribute to vocabulary acquisition, children with dyslexia
often exhibit mild deficits in vocabulary. As such, a stan-
dardized vocabulary measure may be a prudent addition to
a comprehensive assessment battery. In the Appendix, we
provide a sample assessment checklist that may be used to
evaluate a child similar to our initial case study, Ben. Please
note that any commercial assessment tool mentioned is sim-
ply provided as an example of an appropriate option, but
clinicians are encouraged to use the assessment tools avail-
able to them.
Once a child is identified as having dyslexia, the in-
volvement of the SLP continues to be necessary and critical.
For children who are receiving speech therapy services for
a speech sound disorder and/or language impairment, the
SLP should incorporate phonological awareness activities
into therapy and take opportunities to incorporate orthogra-
phy into treatment whenever possible (Gillon, 2005; Nation,
Angell, & Castles, 2007; Saletta, Goffman, & Hogan, 2016;
Sutherland & Gillon, 2007). Baron et al. (2018) found
that including orthography during a word-learning task with
children with dyslexia facilitated learning of novel words.
This suggests that, despite a word reading deficit, children
with dyslexia can still benefit from including orthography
when targeting speech and language learning. Even if the
SLP is not providing direct services to a child with dyslexia,
he or she continues to play a role in supporting language
development in that child (see Figure 1). Children with dys-
lexia are at risk for low vocabulary because of limited access
to language through text (Duff et al., 2015; Stanovich, 1986).
Thus, SLPs play an important role in educating parents
and teachers about facilitating language growth in multiple
language areas. The SLP may consult with the classroom
teacher regarding ways to adapt classroom curricula to en-
sure children with dyslexia are able to access information in
ways beyond text only (e.g., access to audiobooks, use of
text-to-speech technology). Furthermore, SLPs play an im-
portant role in helping parents understand ways to maximize
the home literacy environment to promote language growth,
such as reading aloud with their children to introduce and
teach new vocabulary (Petrill, Logan, Sawyer, & Justice,
2014; Tambyraja, Schmitt, Farquharson, & Justice, 2017).
Conclusion
In this article, we have explicated the role of speech
production deficits in children with dyslexia in children
with and without speech sound disorder. Long term, a
deep understanding of speech production skills in children
with dyslexia has the potential to drive the development of
targeted intervention strategies that will best help protect
children against the impact of dyslexia and/or speech sound
disorder on their academic, psychosocial, and even voca-
tional outcomes (Carroll & Iles, 2006; Hitchcock, Harel, &
Byun, 2015; McCormack, McLeod, McAllister, & Harrison,
2009; Snowling et al., 2007). SLPs possess unique and in-
depth knowledge of the subsystems of language, including
phonology, morphology, syntax, and semantics, and this
knowledge may be used to either directly or indirectly assist
in the assessment and treatment of children with dyslexia. It
is not uncommon for SLPs to feel underprepared or unsup-
ported in their desire to support children with dyslexia in
their settings (Fallon & Katz, 2011; Katz, Maag, Fallon,
Blenkarn, & Smith, 2010). Resources such as this special
issue on dyslexia are designed to help bridge that gap to
help SLPs implement effective practices for improved iden-
tification of children with dyslexia. We refer the reader to
ASHAs Roles and Responsibilities of SLPs in Schools
(ASHA, 2001) and other publications for further clinical
recommendations for SLPs in this domain (Kamhi, Allen,
& Catts, 2001).
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Appendix
Sample Assessment Checklist
This Sample Assessment Checklist includes multiple areas of consideration when conducting a comprehensive assessment
of a child with suspected phonological deficits in speech or reading. Please note that, although we have provided examples
of commercially available assessment tools, these examples are for demonstration purposes only. Clinicians are encouraged
to use assessment tools available to them that similarly assess the recommended constructs.
Screening
Single word-reading list (or letter identification for younger children)
Brief connected speech sample
Single word screener, including multiple opportunities to produce speech sounds in all word positions, particularly more
complex phonemes (/r, s, l/), as well as polysyllables (Masso, McLeod, Baker, & McCormack, 2016)
Oral language screener
Assessment: from the parent
Information about history of reading, speech, or language development (Bishop & Adams, 1990; Magnusson & Nauclér,
1990; Scarborough, 1990; Snowling & Melby-Lervåg, 2016)
Information about family history of reading, speech, or language issues
Parentslevel of concern
Effort for reading-based homework at home
Noticeable speech production issues at home? Intelligibility as a result?
Difficulty in producing certain words? For example, steposcopefor stethoscope
Assessment: from the teacher(s) and other professionals
Detailed report of referralwhat are the functional issues appearing in the classroom?
Report of reading and spelling ability
Recent reading or spelling test
Report of how target child is performing in comparison to same-grade peers
Any noticeable speech production deficits? If so, intelligibility rating? If so, any social issues as a result?
Difficulty in producing certain words? For example steposcopefor stethoscope
Inquire with school psychologist (if possible) regarding nonverbal intelligence testing
Assessment: from the child
Connected speech sample
Connected reading sample
Standardized reading test
Example: Woodcock Reading Mastery TestsThird Edition (Woodcock, 2011)
Standardized spelling test
Example: Test of Written SpellingFifth Edition (Larsen, Hammill, & Moats, 2013)
Standardized speech production test
Example: Goldman-Fristoe Test of ArticulationThird Edition (Goldman & Fristoe, 2015)
Standardized test of oral language, including vocabulary (Duff et al., 2015; Stanovich, 1986)
Example: Clinical Evaluation of Language FundamentalsFifth Edition (Wiig, Semel, & Secord, 2013)
Hearing screening
Oral mechanism exam
Conversation with the child about reading and/ or speech abilities
How does the child feel about his/ her reading ability? What would he or she want to change?
If speech is impacted, how does the child feel about his or her speech ability? What would he or she want to
change?
Examination of phonological processing (McCardle et al., 2001; Stanovich & Siegel, 1994; Vellutino et al., 2004)
Nonword repetition (Melby-Lervåg & Lervåg, 2012; Munson et al., 2005)
Phonological awareness (Farquharson et al., 2014; Swan & Goswami, 1997)
Include phoneme-level manipulation, such as deletion (Pennington et al., 1990; Snowling et al., 1997; Wilson &
Lesaux, 2001)
For preschoolers, examine rhyming and letter identification (Magnusson & Nauclér, 1990)
Example: Comprehensive Test of Phonological ProcessingSecond Edition (Wagner, Torgesen, Rashotte, & Pearson,
2012)
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... Dyslexia has often been considered to be the cause of phonological deficit (Bachmann & Mengheri, 2018) which is normally believed to be responsible for reading comprehension and background knowledge of the child (Share, 2021). Normally, there are two major divisions of dyslexia named as acquired dyslexia and developmental dyslexia where the former is commonly found in people who are exposed to any kind of trauma whereas the latter is the most generic form of dyslexia which is neurobiological in origin where the children have issues with accurate or fluent word recognition, decoding and spelling abilities (Cabbage, Farquharson, Iuzzini-Seigel, Zuk & Hogan, 2018). Importantly, developmental dyslexia, from now onwards dyslexia, (Li, Hu & Liang, 2022) does not stem from any kind of disability, impairment or poor instruction (Parrila, Dudley, Song & Georgiou, 2019) and may affect the child's academic performance in school settings with implicit or explicit emotional or attitudinal problems (Protopapas & Parrila, 2018). ...
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The purpose of the study is to gauge the efficiency of indigenously developed computer assisted reading materials for improving Pakistani dyslexic students' reading skills. For this purpose, the Learning Disabilities Checklist was administered for dyslexia screening to all the grade VI students of the mainstream school. The study sample comprised fifteen purposively selected students whose screening score on the checklist ranged from 70%-100%. Cognitive Theory of Multimedia Learning served as the theoretical framework for the current study. This study employed one group pre-post research design where the students were administered a six week treatment. Pretest and post-test scores of the students helped in collecting quantitative data. Different statistical tests were administered using SPSS for the analysis of the quantitative data. Findings of the current study revealed that the developed materials were efficient for improving reading skills of Pakistani mainstream school's dyslexic students.
... Existe una mayor probabilidad de que los adultos con antecedentes de DFP trabajen mayormente en ocupaciones semicalificadas o no calificadas(Felsenfeld y Broen, 1994). Los niños con DFP se enfrentan a mayores riesgos sociales, emocionales y académicos, cuyo impacto puede extenderse ampliamente a lo largo del desarrollo(Cabbage et al., 2018; Farquharson y Boldini, 2018;Hitchcock et al., 2015;McCormack et al., 2019). En 104 gran parte de los casos, se requerirá de evaluación y tratamiento del habla(Broomfield y Dodd, 2004). ...
... The diagnosis of speech sound disorder (SSD) is conferred on children who exhibit a broad spectrum of difficulty with speech sound production, and constitutes a heterogeneous group with respect to the nature of their disorder, the types of speech errors they produce and the severity of their unintelligibility (Dodd, 2014;Macrae & Tyler, 2014;Preston & Edwards, 2010;Waring & Knight, 2013). Increasing evidence suggests that regardless of the underlying cause, children with SSD, including those with idiopathic SSD, are at heightened risk of subsequent reading problems (Cabbage et al., 2018;Lewis et al., 2011Lewis et al., , 2015Raitano et al., 2004), particularly if their speech difficulties are present at school entry, when formal reading instruction begins (Burgoyne et al., 2019). This is an especially salient issue for speech and language pathologists (SLPs) serving school-age children, who must often simultaneously support children's speech, language and reading skills within the context of therapy (American Speech-Language-Hearing Association, 2001). ...
Article
Background: Children with speech sound disorder (SSD) are at increased risk of reading difficulties due to poor phonological processing skills. However, the extent to which children with SSD demonstrate weaknesses on specific or all phonological processing tasks is not well understood. Aims: To examine the phonological processing abilities of a clinically identified sample of children with SSD, with and without reading difficulties. To determine the extent to which the proportion of children with concomitant SSD and reading difficulties exhibited weaknesses in specific areas of phonological processing, or a more general phonological deficit. Methods & procedures: Data were obtained from 157 school-aged children (Mage = 77 months, SD = 7.01) in receipt of school-based speech therapy. Approximately 25% of the sample was identified as poor readers, based on a standardized measure of word decoding. We compared the proportion of children who scored at or below 1 SD below the mean, or the bottom 16th percentile, on measures of phonological awareness, rapid automatized naming and verbal short-term memory among those identified as poor readers and good readers. Outcomes & results: Children with SSD demonstrated a range of phonological processing difficulties, particularly on the measure of verbal short-term memory. No specific skill differentiated groups of children with SSD with and without reading difficulties; however, those classified as poor readers on the word-decoding measure exhibited more widespread difficulties, even after controlling for language ability. Conclusions & implications: Results support a cumulative risk model such that children with SSD and reading difficulties are likely to demonstrate generally poor phonological processing abilities. What this paper adds: What is already known on the subject Children with SSD are at heightened risk of reading difficulties, particularly if their SSD persists into school age. However, not all children with SSD experience reading problems. Research aimed at determining which children are at the highest risk is mixed as to how best to identify which children with SSD are most likely to experience reading difficulties. What this paper adds to existing knowledge The study used a multiple case study approach to determine if performance on phonological processing skills might differentiate children with SSD who were poor readers from those who were good readers. As a group, children with SSD exhibited poor verbal short-term memory but relatively intact rapid automatized naming skills. No one phonological processing skill differentiated children who were poor readers from good readers. However, children with reading difficulties appeared to experience more general difficulties across phonological processing tasks, even after controlling for language abilities. What are the potential or actual clinical implications of this work? A single deficit (i.e., speech sound production) is not sufficient data to make a complete diagnosis or treatment decisions. Multiple sources of data, including several aspects of phonological processing, should be obtained to understand reading risk in children with SSD.
... The troubles these pupils have with phonology frequently propose they may create a perusing impedance as they develop or mature. Research showed that dyslexia has speech and language problems (Cabbage et al., 2018); phonological awareness, spelling, reading comprehension, and deficits in word and pseudoword reading (Reis et al., 2020); and orthographies problem (Laurence et al., 2018). ...
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Reading skills are an important element for obtaining knowledge in academic learning. Previous research has demonstrated that dyslexia pupils have a major problem with reading skills. The biggest issue of dyslexic pupils includes language learning disorder. Dyslexia could be a long-lasting impedance, and numerous indications hold on into adulthood. Identification of dyslexia at a preliminary phase comes from the ability to notice dyslexia characteristics, for instance, poor handwriting, written expression difficulties, spelling difficulties, reading fluency, and difficulty associating sounds with letters. Nevertheless, the investigation has exhibited that teachers and parents are still unaware of dyslexia. The goal of this article is to explore dyslexia’s definitions and characteristics that are associated with it. Dyslexia comprises different definitions and characters. Each dyslexic pupil encounters indications that are distinctive from each other. Understanding the definition of dyslexia and the character of early dyslexia can assist teachers in planning fitting intercessions for dyslexic pupils. Conclusions: The implications of this work are that it can assist educators in identifying students who have dyslexia characteristics or symptoms.
... Under this view, reading impairment results from a disruption in the grapheme-phoneme mapping learned during typical reading acquisition. However, in recent years, the existence of a purely phonological deficit has been challenged (Banai and Ahissar, 2018;Cabbage et al., 2018;Lachmann, 2018;Giofrè et al., 2019). ...
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One important aspect of human cognition involves the learning of structured information encountered in our environment, a phenomenon known as statistical learning. A growing body of research suggests that learning to read print is partially guided by learning the statistical contingencies existing between the letters within a word, and also between the letters and sounds to which the letters refer. Research also suggests that impairments to statistical learning ability may at least partially explain the difficulties experienced by individuals diagnosed with dyslexia. However, the findings regarding impaired learning are not consistent, perhaps partly due to the varied use of methodologies across studies – such as differences in the learning paradigms, stimuli used, and the way that learning is assessed – as well as differences in participant samples such as age and extent of the learning disorder. In this review, we attempt to examine the purported link between statistical learning and dyslexia by assessing a set of the most recent and relevant studies in both adults and children. Based on this review, we conclude that although there is some evidence for a statistical learning impairment in adults with dyslexia, the evidence for an impairment in children is much weaker. We discuss several suggestive trends that emerge from our examination of the research, such as issues related to task heterogeneity, possible age effects, the role of publication bias, and other suggestions for future research such as the use of neural measures and a need to better understand how statistical learning changes across typical development. We conclude that no current theoretical framework of dyslexia fully captures the extant research findings on statistical learning.
Article
The association between pre-reading skills and phonological production skills has been shown at school age, but less is known about how these skills interact at an earlier age when they are just developing. The focus was to investigate whether a connection between pre-reading skills (letter naming, rapid automatised naming; RAN) and phonological production skills of children at 3;6 could be found. In addition, the possible effects of the following skills were considered in the analysis: auditory word recognition and lexical ability at 3;6; and early expressive lexicon size at 2;0, adding a longitudinal aspect to the study. The participants were Finnish-speaking children (n = 66). The results show a significant connection between letter naming skills and phonological measures (paradigmatic and phonotactic skills) at 3;6, whereas no association was found between RAN and phonological production skills. Phonological production skills were significantly correlated with all the variables: pre-reading, lexical and auditory word recognition. The pre-reading measure correlated only with phonological production skills and lexical ability that was measured concurrently at 3;6. The findings propose a central role for the phonological production skill in terms of pre-reading skills, auditory word recognition and previous and concurrent lexical ability.
Article
Purpose The primary aim of this study was to compare decoding and literacy-related skills of children with suspected childhood apraxia of speech (sCAS) to children with reading disorders (RD) and no history of speech sound disorder (RD-no SSD) to determine if the groups differ in decoding and the endophenotypes that contribute to RD. We also explored the association between language impairment (LI) and decoding and literacy-related skills within the participant group with sCAS. Method Participants were school-age children and adolescents, 8–14 years of age, with a diagnosis of sCAS ( n = 13) or RD-no SSD ( n = 16). The sCAS and RD-no SSD groups were compared on measures of single-word decoding, oral language, motor-speech skills, phonological processing, and speech-in-noise perception, employing t tests and analysis of covariance. The sCAS + LI and sCAS-only groups were compared on similar measures using t tests. Results Compared to the RD-no SSD group, the sCAS group performed significantly worse on measures of phonological processing, multisyllable word repetition, diadochokinetic rate, and speech-in-noise perception. The groups did not differ on measures of single-word decoding, with mean scores for both groups falling below average. All participants with sCAS + LI demonstrated deficits in literacy and literacy-related skills compared to a smaller percentage of the sCAS-only group. Conclusions Children with sCAS and children with RD-no SSD demonstrate similar impairments in literacy. However, the endophenotypes underlying these difficulties can differ between the groups. Deficits in skills needed for literacy may require specifically tailored interventions to address reading difficulties for children with sCAS, especially for those with comorbid LI.
Chapter
This chapter reviews connections between oral and written language skills and points of vulnerability for children with language impairment. It considers how hearing loss may affect oral and written language development. Children learn the languages that they experience through meaningful interactions with caregivers and other children. The chapter focuses on children with persistent language difficulties where the cause is not known, such as those with developmental language disorder. It discusses the need to consider strengths and possible protective factors in addition to deficits and risk factors in the evaluation of risk for reading problems and the promotion of positive outcomes. As a group, children with hearing loss are at higher risk of both spoken and written language difficulties than their peers with normal hearing. Reading development is influenced by multiple genetic and environmental factors, and studies indicate that risk is cumulative.
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Content acquisition podcasts (CAPs) are a popular tool in special educator preparation but little is known about their application to communication disorders. This quasi-experimental study investigated the effectiveness of two instructional methods: lecture plus video and a content acquisition podcast (CAP). Participants were undergraduates in early childhood education and special education programs (N = 62). Participants were assessed on their knowledge and application of communication development and disorders at four time points. Results indicated that the lecture plus video condition was more effective at producing knowledge gains compared to the CAP condition, but both conditions were equally effective at producing gains in application ability at posttest. Neither group maintained their knowledge gains 8 weeks after instruction. Learning condition did not affect participants in the two education programs differently. Implications for teacher preparation are discussed.
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Purpose A growing body of research suggests that a deficit in speech perception abilities contributes to the development of speech sound disorder (SSD). However, little work has been done to characterize the neurophysiological processes indexing speech perception deficits in this population. The primary aim of this study was to compare the neural activity underlying speech perception in young children with SSD and with typical development (TD). Method Twenty-eight children ages 4;1–6;0 (years;months) participated in this study. Event-related potentials (ERPs) were recorded while children completed a speech perception task that included phonetic (speech sound) and lexical (meaning) matches and mismatches. Groups were compared on their judgment accuracy for matches and mismatches as well as the mean amplitude of the phonological mapping negativity (PMN) and N400 ERP components. Results Children with SSD demonstrated lower judgment accuracy across the phonetic and lexical conditions compared to peers with TD. The ERPs elicited by lexical matches and mismatches did not distinguish the groups. However, in the phonetic condition, the SSD group exhibited a more consistent left-lateralized PMN effect and a delayed N400 effect over frontal sites compared to the TD group. Conclusions These findings provide some of the first evidence of a delay in the neurophysiological processing of phonological information for young children with SSD compared to their peers with TD. This delay was not present for the processing of lexical information, indicating a unique difference between children with SSD and with TD related to speech perception of phonetic errors. Supplemental Material https://doi.org/10.23641/asha.16915579
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THIS ARTICLE IS OPEN ACCESS: https://lshss.pubs.asha.org/article.aspx?articleid=2711408 Purpose The purpose of this tutorial is to discuss the language basis of dyslexia in the context of developmental language disorders (DLDs). Whereas most studies have focused on the phonological skills of children with dyslexia, we bring attention to broader language skills. Method We conducted a focused literature review on the language basis of dyslexia from historical and theoretical perspectives with a special emphasis on the relation between dyslexia and DLD and on the development of broader language skills (e.g., vocabulary, syntax, and discourse) before and after the identification of dyslexia. Results We present clinically relevant information on the history of dyslexia as a language-based disorder, the operational definitions used to diagnose dyslexia in research and practice, the relation between dyslexia and DLD, and the language abilities of children with dyslexia. Conclusions We discuss 3 clinical implications for working with children with dyslexia in school settings: (a) Children with dyslexia—with and without comorbid DLDs—often have language deficits outside the phonological domain; (b) intervention should target a child's strengths and weaknesses relative to reading outcomes, regardless of diagnostic labels; and (c) those who have dyslexia, regardless of language abilities at the time of diagnosis, may be at risk for slower language acquisition across their lifetime. Longitudinal studies are needed to assess multiple language skills early, at the time of the diagnosis of dyslexia, and years later to better understand the complex development of language and reading in children with dyslexia.
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Developmental dyslexia is a specific learning disability characterized by deficits reading single words. Dyslexia is heritable and has been associated with neural alterations in regions of the left hemisphere in the brain. Cognitive and neural atypicalities have been observed before children with familial risk for dyslexia begin reading, yet children who are at risk subsequently develop reading abilities on a continuum from good to poor. Of those children who develop good reading skills, what factors are associated with more successful outcomes? In this article, we review findings describing genetic, cognitive, neurobiological, and environmental factors that facilitate reading development and propose a model of neural pathways to support successful reading development in at‐risk children. This research can inform educational and clinical strategies to support at‐risk children. Investigating factors that contribute to the variance in behavioral outcomes among at‐risk children may help us understand developmental disorders and associated etiological, compensatory, and protective factors.
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Background: Lack of agreement about criteria and terminology for children's language problems affects access to services as well as hindering research and practice. We report the second phase of a study using an online Delphi method to address these issues. In the first phase, we focused on criteria for language disorder. Here we consider terminology. Methods: The Delphi method is an iterative process in which an initial set of statements is rated by a panel of experts, who then have the opportunity to view anonymised ratings from other panel members. On this basis they can either revise their views or make a case for their position. The statements are then revised based on panel feedback, and again rated by and commented on by the panel. In this study, feedback from a second round was used to prepare a final set of statements in narrative form. The panel included 57 individuals representing a range of professions and nationalities. Results: We achieved at least 78% agreement for 19 of 21 statements within two rounds of ratings. These were collapsed into 12 statements for the final consensus reported here. The term 'Language Disorder' is recommended to refer to a profile of difficulties that causes functional impairment in everyday life and is associated with poor prognosis. The term, 'Developmental Language Disorder' (DLD) was endorsed for use when the language disorder was not associated with a known biomedical aetiology. It was also agreed that (a) presence of risk factors (neurobiological or environmental) does not preclude a diagnosis of DLD, (b) DLD can co-occur with other neurodevelopmental disorders (e.g. ADHD) and (c) DLD does not require a mismatch between verbal and nonverbal ability. Conclusions: This Delphi exercise highlights reasons for disagreements about terminology for language disorders and proposes standard definitions and nomenclature.
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Purpose: The aim of this study was to explore the role of working memory processes as a possible cognitive underpinning of persistent speech sound disorders (SSD). Method: Forty school-aged children were enrolled; 20 children with persistent SSD (P-SSD) and 20 typically developing children. Children participated in three working memory tasks - one to target each of the components in Baddeley's working memory model: phonological loop, visual spatial sketchpad and central executive. Result: Children with P-SSD performed poorly only on the phonological loop tasks compared to their typically developing age-matched peers. However, mediation analyses revealed that the relation between working memory and a P-SSD was reliant upon nonverbal intelligence. Conclusion: These results suggest that co-morbid low-average nonverbal intelligence are linked to poor working memory in children with P-SSD. Theoretical and clinical implications are discussed.
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Purpose: The acquisition of literacy skills influences the perception and production of spoken language. We examined if orthography influences implicit processing in speech production in child readers and in adult readers with low and high reading proficiency. Method: Children (n = 17), adults with typical reading skills (n = 17), and adults demonstrating low reading proficiency (n = 18) repeated or read aloud nonwords varying in orthographic transparency. Analyses of implicit linguistic processing (segmental accuracy and speech movement stability) were conducted. The accuracy and articulatory stability of productions of the nonwords were assessed before and after repetition or reading. Results: Segmental accuracy results indicate that all 3 groups demonstrated greater learning when they were able to read, rather than just hear, the nonwords. Speech movement results indicate that, for adults with poor reading skills, exposure to the nonwords in a transparent spelling reduces the articulatory variability of speech production. Reading skill was correlated with speech movement stability in the groups of adults. Conclusions: In children and adults, orthography interacts with speech production; all participants integrate orthography into their lexical representations. Adults with poor reading skills do not use the same reading or speaking strategies as children with typical reading skills.
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Purpose: Orthographic facilitation describes the phenomenon in which a spoken word is produced more accurately when its corresponding written word is present during learning. We examined the orthographic facilitation effect in children with dyslexia because they have poor learning and recall of spoken words. We hypothesized that including orthography during spoken word learning would facilitate learning and recall. Method: Children with dyslexia and children with typical development (n = 46 per group), 7-9 years old, were matched for grade and nonverbal intelligence. Across 4 blocks of exposure in 1 session, children learned pairings between 4 spoken pseudowords and novel semantic referents in a modified paired-associate learning task. Two of the pairings were presented with orthography present, and 2 were presented with orthography absent. Recall of newly learned spoken words was assessed using a naming task. Results: Both groups showed orthographic facilitation during learning and naming. During learning, both groups paired pseudowords and referents more accurately when orthography was present. During naming, children with typical development showed a large orthographic facilitation effect that increased across blocks. For children with dyslexia, this effect was present initially but then plateaued. Conclusions: We demonstrate for the first time that children with dyslexia benefit from orthographic facilitation during spoken word learning. These findings have direct implications for teaching spoken vocabulary to children with dyslexia.
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The purpose of this study was to investigate the hypothesis that individuals with dyslexia and individuals with childhood apraxia of speech share an underlying persisting deficit in processing sequential information. Levels of impairment (sensory encoding, memory, retrieval, and motor planning/programming) were also investigated. Participants were 22 adults with dyslexia, 10 adults with a probable history of childhood apraxia of speech (phCAS), and 22 typical controls. All participants completed nonword repetition, multisyllabic real word repetition, and nonword decoding tasks. Using phonological process analysis, errors were classified as sequence or substitution errors. Adults with dyslexia and adults with phCAS showed evidence of persisting nonword repetition deficits. In all three tasks, the adults in the two disorder groups produced more errors of both classes than the controls, but disproportionally more sequencing than substitution errors during the nonword repetition task. During the real word repetition task, the phCAS produced the most sequencing errors, whereas during the nonword decoding task, the dyslexia group produced the most sequencing errors. Performance during multisyllabic motor speech tasks, relative to monosyllabic conditions, was correlated with the sequencing error component during nonword repetition. The results provide evidence for a shared persisting sequential processing deficit in the dyslexia and phCAS groups during linguistic and motor speech tasks. Evidence for impairments in sensory encoding, short-term memory, and motor planning/programming was found in both disorder groups. Future studies should investigate clinical applications regarding preventative and targeted interventions towards cross-modal treatment effects.
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Purpose: The purpose of this study is to investigate word learning in children with dyslexia to ascertain their strengths and weaknesses during the configuration stage of word learning. Method: Children with typical development (N = 116) and dyslexia (N = 68) participated in computer-based word learning games that assessed word learning in 4 sets of games that manipulated phonological or visuospatial demands. All children were monolingual English-speaking 2nd graders without oral language impairment. The word learning games measured children's ability to link novel names with novel objects, to make decisions about the accuracy of those names and objects, to recognize the semantic features of the objects, and to produce the names of the novel words. Accuracy data were analyzed using analyses of covariance with nonverbal intelligence scores as a covariate. Results: Word learning deficits were evident for children with dyslexia across every type of manipulation and on 3 of 5 tasks, but not for every combination of task/manipulation. Deficits were more common when task demands taxed phonology. Visuospatial manipulations led to both disadvantages and advantages for children with dyslexia. Conclusion: Children with dyslexia evidence spoken word learning deficits, but their performance is highly dependent on manipulations and task demand, suggesting a processing trade-off between visuospatial and phonological demands.
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Background This study considers the role of early speech difficulties in literacy development, in the context of additional risk factors. Method Children were identified with speech sound disorder (SSD) at the age of 3½ years, on the basis of performance on the Diagnostic Evaluation of Articulation and Phonology. Their literacy skills were assessed at the start of formal reading instruction (age 5½), using measures of phoneme awareness, word‐level reading and spelling; and 3 years later (age 8), using measures of word‐level reading, spelling and reading comprehension. Results The presence of early SSD conferred a small but significant risk of poor phonemic skills and spelling at the age of 5½ and of poor word reading at the age of 8. Furthermore, within the group with SSD, the persistence of speech difficulties to the point of school entry was associated with poorer emergent literacy skills, and children with ‘disordered’ speech errors had poorer word reading skills than children whose speech errors indicated ‘delay’. In contrast, the initial severity of SSD was not a significant predictor of reading development. Beyond the domain of speech, the presence of a co‐occurring language impairment was strongly predictive of literacy skills and having a family risk of dyslexia predicted additional variance in literacy at both time‐points. Conclusions Early SSD alone has only modest effects on literacy development but when additional risk factors are present, these can have serious negative consequences, consistent with the view that multiple risks accumulate to predict reading disorders.
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Background: Numerous studies suggest a positive relationship between the home literacy environment (HLE) and children's language and literacy skills, yet very little research has focused on the HLE of children with language impairment (LI). Children with LI are at risk for reading difficulties; thus, understanding the nature and frequency of their home literacy interactions is warranted. Aims: To identify unique HLE profiles within a large sample of children with LI, and to determine relevant caregiver- and child-specific factors that predict children's profile membership. Methods & procedures: Participants were 195 kindergarten and first-grade children with LI who were receiving school-based language therapy. Caregivers completed a comprehensive questionnaire regarding their child's HLE, and the extent to which their child engaged in shared book reading, were taught about letters, initiated or asked to be read to, and chose to read independently. Caregivers also answered questions regarding the highest level of maternal education, caregiver history of reading difficulties, and caregiver reading habits. Children completed a language and literacy battery in the fall of their academic year. Outcomes & results: Latent profile analyses indicated a three-profile solution, representing high, average and low frequency of the selected HLE indicators. Multinomial regression further revealed that caregivers' own reading habits influenced children's profile membership, as did child age and language abilities. Conclusions & implications: These results highlight the considerable variability in the frequency of home literacy interactions of children with LI. Future work examining relations between familial reading practices and literacy outcomes for children with LI is warranted.