FOCUS ON THE THREE "L's"
Preschoolers with Phonological Disorders Learn Language and Literacy Skills in 12 Weeks
Dyslexia is defined as persistent difficulties with the acquisition of literacy skills due to impaired phonological processing skills despite adequate instruction (Tunmer & Greaney, 2010). Dyslexia is a common neurodevelopmental disorder that overlaps considerably with speech and language impairments, themselves very common disorders in childhood, with prevalence of approximately 19% in school age children (Catts, Adlof, Hogan, & Weismer, 2005; Johnson et al., 1999; Puranik, Petcher, Al Otaiba, Catts, & Lonigan, 2008; Tomblin et al., 1997). These disorders share common genetic and environmental etiological factors that emerge at a very early age, specifically deficits in phonological processing skills that can be linked to poor speech perception detectable at birth and restricted vocabulary size linked to the cumulative impact of inadequate language inputs (Hayiou-Thomas, Harloar, Dale, & Plomin, 2010; Lyytinen et al., 2004; Rvachew, 2007; Rvachew & Grawburg, 2006). Increasingly, speech-language pathologists understand the importance of intervening early to address emergent literacy skills among preschoolers with speech and language disorders in order to prevent delayed acquisition of reading when the children start school. However, given rationing of service by public providers this new focus on literacy may further dilute treatment intensity and threaten the effectiveness of the speech therapy that the children receive. Although parents report positive outcomes from even brief interventions (Thomas- Stonell, Oddson, Robertson, & Rosenbaum, 2009), research indicates that 12 to 20 weeks of treatment is required to observe change on standardized measures (Rvachew & Brosseau-Lapré, forthcoming) and many children who receive inadequate service as preschoolers go on to struggle in school (Glogowska, Roulstone, Peters, & Enderby, 2006). The Child Phonology Laboratory at McGill University has been collaborating with the Montréal Children's Hospital and the students at the School of Communication Sciences and Disorders to develop a treatment protocol that will be effective and efficient given a short total treatment duration. The results of our randomized control trial indicate that the key to the success of the effective combination of treatment elements is two-fold: first all treatment elements must be theoretically consistent so that they are mutually reinforcing; and second, the children's parents must be fully involved in the intervention (Rvachew & Brosseau-Lapré, 2010). The intervention that we will describe here was developed for 4- to 5-year-old Francophone children with speech and language disorders. The primary outcomes of the intervention were found CASLPA COMMUNIQUÉ - SUMMER 2011 SUSAN RVACHEW, PH.D., S-LP(C) SUSAN.RVACHEW@MCGILL.CA FRANÇOISE BROSSEAU-LAPRÉ M.SC.(A), S-LP(C) FRANCOISE.BROSSEAU-LAPRE@MCGILL.CA ELISABETH CRISTE, M.SC., S-LP (C) ECHRISTE@EMSB.QC.CA to be measurable improvements in phonological awareness skills and speech accuracy after 12 weeks. We hope for better literacy outcomes but long term outcomes have not yet been assessed. The intervention has three 6-week components: individual speech therapy focused on improving the children's acoustic-phonetic representations for target phonemes, small Preschoolers with phonological disorders learn about the sound structure of words in phonological awareness groups conducted by McGill speech-language pathology students. group therapy focused on phonological awareness skills, and parent training focused on dialogic reading techniques. The small group therapy and parent education sessions are provided concurrently so that the full intervention protocol lasts for 12 weeks. The individual therapy sessions are individualized to the child's specific therapy targets but the phonological awareness groups followed a standard curriculum and could easily be administered by communication disorders assistants. The therapists employed input oriented procedures during