Phoneme Awareness Therapy


Phoneme Awareness Intervention

Phonological awareness (PA) is conscious knowledge about the sound structure of words, from syllables to phonemes. Phoneme awareness is a sub-type of PA, concerning awareness of individual phonemes within a word. It covers identification of the word onset, and matching, counting or manipulation (movement or exchange) of phonemes.

Hesketh (2009) writes about PA in 4 and 5 year olds and speech rather than the much-discussed topic of PA and literacy. Hesketh, Dima & Nelson (2007) found it is possible to teach some phoneme awareness skills to some pre-literate children. The highest level skill that can be taught them is phoneme isolation of word-initial consonants (the earliest step into phoneme awareness – earlier than the skill of rhyming, for example).

Hesketh (2009) says, “My intervention principle is to incorporate PA-type activities in support of speech change using stimuli relevant to the child’s target processes, syllable structures, contrasts or

sounds, rather than seeing PA skills as a target in their own right. A typical intervention session will involve the child in listening to, thinking about and producing sounds but the balance between these three elements varies enormously across children and across sessions.”

Hesketh’s phoneme awareness work integrated within speech intervention is directed at a small unit level (awareness of phonemes) and linked to graphemes or supported by sound symbol pictures, depending on the child’s familiarity with letters, and as many cues as required to help the child operate successfully with the tasks provided. Activities highlight the specific current speech targets for that child. Rhyme games may be included in sessions, but discontinued if they prove too difficult.

Games that require children to judge presence/absence of a phoneme, to identify a phoneme in a particular word position, or to match words which have the same (initial or final) phoneme are adaptable to a range of structural and systemic processes and to a range of phonological approaches. Tasks are concretized, e.g., with the used of colouredblocks for phoneme presence and change and symbolic sound linkage pictures (for phoneme identification). Where PA is used as an integral part of a speech intervention, using the sounds, word positions and contrasts relevant to the specific child, then a SLP/SLT should be doing or planning the work. It can be written into a program for home or school practice in carefully explained tasks.


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Hesketh, A. (2004). Early Literacy Achievement of Children with a History of Speech Problems. International Journal of Language and Communication Disorders. 39(4), 453-468.  Click here

Hesketh, A. (2009). PA intervention for children with speech disorder: Who, when and how? In C. Bowen, Children's speech sound disorders. Oxford: Wiley-Blackwell, pp. 143-147.

Hesketh, A. (2010). Metaphonological Intervention: Phonological Awareness Therapy. In A. L. Williams, S. McLeod, & R. J. McCauley (Editors), Interventions for Speech Sound Disorders in Children. Baltimore, MA: Paul H. Brookes.

Hesketh, A., Adams, C. & Nightingale, C. (2000). Metaphonological abilities of phonologically disordered children. Educational Psychology, 20, 484-498. Click here

Hesketh, A., Adams, C., Nightingale, C. & Hall, R. (2000). Phonological awareness therapy and articulatory training for children with phonological disorders: a comparative outcome study. International Journal of Language and Communication Disorders, 35, 337-354.

Hesketh, A, Dima, E. & Nelson, V. ( 2007). Teaching phoneme awareness to pre-literate children with speech disorder: a randomized controlled trial. International Journal of Language and Communication Disorders, 42(3), 251-271. Click here