Literacy and Children with Speech Sound Disorders

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Critical Age Hypothesis

The so called 'Critical Age Hypothesis' is that literacy acquisition is likely to be compromised if children are not intelligible by the age of 5;6 especially if they also have semantic and syntactic difficulties (Bishop & Adams, 1990). As well, persistent, mild speech production difficulties beyond age 6;9 are associated with literacy acquisition difficulties. (Nathan, et al., 2004).

Literacy and SSD

We need to be alert to the possibility that children with speech sound disorders (SSD), and children who have completed therapy for SSD, may have persisting, underlying phonological difficulties, including “fuzzy” representations of speech sounds and structures, and difficulties with auditory working memory (AWM), even if their speech intelligibility has improved during the preschool years and the first year of school.

These problems may manifest as unclear speech with just a few, or many mild articulation errors, difficulties with word retrieval, mazes (becoming “mixed up” when they explain something or tell a story), faltering when they try to say long words or unfamiliar words, and trouble grasping the concept of “sounding words out” when reading. Persisting speech errors and language difficulties appear to have an “additive” effect (Riatano, et al, 2004; see full text article below).

Children who have difficulty comprehending verbal language also have difficulty comprehending text. For them, shorter verbal or written sequences are easier to understand than longer ones (‘The dog is still howling’ and then 'The storm is over, but she's still upset' vs. ‘The dog in the house next door is still howling loudly even though the storm finished 10 minutes ago.’).

Reading and spelling programs and teachers

Teachers may be fully aware of these issues in individual students, but they often have to implement school reading and spelling programs that, ideally, are based on phonological awareness (including phonemic awareness), explicit instruction of the alphabetic code, and systematic phonics programs - and not Whole Language (see Snow, 2016 below for discussion).

Such programs are constructed on the assumption that students have normal underlying phonological skills - which is fine for the students who actually do! But some adaptations and strategies may be needed to help students who have SSD and/or language impairment to compensate for their phonological and auditory working memory (AWM) limitations.

In considering the following activities relative to children with SSD or SSD and language difficulties, teachers can think about ways of incorporating them into everyday experiences and into explicit instruction, through a combination of child-led and adult-led activities. Also, teachers can think about how they can share their expertise with SLPs/SLTs (and vice versa) and parents (and vice versa), and how they can encourage home literacy.

7 ways for teachers and others to help

1. Oral Language

Building vocabulary, even if only in INPUT (without having the child say the words) can enhance phonemic representations making them less “fuzzy”. The more words containing a particular sound that a child knows the easier it will become for them to (a) recognise the sound, (b) distinguish it from other sounds, (c) make accurate sound-letter correspondences, and (d) understand the alphabetic principle. When reading, children will only really recognise the words they are able to decode if the words are at least partly in their spoken vocabulary.

Build on words the child already knows – synonyms (big, large, huge, massive), antonyms (hot, cold), words that are similar (stop, step, steep) or that rhyme (rumble, mumble, tumble, grumble), onomatopoeic words (whisper, swish, pop, ping), new verbs and adverbs – not just new nouns, parts of speech such as plurals (house/houses; cat/cats; mouse/mice). Narrate what is happening as it happens, and re-tell the experience.

  • Provide a variety of interesting experiences that occur seldom, as well as routine experiences.
  • “Re-live” novel and routine experiences that the child enjoys (e.g., birthdays and outings).
  • Make up stories related to the child’s life and use them as a vehicle for cloze tasks.
  • Make links between talking, reading and writing all needing to carry meaning (make sense).

2. Emergent Writing

Help the child to know the various genres of writing, in play and more formal contexts.  These can includes name writing, text (books, letters), signs (WALK, McDonald’s, CITY), cards (Birthday), invitations (party, wedding), labels (S=salt, P=pepper, HOT and COLD taps), lists (4 apples, 4 pears, 8 oranges, 1 avocado, 2Kg tomatoes), text messages, email, and web pages. Aim to show that just as speech carries meaning and can “make things happen”, so too does writing.

Develop activities around Name Writing

Children take pride in knowing the letters in their own names, and name writing provides a good opportunity for children practice forming the letters correctly, and to notice the sounds in their names that the letters correspond to.

Activities might include having the child dictate and you doing the writing,  the child signing his or her name (e.g., a parent signs homework and so does the child), and making bookplates, certificates, door signs and labels with the child’s name.

3. Print Knowledge/Print Referencing

(Justice, Bowles & Skibbe, 2006)

Help the child understand the conventions around books and other print media - such as Title, Author, Illustrator, beginning, end, text direction, print orientation, etc.

Familiarise the child with types of books – picture books, board books, bath books, flap books, alphabet books, nursery rhyme books, puzzle books, colouring books, chapter books, book series (Thomas, Charlie and Lola, Grug, Harry, Spot, Dora the Explorer), books by particular authors (Dr Seuss) or publishers (Ladybird, Picture Puffins), “educational books”, etc.

Familiarise them with other print genres: newspapers, magazines, brochures, menus, certificates.

Help them understand the types of “print units” – letters (ABC…), written words, and sentences.

Talk about familiar symbols and logos: Honda, Toyota, McDonald’s, Target.

Develop activities around Name Recognition, starting with the child’s and family members’ names.

Point to the words in a book during story-reading / book sharing time.

4. Alphabet Knowledge

Teaching alphabet knowledge, including recognising and being able to say the letter names, whether presented in upper or lower case can be challenging with children with SSD and/or language difficulties who have problems with word retrieval. This means it is inadvisable to play games where rapid word-retrieval is required, or where children compete to respond “first”.

  • Teach letter names
  • Teach sound-letter correspondence (Mum starts with /m/; “Morgan, when you say your name, listen for the /m/ at the start – and can you hear where the /g/ comes?”)
  • Teach letter-word relationship (Mum starts with M; “Morgan, when you write your name, you start by writing the letter M, and you write the letter G, for the /g/ sound, there.”)
  • Draw attention to letters in the environment (car registration plates). Create interest in letter names and sounds: monograms, alphabet spaghetti, magnetic letters, puzzles, form-boards, stencils, make play-doh letters, sing the ABC song and letter-related songs (C is for Cookie).

5. Phonological Awareness (PA)

"Phonological awareness (PA) is the ability to attend to, identify and manipulate a variety of sounds within the speech stream. It implies conscious knowledge, at any age, of the sound-structure of spoken words, from syllables to phonemes.

Phonemic awareness (or phoneme awareness) is one aspect of PA, related to consciousness of the smallest speech units: the consonant and vowel phonemes, displayed here in slashes (//).

Other aspects of PA are the skills of: detecting rhymes and alliteration; recognizing that words within the speech stream can be broken down into smaller chunks such as syllables and phonemes; using metalanguage to talk about, reflect upon, and manipulate phonemes; and understanding, explicitly, the relationship between spoken and written language.

As a sub-type of PA, phonemic awareness relates to an individual’s cognizance of the phonemes in a given word. The skills it covers are: identification of word onsets (e.g., knowing batty begins with /b/); phoneme isolation and segmentation (knowing that batty can be broken down into the sequence of phonemes identified as /b/, /æ/, /t/ and /i/; and phoneme manipulation: e.g., knowing: /b/ /æ/ /t/ /i/ is batty, and /t/ /æ/ /b/ /i/ is tabby; that adding /ɹ/ after /b/ in batty results in bratty, and that removing /t/ from tabby makes abbey." Bowen (in press).

PA is a necessary but not sufficient skill for literacy acquisition. Awareness of larger sound segments (words and syllables) is at a lower level (i.e., at an easier level) than awareness of smaller sound elements (phoneme recognition, onset and rime, initial sound in a word, final sound in a word). Children with SSD and language difficulties need us to start at the lower level (Neilson, 2009). Use songs, rhymes, rhythmic activities, finger-plays stories and PA materials to:

  • Work on word awareness within the context of phrases or sentences (find all the instances of the word “Mother” in “Are You my Mother?”).
  • Work on syllable awareness by finding syllables in words. Find “lock” in locket and padlock
  • Count syllables, starting with 1 syllable vs. 2 syllables
  • Add another syllable to make a new word (but/botton)

THEN move to higher level skills

  • Identifying onset and rime
  • Recognising phonemes (first sound/last sound in a word)
  • Matching sounds and letters
  • Identifying rhymes using repetitive, rhythmic, predictable books with rhyming close

6. Strategies that Reduce the Need for the Child to Multitask

Children with SSD and language difficulties are not as “automatic” with speech and language as their age-peers. Children with typical speech and language development can focus on PA tasks, reading, writing, spelling, maths, and symbolic processing relatively easily. Children with speech and language difficulties, including most children with CAS, have to “multitask”. They have to concentrate hard and consciously deal with the speech and language side (because they lack “automaticity”) during reading, writing and spelling tasks. If they also have AWM limitations early reading and writing processes are even more challenging.

  • Ensure that the amount of spoken or written information to be processed is “manageable”.
  • Regulate the complexity and level of abstraction of the information.
  • Take care that the rate of presentation of the information to be processed is slow enough.
  • Modify the environment to exclude irrelevant information including distractions.

7. Explore the Research Evidence

(Start with Pullen & Justice, 2003, below.)

  • Consider integrating shared book-reading approaches (print referencing and dialogic reading - PROMPT - EVALUATE - EXPAND – REPEAT (cloze, recall, open ended, wh-?, distancing)
  • Provide a print-rich environment (literacy enriched play surroundings; mediated writing (motor, meaning, orthography)
  • Consider the suitability or otherwise of formal curricula for children with SSD and children with SSD and language impairment.


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Pullen, P., & Justice, L. M. (2003). Capitalizing on the preschool years: Strategies for increasing literacy prerequisites. Intervention in School and Clinic.39(2), 87-98.

Snow, P. C. (2016). Language is literacy is language. Positioning Speech Language Pathology in education policy, practice, paradigms, and polemics. International Journal of Speech Language Pathology. DOI: 10.3109/17549507.2015.1112837


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Bishop, D.V.M., & Adams, C. (1990). A prospective study of the relationship between specific language impairment, phonological disorders and reading retardation. Journal of Child Psychology and Psychiatry, 31, 1027-1050.

Bowen, C. (in press). Phonological / Phonemic Awareness in M. Ball, and J. Damico (eds). The SAGE Encyclopedia of Human Communication Sciences and Disorders. Thousand Oaks: CA. Sage Publications.

Gillon, G. T. (2000). The efficacy of phonological awareness intervention for children with spoken language impairment, Language, Speech, and Hearing Services in Schools, 31(2), 126-141.

Gillon, G. (2002). Follow-up study investigating benefits of phonological awareness intervention for children with spoken language impairment. International Journal of Language and Communication Disorders, 37(4), 381-400.

Gillon, G. T. (2004). Phonological Awareness: From Research to Practice. New York, NY: Guilford Press.

Gillon, G. T. (2005). Facilitating phoneme awareness development in 3- and 4-year-old children with speech impairment, Language Speech and Hearing Services in Schools, 36, 308–324.

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

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.

Justice, L., Bowles, R., & Skibbe, L. (2006). Measuring preschool attainment of print-concept knowledge: A study of typical and at-risk 3- to 5-year-old children. Language, Speech, and Hearing Services in Schools, 37, 224–235.

Love. E. and Reilly.S. (2009). A Sound Way (2nd edition) and interactive whiteboard CD. Pearson Education, Melbourne.

Nathan, L., Stackhouse, J., Goulandris, N. & Snowling, M.J. (2004). The development of early literacy skills among children with speech difficulties: A test of the ‘Critical Age Hypothesis’. Journal of Speech, Language and Hearing Research, 47(2), 337-391.

Neilson, R. (2009). Assessment of phonological awareness in low-progress readers, Australian Journal of Learning Difficulties,14(1), 53-66.

Pullen, P., & Justice, L. M. 2003. Capitalizing on the preschool years: Strategies for increasing literacy prerequisites. Intervention in School and Clinic. 39(2), 87-98. CLICK HERE

Raitano, N. A., Pennington, B. F., Tunick, B. F., Boada, R., & Shriberg, L. D. (2004). Pre-literacy skills of subgroups of children with speech sound disorders. Journal of Child Psychology and Psychiatry, 45, 821-835. CLICK HERE

Webster, P. E., & Plante, A. S. (1992). Effects of phonological impairment on word, syllable, and phoneme segmentation and reading. Language, Speech, and Hearing Services in Schools, 23, 176-182.

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