Initial Insights into Phoneme Awareness Intervention for Children with Complex Communication Needs (summary)



Phoneme awareness is the ability to recognise and manipulate the individual sounds in spoken words and is part of the broader phonological awareness that is essential to the development of early reading skills. Children with complex communication needs (CCN) often have significant and long-term difficulties in the development of literacy; poor phoneme awareness has been suggested as possibly limiting their word recognition and spelling skills.

To read words children need to be able to convert letters (graphemes) into sounds (phonemes) and then blend the sounds together to create words. Children who have poor phoneme awareness often find this difficult.

Children with CCN have reduced or no ability to speak the words themselves, this will reduce the amount of information they are able to store about a words’ makeup in their own mind. Indistinct word production can be difficult to break-up, or segment, into individual sounds and therefore children cannot use the information to further develop literacy skills.

Children with CCN have been found to receive reading and writing teaching that is different from that of typically developing children, both in the amount of time given and the teaching methods used. There is limited evidence regarding ‘best practice’ in these cases.

Generally children with CCN have a more limited experiential language base than their typically developing peers and as they don’t have experience of producing speech patterns orally they might need instruction and practice to recognise the links between speech and the printed word.

It is suggested that in developing reading skills children with CCN should be able to manipulate their own word productions and that phoneme awareness training might be beneficial in helping them acquire more distinct phonological representations of words.

What did they do?

The aims of this study were to determine if phoneme awareness skills can be taught to children with CCN, to observe any transfer effects to tasks that were not directly targeted during the intervention and to their ability to produce and record written words.

Two children, a boy aged 7 and a girl aged 10, took part in the study. Both had CCN, cerebral palsy and poor word decoding skills as measured by a speech to print matching task.

Both used low-tech symbol communication boards. The boy had delayed receptive language levels; expressively he could combine symbols to produce simple phrases. He had some cognitive delay and difficulty retaining new information.

The girl used a switch to access a computer and used eye-gaze to make choices from 4 items. She was said to read books at the 4-6year level but had difficulty recognising vowels and final consonants.

The children were assessed before and after the interventions. Interventions for each child were personalised, based on literacy measures before the intervention began.

Objectives for the boy were to improve his phoneme identifying skills and increase his letter name and letter sound knowledge. Six letters and their corresponding sounds were targeted. He completed seven of eleven planned hours of intervention.

The girl’s intervention programme aimed to improve her phoneme segmentation and manipulation skills and to increase her awareness of the relationship between speech and print. She received the full 11 hours of intervention.

 What did they find?

The boy’s results showed improvement in his ability to match sounds to letters and letters to sounds, and in his knowledge of trained letter names. There was no significant change in his knowledge of trained letter sounds when the written form was presented in a different font or on a different colour card from those used in the intervention. When the same coloured cards used in the intervention were used in the reassessment his responses were much more accurate than when different stimuli cards were used.

There was no improvement in his knowledge of untrained letter names and sounds following the intervention.

The girl demonstrated progress in her ability to ‘track speech sounds with letters’ i.e. identify the position of a sound change in a word and to select the sound needed to make the change.

Her phoneme segmentation skills improved and she was able to transfer the ability to breakdown words into sounds to untaught words with 2, 3 and 4 sounds. Her attempts at non-word spelling showed a decrease over the intervention period, this was linked to a reduction in her use of vowels. Before the intervention she used /u/ in 4/5 words and got two of these correct. After the intervention she did not use any vowels at all. Possible reasons for this are suggested. 


The authors found improvements in the skills targeted during the interventions, indicating that children with CCN can benefit from some types of input used to develop the literacy skills of children with a recording disability or spoken language impairment.

They found that neither child was able to transfer taught skills to other skills that had not been directly trained. This might have improved with longer term support.

The fact that children with CCN often take longer to give a response than typically developing peers means that they might need a longer time to consolidate and generalise skills.

This study provided initial evidence to support the usefulness of phoneme awareness intervention for children with CCN, but further studies are needed.


This was a very small scale study and therefore cannot necessarily be widely generalised. The children’s levels of language and cognitive functioning might have had an influence on the outcomes. The way the assessment task was presented might also have affected the results; the male participant’s teachers indicated that progress was seen in the classroom that was not evident during the assessment tasks.

Things you may want to look into:
An Analysis of Reading and Spelling Abilities of Children Using AAC: Understanding a Continuum of Competence
Introduction to direct/explicit instruction in reading for the struggling reader: Phonemic awareness, phonics, fluency, vocabulary, andcomprehension
Teaching Sound Letter Correspondence and Consonant-Vowel-Consonant Combinations to Young Children who Use Augmentative andAlternative Communication
A Developmental Continuum of Phonological Sensitivity Skills
Evidence-based literacy instruction for individuals who require augmentative and alternative communication: a case study of a student withmultiple disabilities

Added to site May 2016