ABSTRACT

1
ABSTRACT

• Phonemic awareness is a robust predictor of
  literacy in typically developing (TD) children.
  Despite primacy of literacy as fundamental to
  learning, little information exists documenting
  reading skills of children with cerebral palsy
  (CP), the most common condition associated with
  childhood physical disability. Traditional
  standardized tests of phonemic awareness (PA)
  require either clear speech or consistent
  pointing ability. The current study demonstrates
  the need for accessible assessment methods of
  literacy for children with severe speech and
  motor impairment. Pilot data associated with
  aspects of PA are presented, and adapted measures
  of PA are proposed and discussed.

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BACKGROUND

• Phonological awareness is defined as the capacity
  to consciously represent and reflect on
  phonological properties, independent of focus on
  the meaning of spoken stimuli (Smith M. 2005). A
  subcomponent of this, phonemic awareness (PA),
  comprises the explicit awareness of phonemes as
  units of sound, and is intimately linked with
  alphabetic literacy.

3

• Existing traditional assessments of phonemic
  awareness require a verbal response from the
  participant. Examples of such tests include the
  CTOPP Elision subtest, which measures ability to
  remove phonological segments from spoken words to
  form other words this subtest has been shown to
  have a strong correlation with reading measures.

4

• Children with severe speech and physical
  impairments (SSPI) are not able to participate in
  traditional assessments due to inability to
  provide verbal responses. The majority of these
  children experience severe literacy and learning
  difficulties (Greer JV, 1991, Koppenhaver D., and
  D. Yoder, 1993)
• Previous research demonstrates that anarthria or
  severe dysarthria in CP does not preclude
  development of phonological processing skills
  (Sandberg A, and E. Hjelmquist, 1997).

5

• There is evidence that instruction in phonemic
  awareness is a critical part of effective
  intervention for many students with early reading
  delays, including preliminary evidence that such
  interventions specifically can increase reading
  skills in children with severe speech
  impairments.
• No standardized assessment of PA is currently
  available for children with severe speech and
  physical impairment (SSPI).

6

• The objective of this study was to create a
  reliable, valid means of assessing phonological
  awareness in children with severe speech and
  motor impairments.
• Our research team developed and piloted an
  adapted version of the Comprehensive Test of
  Phonological Processing (CTOPP, Wagner R., et
  al., 1999) subtest of Elision, incorporating a
  multiple choice format. The CTOPP
  Elision-Adapted preserved the item prompts and
  targets, but included substantial changes in
  administration and format in order to create a
  multiple choice response format.

7
METHODS

• Demographic and Developmental Characteristics by
  Group
• Variable CP TD
• n24 n24
• Age (years) 9.4 (1.8) 9.6 (1.7)
• Gender ( female) 54.2 58.3
• Socioeconomic Status 2.8 (.79) 3.5 (.77)
• Gestation if premature (weeks) 28.9 (3.2) 33.8
  (3.9)
• Birth Weight if LBW (lbs) 3.8 (2.1) 4.7
  (1.7)
• History of seizure 21 0.0
• n16
• n3
• n15

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• Instruments and Procedures
• PPVT-III - provides estimation of overall
  intellectual ability.
• CTOPP Elision - provides information on phonemic
  awareness, an important predictor of reading
  acquisition.
• PIAT-R/NU Reading Comprehension provides an
  estimation of current reading ability.
• For modified administrations, stimuli were
  computerized using BoardMakerTM software,
  allowing responses to be made using a switch
  interface system (HeadMouse or switch).

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• Modified CTOPP Elision The test is presented on
  a computer screen using BoardMakerTM software. A
  screen with three pictures, each on a virtual
  button, is presented for each item. The examiner
  points to and verbally labels each picture e.g.,
  This is tail, this is pail, this is train.
  Then, the examiner provides the prompt Listen
  carefully. Show me trail, without /r/. The
  examinee then uses AT to select the picture of
  the target word (tail) from among three
  choices. Foils were created to systematically
  alter the beginning, middle, or end of the target
  word.
• Standard and Adapted versions of each test were
  administered in counterbalanced order. Children
  were randomly assigned to either a HeadMouse or
  switch response for the Adapted versions of
  tests.

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RESULTS

• Means and Standard Deviations for Standard and
  Modified Tests
• by Group
• Instrument Group
• CP TD
• Standard Modified Standard Modified
• __________________________________________________
  _________________
• Elision 8.2 (3.5) 10.2 (3.6) 10.8 (3.0) 12.0
  (2.3)
• PPVT-III 104.0 (14.2) 103.4 (14.9) 104.7
  (9.5) 105.9 (10.4)
• Ravens 103.2 (16.9) 100.9 (16.6) 107.4
  (10.0) 108.4 (15.4)
• CPM
• PIAT-R RC 100.4 (14.4) 99.3 (15.6) 101.4
  (12.1) 101.5 (11.4)
• __________________________________________________
  _________________
• Note. Elision Comprehensive Test of
  Phonological Processing Elision subtest PPVT-III
  Peabody Picture Vocabulary Test Third Edition
  Ravens CPM Ravens Coloured Progressive
  Matrices PIAT-R RC Peabody Individual
  Achievement Test Revised Reading Comprehension.

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• Bivariate Correlations for Standard and Modified
  Tests
• by Group
• PPVT-III Ravens Elision PIAT-C ____________
  _____________________________________________
• PPVT-III CP - .09 .04 .52
• (TD) - (.36) (.38) (.74)
• Ravens CP .12 - .54 .57
• (TD) (.24) - (.09) (.35)
• Elision CP .31 .18 - .54
• (TD) (.33) (.20) - (.63)
• PIAT-RC CP .56 .49 .40 -
• (TD) (.72) (.31) (.72) -
• __________________________________________________
  _______________
• Note. Standard version above the diagonal and
  modified version below the
• diagonal. PPVT-III Peabody Picture Vocabulary
  Test Third Edition
• Ravens Ravens Coloured Progressive Matrices
  Elision Comprehensive
• Test of Phonological Processing Elision subtest
  PIAT-R RC Peabody
• Individual Achievement Test Revised Reading
  Comprehension.
• p

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• Findings
• Adapted measures of intellect and reading
  comprehension were psychometrically comparable to
  standard versions
• The CTOPP Elision-Adapted generated inflated
  scores in both TD children and children with CP.
• Type of assistive technology access (HeadMouse
  v. switch) did not affect scores.
• Significant correlation was found between Elision
  and Reading Comprehension in both the TD group
  and the CP group

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CONCLUSIONS

• Initial results from the study suggest that while
  adapted measures of intellect and reading
  comprehension were psychometrically comparable to
  standard versions, the CTOPP Elision-Adapted
  generated inflated scores in both TD children and
  children with CP.
• .

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• A significant correlation was found between
  Elision and Reading Comprehension in both the TD
  group, as supported in the literature, and the CP
  group. Although our sample was small, findings to
  date suggest that phonemic awareness may be a
  reliable predictor of literacy outcome in
  children with CP.

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• This question warrants further investigation, as
• the creation of valid, reliable adapted measures
  of phonemic awareness will further our
  understanding of the complex nature of literacy
  in children with CP and SSPI, and contribute to
  the development of optimal teaching and learning
  strategies for these children.

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FUTURE DIRECTIONS

• Develop novel and adapted measures of PA that
  follow a hierarchy of difficulty corresponding to
  that accepted in the literature on PA
  Identification, segmentation, and manipulation
  (including elision).
• Contribute to understanding role of phonemic
  awareness in predicting literacy outcome in
  children with CP.

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• Accessible Elision
• Uses forced choice format
• Requires isolation and manipulation of phonemes
  in words
• Requires no verbal response
• Uses novel prompt and target words for all items

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• Accessible Phonemic Awareness
• Uses forced choice format
• Assesses PA at levels of identification,
  segmentation, manipulation
• Uses colored squares to represent phonemes
• Presents squares in virtual buttons using
  computer software
• Requires no verbal response.

19
ACKNOWLEDGEMENTS

• This work was supported by a U.S. Department
• of Education, Office of Special Education
• Programs (OSEP) Model Demonstration Project
• award H234M020077, NIH R21 HD052592-
• 01A, and NIDRR FI H133G070044.