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Rev. CEFAC. 2015 Nov-Dez; 17(6):1827-1837
EFFICACY OF PHONOLOGICAL INTERVENTION
PROGRAM IN STUDENTS AT RISK FOR DYSLEXIA
Eficácia de um programa de intervenção fonológica
em escolares de risco para a dislexia
Cláudia da Silva
(1)
, Simone Aparecida Capellini
(1)
(1)
Departamento de Fonoaudiologia da Faculdade de Filo-
soa e Ciências, Universidade Estadual Paulista “Júlio de
Mesquita Filho” – UNESP – Marília (SP), Brasil.
Source: Conselho Nacional de Desenvolvimento Cientíco e
Tecnológico (CNPq)
Conict of interest: non-existent
The dyslexia can be dened as a specic
learning disorder of the reading that causes
diculties of processing of stimuli linguistic and
non-linguistic brief, rapid and successive. However,
when thinking about early identication of students
at risk for dyslexia the principal manifestations found
are phonological alterations, diculty in recognizing
letters, no association of relation letter/sound,
alteration in the discrimination of sounds, diculty in
distinguishing letters with nearby sounds, recurring
exchanges in speech and in the initial learning
writing
3,5,7-9
.
The phonological disorder has been pointed out
as one of the rst signs of risk for dyslexia, since
the phonological skills that should develop naturally
and spontaneously were not acquired, which
complicates the development of other skills such
as analysis, synthesis, segmentation and phonemic
INTRODUCTION
The early identication of students at risk for
dyslexia is a subject discussed in the international
literature since the decade of 80
1,2
. However, recent
studies claim that the sooner the principal signs
that characterize dyslexia is identied, the sooner
these students will be placed in the context of the
intervention to minimize the characteristics of the
framework and its interference in learning of the
reading and writing and actually conrm or not the
framework of dyslexia
3-6
.
ABSTRACT
Purpose: to verify the ecacy of phonological intervention program in students at risk for dyslexia.
Methods: participated these study 40 students of the 1
st
grade level of elementary school, of both
genders, with aged between5 years and 11 months to 6 years and 7 months. The students were
divided into two groups: GI (20 students without risk for dyslexia); and GII (20 students with risk
for dyslexia), both groups were subjected to phonological intervention program, composed by tasks
of identifying of sounds and letters of the alphabet in sequence and random order, identication
and production of rhyme, rhyme production with phrases, identication and manipulation of words,
identication and production of syllables, syllabic segmentation and analysis, phonemic identication
and segmentation, replacement, synthesis, analysis and phonemic discrimination. In situation of pre
and post-testing, all subjects in this study were submitted to the Evaluation Cognitive Linguistic Skills
Protocol – collective and individual version. Results: in comparison of the pre with post testing of
the performance of students of GI and GII, was statistical dierence for the subtests of the skills
of reading, writing, phonological awareness, auditory processing and processing speed, indicating
average of superior performance for GII in post testing compared to pre testing. Conclusion: the
phonological intervention program was eective for students at risk for dyslexia because it made
possible the development of phonological awareness through intervention, assisting in the acquisition
of skills necessary for the learning of reading and writing.
KEYWORDS: Early Intervention; Dyslexia; Reading; Writing; Learning
1828 Silva C, Capellini SA
Rev. CEFAC. 2015 Nov-Dez; 17(6):1827-1837
METHODS
This study was submitted and approved for the
Ethics Committee from the Faculty of Philosophy
and Sciences of São Paulo State University – CEP/
FFC/UNESP – Marília (SP), under protocol nº
686/2009.
Participated in these study 40 students from
1
st
year of elementary school, 17 (42,5%) female
gender and 23 (57,5%) male gender, with aged
between 5 years and 11 months and 6 years and 7
months, were divided into two groups:
Group I (GI): composed of 20 students without
risk for dyslexia that were submitted to phonological
intervention program, 10 students of the females
and 10 of the males, with aged between 5 years
and 11 months to 6 years and 7 months, regularly
registered in the 1
st
year of elementary school.
We considered students without risk for dyslexia
those that presented good academic performance,
indicated by teachers following the criterion of satis-
factory performance for two consecutive bimesters,
compared to its class group and absence of phono-
logical disorder.
Group II (GII): composed of 20 students at risk
for dyslexia that were submitted to phonological
intervention program, seven students of the females
and 13 males, with aged between 5 years and 11
months to 6 years and 3 months , regularly regis-
tered in the 1
st
year of elementary school.
The students of group GII were identied among
70 students regularly registered in 1
st
year of
elementary education at a public school in Marília-SP,
through the application of Child Language Test in
the areas of phonology, vocabulary, uency and
pragmatic – ABFW
16
for identication and conr-
mation of the diagnosis of phonological disorder. To
determine the severity of phonological disorder was
used the index of Percentage of Correct Consonants
– PCC
1
, this index checks the number of correct
consonants produced in a sample of speech
according to the total number of consonants in the
sample, which is considered as incorrect consonant,
the omissions, substitutions and common and not
common distortions.
Thus, the index of phonological disorder was
calculated after classifying phonological processes,
the quantity and productivity of each process
observed in the speech sample obtained through
naming and imitation proofs of the ABFW. This
index was calculated with the division the correct
consonants emitted by total consonants of the proof
multiplied by 100%. That way, phonological disorder
was considered mild if the PCC is 85% to 100%,
lightly moderate from 65% to 85%, moderately
severe in 50% to 65% and severe if lower than 50%.
manipulation
9-11
, which may inuence the acqui-
sition of the mechanism of phoneme-grapheme
conversion for the learning of reading and writing
(4,7)
.
The phonological disorder characterized by
disorganization of speech that impairs the language
development owing to the presence of substitutions,
distortions and omissions of sounds
10
. However,
despite being considered the main sign of risk for
dyslexia, should be taken into consideration, the
other signs, mentioned above, which manifest
themselves in the classroom, taking this school to
a lower performance relative to their group-class in
activities related to reading and writing
12,13
.
The thematic about early identication of
students at risk for dyslexia and the practice of
interventional work is still very recent and developed
studies have as its primary focus, the intervention
with phonological basis, and have shown good
results through of the intervention using activities
that involve phonological awareness, among them
stand out the sound perception (rhyme and allit-
eration) and the manipulation of speech segments
(segmentation, analysis and synthesis phonemic),
beyond the letter/sound relationship
4,10
.
The early intervention proposes to provide insight
to verify if, after the implementation of specic
programs, involving the stimulation of cognitive-
linguistic skills that have been altered or delayed,
the students show or no improvement in learning of
reading.
Those who, after submitted to an intervention
program, remaining with gaps in skills of phono-
logical awareness, processing speed, visual
and auditory processing, and in the letter/sound
relationship, suggest a disorder present in the
processing, storage and/or access information,
which impairs the acquisition and development of
perceptive and linguistic skills, should submitted the
interdisciplinary evaluation to conrm the manifes-
tation of dyslexia and periodic monitoring order to
minimize the deciencies identied in the evaluation
process
3,14,15
.
Thus, based on the specialized literature, as
before phonological disorders in school phase is
identied, the faster early intervention programs can
be realized by decreasing the impact of this disorder
on the reading and writing learning, especially at
the beginning of the 1
st
year of elementary school
3
.
However, in Brazil, are still few studies that use inter-
vention programs directed for early identication of
dyslexia and, therefore, for tracking of students at
risk for dyslexia
8,9
.
In result of the above, this study aimed to verify
the ecacy of phonological intervention program in
students at risk for dyslexia.
Phonological intervention at risk for dyslexia 1829
Rev. CEFAC. 2015 Nov-Dez; 17(6):1827-1837
Table 1 – Comparison of the index of gravity of the phonological disorder – PCC in the naming and
imitation task
Appointment Degree of severity pre
Appointment Degree of severity post
Total
1 2
1
16 0 16
80,00% 0,00% 80,00%
2
3 0 3
15,00% 0,00% 15,00%
3
0 1 1
0,00% 5,00% 5,00%
Total
19 1 20
95,00% 5,00% 100,00%
Appointment Degree of severity pre
Appointment Degree of severity post
Total
1
1
17 17
85,00% 85,00%
2
3 3
15,00% 15,00%
Total
20 20
100,00% 100,00%
Legend: 1: mild; 2: lightly moderate; 3: moderately severe
* Signicant values for the nomination (p=0,125) – Signal Test
* Signicant values for the imitation (p=0,250) – Signal Test
The data collection was realized at the Laboratory
of Investigation of Deviations from Learning – LIDA/
UNESP-Marília-SP and started after signing of the
Consent Term form by parents or those responsible
for students.
All students in this study was submitted the same
procedures in situation of pre and post-testing and
intervention. The choice of procedures pre and post-
testing followed the following criteria: instruments to
verify the skill of reading words and pseudowords,
phonological skills (rhyme and alliteration), writing
skills and auditory processing skills, so they could
be evaluated skills worked in the intervention
process. Thus, in situation of pre and post-testing,
the following procedures were used:
A) Cognitive-Linguistic Performance Test –
collective version
17
. This version was composed of
the following subtests: recognition of the alphabet
in sequence, words dictated and pseudowords and
dictation of digits. Besides the subtests cited were
added the subtests of recognition of the alphabet in
random order and mute dictation.
B) Cognitive-Linguistic Performance Test –
individual version
17
. This version was composed of
the following subtests: reading words and non-words,
rhyme, alliteration, syllabic segmentation, auditory
discrimination, repetition of words and non-words,
numbers game inverted, rapid automatized naming
pictures and rapid automatic naming of digits. This
version was added subtest rapid automatic naming
of colors.
The evaluation tests used in pre and post-testing
were applied in four sessions, with two sessions for
pre-testing and two sessions for post-testing, lasting
50 minutes each.
The phonological intervention program was
realized in 15 sessions cumulative, in each session
was presented a new activity that was worked
coupled with the task developed in the previous
session, lasting 50 minutes each, twice a week.
The stages of phonological intervention program
were worked sequentially in the following order:
identication of sounds and letters of the alphabet,
identifying of sounds and letters of the alphabet
in random order, identication and production of
rhyme, rhyme production with phrases, identi-
cation and manipulation of words, identication and
production of syllables, segmentation and analysis
syllabic, identication and segmentation phonemic,
substitution, synthesis, analysis and phonemic
discrimination.
The results were statistically analyzed using
the program SPSS (Statistical Package for Social
Sciences), in its version 20.0, based on the number
of correct answers submitted by GI and GII, to
obtain the results. As a statistical test was used
Mann-Whitney Test, in order to verify possible dier-
ences in comparing the groups studied. The level
1830 Silva C, Capellini SA
Rev. CEFAC. 2015 Nov-Dez; 17(6):1827-1837
In phonological awareness skill we can verify
that there was statistical dierence for the subtests
of alliteration, rhyme and syllabic segmentation in
pre and post-test, suggesting that the interventive
work with phonological skills resulted in increased
average performance of phonological skills.
For auditory processing, in comparison of
the pre with post-testing of GI and GII was found
statistical dierence in the subtests of discrimi-
nation of sounds, repetition of words and dictation
of numbers for pre and post-testing, indicating an
improvement in performance of students regarding
sound perception, for storage and retrieval of infor-
mation for words and digits.
For the ability of processing speeding, in the
comparison of the pre with post- testing between
the performance of GI and GII, was found statis-
tical dierence for the subtests of rapid naming of
gures, rst and second rapid naming of digits in pre
and post-testing. The data suggest improvement
in processing, access and retrieval of visual infor-
mation quickly and successively, both for gures as
for digits.
Concerning the performance of students of GII,
after phonological intervention, for tests of naming
and imitation, we can observe that the students had
similar performance when comparing the situations
of pre and post-testing.
of signicance adopted was 5% (0,05) for the appli-
cation statistical tests.
RESULTS
In comparison of the pre with post-testing of the
performance of students of GI and GII for reading
ability, we can verify that occurred statistical
dierence in subtests of alphabet recognition pre
and post-testing, alphabet recognition in random
order to pre-testing, words read correctly in one
minute in the pre and post-testing.
The results show that GI and GII had mean
scores on superior performance in tests of recog-
nition of the alphabet that reected in the number
of words read correctly, even with no statistical
dierence in the subtests of reading words and not
words, the data suggest the inuence of the recog-
nition of alphabet for reading.
For writing skills, in comparison of the pre with
post-testing, we found that there was statistical
dierence in the writing subtest of the alphabet pre
and post-testing, word dictation post-testing, no
words dictation pre and post-testing, total dictation
pre and post-testing and mute dictation pre and
post-testing. The data suggest improvement in the
performance of students presenting a reection of
the relation letter/sound for acquisition and increase
of average of writing performance.
Phonological intervention at risk for dyslexia 1831
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Table 2 – Distribution of the performance of students of the GI and GII, in pre and post-testing, in the
skill of reading and writing
Variable Group Mean
Standard-
deviation
Minimum Maximum p-value
Alf Pré
GI 26,00 0,00 26,00 26,00
0,000*
GII 23,15 4,60 7,00 26,00
Alf Pós
GI 26,00 0,00 26,00 26,00
0,038*
GII 25,60 1,00 22,00 26,00
Alf Al Pré
GI 25,85 0,67 23,00 26,00
0,000*
GII 21,40 5,55 6,00 26,00
Alf Al Pós
GI 25,85 0,67 23,00 26,00
0,071
GII 24,60 2,85 18,00 26,00
LP Pré
GI 180,75 108,84 60,00 493,00
0,133
GII 373,45 398,75 0,00 1453,00
LP Pós
GI 160,80 95,19 54,00 467,00
0,304
GII 260,35 239,22 0,00 866,00
LNP Pré
GI 56,65 31,05 0,00 145,00
0,357
GII 91,75 91,91 0,00 337,00
LNP Pós
GI 56,70 44,23 13,00 217,00
0,935
GII 73,35 79,72 0,00 294,00
Cor1m Pré
GI 23,15 11,31 0,00 40,00
0,010*
GII 13,00 11,48 0,00 37,00
Cor1m Pós
GI 32,20 8,09 12,00 40,00
0,000*
GII 18,95 10,69 0,00 40,00
E Alf Pré
GI 25,85 0,49 24,00 26,00
0,000*
GII 20,75 6,46 7,00 26,00
E Alf Pós
GI 26,00 0,00 26,00 26,00
0,004*
GII 24,20 3,58 12,00 26,00
DitP Pré
GI 17,75 4,51 8,00 26,00
0,065
GII 12,65 9,19 0,00 28,00
DitP Pós
GI 27,50 3,76 16,00 30,00
0,000*
GII 20,25 9,17 0,00 30,00
DitNP Pré
GI 5,15 1,76 2,00 9,00
0,000*
GII 2,30 2,39 0,00 7,00
DitNP Pós
GI 7,55 1,23 5,00 9,00
0,000*
GII 3,90 2,17 0,00 7,00
DitT Pré
GI 30,70 5,12 23,00 39,00
0,000*
GII 14,95 10,66 0,00 33,00
DitT Pós
GI 35,05 4,63 21,00 39,00
0,000*
GII 24,15 11,14 0,00 36,00
DM Pré
GI 16,95 1,99 13,00 20,00
0,000*
GII 5,90 4,90 0,00 14,00
DM Pós
GI 18,50 1,64 15,00 20,00
0,000*
GII 9,10 4,86 0,00 16,00
Legend: Alf: alphabet, Alf Al: random alphabet, LP: words reading, LPN: no words reading, Cor1m: correct in 1(one) minute, E Alf:
writing of the alphabet, DitP: words dictation, DitNP: no words dictation, DM: mute dictation
* Signicant values (p≤0,05) – Statistical Mann-Whitney Test