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Literacy and Children with Apraxia of Speech

Sharon Gretz, M.Ed.

Many parents wonder if their young child with apraxia of speech (verbal dyspraxia) will go on to experience difficulties in their education . While there is no certainty that literacy problems will or will not develop, there is research that has shown that children with spoken language problems are at higher risk for literacy related problems. The purpose of this paper is to summarize some pertinent research and articles on the relationship of spoken language problems to literacy development.

Children with spoken language problems may have difficulty developing what are called phonological awareness skills. Joy Stackhouse has described phonological awareness in this way:

“Phonological awareness refers to the ability to reflect on and manipulate the structure of an utterance (e.g., into words, syllables, or sounds) as distinct from its meaning. Children need to develop this awareness to make sense of an alphabetic script, such as English, when learning to read and spell. For example, children have to learn that the sounds (phonemes) in a word can be represented by letters (graphemes). When spelling a new word, children have to be able to segment the word into its sounds before they can attach the appropriate letters, and when reading an unfamiliar word, they have to be able to decode the printed letters back to sounds.” (Stackhouse, 1997, p.157)

Phonological awareness is made up of many related skills including: recognition and production of rhyme; identification of number of syllables; sound to word matching, word to word matching; sound deletion; and sound segmentation.

Research has found that a strong predictor of literacy development is phonological awareness. Perhaps the stronger predictors of literacy development are later developing phonological awareness skills like sound segmentation and manipulation. When children demonstrate difficulty with phonological awareness, as do many children with spoken language problems, they are at higher risk of difficulty in literacy related skills like reading and spelling. Stackhouse writes that, “Although recent work has clarified how visual deficits may also affect reading performance, there is an overwhelming consensus that verbal skills are the most influential in literacy development (Catts, Hu, Larrivee, & Swank, 1994).” (Stackhouse, 1997, p. 163)

However, not all children with spoken language problems differ in developing reading and spelling skills. Stackhouse compared the reading and spelling skills of a group of children ages 7 – 11 years. She compared children who had speech problems deriving from cleft palate/cleft lip to those described by their therapists as having developmental verbal dyspraxia. The study showed that children with cleft palate did not differ significantly from age-matched typically developing children in tests of reading and spelling. However, the children with developmental verbal dyspraxia did show significant differences and did poorer on these same tests than did their age matched typically developing peers. Many of these children demonstrated errors that suggested they used guess work versus sounding out strategies. Their spelling errors were somewhat bizarre and illogical compared to those children with cleft palate. Therefore, Stackhouse concluded that, ” It is the children with persisting speech difficulties with no obvious medical etiology (who are often described as having phonological impairments or Developmental Verbal Dyspraxia), however, who are most at risk for related specific literacy problems.” (Stackhouse, 1997, p. 169) Other studies appear to report similar findings. One by Bridgeman and Snowling which compared children with developmental verbal dyspraxia to reading age-matched, typically developing children concluded that, “children with persisting phonological impairments have sound segmentation difficulties when processing sound sequences within novel words.” (Stackhouse, 1997, p.175)

A study of four dyspraxic children by Snowling and Stackhouse found that, “children diagnosed as having DVD experience more difficulty in using a phonetic spelling strategy than children who have normal articulation.” (Snowling & Stackhouse, 1983, p. 435) The results support earlier work suggesting that dyspraxic children are less able to carry out grapheme-phoneme conversions than would be predicted from their reading age (Stackhouse, 1982). Finally, Stackhouse writes that, “Persisting phonological impairments beyond the age of 5.6 years may be a sign that a child is at risk for literacy problems.” (Stackhouse, 1997, p.169)

Reading and Spelling Issues:

While many people want to think about reading and spelling as two sides of the same coin, research does not bear this out. Various researchers point to the growing evidence that reading and spelling are independent of one another. For instance, Bradley and Bryant demonstrated that young children may be able to read words that they cannot spell and, conversely, spell words that they cannot read. Snowling and Stackhouse write:

“Spelling is more difficult than reading for most people because reading is a recognition process which can proceed using only ‘partial cues,’ where as spelling is a retrieval process which requires ‘full cues’. In order to spell well one must be able to reproduce the correct letter-by-letter sequence of words (Frith & Frith 1980).” (Snowling & Stackhouse, 1983, p.431)


There are various models that describe the acquisition of reading skills. To simplify this, one can say that in normal reading development children first develop a sight vocabulary – words that they can identify purely by looking at the whole word. This can be described as the direct route. Later, children learn phoneme – grapheme correspondences (sound-letter correspondences) and learn strategies for sounding out words they are trying to read. This can be described as the indirect route. It is important for children to develop this indirect route because if they do not, their reading only progresses to the limits of their visual memory. If they don’t learn phonological strategies via the indirect route then when they are attempting to read an unfamiliar word they will have difficulty decoding the printed letters back to sounds. It is suspected that some children with apraxia of speech or verbal dyspraxia may have difficulty making the leap from the direct to indirect route in reading acquisition.

Spelling Issues

When spelling new words a child needs to be able to segment the word into sounds before they attach an appropriate letter to the sound. In the case of children with apraxia of speech or phonological impairments the types of spelling errors they make aren’t always directly related to their mispronunciation of the words. It is believed that more frequently, their spelling errors are a result of limited phonological awareness, specifically sound segmentation abilities. The literature reports that these children appear to use guesswork vs. logical strategies and that their spelling errors can seem quite bizarre. However, the nature or underlying reason for their spelling difficulties needs to be explored and evaluated because not all children are affected similarly. For any particular child the root of the problem can stem from input, output, representation or a combination of factors.

Some clues that a child with apraxia of speech (verbal dyspraxia) may be having difficulty in reading and/or spelling are:

  • The child is not progressing from reading words as visual wholes to breaking the words down into their sounds.
  • The child fails to segment the word into syllables and syllables into sounds. Spelling attempts may seem bizarre.
  • The child has difficulty in rhyme detection and particularly, rhyme production.
  • The child has difficulty with sound blending.

What Can Be Done To Help?

Various studies conducted with children with limited phonological awareness or poor reading skills point to some suggestions. For instance, a study by Hatcher, Hulme, & Ellis who divided seven year olds who were poor readers into three groups and provided different arrangements of phonological awareness training, reading instruction, or no other training outside of the routine classroom work, found that the only group that made significantly more progress than the control group, was the group that focused on both phonological awareness plus explicit reading strategies. In her article reporting the results of this study, Stackhouse writes, “phonological awareness training alone does not necessarily facilitate literacy development. Literacy development is dependent on children’s ability to link their phonological awareness skills to letter knowledge and reading experience.” (Stackhouse, 1997, p.162) An earlier study by Bradley and Bryant of 65 children with below average ability on phonological awareness tasks as nonreaders before entering school demonstrated that phonological awareness training needs to be combined with explicit letter knowledge teaching for these children to make actual gains in literacy development.

Further, a complete language assessment needs to be done. Such an assessment must not only look at and define the symptoms of the speech, reading, and spelling problems but also the underlying nature of those problems. A full assessment would include: speech, language and oral-motor abilities; auditory skills (such as auditory discrimination, memory and organization); rhyme detection and production; syllable and phoneme segmentation; reading comprehension and expression; spelling and awareness of reading and spelling strategies. It is also important to include more difficult items in reading and spelling tests (for instance, multisyllabic words) in order to determine a particular child’s difficulty. At the end of a thorough assessment, Stackhouse suggests that:

“…having identified through the assessment

  • (a) a profile on speech, language, and reading tests
  • (b) the level and modality of breakdown
  • (c) the severity of the difficulties and their manifestation in ‘real life’
  • (d) the coping strategies adopted

then remediation can be planned” (Stackhouse, 1985, p.109)

The Role of the Speech and Language Pathologist:

The literature and studies reviewed for this paper indicate that there needs to be awareness and vigilance to the literacy development of children with spoken language problems, especially those who have apraxia of speech. “There is a danger that as intelligibility reaches an acceptable level, the child is discharged from the speech therapist’s care only to be left struggling with residual speech difficulties and related spelling problems,” concludes Joy Stackhouse. (Stackhouse, 1985, p.115) While the role of the speech and language pathologist is not to teach reading and spelling per se, Snowling & Stackhouse indicate that, “the role is one of identification and promoting the underlying skills that contribute to literacy development.” (Stackhouse, 1997, p.190) It is hoped that by receiving early, intensive communication therapy for apraxia of speech or phonological deficits, these children may, in fact, heighten their phonological awareness and, in part, strengthen a potentially intrinsic weakness.

Stackhouse suggests that some possibly relevant tools, techniques and activities include:

  • phoneme-grapheme matched cards (cards with pictures that represent sounds)
  • color coded systems as visual reminders of language structures or of sound groups
  • sound categorization activities using multi-sensory approaches
  • syllable and sound segmentation activities
  • rhyming work
  • explicit teaching of reading and spelling rules

Reading instruction

Research accumulated over time indicates that many children need explicit teaching using a phonics approach with phonological awareness; sound-letter correspondence and decodable text with kindergartners and first graders. Research appears to indicate that whole language can enhance comprehension and that a balance of comprehension and decoding skills should be focused on but that whole language should not be the only strategy used with nonreaders. This data may be especially important to children with apraxia of speech and residual problems.

What can parents do?

Parents can support the work of speech pathologists and teachers by following through on home activities that are suggested. For young children, these include nursery rhymes and rhyme games; making games with syllable beats in words; drawing attention to the printed word while reading to children; using books with rhymes and word patterns. Most importantly, parents need to be proactive by knowing what is happening in their child’s school program. Developing effective communication with teachers and therapists will help promote skill development and also help to identify potential roadblocks at the earliest possible time, before a significant problem has developed.


Children with spoken language problems that follow them into school need the proactive involvement of speech pathologists, teachers, and parents. Literacy related skills need to be carefully monitored. Children experiencing difficulty require a full language assessment to not only identify the problems but also to uncover the underlying reason for those problems in order for proper treatment to be outlined and delivered. The potential or risk for literacy related difficulties makes the jobs of both parents and therapists all the more challenged. While much of the focus for children with apraxia is necessarily on their speech production and oral motor sequencing skills, these children also need support and assistance throughout the course of therapy to assure that the proper groundwork is laid for developing literacy skills.

References for this paper:

Stackhouse, Joy (1997). Phonological awareness: Connecting speech and literacy problems. In B. Hodson and M.L. Edwards (Eds.), Perspectives in Applied Phonology (pp. 157 – 196). Gaithersburg, MD: Aspen Publications.

Snowling, M, & Stackhouse, J. (1983). Spelling Performance of Children with Developmental Verbal Dyspraxia. Developmental Medicine and Neurology, 25, 430 – 437.

Stackhouse, J. (1985). Segmentation, speech and spelling difficulties. In M. Snowling (Ed.), Children’s Written Language Difficulties (pp. 96 – 115). Philadelphia: NFER-Nelson Publishing.

Bridgeman, E. & Snowling, M. (1988). The perception of phoneme sequence: A comparison of dyspraxic and normal children. British Journal of Disorders of Communication, 23, 245 – 252.

30 years of research: How children learn to read. G. DeAngelis Sedlak (Ed.) SpeechJargon newsletter, Volume 2, Issue 4, November 1997.

30 years of research: What we know about how children learn to read, a synthesis of research on reading from N.I.C.H.D.

© Apraxia-KIDS℠ – A program of The Childhood Apraxia of Speech Association (CASANA)