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See The Sound/Visual Phonics: An Intervention For Struggling Readers Without Hearing

Impairments

A Research Paper

Submitted

in Partial Fulfillment

of the Requirements for the Degree

Master of Arts

Kristie Carlson

Emily Sorensen

University of Northern Iowa

December 2010

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APPROVAL SHEET

Title: See The Sound/Visual Phonics: An Intervention For Struggling Readers Without Hearing

Impairments

Name of Candidate: Emily Sorensen/Kristie Carlson

Research Project Approved: __________________________________

Jennifer Garrett, Ph.D., CCC-SLP

Research Director

__________________________________

Lauren Nelson, Ph.D., CCC-SLP

Second Reader

__________________________________

Date

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Abstract

See The Sound/Visual Phonics (STS/VP) is a technique that utilizes visual input through

hand movements to aid auditory discrimination of English phonemes. STS/VP was originally

developed to assist the deaf and hard of hearing (DHH) population. Due to the success of

STS/VP with this population, hypotheses are now being proposed regarding the application of

STS/VP for children with typical hearing. The purpose of this investigation was to examine the

application of STS/VP on phonemic awareness goals, specifically segmenting and blending, for a

hearing child determined as an at-risk reader. Using a single-subject A-B-BC design with

multiple baselines, the results show improvement due to combined use of STS/VP and traditional

phonological awareness therapies. The subject’s results indicated mild improvement in accuracy

of segmenting tasks and exceptional improvement in accuracy of blending tasks. This study

revealed positive results encouraging further research of STS/VP implemented in the instruction

of hearing populations.

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Literature Review

See The Sound/Visual Phonics (STS/VP) is a technique that utilizes visual input through

hand movements to aid auditory discrimination of English phonemes. STS/VP was originally

developed to assist the deaf and hard of hearing (DHH) population. Some teachers and speech-

language pathologists utilizing early literacy instruction, particularly instruction of phonemic

awareness skills, have successfully incorporated STS/VP into classroom and therapy settings.

Due to the success of STS/VP with DHH population, hypotheses are now being proposed

regarding the application of STS/VP for children with typical hearing. Researchers are exploring

the effects on phonological awareness and pre-literacy goals by supplementing instruction of

hearing children with STS/VP.

Phonological Awareness

Phonological awareness is defined as “the metaliguistic ability that involves the more or

less explicit understanding that words are made of discreet units” (Ball, 1993, p. 130).

According to Schuele and Boudreau (2008), while often listed in a sequential format,

phonological awareness skills develop in overlapping stages rather than a series of prerequisites

(see Table 1). Early levels of instruction, in accordance with order of acquisition, begin with

syllable-level segmentation, rhyme, alliteration of either initial or final phonemes, and phoneme

categorization. More complex tasks include blending, segmentation, and deletion at the

phonemic level. Following this order of acquisition, the skill of blending phonemes into words is

mastered before the skill of segmenting words into phonemes (Ball, 1993).

Phonemic awareness refers to the phonological awareness skills that relate directly to

manipulation of phonemes. According to Ehri, Nunes, Willows, Schuster, Yaghoub-Zadeh, and

Shanahan (2001), phonemic awareness is a deeper level of phonological awareness that includes:

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phoneme isolation, phoneme identity, phoneme categorization, phoneme blending, phoneme

segmentation, and phoneme deletion (see Table 1). This study focused specifically on the

acquisition of phoneme blending and phoneme segmentation. Phoneme blending is defined as

the ability to combine individual phonemes into a single word, whereas phoneme segmentation is

defined as the ability to separate a single word into its individual phonemes. Success in

phonemic awareness, especially phoneme blending and segmentation (Schuele & Boudreau,

2008), is an area of interest, as it has been researched to be one of the best predictors of how well

children will read. The National Reading Panel conducted a meta-analysis to examine the impact

of phonemic awareness instruction on reading development (Ehri et al., 2001). The results of the

meta-analysis show that the manipulation of sounds in words is beneficial in reading instruction

for children aged preschool through first grade, and benefits increased when instruction focused

on only one or two phonological awareness skills rather than all six (Ehri et al., 2001).

Just as phonemic awareness success indicates future reading success, a primary indicator

for future reading difficulties in young children is a deficit in phonemic awareness skills (Birsh,

2005; Cihon, Gardner, Morrison, & Paul, in press). Phonological awareness skills of letter and

sound correspondence are vital to reading ability, especially word recognition and decoding. “In

addition to phonological awareness, understanding of the alphabetic principle [the relationship

between words and sounds] is necessary for developing word recognition and decoding skills;

however the alphabetic principle makes little sense to children with deficits in phonological

awareness” (Pullen & Justice, 2003, p. 88). Morrison et al. (2008) described the confusing

nature of the English language, stating, “Twenty-six letters of the English alphabet represent 45

sounds which can be spelled 398 different ways.” (p. 18). STS/VP teaches children that sounds

have a visual representation versus the traditional notion that the visual symbol is the basis for

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the sound (Montgomery, 2006). According to Morrison et al. (2008) “[STS/VP] regularizes the

irregularities of the English phonemic system” (pg. 18). Furthermore, “numerous studies have

found that intensifying teaching strategies with hearing students who have difficulty with

phonological awareness skills yields positive results for later reading achievement” (Narr, 2006,

p 54). Combining STS/VP techniques with traditional phonological awareness therapy may

provide such intensified teaching strategies to strengthen reading success.

Table 1 Phonological Skills _____________________________________________________________________________ Phonological Skill Definition Example Syllable Segmentation Ability to separate a word into syllables baseball > base ball Rhyme Ability to categorize words with similar rat, cat, bat initial/final phonemes Phoneme Isolation Ability to recognize individual sounds cat begins with /k/ in words Phoneme Identity Ability to recognize common sounds in cat, car, and kite different words begin with /k/ Phoneme Categorization Ability to recognize the odd sound in a sun doesn’t belong sequence of words with cat and cup Phoneme Blending Ability to organize a sequence of sounds /r/ /∧/ /g/ blend into a word into rug Phoneme Segmentation Ability to separate a word into individual sun segments into sounds /s/ /∧/ /n/ Phoneme Deletion Ability to recognize what remains of a fox without /f/ word when a phoneme is deleted is ox

Traditional Phonological Awareness Therapy

Traditional phonological awareness teaching and therapy techniques rest heavily on the

child’s ability to rely on auditory skills to discriminate between different sounds. There are

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several phonics programs that encompass such an approach, including but not limited to,

Lindamood Phoneme Sequencing Program for Reading, Spelling, and Speech, Road to the Code:

A Program of Early Literacy Activities to Develop Phonological Awareness, Phonological

Awareness Training for Reading, Phonemic Awareness in Young Children, Ladders to Literacy,

and Sounds Abound (Lane, Pullen, Eisele, & Jordan, 2002). While each may have a different

protocol, they all center around the idea of letter to sound correspondence, which is key to

reading and writing success (Adams, 1990). A traditional approach to segmenting instruction

includes teaching a child to differentiate the individual phonemes in a given word. This

technique is practiced by repetitively sounding out the given word at decreasing rates to identify

the individual phonemes. Textual cues are often used when the phonemes are easily

corresponded to the individual letters (e.g., the /a/ vowel is simply depicted in “cat”). A

traditional approach to blending instruction is teaching a child to combine phonemes to create the

targeted word. This is primarily executed by increasing the rate in which phonemes are produced

to clue the identity of the target word. Traditional segmenting and blending techniques are

centered on the skills of auditory discrimination and phoneme manipulation. While most

phonological skills are integrated into relevant reading and writing tasks, students who struggle

with these skills often need extra instruction outside of standard curriculum (Lane, Pullen, Eisele,

& Jordan, 2002).

See The Sound/Visual Phonics

STS/VP is a multi-sensory strategy used to aide the acquisition of literacy skills by

connecting sound with print in a non-textual yet visible, concrete way (Montgomery, 2008). It is

comprised of forty-five hand and symbol cues that represent all English phonemes (Narr, 2008).

Each sound is tied kinesthetically to the production of English sounds easing their attainability to

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learners (Montgomery, 2008). The hand signs are intended to mimic and exaggerate the

articulatory features of the mouth, lips, and/or tongue for each phoneme (Morrison, Trezek, &

Paul, 2008). Originally, STS/VP was used as a tool for teaching literacy skills to children who

were DHH. It was invented by the mother of a child who was deaf to assist him in understanding

phonemic awareness tasks associated with learning to read (Montgomery, 2008). Her innovation

was an attempt to answer the question: “If the students cannot hear a sound, how does a parent or

teacher represent it to them in such a way that they understand the sound a letter makes?”

(Morrison et al., 2008, p. 13). Little research has been published regarding the effect of STS/VP

on literacy success until recently, with most studies focusing on the DHH population (Morrison

et al., 2008). As phonological awareness skills have been shown to lead to reading success,

therapy techniques that lead to the acquisition of these skills is the motivation behind applying

STS/VP to children with phonemic awareness deficits by bridging the gap between sounds and

letters. STS/VP is not meant to replace traditional reading instruction, but to support that

instruction by further clarifying the complexities of the English language.

Deaf or Hard of Hearing Population

The research regarding the DHH population explores the use of STS/VP as a teaching

technique for phonological awareness. An example of this research was conducted by Narr

(2008), and results indicated a positive correlation of the use of STS/VP. Trezek and Malmgren

(2005) composed a study that investigated the ability of DHH middle school students to learn

and generalize phonics skills through a corrective reading and decoding curriculum, which

included the use of STS/VP. The results of their study indicate that students receiving

instruction from the phonics therapy treatment were able to acquire knowledge of phonics skills

regardless of their degree of hearing loss (Trezek & Malmgren, 2005). In a related study, Trezek

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and Wang (2006) examined the effects of visual phonics on kindergarten and first-grade students

who were DHH. The results of the study revealed one year of instruction from a phonics-based

reading curriculum supplemented by visual phonics was enough to boost performance of

beginning reading skills for these children. Measurements evaluated included: word reading,

pseudoword decoding, and word comprehension (Trezek & Wang, 2006). Again, degree of

hearing loss did not affect performance for any of these children. “Students with various degrees

of hearing loss benefited equally well from this phonics-based reading curriculum supplemented

by visual phonics” (Trezek & Wang, 2006, p. 212). Trezek, Wang, Woods, Gampp, and Paul

(2007) also examined the effects of visual phonics on kindergarten and first-grade students who

were DHH. The purpose of the study was to expand upon the findings of Trezek’s previous two

studies by analyzing beginning reading skills measured by sentence writing, spelling, phonemic

awareness segmentation, phonemic awareness deletion, phonic onsets, and phonics rimes

(Trezek et al., 2007). Results of this study were consistent with the results of previous studies of

this type, showing a positive outcome for the use of STS/VP as an instructional tool (Trezek et

al., 2007). Although STS/VP research is limited, results seem to support its use in teaching

phonemic awareness to children who are DHH. Due to STS/VP’s success with DHH children,

research is now being done to evaluate its effectiveness with struggling readers of the hearing

population.

Multi-Sensory Learning

The hearing children who are struggling to read may also have difficulty learning from a

primarily auditory environment similar to their peers who are DHH. It has been theorized that

children have combinations of different learning strengths, meaning they gain access to new

information more quickly or more easily through certain modalities (Moats & Farrell, 2005). By

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definition, multi-sensory learning utilizes the combination of two or more senses to facilitate

instruction. There are three primary sensory groups known to distinguish children’s learning

styles: visual-spatial, auditory, and kinesthetic.

Visual-spatial learners work best with imagery of the task at hand (Discovering, n.d.).

These children may prefer art, drawing, charts, diagrams, and puzzles. They succeed by visually

memorizing the appearance of the target (e.g., the way a spelling word looks). Strategies for

teaching this population include bulleted lists, highlighting, charts, diagrams, and flash cards.

Auditory learners prefer spoken instruction (Discovering, n.d.). Therefore, these children tend to

benefit from traditional teaching instruction, which uses oral direction and presentation. Auditory

learners are successful when reading aloud and studying in groups. Kinesthetic learners acquire

knowledge through manipulation of objects and movement (Discovering, n.d.). They learn by

touching or experiencing the learning task. These children may have a shorter attention span,

need movement to learn, and prefer a teaching method of demonstration versus explanation.

“Most kindergartners are physical [kinesthetic] learners, but by second or third grade their

learning styles may change to visual or auditory” (Discovering, n.d.). As phonological

awareness most often begins in preschool and kindergarten, the majority of the classroom

population may be kinesthetic learners and not receptive to traditional auditory instruction. Narr

(2008) stated that STS/VP “provides students with visual, tactile, and kinesthetic support for

phoneme perception, without the need for hearing or articulation” (p. 414).

Purpose

As early literacy learners may not be receptive to traditional phonological awareness

techniques, a new strategy needs to be found. The success of STS/VP with the DHH population

alludes to the idea that hearing children may also benefit from a visual and kinesthetic technique.

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Yet application of STS/VP in hearing classrooms has not been thoroughly explored at this time.

By studying the effect of STS/VP in combination with traditional therapy on hearing children’s

phonological awareness skills, a clearer understanding of therapy techniques effective for

remedying reading deficits can be found. Studies continuing this investigation can lead to more

effective therapy and innovative teaching techniques in the classroom. This in turn will facilitate

therapy goals and strategies for those facing reading difficulties that place them in the care of

speech-language pathologists. Studies have traditionally focused on the use of STS/VP with

children who are DHH, so this study focused on the hearing population. By focusing on hearing

children with reading deficits, the missing information can lead to a better understanding of how

STS/VP can be applied to reading instruction, particularly phonological awareness skills.

The purpose of this research was to examine the effectiveness of modifying traditional

therapy with the STS/VP for hearing children with phonological awareness deficits. The study

was directed to answer the following question. Does STS/VP in combination with traditional

therapy generate a descriptive difference between pre- and post-test measures of blending and

segmenting tasks completed by hearing children with phonological awareness deficits? By

answering this question, this study determined if STS/VP is an effective addition to traditional

phonological awareness treatment of hearing children.

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Method

This study was designed to investigate the effects of See The Sound/Visual Phonics on

phonological awareness deficits in hearing children with reading difficulties. A single-subject

study was conducted using an A-B-BC design implementing traditional phonological awareness

training and STS/VP over the course of six weeks. Baseline data was established during the first

week, followed by traditional therapy during week two. Traditional therapy in combination with

STS/VP was administered in week three. This three-week cycle was repeated over weeks four,

five, and six, beginning with the second collection of baseline data. A final data collection was

gathered on the last day of week six. The subject attended 30-minute therapy sessions three times

a week for a total of six weeks. To ensure reliability, both researching clinicians scored audio

and video recordings of the baseline data.

Subject

The subject was a four-year, three-month old male who had been receiving speech

services since he was two-years, seven-months. The initial evaluation revealed delays in

expressive and receptive language and a slight delay in speech. During the previous year, the

subject took part in 120-minute group therapy sessions three days a week. These sessions used

the traditional phonological awareness approach on goals including blending two to three

syllables into words presented in written and verbal form and segmenting two to three syllable

words presented in written and verbal form. After 38 sessions, he was able to consistently blend

two to three syllables into words with 85-100% accuracy and segment two to three syllable

words into syllables with 100% accuracy. Based on his success in blending and segmenting

words at the syllable level, it was appropriate to move to blending and segmenting at the

phoneme level.

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Parent Questionnaire

The subject’s mother was given a pre- and post-therapy questionnaire regarding her son’s

reading and phonological awareness skills (Appendix A). The questions were developed to

inquire about his current phonological awareness abilities and to determine if any significant

progress had occurred over the six weeks of therapy. The questionnaire helped identify any

perceived differences in ability after participation in phonemic awareness therapy. The subject’s

mother was also able to relate any preferences regarding phonemic awareness therapy.

Baseline Testing

Baseline data was taken on the subject’s performance of segmenting and blending one-

syllable words on weeks one, four, and six. Two sets of words were presented for each task; one

consisting of words the subject continued to practice in treatment and one consisting of words

avoided in treatment to gauge his ability to generalize. The same sets of practiced and

unpracticed words were administered for the initial, intermediate, and final baseline data

collections (Appendix B). Baseline data was taken three times for the initial baseline, resulting

in an average score. Baseline data was taken only one time for the intermediate and final baseline

collections. The clinicians’ elicited baseline segmenting tasks by saying, “I will say a word. I

would like you to say each sound that you hear in the word. For example, the word is ‘top.’

Listen to the sounds: /t/ /a/ /p/,” the clinicians then asked the subject to segment both the trained

and untrained word lists. The clinicians’ elicited baseline blending tasks by saying, “I will say

the sounds in the word. You see if you can tell what word it is. For example, listen to the sounds:

/k/ /Λ/ /t/. The word is ‘cut,’” the clinicians then asked the subject to blend both the trained and

untrained word lists. Along with the clinicians’ verbal prompts regarding the target words, the

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subject was shown picture representations using Boardmaker images to aid in receptive

knowledge of the word list vocabulary.

Scoring for segmenting consisted of the number of sounds correctly produced compared

to the total sounds targeted by the segmenting goal. If segmented incorrectly, the subject’s

productions were recorded for comparison. Scoring for blending goals consisted of correct words

blended compared to the total number of words targeted. If blended incorrectly, the subject’s

productions were noted for comparison. Both clinicians scored each baseline independently and

results were later reviewed and compared to audio-video footage.

Therapy

For weeks two and five, traditional therapy was implemented to target the subject’s

segmenting and blending goals. Traditional therapy targeted these goals through structured play

and focused on improving his letter-sound correspondence skills. Therapy consisted of

reviewing flashcards while playing games including, but not limited to, Candy Land, Chutes and

Ladders, flashlight hide and seek, Lego blocks, build your own puppets, Ker-plunk, bowling, and

basketball. The targeted word was presented visually and/or verbally depending on phonemic

task. Immediate verbal feedback followed the subject’s response. If incorrect, the subject was

provided with cues and models to elicit the correct response. The clinicians targeted the trained

words by presenting the same picture representations used in the baseline collection but also

included the written words for sound-letter correspondence cues. Additionally, a reward system

was implemented to provide the subject tangible reinforcement.

During weeks three and six, STS/VP was added to the traditional therapy activities. The

activities continued as in weeks two and five, but the visual hand cues of STS/VP were added to

the clinicians’ verbal cues and pronunciations throughout the sessions. The subject was not

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instructed to learn or use the hand cues, however, he was not penalized if he chose to produce the

hand cues independently.

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Results

Pre-Treatment Questionnaire

The pre-treatment questionnaire was given to the subject’s mother prior to the first

session. She described her son’s current reading abilities as emerging. She noted recognition of

letters but not letter-sound correspondence. She stated he struggled to sound out words and put

sounds together, however, he exhibited strong memory in retelling stories once read.

Baseline Results

A total of six weeks of treatment using an A-B-BC treatment design was utilized for the

purpose of this study. Informal measures were used to obtain baseline, intermediate, and final

data. The traditional and STS/VP therapies were alternated every other week when data was not

obtained. Data regarding the subject’s response accuracy was not collected during therapy

weeks, see Appendix C for target word frequency during therapy weeks. The subject’s responses

to blending and segmenting tasks were not scored during STS/VP and phonological awareness

training weeks. The data collected for initial, intermediate, and final baselines are shown in

Table 2.

Scores were calculated for each baseline of trained and untrained words. The segmenting

scores shown in Table 2 represent the percentage correct of segmented sounds from 40 trained

and untrained target words, totaling 118 sounds. The blending scores shown in Table 2 represent

the percentage correct from 40 blended trained and untrained target words. The subject showed

mild progress from initial to intermediate baseline increasing his score from 8% to 21% over the

course of three weeks. There was no improvement from intermediate to final baseline. These

percentages indicate minimal progress in accuracy of segmenting tasks after both traditional

phonological awareness training and STS/VP cuing. The blending scores showed improvement

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from initial to intermediate baseline increasing his score from 10% to 15% over the course of

three weeks. The subject made greater improvements from intermediate to final baseline,

increasing his score from 15% to 75% in the final three weeks. These percentages indicate

exceptional progress in blending tasks during the six-week study.

Table 2 Segmenting and Blending Baselines ______________________________________________________ Baseline Segmenting Blending Initial 8% 10% Intermediate 21% 15% Final 21% 75% ______________________________________________________ Note: The Initial Baseline percentages for both segmenting and blending are averages of three consecutive days of initial baseline testing. Post-Treatment Questionnaire

A post-treatment questionnaire was given to the subject’s mother to answer following the

completion of the study. She indicated he now tries to read words in books by sounding out

letters while continuing to use pictures as context clues. The subject’s mother did not observe

any use of STS/VP at home following the conclusion of the study. She believes that had STS/VP

cues been implemented when her older child was learning to read, it would have benefited her

reading success. Overall, she was happy with the outcome of the study and the additional support

her son was given towards his reading endeavors.

Summary of Results

The purpose of this investigation was to examine the application of STS/VP on phonemic

awareness goals, specifically segmenting and blending, for a hearing child determined as an at-

risk reader. Using a single-subject A-B-BC design with multiple baselines, the results show

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improvement due to combined use of STS/VP and traditional phonological awareness therapies.

The subject’s results indicated mild improvement in accuracy of segmenting tasks and

exceptional improvement in accuracy of blending tasks.

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Discussion

This study sought to further investigate STS/VP as a multi-modality strategy used to

assist phonemic awareness in a preschool child. The results of this study are inconclusive if

STS/VP alone was the driving force for the subject’s improvement in segmenting and blending at

the phonemic level, as this study did not include a control group for comparison. The subject

acquired phonemic blending more easily than phonemic segmenting which appropriately follows

age of acquisition of phonemic awareness according to Ball (1993) and Ehri et al. (2001).

Clinicians found that the subject benefited from the multi-modal approach taken in this study,

supporting Narr’s (2008) investigation. The subject was able to distinguish /m/ and /n/ more

easily following the use of STS/VP hand cues versus auditory cues alone, just as Trezek and

Malmgren (2005) found in their study of the DHH population. The subject also demonstrated

improvements in beginning reading skills just as kindergarten and first-grade students in

previous studies of the DHH population showed improvements (Trezek, et al., 2007; Trezek &

Wang, 2006). In comparing this study with DHH research, the subject’s improvement due to use

of STS/VP support Trezek et al. (2007), Trezek and Malmgren (2005), and Trezek and Wang’s

(2006) findings that STS/VP can improve beginning reading skills in children regardless of

hearing loss severity. As there is a lack of research in the area of STS/VP, few comparisons

could be made between this study and previous studies at this time. Therefore, this study will aid

future research as a means for comparison.

Findings of the Study

The subject’s previous experiences with speech-language therapy found him to be a

highly kinesthetic learner. He is motivated by fast pace, gross motor activities. The STS/VP

program benefited the subject by allowing him a more interactive therapy session. While he did

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not regularly imitate the hand cues, his attention was drawn to the visual input from the

clinicians. In one instance of imitation, the subject segmented “bed” as /b/ /ε/ /b/. The clinician

compared the /b/ hand cue to the /d/ hand cue, and he immediately produced the /d/ phoneme

along with the hand cue. Treatment through week four utilized modeling, verbal cueing, and

tangible rewards (e.g., candy, games) as the subject did not consistently respond independently

to segmenting and blending prompts until week five. Before becoming independent, the subject

explored blending by silently mimicking the clinicians’ phoneme productions during blending

prompts.

The subject’s phonemic repertoire following the initial baseline consisted of ten

phonemes identified in blending and segmenting tasks, /s, p, t, h, k, r, m, n, t∫, ∧/. A majority of

his initial segmenting productions consisted of only the /s/ phoneme. By the end of the

intermediate baseline, the subject’s productions for the segmenting goal included 18 phonemes,

/s, p, t, h, k, r, m, n, b, dz, d, g, l, t∫, ∧, ∫, ε, o/. Even though he was able to produce both /m/ and

/n/, he frequently interchanged the two phonemes incorrectly. The subject’s phonemic

productions for the final baseline of the segmenting goal increased to 20 phonemes, /s, p, t, h, k,

r, m, n, b, dz, d, g, l, t∫, ∧, a, ∫, ε, I, o/. Vowels proved difficult for him to independently

recognize and produce in isolation, and he often requested clinician assistance while segmenting

vowels (e.g., “What does “I” say?”). The subject conveyed satisfaction as he mastered

segmenting “sun” and “dad” independently by week four.

Clinical Implications

While the subject showed progress in his knowledge of phonological awareness, the

findings of this study could not link STS/VP as the primary reason for his improvements. Such a

conclusion could not be made because STS/VP was incorporated with traditional phonological

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awareness treatment without the use of a control group for comparison. While the traditional

phonological awareness treatment could be the sole acting force for the subject’s success, the

clinicians noted improvements in attention and phonemic discrimination when STS/VP cues

were implemented.

In conjunction with past phonological awareness research, the subject’s rate of success in

this study follows the estimated progression of skill acquisition for blending and segmenting.

During the six-week duration of this study, the subject showed significant improvement in the

skill of blending, yet did not show the same improvement in the skill of segmenting. This

supports the research that blending tasks precede segmenting tasks in acquisition and mastery

(Ball, 1993).

Research has noted most preschool children require instruction beyond auditory input.

Therefore, STS/VP offers a meaningful and realistic way of teaching children phonological

awareness skills through multi-modal instruction including kinesthetic, visual, and auditory

elements. By incorporating STS/VP in everyday instruction, teachers and clinicians have a

stronger opportunity to engage more students using a multi-modal approach. While rate and

degree of improvement varied for this subject’s segmenting and blending skills, STS/VP may be

a strategy for long-term instruction, possibly as a classroom teaching supplement as

recommended by Trezek et al. (2007).

Further Research

Research in the area of STS/VP is lacking in regards to its use in treatment for

phonological awareness, especially with the hearing population. While any STS/VP research

with the hearing population would be beneficiary, there are recommendations to be made. This

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study was conducted as a single-subject case study, yet a randomized control group study

comparing STS/VP with traditional phonological awareness therapy would be optimal.

Additionally, the duration of the study needs to be extended beyond the six-week time

frame. Conducting a study during the school year would provide a better foundation due to

stronger structure and routine compared to this study’s summer schedule. This study may not

have been long enough to fully capture the impact of STS/VP on phonological awareness tasks.

The subject’s significant improvements occurred in the last three weeks and may have

strengthened had the study continued. The time frame limitations also restricted the ability to

gather multiple intermediate and final baselines, which may have influence the final results of

this study.

The word list chosen for this study was ideal due to phonemic variance, yet difficult to

implement due to time restrictions and the subject’s mood and motivation. A better word list for

this study would have included only ten trained and ten untrained words for each goal versus

twenty of each. Motivation of the subject was the biggest hurdle overall. Due to conducting this

study during the summer, the subject’s motivation was highly variable and often needed

redirection. Motivation may improve in a school setting or during a time of regular routine.

Summary

This study did not find conclusive evidence that STS/VP in combination with traditional

phonological awareness therapy enhances segmenting and blending abilities in a four-year-old

male at risk for reading difficulties. However, it revealed positive results encouraging further

research of STS/VP implemented in the instruction of hearing populations. This hand cue

technique was easily incorporated into the speech therapy setting for the study and demonstrated

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potential to be utilized in a classroom. STS/VP can be an instructional aid of phonological

awareness skills, especially for children with kinesthetic and visual-spatial learning preferences.

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Appendix A

Pre-Treatment Questionnaire

• What is your child’s current reading level?

• Describe your child’s reading abilities before the implementation of See the Sound/Visual

Phonics? Did they struggle to sound out words or put sounds together?

Post-Treatment Questionnaire

• What changes, if any, did you notice in your child due to participating in the See the

Sound/Visual Phonics study? Reading, writing, motivation? Did you notice any changes in

reading if so what?

• Did your child use See the Sound/Visual Phonics hand cues when sounding out words or

reading with you at home?

• How would you feel about your child’s speech-language pathologist using See the

Sound/Visual Phonics at school? Would you want it to be in addition to or an alternative to

what your child receives now?

• Do you have any comment or feedback about your child participating in the See the

Sound/Visual Phonics study? Is there anything you wish had been done differently during the

session?

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Appendix B Initial Baseline #1 _____________________________________________________________________________ Trained Target Word Segmenting Blending pop /p/ rug hot /s/ + sun /s/ + bed /s/ dog cat /s/ shooter rug /s/ + it /s/ + jet IDK S lamp IDK rug dad dad hammer bus /s/ man fan /s/ helicopter gap /s/ pig mat no camera tub /t/ /∧/ wheel ham IDK spoon lip /p/ cow dog /s/ + no /s/ + tin /s/ triple

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Untrained Target Word Segmenting Blending pan IDK bat hop /h/ octopus bat IDK frog sad /s/ snake rat /r/ Syler bug /s/ dog cup /k/ paper at bat, /s/ pencil camp /k/ at dot /s/ door fun /f/ fish gas /s/ wish mom /s/ water rub /s/ chair lid /s/ shoe tip /s/ teeth fog /s/ head jam /s/ hammer nap /s/ colors go /s/ + ______________________________________________________________________________ Note: The notation of “IDK” indicates the subject’s response, “I don’t know,” and the notation of “+” indicates the subject’s response was correct.

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Initial Baseline #2 _____________________________________________________________________________ Trained Target Word Segmenting Blending pop /s/ glue hot /s/ shoe sun /s/ video camera bed /s/ wall cat /k/ table rug /m/ paper it /s/ + jet /s/ eyes lamp IDK Emily dad /k/ D bus /s/ D fan /f/ spoon gap /s/ cow mat /m/ chair tub /s/ cheese ham /t/ ceiling lip /∫/ picture dog /s/ + no /s/ + tin /s/ shirt

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Untrained Target Word Segmenting Blending pan /s/ mouth hop /s/ pig bat /s/ mom sad /s/ spoon rat /s/ /r/ bug /s/ seal cup /s/ pig at /s/ /t/ yes camp /s/ pictures dot /s/ under fun /s/ pizzle gas /s/ pig mom /s/ dad rub /s/ Jackson lid /s/ /l/ tip /s/ P fog /s/ mom jam /s/ finger nap /n/ /p/ pig go /s/ no ______________________________________________________________________________ Note: The notation of “IDK” indicates the subject’s response, “I don’t know,” and the notation of “+” indicates the subject’s response was correct.

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Initial Baseline #3 _____________________________________________________________________________ Trained Target Word Segmenting Blending pop /s/ ground hot /r/ shaver sun /s/ yes bed /s/ Hawkeye cat /s/ knee rug /s/ /f/ xylophone it /s/ bit jet /s/ camera lamp /s/ fence dad /s/ saw bus /s/ board fan /f/ pencil gap /s/ pig mat /s/ cha-cha tub /s/ fireplace ham /s/ tie lip /s/ wall dog /s/ water bottle no /s/ + tin /s/ sock

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Untrained Target Word Segmenting Blending pan /s/ pants hop /s/ table bat /s/ dog sad /s/ xylophone rat /r/ head bug /f/ /a/ dog cup /f/ baseball at /s/ me camp /s/ paper dot /s/ machine fun /s/ pants gas /s/ eyes mom /s/ wall rub /s/ basket lid IDK cut tip /s/ go fog /s/ shirt jam /s/ mouth nap /s/ tank top go /s/ + ______________________________________________________________________________ Note: The notation of “IDK” indicates the subject’s response, “I don’t know,” and the notation of “+” indicates the subject’s response was correct.

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Intermediate Baseline _____________________________________________________________________________ Trained Target Word Segmenting Blending pop /s/ Shane hot IDK pig sun /s/ /∧/ /n/ go bed /b/ /∧/ /t/ dog cat /s/ /k/ C /t/ chute rug /k/ shaver it I /t/ + jet /dz/ /t/ + lamp /p/ fan dad /d/ /æ/ /d/ dean bus /s/ Candy Lane fan IDK pig gap IDK sheen mat /t/ T kid tub /t/ color ham /s/ machine lip /s/ /k/ driveway dog /d/ + no /n/ /o/ + tin /s/ sheen

35

Untrained Target Word Segmenting Blending pan /s/ shaving cream hop /k/ /t/ fish bat /k/ /s/ kid sad IDK dog rat IDK + bug /s/ /k/ /t/ /s/ S cup /k/ pig at /t/ shat camp IDK shat dot I /t/ sheen fun S T R /k/ /t/ /s/ chute gas /s/ /t/ sat mom /s/ shaver rub /k/ bat lid /s/ IDK tip IDK hat fog /s/ fish jam /s/ /æ/ /t/ chute nap IDK /n/ /s/ H go /g/ + ______________________________________________________________________________ Note: The notation of “IDK” indicates the subject’s response, “I don’t know,” and the notation of “+” indicates the subject’s response was correct.

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Final Baseline _____________________________________________________________________________ Trained Target Word Segmenting Blending pop /p/ /a/ /p/ + hot /h/ /au/ /p/ + sun /s/ /a/ /∧/ /p/ bat bed /b/ /æ/ + cat /g/ /k/ /æ/ /t/ + rug /r/ IDK /t/ + it /I/ /t/ + jet IDK + lamp /f/ IDK /n/ + dad /d/ /æ/ /d/ + bus /b/ /∧/ /s/ + fan /f/ /æ/ /n/ at gap IDK + mat /r/ IDK at tub /t/ IDK + ham /h/ /b/ + lip /s/ /æ/ /k/ + dog /d/ /a/ /g/ + no /n/ /o/ + tin /t/ /æ/ /n/ +

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Untrained Target Word Segmenting Blending pan /p/ /n/ /t/ rap hop /h/ /g/ /æ/ + bat /n/ /o/ + sad /s/ /æ/ /d/ dad rat /n/ /t/ + bug /n/ ‘it’ /t/ + cup /t/ /æ/ + at /æ/ /t/ + camp /n/ /o/ I ‘it’ fan dot /f/ /æ/ /n/ + fun /f/ /æ/ /n/ fan gas /n/ /æ/ /g/ + mom /m/ /o/ /m/ am rub /t/ /r/ /∧/ /g/ + lid /n/ /o/ /g/ /æ/ + tip /n/ /o/ /g/ + fog /f/ /au/ /n/ /au/ + jam /t/ /æ/ /n/ jat nap /n/ /o/ rap go /g/ /o/ + ______________________________________________________________________________ Note: The notation of “IDK” indicates the subject’s response, “I don’t know,” and the notation of “+” indicates the subject’s response was correct.

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Appendix C Target Frequency in Therapy: Week 2 _____________________________________________________________________________ Trained Target Word Segmenting Blending pop X X X hot X X X X sun X X X bed X X X cat X X X rug X X X X it X X jet X X X X lamp X X dad X bus X X X fan X X X gap X X X mat X tub X ham X X lip dog X no X X tin X X

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Target Frequency in Therapy: Week 3 _____________________________________________________________________________ Trained Target Word Segmenting Blending pop X X X hot X X X sun X X X X bed X X X X X cat X X X X X rug X X X X it X X X X jet X X X X X lamp X X dad X X X X X X bus X X X X X X fan X X X X gap X X X X mat X X X tub X X X ham X X X lip X X X dog X X X no X X X tin X X X X

40

Target Frequency in Therapy: Week 5 _____________________________________________________________________________ Trained Target Word Segmenting Blending pop X X X X hot X X X sun X X X X bed X X X cat X X X X rug X X X it X X X jet X X X lamp X X X dad X X X X bus X X X fan X X X X gap X X X mat X X X X tub X X X X ham X X X lip X X X X dog X X X X no X X X X tin X X X X

41

Target Frequency in Therapy: Week 6 _____________________________________________________________________________ Trained Target Word Segmenting Blending pop X X X hot X X X sun X X X bed X X cat X X X rug X X X it X X X X jet X X lamp X X X dad X X X bus X X X X fan X X X X gap X X X mat X X X X tub X X X ham X X X lip X X X dog X X X X no X X X tin X X X