Abstracts
Purpose
To characterize phonological impairment and short-term memory performance of school-aged children with specific language impairment (SLI) and investigate the possible correlations between these variables.
Methods
The group comprised 15 school-aged children of both genders (14 boys) with SLI, aged between 7 years and 12 years and 11 months. They were all undergoing speech therapy. To verify phonological impairment, the tasks of naming and imitation from the phonology test were used and based the calculus of percentage of correct consonants reviewed (PCC-r). Phonological short-term memory was assessed by the Test of Pseudoword Repetition.
Results
There was no difference in PCC-R accuracy between picture naming and word imitation tasks. Phonological short-term memory performance was better for pseudowords that showed greater similarity and had fewer syllables. A positive correlation was observed between phonology and phonological short-term memory; however, while phonological performance approached the maximum number of possible correct answers, the average short-term memory performance did not reach half of the possible correct answers. PCC-r mean correct answer was higher than 85%.
Conclusion
Phonological short-term memory performance of school-aged children with SLI differs according to word similarity and pseudoword extensions, since positive correlations between these variables were observed.
Memory; Short-term; Language development; Child; Language development disorders; Child language
Objetivo
Caracterizar a alteração fonológica e o desempenho na memória de curto prazo fonológica de escolares com distúrbio específico de linguagem (DEL), além de investigar se há correlação entre essas variáveis.
Métodos
O grupo foi composto por 15 escolares com DEL, de ambos os gêneros (14 meninos), com idades variando entre 7 anos e 12 anos e 11 meses. Todos estavam em terapia fonoaudiológica. A alteração fonológica foi caracterizada pela Porcentagem de Consoantes Corretas Revisada (PCC-R) das provas de Fonologia do ABFW. A memória de curto prazo fonológica foi avaliada a partir da porcentagem de acertos na similaridade e na extensão das pseudopalavras do Teste de Repetição de Pseudopalavras. A correlação foi investigada a partir do PCC-R, em cada prova, e da porcentagem total de acertos na repetição das pseudopalavras.
Resultados
Não houve diferença entre o PCC-R na nomeação de figuras e na imitação de palavras e o desempenho na memória de curto prazo fonológica foi melhor quando a similaridade das pseudopalavras era maior e o número de sílabas menor. Houve correlação positiva entre a fonologia e a memória de curto prazo fonológica. Todavia, enquanto o desempenho na fonologia esteve próximo do máximo de acertos possíveis, na memória de curto prazo o desempenho médio não alcançou a metade dos acertos possíveis. A média de acertos na porcentagem de consoantes corretas foi superior a 85%.
Conclusão
O desempenho dos escolares com DEL na memória de curto prazo fonológica diferiu quanto à similaridade e à extensão das pseudopalavras. Constatou-se ainda correlação positiva entre estas variáveis.
Memória de curto prazo; Desenvolvimento da linguagem; Criança; Transtornos do desenvolvimento da linguagem; Linguagem infantil
INTRODUCTION
Specific language impairment (SLI) is a primary impairment that occurs in the
absence of hearing or motor disorders, alterations of cognitive and speech motor
development, neurological disorders, limited social interaction, and significant
emotional disorders(11 Bishop DV. The underlying nature of specific language impairment. J
Child Psychol Psychiatry. 1992;33(1):3-66.
http://dx.doi.org/10.1111/j.1469-7610.1992.tb00858.x
https://doi.org/10.1111/j.1469-7610.1992...
,22 Befi-Lopes DM. Avaliação diagnóstica e aspectos terapêuticos nos
distúrbios específicos de linguagem. In: Fernandes F, Mendes B, Navas A,
editores. Tratado de Fonoaudiologia. 2a ed. São Paulo: Roca; 2010. Capítulo 13,
p. 314-22.). This diagnosis is confirmed when the
language impairment persists in children older than 5 years, who previously
underwent adequate specific intervention(33 Reed V. Toddlers and preschoolers with Specific Language
Impairments. In: Reed V. An introduction to children with language disorders.
2nd ed. New York: Macmillan; 1994. Chapter 5, p. 117-46.).
Language impairment in children with SLI persists throughout life, and the types
and degrees of this condition are highly variable. Usually, it is possible to
observe phonological impairment (characterized by the use of phonological
idiosyncratic processes, the maintenance of some phonological processes common
to normal development, and altered phonological
representations)(44 Befi-Lopes DM, Pereira AC, Bento AC. Representação fonológica em
crianças com Distúrbio Específico de Linguagem (DEL). Pró-Fono.
2010;22(3):305-10.
http://dx.doi.org/10.1590/S0104-56872010000300025
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,55 Befi-Lopes DM, Rondon S. Características iniciais da comunicação
verbal de pré-escolares com Alterações Específicas do Desenvolvimento da
Linguagem em fala espontânea. Rev Soc Bras Fonoaudiol. 2010;15(3):415-20.
http://dx.doi.org/10.1590/S1516-80342010000300017
https://doi.org/10.1590/S1516-8034201000...
); lexical acquisition
impairments(66 Gândara JP, Befi-Lopes DM. Tendências da aquisição lexical em
crianças em desenvolvimento normal e crianças com Alterações Específicas no
Desenvolvimento da Linguagem. Rev Soc Bras Fonoaudiol. 2010;15(2):297-304.
http://dx.doi.org/10.1590/S1516-80342010000200024
https://doi.org/10.1590/S1516-8034201000...
); the presence of longer silences in
narrative tasks(77 Befi-Lopes DM, Pedott PR, Bacchin LB, Cáceres AM. Relação entre
pausas silentes e classe gramatical em narrativas de crianças com distúrbio
específico de linguagem. CoDAS. 2013;25(1):64-9.
http://dx.doi.org/10.1590/S2317-17822013000100012
https://doi.org/10.1590/S2317-1782201300...
); and difficulties in oral language
comprehension(88 Befi-Lopes DM, Toba JR. Como crianças e adolescentes com Distúrbio
Específico de Linguagem compreendem a linguagem oral? Rev Soc Bras Fonoaudiol.
2012;17(1):106-11.) and conflict resolution(99 Paula EM, Befi-Lopes DM. Habilidades de resolução de conflito em
crianças com Distúrbio Específico de Linguagem. CoDAS. 2013;25(2):102-9.
http://dx.doi.org/10.1590/S2317-17822013000200003
https://doi.org/10.1590/S2317-1782201300...
).
Phonological issues represent one of the impairments that persist in these
children, as they show no improvement with age(1010 Befi-Lopes D, Tanikawa CR, Cáceres AM. Relação entre a porcentagem
de consoantes corretas e a memória operacional fonológica na alteração
específica de linguagem. Rev Soc Bras Fonoaudiol. 2012;17(2):196-200.
http://dx.doi.org/10.1590/S1516-80342012000200016
https://doi.org/10.1590/S1516-8034201200...
). The Percentage of Consonants
Correct – Revised (PCC-R) index represents a sensitive approach to characterize
phonological impairments in children with SLI.
PCC-R calculates the percentage of consonant accuracy and considers only
substitutions and omissions as errors(1111 Wertzner HF, Alves RR, Ramos ACO. Análise do desenvolvimento das
habilidades diadococinéticas orais em crianças normais e com transtorno
fonológico. Rev Soc Bras Fonoaudiol. 2008;13(2):136-42.
http://dx.doi.org/10.1590/S1516-80342008000200007
https://doi.org/10.1590/S1516-8034200800...
,1212 Shriberg LD, Austin D, Lewis BA, McSweeny JL, Wilson DL. The
percentage of consonants correct (PCC) metric: extensions and reliability data.
J Speech Lang Hear Res. 1997;40(4):708-22.
http://dx.doi.org/10.1044/jslhr.4004.708
https://doi.org/10.1044/jslhr.4004.708...
). This index is commonly used to
compare speakers of several ages with distinct speech
characteristics(1212 Shriberg LD, Austin D, Lewis BA, McSweeny JL, Wilson DL. The
percentage of consonants correct (PCC) metric: extensions and reliability data.
J Speech Lang Hear Res. 1997;40(4):708-22.
http://dx.doi.org/10.1044/jslhr.4004.708
https://doi.org/10.1044/jslhr.4004.708...
). Studies have shown that 6-year-old
children who do not evidence phonological impairment have a PCC-R with an
accuracy rate higher than 95%(1313 Rodrigues A, Befi-Lopes DM. Memória de curto prazo fonológica em
crianças pré-escolares. CoDAS. 2013;25(5):422-8.
http://dx.doi.org/10.1590/S2317-17822013000500005
https://doi.org/10.1590/S2317-1782201300...
), whereas same-aged children with SLI
show average values lower than 75%(1010 Befi-Lopes D, Tanikawa CR, Cáceres AM. Relação entre a porcentagem
de consoantes corretas e a memória operacional fonológica na alteração
específica de linguagem. Rev Soc Bras Fonoaudiol. 2012;17(2):196-200.
http://dx.doi.org/10.1590/S1516-80342012000200016
https://doi.org/10.1590/S1516-8034201200...
).
Phonological memory is also commonly affected in this population; thus, it is a
possible clinical marker of this pathology(1414 Montgomery JW, Magimairaj BM, Finney MC. Working memory and
specific language impairment: an update on the relation and perspectives on
assessment and treatment. Am J Speech Lang Pathol. 2010;19(1):78-94.
http://dx.doi.org/ 10.1044/1058-0360(2009/09-0028)
https://doi.org/10.1044/1058-0360(2009/0...
). According to the working memory
model, phonological memory is responsible for the temporary storage of
information while a series of cognitive tasks are performed(1515 Baddeley A. The episodic buffer: a new component of working memory?
Trends Cogn Sci. 2000;4(11):417-23.
http://dx.doi.org/10.1016/S1364-6613(00)01538-2
https://doi.org/10.1016/S1364-6613(00)01...
,1616 Baddeley A. Working memory: looking back and looking forward. Nat
Rev Neurosci. 2003;4(10):829-39.
http://dx.doi.org/10.1038/nrn1201
https://doi.org/10.1038/nrn1201...
). During language
acquisition, phonological memory allows a child to analyze the structural
properties of the language he/she is most often exposed to and plays a critical
role in language processing(1717 Rodrigues A, Befi-Lopes D. Memória operacional fonológica e suas
relações com o desenvolvimento da linguagem infantil. Pró-Fono. 2009;21(1):63-8.
http://dx.doi.org/10.1590/S0104-56872009000100011
https://doi.org/10.1590/S0104-5687200900...
).
Language and working memory, in particular the phonological support system, also
known as phonological short-term memory (STM-p) are related to the process of
subvocal rehearsal and to factors associated with speech planning (phonological
output). The ability to form and retain an accurate phonological speech sequence
in order to process verbal input is also part of this system. STM-p storage is
affected by word extension and phonological similarity. STM-p may be evaluated
by assessing the repetition of non-words or pseudowords(1313 Rodrigues A, Befi-Lopes DM. Memória de curto prazo fonológica em
crianças pré-escolares. CoDAS. 2013;25(5):422-8.
http://dx.doi.org/10.1590/S2317-17822013000500005
https://doi.org/10.1590/S2317-1782201300...
,1818 Baddeley A. Working memory. Curr Biol. 2010;20(4):R136-40.
http://dx.doi.org/10.1016/j.cub.2009.12.014
https://doi.org/10.1016/j.cub.2009.12.01...
).
It is important to note that there are practical empirical differences between
nonwords and pseudowords. While the first shows no similarity with actual words
from the language of interest, the second shows phonological or morphological
similarities that can facilitate repetition of these words(1313 Rodrigues A, Befi-Lopes DM. Memória de curto prazo fonológica em
crianças pré-escolares. CoDAS. 2013;25(5):422-8.
http://dx.doi.org/10.1590/S2317-17822013000500005
https://doi.org/10.1590/S2317-1782201300...
,1919 Baddeley A, Gathercole S, Papagno C. The phonological loop as a
language learning device. Psychol Rev. 1998;105(1):158-73.).
STM-p impairment is considered to be one of the factors that affect lexical
acquisition, morphosyntatic performance, and sentence comprehension in
individuals with SLI(1414 Montgomery JW, Magimairaj BM, Finney MC. Working memory and
specific language impairment: an update on the relation and perspectives on
assessment and treatment. Am J Speech Lang Pathol. 2010;19(1):78-94.
http://dx.doi.org/ 10.1044/1058-0360(2009/09-0028)
https://doi.org/10.1044/1058-0360(2009/0...
,2020 Alt M. Phonological working memory impairments in children with
specific language impairment: Where does the problem lie? J Commun Disord.
2011;44(2):173-85.
http://dx.doi.org/10.1016/j.jcomdis.2010.09.003
https://doi.org/10.1016/j.jcomdis.2010.0...
). Impaired STM-p can compromise the
retention of the phonological sequence of new words for a sufficient period of
time to inhibit the establishment of connections between meaning
representations, acoustic input, and articulatory patterns(2121 Petruccelli N, Bavin EL, Bretherton L. Children with specific
language impairment and resolved late talkers: working memory profiles at 5
years. J Speech Lang Hear Res. 2012;55(6):1690-703.
http://dx.doi.org/10.1044/1092-4388(2012/11-0288
https://doi.org/10.1044/1092-4388(2012/1...
,2222 Rispens J, Baker A. Nonword repetition: the relative contributions
of phonological short-term memory and phonological representations in children
with language and reading impairment. J Speech Lang Hear Res. 2012;55(3):683-94.
http://dx.doi.org/10.1044/1092-4388(2011/10-0263)
https://doi.org/10.1044/1092-4388(2011/1...
).
Even though the only difference between children with SLI and normal children
involves long words(2020 Alt M. Phonological working memory impairments in children with
specific language impairment: Where does the problem lie? J Commun Disord.
2011;44(2):173-85.
http://dx.doi.org/10.1016/j.jcomdis.2010.09.003
https://doi.org/10.1016/j.jcomdis.2010.0...
), a meta-analysis proposes that children
with SLI perform worse than normal children on all word extensions, suggesting
the association of this impairment with phoneme perception and word
codification(2323 Graf Estes K, Evans JL, Else-Quest NM. Differences in the nonword
repetition performance of children with and without specific language
impairment: a meta-analysis. J Speech Lang Hear Res. 2007;50(1):177-95.
http://dx.doi.org/10.1044/1092-4388(2007/015)
https://doi.org/10.1044/1092-4388(2007/0...
).
A positive correlation between nonword repetition and the severity of
phonological impairment was observed in preschool children with
SLI(1010 Befi-Lopes D, Tanikawa CR, Cáceres AM. Relação entre a porcentagem
de consoantes corretas e a memória operacional fonológica na alteração
específica de linguagem. Rev Soc Bras Fonoaudiol. 2012;17(2):196-200.
http://dx.doi.org/10.1590/S1516-80342012000200016
https://doi.org/10.1590/S1516-8034201200...
). However, it is not clear whether
schoolchildren with SLI maintain these improvements in their phonological
abilities or phonological short-term memory, or even whether the correlations
between these abilities are maintained.
Given the fact that school creates a higher demand for language processing and
metalinguistic analysis(2424 Alt M. Phonological working memory impairments in children with
specific language impairment: where does the problem lie? J Commun Disord.
2011;44(2):173-85.
http://dx.doi.org/10.1016/j.jcomdis.2010.09.003
https://doi.org/10.1016/j.jcomdis.2010.0...
), it is important to understand whether
these children show progress in their phonological abilities, especially in
their short-term memory, in order to support their written language acquisition.
Therefore, the objective of this study was to characterize the phonological
impairment and phonological short-term memory performance of school-aged
children with specific language impairment (SLI) and investigate the possible
correlations between these variables.
METHODS
This study was approved by the Research Ethics Committee of the School of Medicine of the Universidade de São Paulo (USP), under protocol number 065/12. Before data collection, parents and guardians signed informed consent forms.
A total of 15 school-aged children with SLI of both genders (14 boys) aged between 7 and 12 years (average age of 144 months, standard deviation of 24.9) were recruited. The average age for language evaluation was 4 years and 4 months (standard deviation of 17.4 months), and these children had undergone language therapy for approximately 5 years (standard deviation of 22.7 months). All participants were clients at the institution where this study was performed.
Diagnosis was based on internationally adopted criteria, including impairment on
at least two language tests that compose the complete language assessment;
normal results obtained from nonverbal intelligence quotient tests; and the
absence of neurological, psychiatric and/or sensorial disorders(11 Bishop DV. The underlying nature of specific language impairment. J
Child Psychol Psychiatry. 1992;33(1):3-66.
http://dx.doi.org/10.1111/j.1469-7610.1992.tb00858.x
https://doi.org/10.1111/j.1469-7610.1992...
).
During participant selection, it was established that the number of correct
designations obtained in the ABFW vocabulary test(2525 Befi-Lopes DM. Vocabulário. In: Andrade CRF, Befi-Lopes DM,
Fernandes FDM, Wertzner HF, editores. ABFW: teste de linguagem infantil nas
areas de fonologia, vocabulário, fluência e pragmática. 2a ed. rev. ampl. atual.
Barueri: Pró-Fono; 2004. Capítulo 2, p. 33-50.) should be above
the level expected for a 6-year-old child, given that all subjects were older
than this. Moreover, all children were required to have been under language
rehabilitation care at the Laboratory of Speech-Language Investigation in
Language Development and Its Disorders from School of Medicine of University of
São Paulo for at least two years, but without having overcome their language
deficit. This participant requirement has been suggested in previous literature
in order to confirm SLI diagnosis(2626 Bishop DV, Hayiou-Thomas ME. Heritability of specific language
impairment depends on diagnostic criteria. Genes Brain Behav. 2008;7(3):365-72.
http://dx.doi.org/10.1111/j.1601-183X.2007.00360.x
https://doi.org/10.1111/j.1601-183X.2007...
).
The selected subjects were evaluated individually in a previously prepared quiet
room. Phonological impairment was verified by applying the Percentage of
Consonants Correct – Revised (PCC-R)(1212 Shriberg LD, Austin D, Lewis BA, McSweeny JL, Wilson DL. The
percentage of consonants correct (PCC) metric: extensions and reliability data.
J Speech Lang Hear Res. 1997;40(4):708-22.
http://dx.doi.org/10.1044/jslhr.4004.708
https://doi.org/10.1044/jslhr.4004.708...
) index in the ABFW Phonology
test’s(2727 Wertzner HF. Fonologia. In: Andrade CRF, Befi-Lopes DM, Fernandes
FDM, Wertzner HF, editores. ABFW: teste de linguagem infantil nas areas de
fonologia, vocabulário, fluência e pragmática. 2a ed. rev. ampl. atual. Barueri:
Pró-Fono; 2004. Capítulo 1, p. 5-32.)
picture naming and word imitation tasks. PCC-R scores were calculated from
the number of correct consonants obtained for each word in each test. Therefore,
each subject obtained two PCC-R measurements. It is also necessary to mention
that phonetics distortions were not considered to be errors.
The Pseudoword Repetition test was used to evaluate phonological short-term
memory(2828 Santos FH, Bueno OFA. Validation of the Brazilian Children’s Test
of Pseudoword Repetition in Portuguese speakers aged 4 to 10 years. Braz J Med
Biol Res. 2003;36(11):1533-47.
http://dx.doi.org/10.1590/S0100-879X2003001100012
https://doi.org/10.1590/S0100-879X200300...
). This test, which was standardized for
Brazilian Portuguese (BP)-speaking children, comprises 40 pseudowords
distributed according to their similarity to actual BP words (10 of low
similarity, 20 of medium similarity, and 10 of high similarity) and their
extension (disyllable, trisyllable, polysyllable).
A pseudoword assessment was considered correct when there was a perfect match with the target word (i.e., phonological replacements were considered to be errors). This criterion was adopted, as suggested by the authors of the test and also because it is expected that children in this age group would have already mastered all phonemes. For data analysis, the total number of correct answers based on similarity, extension, and the overall test scores were calculated and converted into percentages.
To achieve the objective of this study, the characterization of a phonological impairment was based on the PCC-R values obtained by comparing the naming and imitation tasks. The characterization of the phonological short-term memory was assessed using the percentage of correct answers based on the similarity and extension of pseudowords. The correlation between the phonological impairment and phonological short-term memory was investigated based on the PCC-R obtained at each test and the total percentage of correct answers generated from the pseudoword repetition test.
Performance data obtained from each test were subjected to statistical analysis using SPSS 18. Friedman’s ANOVA and the Wilcoxon signed-rank test were used to compare subject performances. Spearman’s rank correlation coefficient was used to assess the correlations among the variables. The level of significance was initially set at 5%.
RESULTS
Based on the results obtained from the naming and imitation tests, there were no differences in the subjects’ phonological impairment, even though the imitation test results showed a higher gap between the minimum and maximum values. Likewise, there was no difference in the percentage of correct consonants for the variables picture naming and word imitation, since the correct answer average was higher than 85%.
In reference to the similarity and extension of pseudowords, the results showed differences in phonological short-term memory performance. The descriptive analysis of the percentage of correct answers obtained for both tasks is shown in Table 1.
The Wilcoxon signed-rank test with Bonferroni correction was used to identify test conditions in which differences were present. For similarity, three planned effects were tested, resulting in a level of significance of 0.017. For extension, six planned effects were tested, resulting in a level of significance of 0.008.
Differences were observed for all conditions, and the number of correct answers was higher when pseudoword similarity increased. As for the extension, even though the average suggests that there was a difference among all the conditions, inferential statistics indicated that only dissyllable pseudowords differed from words with four syllables and words with five syllables, as shown in Table 2.
These school-aged children demonstrated a positive correlation both for naming (r=0.809, p<0.001) and for imitation tasks (r=0.898, p<0.001) given their phonological impairment and phonological short-term memory performance.
DISCUSSION
The results of this study suggest there was no difference between the performance
for picture naming and word imitation tasks, in contrast to a previous study
involving preschool children, which showed better performance in imitation
tasks(1010 Befi-Lopes D, Tanikawa CR, Cáceres AM. Relação entre a porcentagem
de consoantes corretas e a memória operacional fonológica na alteração
específica de linguagem. Rev Soc Bras Fonoaudiol. 2012;17(2):196-200.
http://dx.doi.org/10.1590/S1516-80342012000200016
https://doi.org/10.1590/S1516-8034201200...
). This difference could be explained by the
fact that, up to 6 years old, an individual’s phonological system is less
stable. Therefore, the tips the evaluator provided by producing words may have
assisted the children’s performance. However, school-aged children tend to have
a broader vocabulary and a more stable phonological system; therefore, there
would be no negative effect of semantics on picture naming or on the positive
effects on word imitation.
In the case of phonological short-term memory, there were a higher number of
correct answers with more similarity and lower numbers of syllables. Similarity
differed for all conditions demonstrating, once again, that better reproduction
occurs when the morphology more closely resembles that of real
words(2828 Santos FH, Bueno OFA. Validation of the Brazilian Children’s Test
of Pseudoword Repetition in Portuguese speakers aged 4 to 10 years. Braz J Med
Biol Res. 2003;36(11):1533-47.
http://dx.doi.org/10.1590/S0100-879X2003001100012
https://doi.org/10.1590/S0100-879X200300...
,2929 Santos FH, Bueno OFA, Gathercole SE. Errors in nonword repetition:
bridging short- and long-term memory. Braz J Med Biol Res. 2006;39(3):371-85.
http://dx.doi.org/10.1590/S0100-879X2006000300008
https://doi.org/10.1590/S0100-879X200600...
).
As for the extension of the pseudowords, a significant difference in performance
was only observed between disyllables and polysyllabic words, indicating that
word evocation improves as the number of syllables decreases(1717 Rodrigues A, Befi-Lopes D. Memória operacional fonológica e suas
relações com o desenvolvimento da linguagem infantil. Pró-Fono. 2009;21(1):63-8.
http://dx.doi.org/10.1590/S0104-56872009000100011
https://doi.org/10.1590/S0104-5687200900...
,2020 Alt M. Phonological working memory impairments in children with
specific language impairment: Where does the problem lie? J Commun Disord.
2011;44(2):173-85.
http://dx.doi.org/10.1016/j.jcomdis.2010.09.003
https://doi.org/10.1016/j.jcomdis.2010.0...
).
Since this memory is linked to speech planning and to the ability to form and
retain an accurate phonological sequence of speech(1313 Rodrigues A, Befi-Lopes DM. Memória de curto prazo fonológica em
crianças pré-escolares. CoDAS. 2013;25(5):422-8.
http://dx.doi.org/10.1590/S2317-17822013000500005
https://doi.org/10.1590/S2317-1782201300...
,1717 Rodrigues A, Befi-Lopes D. Memória operacional fonológica e suas
relações com o desenvolvimento da linguagem infantil. Pró-Fono. 2009;21(1):63-8.
http://dx.doi.org/10.1590/S0104-56872009000100011
https://doi.org/10.1590/S0104-5687200900...
), it seems
difficult for children with SLI to maintain this phonological sequence for a
period of time that is sufficient for meaning representations, acoustic entry,
and articulatory patterns to establish the right connections, thus justifying
their difficulties in several language aspects(1111 Wertzner HF, Alves RR, Ramos ACO. Análise do desenvolvimento das
habilidades diadococinéticas orais em crianças normais e com transtorno
fonológico. Rev Soc Bras Fonoaudiol. 2008;13(2):136-42.
http://dx.doi.org/10.1590/S1516-80342008000200007
https://doi.org/10.1590/S1516-8034200800...
,1212 Shriberg LD, Austin D, Lewis BA, McSweeny JL, Wilson DL. The
percentage of consonants correct (PCC) metric: extensions and reliability data.
J Speech Lang Hear Res. 1997;40(4):708-22.
http://dx.doi.org/10.1044/jslhr.4004.708
https://doi.org/10.1044/jslhr.4004.708...
,1717 Rodrigues A, Befi-Lopes D. Memória operacional fonológica e suas
relações com o desenvolvimento da linguagem infantil. Pró-Fono. 2009;21(1):63-8.
http://dx.doi.org/10.1590/S0104-56872009000100011
https://doi.org/10.1590/S0104-5687200900...
,2121 Petruccelli N, Bavin EL, Bretherton L. Children with specific
language impairment and resolved late talkers: working memory profiles at 5
years. J Speech Lang Hear Res. 2012;55(6):1690-703.
http://dx.doi.org/10.1044/1092-4388(2012/11-0288
https://doi.org/10.1044/1092-4388(2012/1...
,2222 Rispens J, Baker A. Nonword repetition: the relative contributions
of phonological short-term memory and phonological representations in children
with language and reading impairment. J Speech Lang Hear Res. 2012;55(3):683-94.
http://dx.doi.org/10.1044/1092-4388(2011/10-0263)
https://doi.org/10.1044/1092-4388(2011/1...
).
Finally, in this study it became evident that the phonological performance and
phonological short-term memory of school-aged children with SLI are related. The
better their control over phonological rules and their ability to correctly
articulate phonemes, the greater the probability that they will retain the
phonological information for the presented item and repeat it
correctly(1313 Rodrigues A, Befi-Lopes DM. Memória de curto prazo fonológica em
crianças pré-escolares. CoDAS. 2013;25(5):422-8.
http://dx.doi.org/10.1590/S2317-17822013000500005
https://doi.org/10.1590/S2317-1782201300...
).
Even though this is not a longitudinal study, this finding confirms those from a
previous study involving preschool children with language impairment, thus
demonstrating that this correlation is maintained even for school-aged children,
for whom it is already possible to confirm an SLI diagnosis(1010 Befi-Lopes D, Tanikawa CR, Cáceres AM. Relação entre a porcentagem
de consoantes corretas e a memória operacional fonológica na alteração
específica de linguagem. Rev Soc Bras Fonoaudiol. 2012;17(2):196-200.
http://dx.doi.org/10.1590/S1516-80342012000200016
https://doi.org/10.1590/S1516-8034201200...
). It is important
to note that nonwords were used for preschool children, while pseudowords were
used for school-aged children. This could have led to more accurate results for
the school-aged children, since pseudowords resemble actual Brazilian Portuguese
words(1313 Rodrigues A, Befi-Lopes DM. Memória de curto prazo fonológica em
crianças pré-escolares. CoDAS. 2013;25(5):422-8.
http://dx.doi.org/10.1590/S2317-17822013000500005
https://doi.org/10.1590/S2317-1782201300...
).
The performance of these subjects, however, did not reach half of the possible
accuracy potential, while the phonological performance was close to the maximum
number of possible correct answers. The disparity between accuracy for
phonological progress and phonological memory suggests that although school-aged
children with SLI are able to improve their phonological processing skills, thus
allowing them to develop phonological awareness and acquire written language
skills, the short-term memory impairment is typical of SLI, which explains their
difficulty in overcoming this condition(1414 Montgomery JW, Magimairaj BM, Finney MC. Working memory and
specific language impairment: an update on the relation and perspectives on
assessment and treatment. Am J Speech Lang Pathol. 2010;19(1):78-94.
http://dx.doi.org/ 10.1044/1058-0360(2009/09-0028)
https://doi.org/10.1044/1058-0360(2009/0...
,2323 Graf Estes K, Evans JL, Else-Quest NM. Differences in the nonword
repetition performance of children with and without specific language
impairment: a meta-analysis. J Speech Lang Hear Res. 2007;50(1):177-95.
http://dx.doi.org/10.1044/1092-4388(2007/015)
https://doi.org/10.1044/1092-4388(2007/0...
,2424 Alt M. Phonological working memory impairments in children with
specific language impairment: where does the problem lie? J Commun Disord.
2011;44(2):173-85.
http://dx.doi.org/10.1016/j.jcomdis.2010.09.003
https://doi.org/10.1016/j.jcomdis.2010.0...
).
It is worth mentioning that pseudoword repetition with phonological replacements was considered to be an error, even when these replacements resulted from productive phonological processes that were not overcome. This may have decreased subjects’ scores, not because of a memory restriction but due to the restricted control of phonological rules and articulation. Moreover, this may have affected the correlations between the variables, as the pseudoword repetition performance could have been improved if the phonological replacements (those shown during the phonological evaluation of the subjects) were not considered to be errors. Thus, future studies should be performed in order to clarify this issue.
One of the limitations of this study had to do with the small number of subjects. However, this small sample size was a direct result of the choice to use strict inclusion criteria in order to ensure the quality of the study. Longitudinal studies should be conducted in the future to follow the progress of subjects during different phases of the rehabilitation process, and these examinations would make important contributions to the field.
Our results indicate that speech-language pathologists should consider both the severity of the phonological impairment and the similarity and extension of the words and sentences used during therapy, as these abilities are associated. Care in the selection of specific materials for each subject under rehabilitation may reduce the competition between processing systems, thus optimizing the therapeutic process.
CONCLUSION
The phonological short-term memory performance of school-aged children with SLI was different in relation to the similarity and extension of the pseudowords. There was also a positive correlation between phonological performance and phonological short-term memory performance.
ACKNOWLEDGMENTS
Financial support for this project was obtained from the Programa Institucional de Bolsas de Iniciação Científica (PIBIC), process Nº 135145/2012-0.
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» https://doi.org/10.1044/1092-4388(2011/10-0263) -
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» https://doi.org/10.1044/1092-4388(2007/015) -
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This study was performed at the Department of Physiotherapy, Speech-Language Pathology and Audiology, and Occupational Therapy, School of Medicine, Universidade de São Paulo – USP – São Paulo (SP), Brazil.
Publication Dates
-
Publication in this collection
30 Sept 2014 -
Date of issue
Oct-Dec 2014
History
-
Received
1 Oct 2013 -
Accepted
23 Apr 2014