Temporal auditory processing and phonological awareness in reading and writing disorders : preliminary data

Purpose: To verify if there is an association between temporal auditory tests and phonological awareness in individuals with reading and writing disorders. Methods: Sixteen children were subjects of this study, aged between 7 and 12 years old, who had reading and writing disorders confirmed after specific assessment. All participants underwent phonological awareness assessment using CONFIAS test. In order to assess the auditory temporal processing, duration and frequency pattern tests were used. Results: The descriptive analysis indicated low performance in syllabic and phonemic activities of phonological awareness as well as in temporal auditory tests. Fisher’s test indicated association between disorders in auditory temporal processing and phonological awareness (p>0.001). It suggests that disorders in temporal processing contribute to low performance in phonological awareness tasks. Conclusions: There was association between performance in temporal auditory tests and in the phonological awareness. Data found provide reflections about including temporal auditory assessment among procedures used in the analysis of individuals with reading and writing disorders.


RESULTS
The descriptive analysis showed disorders in the performance of syllabic and phonemic skills (Table 1).Fisher's test indicated a relationship between the deviation in temporal processing and CF tasks (p<0.001),suggesting that auditory processing disorders led to a poor performance in CF skills (Table 2).

DISCUSSION
Temporal processing is a characteristic of perception that helps identify small acoustic variations that occur in speech, allowing an individual to distinguish between segments, syllables, and words in continuous speech (13) .Thus, it may be said that the development of temporal processing skills is important to CF because it includes tasks of synthesis and segmentation as well as syllabic and phonemic transposition.
Assuming that temporal processing is related to the perception of suprasegmental features of speech, because it involves the abilities to perceive and store nonverbal acoustic stimuli, temporal deficit may lead to a poor performance in reading skills and general learning (2) .This hypothesis was confirmed in this study, which showed an association between poor performance in temporal processing and CF, a skill considered to be one of the precursors of reading.
An investigation (14) concluded that difficulties involving temporal processing would be expressed by a limited ability to identify and analyze short acoustic elements", such as consonants, which are characterized by rapid formant transition.This would lead to a difficulty in associating letters with specific sounds; therefore, temporal processing plays an important role in CF skills.
The association between disorders in temporal processing and low performance in CF tasks indicates the need for including temporal processing training in the treatment of

INTRODUCTION
Disorders in temporal auditory processing may lead to a poor performance in reading and writing (1,2) .A high proficiency in handling the sounds of speech is directly related to a better reading performance.Such skill characterizes phonological awareness (CF) (3)(4)(5) , which is usually impaired in reading and writing disorders.Studies show that people with reading and writing disorders may develop some kind of hearing impairment, preventing information from being correctly processed, therefore interfering with the learning process (6)(7)(8)(9) .
Considering that temporal auditory processing is related to the perception of speech (10) , it is very important to perform hearing tests, including oral and written language tests, to correctly diagnose temporal skill disorders.Moreover, it is necessary to investigate the relationship between CF performance and temporal auditory tests, because the integrity of the physiological auditory mechanism plays a fundamental role in learning how to read and write (11) .Hence, the main goal of this study was to examine the relationship between performance in auditory temporal tests and CF tasks among individuals with reading and writing disorders.

METHOD
The study was conducted after obtaining approval from the Comitê de Ética da Faculdade de Medicina da Universidade de São Paulo (USP), resolution number 305/10.Sixteen children with reading and writing disorders were included in this study (age 7-12 years; average age of 10 years and 6 months; 5 females and 11 males).Criteria used for selecting the children included: children taking audiological treatment; not presenting signs and symptoms of neurological, behavioral, or cognitive diseases; and an auditory tone limit of ≤20 dBNA.All children underwent audiological evaluation (pure tone audiometry and speech) and specific assessment of reading; writing; and skills such as rapid automatized naming, CF, and phonological operational memory; the tests were conducted by the researchers.
In order to evaluate CF, the CF test was performed using the Sequential Evaluation Instrument (CONFIAS) (12) , and it individually performed according to the test descriptions (12) .The maximum score was 70 (40 points -syllable and 30 points -phonemic).The childrens' performance was rated as expected or disordered considering the rate ranking described in the test, which is defined by the number of hits expected for each child according to his/her writing level (12) .
In order to evaluate temporal auditory processing, the standard tone duration (TPD) and frequency (TPF) tests were used (AUDITEC, Saint Louis, USA).The tests were performed in an audiometric cabin and applied in both ears at the same time with an intensity of 40 dBNS above the speech recognition limit using a CD-player connected to audiometer GSI 61 (GSI Grason Stadler, Eden Prairie, MN, USA).
The obtained data were then subjected to statistical analysis.To verify the association between the variables, Fisher's exact test was used with a significance level of 0.05.children with reading and writing disorders as well as CF disorders.This will benefit CF development and improve reading and writing skills.
This study makes an important contribution in explaining the impact of temporal skills on CF performance, which may lead to new paths in the treatment of reading and writing disorders.

CONCLUSIONS
There was an association between performance in temporal auditory tests and CF tasks.The data obtained provide reflections on including temporal auditory assessment among procedures used for assessment of children with reading and writing disorders.

Table 1 .
Performance of children in the phonological awareness tests

Table 2 .
Performance of children according to the presence of a change in the temporal auditory tests and phonological awareness performance (n=16)