ACQ Vol 11 no 2 2009

Research updates

Literacy skills of children born preterm University of Queensland Centre for Clinical Research Alison Holm and Sharon Crosbie

Alison Holm and Sharon Crosbie are research speech pathologists based at the Perinatal Research Centre at the Royal Brisbane and Women’s Hospital. Over the last four years their research has focused on the communication outcomes of children who are born preterm (<33 weeks gestational age). The majority of children who are born preterm are considered neuro­ logically normal and free of disability. However, more subtle impairments of attention, executive function, language, visual-perceptual abilities, and fine motor function are reported to influence the ability to function. These “functional deficits” affecting 50–70% of very preterm children are often evident when children start attending school (Allen, 2008; Brunssen & Harry, 2007). One of the areas Alison and Sharon were interested in looking at was the literacy of children born pre- term. This issue of the ACQ provides an excellent forum for a quick summary of the findings. The aim of the study was to investigate the literacy, phonological awareness and language abilities of preterm children. We assessed 169 preterm and 141 full-term children aged between 5 and 12 years. All children were attending mainstream schools in south-east Queensland; had monolingual English language development; and did not have major physical or sensorineural impairment. Phonological awareness skills, reading (accuracy and comprehension) and real word spelling were assessed. Language and cognitive skills were also assessed. The results indicate the preterm children achieved poorer scores across all domains assessed in comparison to their full-term classmates. However, the results of the preterm children did not differ significantly from the standardised assessment populations. That is, while there is a subgroup of children experiencing difficulty, on most tasks the proportion of children having difficulty was the same as you would expect in any normally distributed population. Phonological awareness The Sutherland phonological awareness test–revised (SPAT-R; Neilson, 2003) was used to assess the phonological aware­ ness abilities of the children in year 1 and 2 (5–7 years of age). Raw scores were obtained and then compared to the standardised average range. Each child was then allocated a SPAT category of 1 (below average range), 2 (average range) or 3 (above average range). While more preterm children (11% of the sample) fell in the below average category than full-term children (6%), the proportion of children in this category is what would be expected in a normally distributed population. Reading In order to examine the reading skills of the preterm and full-term children in more detail, the children were grouped into good and poor readers based on their Neale Analysis of Reading Ability (NARA; Neale, 1999) accuracy profile levels.

There was an interesting pattern of results: in comparison with their preterm good reader peers, the preterm poor readers appeared to have global deficits; in contrast, the full-term poor readers had difficulties only on the literacy measures. This pattern indicates that the full-term group included a small group of children with specific reading difficulties, while the poor readers in the preterm group had more widespread cognitive, literacy and language processing problems. Spelling The preterm group performed poorly in comparison to both the full-term control group and the standardised assessment means on the measures of real and non-word spelling. In addition, more preterm children were identified with speech difficulties and had a history of receiving speech therapy. Children who have current speech impairment and those with a history of speech impairments but currently error-free speech are both at increased risk of experiencing reading and spelling difficulties (Holm, Farrier & Dodd, 2008). Studies investigating the long-term effects of speech difficulties in the preschool years show that even as adolescents, children with a history of phonological difficulties are likely to have literacy difficulties (Leitão & Fletcher, 2004). Conclusions The high number of preterm children who were identified with speech difficulties needs further investigation. Speech difficulty is a significant risk factor for children’s literacy development, indicating that preterm children need to be carefully monitored. References Allen, M. (2008). Neurodevelopment outcomes of preterm infants. Current Opinion in Neurology , 21 , 123–128. Brunssen, S., & Harry, G. (2007). Diffuse white matter injury and neurologic outcomes of infants born very preterm in the 1990s. Journal of Obstetric, Gynecologic, & Neonatal Nursing , 36 , 386–395. Holm, A., Farrier, F., & Dodd, B. (2008). Phonological awareness, reading accuracy and spelling ability of children with inconsistent phonological disorder. International Journal of Language & Communication Disorders , 43 , 300–322. Leitão, S., & Fletcher, J. (2004). Literacy outcomes for students with speech impairment: Long-term follow-up. International Journal of Language & Communication Disorders , 39 , 245–256. Neale, M. (1999). Neale Analysis of Reading Ability (3rd ed.). Australian standardisation. Camberwell, Vic.: ACER. Neilson, R. (2003). Sutherland Phonological Awareness Test – Revised (SPAT-R). Camberwell, Vic.: ACER.

Correspondence to: Dr Sharon Crosbie and Dr Alison Holm University of Queensland Centre for Clinical Research Level 4, Building 71/918 Royal Brisbane and Women’s Hospital, Herston, QLD 4029 phone: 07 3346 6013 fax: 07 3346 5594 email: s.crosbie@uq.edu.au; a.holm@uq.edu.au

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ACQ Volume 11, Number 2 2009

ACQ uiring knowledge in speech, language and hearing