Phonological awareness and writing development in Down syndrome: a longitudinal case study

The aims of this study were to: verify performance advances in phonological awareness and writing skills in a child with Down syndrome speaking Brazilian Portuguese; identify which phonological awareness skills developed; analyze the influence of working memory skills on performance in phonological awareness tasks; verify the participant’s performance in phonological working memory tasks and verbal and execution intelligence. The child was seven years old at the onset of the study and was receiving mainstream schooling. Phonological awareness and writing skills were assessed at three time points (T1, T2, T3) during a period of 4 years and 8 months. The Phonological Awareness: Sequential Evaluation Instrument (CONFIAS) was used to assess phonological awareness. In T1 and T2, writing skills were also evaluated using the same instrument. At T3 we used the writing subtest of the Child Brief Neuropsychological Assessment Battery (NEUPSILIN-INF). At T1 phonological working memory was evaluated using the word span task and at T3 we used the non-words subtest of the NEUPSILIN-INF. To evaluate verbal and performance intelligence quotient (T3) we used the Wechsler Abbreviated Scale of Intelligence (WASI). Progress in writing skills and phonological awareness were identified throughout the study. Some skills in syllabic awareness also improved, but tasks that required handling of the phonemic constituents and rhyming awareness remained difficult for the patient. The participant demonstrated good performance in repeating real words. Word span of real words was superior to pseudowords span. The ability to memorize real words seemed to have improved the patient’s performance on phonological awareness tasks. The general intelligence quotient was considered borderline. It is believed that in this case, linguistic and cognitive abilities, such as verbal vocabulary, phonological working memory and intellectual capacity, influenced the performance on phonological awareness tests and enabled the child to learn written language.

本研究旨在达成以下四项目标：验证一名使用巴西葡萄牙语（Brazilian Portuguese）的唐氏综合征（Down syndrome）儿童在语音意识（phonological awareness）与书写技能上的表现提升情况；明确其获得发展的语音意识技能类型；分析工作记忆（working memory）技能对语音意识任务表现的影响；评估受试者在语音工作记忆（phonological working memory）任务以及言语智力与操作智力方面的表现。
受试者在研究启动时年满7岁，就读于普通学校，接受主流学校教育（mainstream schooling）。在长达4年8个月的周期内，研究团队于三个时间点（T1、T2、T3）对其语音意识与书写技能开展评估。
本研究采用语音意识序列评估工具（Phonological Awareness: Sequential Evaluation Instrument，缩写CONFIAS）对语音意识进行评估；在T1与T2阶段，同时使用该工具评估书写技能；在T3阶段，则采用儿童简短神经心理评估量表（Child Brief Neuropsychological Assessment Battery，NEUPSILIN-INF）的书写子测验完成评估。语音工作记忆在T1阶段采用词语广度任务（word span task）进行评估，T3阶段则使用NEUPSILIN-INF的非字词子测验。针对T3阶段的言语智商与操作智商，研究采用韦氏简明智力量表（Wechsler Abbreviated Scale of Intelligence，缩写WASI）进行测评。
研究全程均观察到受试者在书写技能与语音意识方面的进步。音节意识的部分技能亦有所提升，但涉及音位成分处理与押韵意识的任务对受试者仍存在难度。受试者在复述真实词语时表现良好，真实词语的词语广度优于假词广度。真实词语的记忆能力似乎改善了受试者在语音意识任务中的表现。总智商被评定为边界水平。研究认为，在此案例中，言语词汇、语音工作记忆与智力水平等语言与认知能力，对语音意识测试的表现产生了显著影响，并助力该儿童掌握书面语言。