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DOI: 10.1177/1525740108328410

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Communication Disorders Quarterly
http://cdq.sagepub.com

Phonological Awareness and Word Recognition in Reading by Children With Autism


Cheryl Smith Gabig
Communication Disorders Quarterly 2010; 31; 67 originally published online Jan 7, 2009;
DOI: 10.1177/1525740108328410

The online version of this article can be found at:


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Communication Disorders
Quarterly
Volume 31 Number 2
February 2010 67-85
Phonological Awareness and Word Recognition © 2010 Hammill Institute
on Disabilities

in Reading by Children With Autism 10.1177/1525740108328410


http://cdq.sagepub.com
hosted at
http://online.sagepub.com
Cheryl Smith Gabig
Lehman College/City University of New York, Bronx

This research examined phonological awareness (PA) and single word reading in 14 school-age children with autism and
10 age-matched, typically developing (TD) children between 5-7 years. Two measures of PA, an elision task (ELI) and a
sound blending task (BLW), were given along with two measures of single word reading, word identification for real words
(WID) and phonetic decoding of nonwords (WATTK). Group differences were found for performance on PA tasks but no
group differences were found for WID or WATTK. All the children with autism scored within the average range on WID
and WATTK, although a statistical bias was noted for WID. No relationship was found between PA and measures of word
reading in children with autism. Children with autism have adequate ability in single word reading but below average PA.
Word reading does not appear to be related to PA for some of the children with autism

Keywords: word recognition; reading; decoding; phonological awareness; autism

A lthough there is significant evidence that phonolog-


ical awareness is critically tied to word recognition
in reading (Liberman, Shankweiler, Fischer, & Carter,
(Nation, 1999; Nation, Clarke, Wright, & Williams,
2006). The other viewpoint is that most children with
autism show average ability to recognize words while
1974; Liberman, Shankweiler, Liberman, Fowler, & reading and to accurately spell words for age and grade
Fischer, 1977; Mann, 1984; Stanovich, 1985; Vellutino & level, again suggesting that the underlying psychological
Scanlon, 1987), systematic data concerning the develop- and cognitive mechanisms for understanding print are
ment of phonological awareness and its relationship to available for the child with autism when learning to break
word recognition in children with autism are lacking. the code for reading or spelling (Minshew, Goldstein,
The existing literature on reading ability in children Taylor, & Siegel, 1994). What is not known from these
with autism contains two viewpoints that suggest that the two perspectives on reading ability in children with
children may develop and understand the phonemic struc- autism is whether the children demonstrated facility in
ture of words, despite having significant language and phonological awareness that is associated with early word
communication deficits frequently associated with reading and phonetic decoding in young, typically devel-
autism. The first is that many children with autism show oping (TD) children (Liberman et al., 1974, 1977; Mann,
an unusual preoccupation with letters and print, fre- 1984; Stanovich, 1985; Vellutino & Scanlon, 1987).
quently developing precocious reading ability for age
despite a lack of formal training, a characteristic
referred to as hyperlexia (Aaron, Frantz, & Manges,
Author’s Note: This research was supported in part by a PSC-CUNY
1990; Nation, 1999). Children with hyperlexia have supe-
Faculty Development Award No. 60159-34-35 and the George N.
rior word recognition ability, including phonetic decod- Shuster Fellowship Award, to the author. The author wishes to thank the
ing skill, in advance of reading comprehension and AHA/Asperger Syndrome and High Functioning Autism Association,
cognitive ability. The precocious word reading and pho- Bethpage, NY; the Cody Center for Autism, Stony Brook University; the
netic decoding ability suggests that children who are School for Language and Communication Development, Glenn Cove,
hyperlexic use some underlying knowledge of letter- NY; and the Eden School, Staten Island, NY, for their assistance in
recruitment. Thank you to the families who opened their homes to the
sound correspondence in order to quickly recognize or author and participated in this research. Please address correspondence to
sound out words. However, not all children with autism Cheryl Smith Gabig, PhD, Speech-Language-Hearing Sciences, 250
show this unusual, early preoccupation with print and Bedford Park Blvd. West, Lehman College/CUNY, Bronx, NY 10468;
word recognition and are not considered to be hyperlexic e-mail: cheryl.gabig@lehman.cuny.edu.

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67
68 Communication Disorders Quarterly

Word Recognition in Reading word, called word identification (WID), or sight word
reading. The nonlexical route refers to the procedure of
Reading is a complex skill involving two basic informa- applying knowledge of sound-letter correspondence
tion processing activities: word recognition and compre- rules to sound out the syllables and phonemes of a word
hension. The simple view of reading (Gough & Tunmer, from its printed form (Adams, 1992; Ehri, 1992, 1998;
1986; Hoover & Gough, 1990) defines reading ability as a Ehri & Snowling, 2004). The lexical procedure accesses
function of decoding and language comprehension skills. information about a stored word’s visual form or
Word recognition in reading refers to the processes that spelling pattern, an orthographic representation, whereas
transform print into speech and includes both the identifi- the nonlexical procedure accesses a word’s phonological
cation of words by their visual configuration, called sight representation, or its pronunciation, by applying grapheme-
word identification, and the ability to apply phonetic decod- phoneme correspondence rules. A printed word, identi-
ing strategies to sound out unfamiliar written words, fied either through the lexical procedure (i.e., sight word
referred to as word attack or decoding skill. Reading com- recognition) or through a nonlexical procedure (i.e.,
prehension refers to the cognitive-linguistic processes that phonological recoding), activates or instantiates its asso-
construct meaning from printed words, phrases, and sen- ciated meaning in the mental lexicon (Adams, 1992;
tences (Coltheart, 2006; Perfetti, 1985; Perfetti & Coltheart, 2006). The mental lexicon contains one’s
Hogaboam, 1975). Although intricately related, there is evi- stored concepts or vocabulary with information about
dence that skill in word recognition is necessary but not suf- each word’s phonologic structure, spelling pattern or
ficient for ability in reading comprehension (Perfetti, 1985; visual-orthographic form, and meaning. A written word
Perfetti & Hogaboam, 1975). Some individuals may that has been read several times is easily recognized,
demonstrate adequate and fluent word recognition yet have activating its pronunciation, spelling, and meaning (Ehri,
poor reading comprehension, referred to as a specific com- 1998). For children learning to read, a progressive
prehension deficit (Cain & Oakhill, 2007). expansion of easily recognized visual-orthographic
During the early stages of learning to read, children are spelling patterns is critical to develop an automatic and
focused on learning to accurately recognize words and robust sight word vocabulary for ease in retrieving each
apply phonetic decoding strategies to sound out unfamil- word’s corresponding pronunciation and meaning.
iar words (Chall, 1983; Chall, Jacobs, & Baldwin, 1990; In addition to expansion of skill with repeated word
Ehri, 1987, 1992, 1998). Reading researchers have noted recognition, children progress in their analysis of
that in the early elementary grades, from kindergarten to printed words by applying increasingly more sophisti-
third grade, children develop skill and automaticity in cated phonetic decoding strategies aimed at generating
word recognition, including both automatic sight word a pronunciation of a word that is not automatically rec-
identification and robust phonetic decoding ability, allow- ognized. Initially, this may take the form of a sounding
ing for increased reading accuracy, fluency, and rate out strategy, wherein there is a sequential recoding of
(Chall, 1983; Chall et al., 1990; Ehri, 1992; Ehri & letters into sounds. The relationship between letters and
Snowling, 2004). The importance of word recognition sounds must be easily tapped by the child in order to
ability to overall reading skill cannot be ignored. In order sound out or phonetically decode unfamiliar print
to comprehend what is read, a reader must rely on using sequences into a spoken word (Adams, 1992; Coltheart,
the highly developed ability to convert print into lan- 2006; Ehri, 1998). However, a sequential letter-to-
guage. Research has shown that basic word recognition sound decoding strategy can be slow and inefficient,
skills are superior in individuals with good reading com- overloading the memory burden and resulting in an
prehension, whereas poor comprehenders have less inadequate pronunciation and lack of association to
developed automatic word recognition and decoding meaning (Ehri & Snowling, 2004; Stahl & Murray,
skills (Catts, Adolf, & Ellis Weismer, 2006; Perfetti & 1994; 1998). With repeated exposure to printed words,
Hogaboam, 1975). children expand their knowledge of orthographic
The ability to recognize printed words is accom- spelling patterns, which facilitates their ability to
plished by two distinct yet interactive information pro- quickly generate an approximate pronunciation of a
cessing procedures referred to as the lexical and word in order to retrieve its meaning (Ehri & Snowling,
nonlexical routes (Coltheart, 2006; Coltheart, Rastle, 2004; Stahl & Murray, 1993). Skilled readers access the
Perry, Langdon, & Ziegler, 2001). The lexical route meaning of an unfamiliar word through the successful
refers to the whole word, visual recognition of a printed phonological recoding of a printed spelling pattern to its

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Smith Gabig / Reading by Children With Autism 69

pronunciation (Share, 1995, 1999; Stahl & Murray, Phonologically, a word can be described by its sylla-
1992). ble structure, onset-rime structure, and the individual
phonemes within the word. Likewise, the development
Phonological Awareness of phonological awareness in TD children progresses
from larger units in words to smaller units of sounds
Phonological awareness is a metalinguistic ability that within words (Fox & Routh, 1975; Liberman et al., 1974;
refers to the awareness of syllables and phonemes within Stanovich, Cunningham, & Cramer, 1984). For example,
spoken words and to the ability to manipulate the word at children begin first to isolate and segment words into syl-
both the level of the syllable and individual phonemes lables followed by the phonological awareness of the
(Gillon, 2004; Muter, Hulme, Snowling, & Taylor, 1997). onset-rime structure of words and finally awareness of
Phonological awareness can be distinguished from the the discrete phoneme within words (Liberman et al.,
more narrow term of phoneme awareness, which restricts 1974; Lundberg, Frost, & Peterson, 1988; Stanovich
the knowledge and skill to the understanding that words et al., 1984). When words are spoken, a listener may not
are composed of segments smaller than a syllable, includ- be aware of the individual phonemes within the words
ing the ability to isolate and manipulate individual because phonemes are not spoken as discrete separate
phonemes (Morais, 1991; Torgesen, Al Otaiba, & Grek, entities but are embedded within syllables and the speech
2005). Phonological awareness is broader because it taps stream (Liberman, Cooper, Shankweiler, & Studdert-
knowledge and manipulation of spoken words at the level Kennedy, 1967). Because phonemes are an abstract con-
of both the syllable and phoneme. It is considered to be a cept, they must be consciously isolated and perceived in
metalinguistic ability in that it is an intellectual achieve- the speech stream.
ment distinct from learning to understand and use spoken
language in everyday interactions (Mattingly, 1972). Phonological Awareness in Children
The development of phonological awareness in children
With Autism
has been shown to play a central role in learning to read
and write in an alphabetic system (Liberman, Shankweiler, Despite the evidence in the literature of the signifi-
& Liberman, 1989; Vellutino & Scanlon, 1987). In learn- cance of phonological awareness to word recognition in
ing to read, a child must be aware that words are made up reading, little is known about phonological awareness in
of sounds and that these sounds are represented by letters children with autism. A search of the literature on chil-
and letter combinations. This is called the alphabetic prin- dren with autism and their development or ability in
ciple and is an important conceptual achievement for chil- phonological awareness and reading revealed two studies
dren in the early stages of learning to read (Adams, 1992). that included a measure of phonological awareness in the
Phonological awareness assists in the process of word research design. Heimann, Nelson, Tjus, and Gillberg
recognition and decoding because the structure of the (1995) included a measure of phonological awareness as
English writing system is alphabetic. a dependent variable in their study of the effects of com-
Research over the past 20 years has shown that the con- puter-aided instruction (CAI) on teaching reading and
scious awareness of the discrete sounds in words and the writing to 11 children with autism, 9 children with mixed
ability to manipulate sounds in words is critically tied to handicaps, and 10 TD children. The children ranged in
the development of word recognition and decoding ability chronological age from 6 to 13 years. Phonological
in reading (Bradley & Bryant, 1983; Fox & Routh, 1975; awareness was measured for sound blending (i.e., syn-
Liberman et al., 1974, 1977; Pennington & Lefly, 2001; thesis) using an experimental task. Examination of the
Stanovich, 1985) and is essential for accuracy in spelling mean scores reported for phonological awareness across
(Ehri, 2000; Treiman, 1984; Troia, 2004). In order to the three groups of children studied indicated signifi-
acquire efficiency in word recognition ability and profi- cantly lower scores for both the children with autism and
ciency in spelling, an individual must be explicitly aware of the children with mixed handicaps compared to the TD
the individual speech sounds within words. Phonological controls. Moreover, following the course of CAI, an
awareness has been shown to play a critical role in both the unexpected decline in the mean score for phonological
decoding of unfamiliar words but also in the expansion of awareness by the children with autism was noted by the
a sight word vocabulary that can be easily recognized authors but not for the other two groups of children stud-
orthographically and transformed into its spoken form ied. Because phonological awareness was included in the
(Ehri, 2000; Share & Stanovich, 1995; Troia, 2004). study as a dependent variable of reading ability, no

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70 Communication Disorders Quarterly

further discussion of phonological awareness by children with autism did not show a preference for the visual
with autism was offered. recognition of sight words over the decoding of pseu-
Researchers (Newman et al., 2007) interested in the read- dowords, suggesting that children were capable of
ing-related skills of children with autism spectrum disorders using both a visual recognition process and a phono-
(ASD; with and without a history of hyperlexia) and a con- logical coding process to identify and pronounce writ-
trol group of TD children matched on age and single word ten words. However, reading comprehension was
reading included the Sound Awareness subtest from the depressed relative to single word recognition, indicat-
Woodcock-Johnson Tests of Achievement– III (Woodcock, ing that children with autism are capable of acquiring
McGrew, & Mather, 2001) in their study. The Sound basic word reading skills but are more impaired in their
Awareness subtest is a measure of phonological awareness ability to retrieve and integrate meaning necessary for
that includes tasks of rhyming, sound deletion, sound sub- reading comprehension.
stitution, and sound reversal within words. Between-group Adequate word recognition has also been demon-
differences in performance on the sound awareness test strated in older, adolescent children with autism.
were seen for the children with ASD. Children with ASD Minshew et al. (1994) examined academic achievement,
and a positive history of hyperlexia outperformed the chil- including reading ability, in 54 high-functioning (verbal
dren with ASD and no history of hyperlexia on the phono- IQ > 70) adolescent males and a control group of 41 TD
logical awareness tasks, indicating stronger phonological males. Reading ability was evaluated using the
analysis skills in the group with hyperlexia. The children Woodcock Reading Mastery Test–Revised (Woodcock,
with ASD who had no history of hyperlexia performed sig- 1988). Results indicated that the high-functioning ado-
nificantly below both the group with ASD/hyperlexia and lescents with autism performed similarly to their age-
the TD children. matched counterparts in both word identification (sight
It is not surprising that children with autism would score word vocabulary reading) and word attack (decoding of
below TD children. Children with autism demonstrate sig- pseudowords). However, statistical analysis revealed that
nificant oral language and communication deficits, espe- pseudoword reading was slightly better than sight word
cially in the area of semantics and vocabulary, that may identification in the adolescents with autism, suggesting
influence the underlying phonological representation of a heightened ability to apply phonetic analysis skills to
words stored in the mental lexicon (Kjelgaard & Tager- decode nonwords. As expected, performance on the pas-
Flusberg, 2001). As children acquire more vocabulary, the sage comprehension measure was significantly differ-
structure of spoken word representations gradually become ent between the two groups, with the adolescents with
increasingly segmental and more robust, a process referred autism scoring significantly lower than the age-matched,
to as lexical restructuring (Metsala & Walley, 1998), and TD cohorts.
these representations are available for children during tasks Taken together, results from these studies suggest that
of phonological awareness (Metsala, 1999). Children with word recognition abilities are adequately developed in
autism have reduced vocabularies relative to age-matched individuals with autism and do not differ from age-
children (Kjelgaard & Tager-Flusberg, 2001); therefore, matched, TD children and adolescents. Moreover, stud-
phonological awareness ability may be influenced by ies underscore that children and adolescents with autism
weaker or fewer phonological representations in the may be using a phonological recoding strategy to recog-
lexicon. nize or decode unfamiliar words. However, knowledge
and ability in phonological awareness was not included
in any of the reported studies; therefore, no firm conclu-
Word Recognition in Children With Autism
sions can be drawn about the cognitive processes con-
Many investigators have noted that children with tributing to phonetic decoding of pseudowords by
autism acquire adequate word recognition, frequently individuals with autism.
indistinguishable from age-matched, TD children (Frith Indirect evidence exists that the ability to analyze the
& Snowling, 1983; Minshew et al., 1994). Frith and phonemic units within words and apply that analysis dur-
Snowling (1983) examined word reading ability and ing decoding of unfamiliar words may be highly devel-
reading comprehension in nine children with autism, oped in individuals with autism. Welsh, Pennington, and
speculating that the children would perform poorer Rogers (1987) examined word recognition skills in five
when decoding pseudowords than when reading sight boys with hyperlexia from 4 years 5 months to 10 years
words because of a rote memorization of the visual of age. The results showed that each of the five children
shape of words. Their results indicated that the children showed superior pseudoword decoding ability and

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Smith Gabig / Reading by Children With Autism 71

accurate reading of real words following regular spelling Some investigators reported no difference in reading
patterns but less accuracy in reading real words that fol- real words versus pseudowords by high-functioning
lowed irregular spelling patterns (e.g., debt, subtle, children with autism and age-matched counterparts
gauge), suggesting a clear preference for the use of the (Minshew et al., 1994; O’Connor & Hermelin, 1994);
phonologic route to word identification rather than a others noted that some children within the broader
whole word or lexical route, a finding in support of an diagnostic category of ASD are able to read aloud real
underlying ability to apply grapheme-phoneme corre- words but struggle with decoding nonwords, suggesting
spondence rules when reading words. Similar findings a discrepancy in their ability to use a phonological cod-
were reported by O’Connor and Hermelin (1994), who ing strategy when reading unfamiliar words (Nation
used repeated readings and randomized word order to et al., 2006). Because the children in these studies rep-
assess reading ability for two high-functioning children resented several separate diagnoses within the spectrum
with autism. Their results indicated an efficient grapheme- of ASD, including Asperger syndrome, atypical autism
phoneme conversion process responsible for the fast (e.g., PDD-NOS), and autism, it is difficult to general-
reading by the children studied. Both of these studies ize the results to children with a specific diagnosis of
suggest that children with autism apply an underlying autism. Moreover, given the close association between
phonological recoding strategy during the recognition of phonological awareness and word recognition in read-
unfamiliar words while reading single words, although a ing in TD children (Wagner & Torgesen, 1987), it is
direct measurement of phonemic awareness skills was important to consider whether children with autism
not included in either study. demonstrate phonological awareness ability and
Although these studies have been fruitful in demon- whether phonological awareness is related to word
strating the accuracy of word reading ability in high- recognition in reading.
functioning individuals with autism, a recent investigation
(Nation et al., 2006) of reading ability in a broader sample Purpose of Study
of 41 children with autism spectrum disorder found that
some of the children struggled with reading nonwords, The purpose of this study was to investigate single-
even when their sight word reading was developmentally word recognition in reading and phonological awareness
adequate for age. Nation et al. (2006) studied reading in children with autism relative to a group of age-
ability in 16 children who met the diagnostic criteria for matched, TD children at early stages of reading acquisi-
autism, 13 children diagnosed with pervasive developmen- tion. The following questions and predictions were
tal disorder–not otherwise specified (PDD-NOS), and 12 explored:
children diagnosed with Asperger syndrome (AS). Reading
skills were measured for word reading accuracy for both 1. Do children with autism demonstrate word identifica-
tion and word decoding skills during single word read-
word decoding and sight word identification as well as for
ing similar to age-matched, TD children? Based on the
reading comprehension. Of the children, 9 (22%) were not
review of the literature on single word reading in chil-
able to read sufficiently to complete the reading assessment dren with ASD, it was hypothesized that children with
and were not considered further in the analyses. Of the autism would perform similarly to age-matched, TD
remaining 32 children, problems in reading comprehension children for both sight word identification and for
characterized the majority of children with ASD, but as a decoding of nonsense words.
group, the children demonstrated average word reading 2. Do children with autism demonstrate a within-group
ability for age. However, closer analyses of performance discrepancy between reading accuracy for sight words
patterns in word recognition indicated that some of the versus nonwords? It was predicted that children with
children struggled with reading nonwords even when their autism would show better performance on sight word
sight word reading was developmentally adequate for age. recognition than decoding of nonwords based on the
Nation and her colleagues speculated that children with research by Nation et al. (2006).
3. Do children with autism demonstrate phonological aware-
autism may have difficulty applying phonological coding
ness ability similar to age-matched, TD children? It was
strategies when faced with unfamiliar letter sequences as in
anticipated that children with autism would perform below
a nonsense word and may be relying on a visual associa- TD children in this area of cognitive-linguistic develop-
tion or visual memory when asked to read aloud words in ment based on the research reported by Heimann et al.
a word identification reading task. (1995) and Newman et al. (2007) indicating poor perfor-
In summary, there is conflicting evidence concern- mance on measures of phonological awareness by chil-
ing word recognition skills in children with autism. dren with autism.

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72 Communication Disorders Quarterly

4. Is phonological awareness related to accuracy in word criteria from the Diagnostic and Statistical Manual of
recognition for children with autism? Based on the Mental Disorders–Fourth Edition (DSM-IV; American
hypothesis that phonological awareness was delayed in Psychiatric Association, 1994). The diagnosis of autism
children with autism, it was anticipated that no relation- using validated instruments such as the ADI-R or ADOS or
ship would be seen between ability on phonological the specific criteria from the DSM-IV reflects the current
awareness tasks and accuracy in word recognition in
direction in research on autism (Tager-Flusberg, Joseph, &
children with autism.
Folstein, 2001). According to Tager-Flusberg et al. (2001),
it is important for research that the diagnosis of autism be
Method made by individuals specifically trained in the use of the
ADI-R, ADOS, and/or DSM-IV criteria in order to ensure
the accuracy and specificity of the diagnosis. For clinical
Participants
and research purposes, the diagnosis of autism must be dis-
The study included 14 children with autism, 12 boys tinguished from other possible diagnoses within the cate-
and 2 girls, between the ages of 5 and 7 years 11 months gory of autism spectrum disorder, including Asperger
and 10 TD controls, 7 boys and 3 girls, matched on syndrome or pervasive developmental disorder–not other-
chronological age to the children with autism. Parent/ wise specified, based on careful and systematic evaluation
guardian consent and child assent, as required for human of developmental history and clinical presentation. All the
participant protection, was granted for all participants. children with autism recruited for the study had been iden-
More parents of boys with autism than girls with autism tified prior to recruitment within an interdisciplinary eval-
responded to the recruitment postings; this may be due to uation center by an expert clinician, specifically, a
the increased prevalence of autism in males (Volkmar & psychiatrist or licensed psychologist, using one of these
Klin, 2005; Volkmar, Szatmari, & Sparrow, 1993). methods.
In this study, age-matched, TD controls were used for Children with autism were included in the study if
two reasons. First, the selection of a comparison group in they met the following criteria: (a) clinical and educa-
research on individuals with autism has historically included tional history of significant social, behavioral, and com-
a language/age-matched and/or a cognitive-matched con- munication impairment; (b) currently enrolled in special
trol group, yielding critical information on communication education services; (c) chronological age between 5 and
or cognitive behaviors unique to autism (Tager-Flusberg, 7 years 11 months; (d) functional verbal ability at the
2004). Although this line of research has proved to be phrase or sentence level; and (e) nonverbal intelligence
very significant, Tager-Flusberg (2004) recently pro- greater than or equal to 70. None of the children with
posed that future research in autism embrace the study of autism had a history of hearing impairment and all had a
within-group variation and performance profiles of current hearing screenings either through their educa-
selected subgroups of children with autism rather than tional settings or pediatric visits.
identifying and categorizing the language or communi- Functional verbal ability at the phrase and sentence
cation features that distinguish autism from control level was initially screened by telephone interview at the
groups matched on language or cognition. Second, the time of recruitment and was verified through clinical
inclusion of age-matched, TD children as a control group observations by the investigator, a licensed speech-lan-
is important to investigate how verbal children with guage pathologist, during the initial visit with the child
autism perform relative to their age peers in the area of and family by the investigator. Functional verbal ability
reading. Understanding the phonological awareness and means the intentional use of language beyond single
reading ability of children with autism relative to age- words to perform communicative functions such as
matched peers may lead to informed instructional prac- requesting, commenting, or greeting. All of the children
tices for teaching reading to children with autism. with autism met the criterion of functional verbal ability
The children with autism were recruited through parent at the phrase or sentence level.
association/advocacy Web sites and newspaper notices. All TD children between 5 and 7 years 11 months were
of the children recruited had a diagnosis of autism within recruited from posted notices on Web sites, campus bul-
an interdisciplinary evaluation center using either the letin boards, and newspaper notices. None of the TD chil-
Autism Diagnostic Interview–Revised (ADI-R; Lord, dren had a history of speech-language delay, hearing loss,
Rutter, & Le Couteur, 1994), the Autism Diagnostics special education services, or a sibling with a diagnosis of
Observation Schedule (ADOS; Lord et al., 2000), or the autism.

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Smith Gabig / Reading by Children With Autism 73

Validation of Group Differences prior to presentation of the standardized measures of word


recognition and phonological awareness. Speech articula-
Parents of both groups of children were asked to com- tion was assessed in all the children because investigators
plete the Social Communication Questionnaire (SCQ), have reported relationships among speech articulation,
Lifetime form (Rutter, Bailey, & Lord, 2003), in order to phonological awareness, and reading ability in children
validate group differences for research. The SCQ has been with speech-language disorders (Gillon, 2004; Webster &
shown to have significant sensitivity and high specificity Plante, 1995). Receptive vocabulary was assessed because
in identifying children with ASD, especially children of the increasing evidence that children’s phonological
older than 4 years of age (Allen, Silove, Williams, & awareness may be a function of their vocabulary develop-
Hutchens, 2007; Bölte, Holtmann, & Poustka, 2008). All ment (Metsala, 1997, 1999; Metsala & Walley, 1998).
of the 14 children with autism scored above the recom- Receptive vocabulary was assessed using the Peabody
mended cutoff score of 15, with a mean SCQ score of 23, Picture Vocabulary Test–III (PPVT-III; Dunn & Dunn,
whereas the mean SCQ score for the TD children was 2, a 1997), and single word articulation ability was assessed
significant group difference, t = 10.2(22), p < .01. using the Word Articulation (WA) subtest of the Test of
Language Development–Primary (TOLD-P; Newcomer &
Nonverbal Intelligence
Hammill, 1997).
In order to assure nonverbal intelligence (NVIQ)
within an acceptable range for children enrolled in the Measures of Phonological Awareness
study, nonverbal intelligence was assessed for all the
children using the Differential Ability Scale (DAS; Phonological awareness (PA) was measured using two
Elliott, 1983). Children with autism demonstrated an tasks from a standardized test of phonological processing,
average NVIQ of 96 (standard score; range 83–109), the Comprehensive Test of Phonological Processing
whereas the mean score for the age-matched, TD group (CTOPP; Wagner, Torgesen, & Rashotte, 1999). The
was 106 (range 91–120), t(22) = 3.0, p < .01, d = 1.28. CTOPP is a frequently used clinical tool, with good relia-
Although the group mean score for NVIQ was lower for bility and validity, designed to assess aspects of phonolog-
the children with autism, both groups of children had ical processing in individuals between 5 and 24 years of
mean standard scores for NVIQ within the average range age. The two phonological awareness tasks on the CTOPP
(i.e., 90–110). A majority of the children (87%, n = 12) tap phonological awareness at the syllable and phoneme
received an NVIQ score above 90, within the average levels. The Elision subtest requires the child to isolate and
expected performance range for chronological age. Two delete a phoneme in a word (e.g. “Say cup. Now say cup
children with autism received a nonverbal quotient less without the /k/.”). The Sound Blending Words subtest
than 90 (e.g., standard scores of 87 and 83). A standard requires the child to blend either syllables or phonemes
score on NVIQ of 87 is considered in the low average into words (e.g., “What words do these sounds make?
range. The child with standard score of 83, although con- sun”). Both of these tasks are considered to reflect mea-
sidered below average for chronological age, was sures of phoneme awareness in that the child must isolate
included in the study because the score does not fall the separate sounds within words to either delete a phoneme
below an NVIQ of 70, a cutoff score considered to place or blend individual phonemes into a word (Gillon, 2004).
the individual within the diagnostic category of learning However, they also provide some information about sylla-
impaired (American Association on Intellectual and ble awareness in children because both tasks begin with
Developmental Disabilities, 2007). All of the children in identification of the syllable structure of words and move
this study would be considered by existing research prac- toward isolation of the phoneme structure of the words.
tices in autism to be high functioning, based on nonver- Therefore, the broader term of phonological awareness is
bal IQ greater than or equal to 85 (with the exception of used to describe the metacognitive ability under study.
one child with an NVIQ = 83, below average but not
learning impaired) and the presence of functional speech Measures of Word Recognition
at the phrase or sentence level (Tsatsanis, 2005).
Word recognition is typically measured in children for
both single word reading and for ability to phonetically
Measures of Oral Language
decode pseudowords. Accuracy in word recognition was
All children received two measures of oral communica- measured for both real words and for nonwords using sub-
tion, word articulation ability and receptive vocabulary, tests from the Woodcock Reading Mastery Test–Revised

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74 Communication Disorders Quarterly

(WRMT-R; Woodcock, 1988). The WRMT-R is a commonly Standardized presentation practices, as outlined in the
used norm-referenced standardized measure of reading abil- examiner’s manuals for each measure, were followed.
ity, with good reliability and validity, developed for assess- Both the phonological awareness measures and the word
ing reading in individuals from age 5 years though older recognition measures were audio recorded for the pur-
adults. Word recognition was measured using two subtests: pose of reliability in scoring.
the Word Identification (WID) subtest and the Word Attack
subtest (WATTK). The WID subtest assesses the child’s abil- Reliability in Scoring
ity to recognize sight word vocabulary of increasing diffi-
culty; the WATTK subtest assesses the ability to Interjudge agreement in scoring was calculated for
phonetically decode pseudowords. responses during the phonological awareness tasks and for
word identification and word decoding during the word
recognition tasks using percentage of agreement. The
Procedures
examiner randomly selected 25% of individual audio
Children were seen individually for two to three visits recordings of the performance on these tasks from each
in their home or school, in a quiet room away from every- group for scoring by a second scorer, a graduate student in
day distractions, for approximately 45 to 60 minutes. One speech pathology trained in the administration and scoring
child with autism was seen for all visits in the university of the standardized measures used in this study. The per-
speech and language clinic where the child was receiving centage of agreement between the investigator and the sec-
individual speech-language intervention. The initial meet- ond scorer for accuracy in scoring the responses on the
ing with the other 13 children was in the home so that tasks of phonological awareness and word recognition was
information regarding the study could be given to the fam- greater than 90% for each measure.
ilies and informed consent obtained. During this first visit,
information was obtained regarding the child’s develop- Results
mental history, including any early interest in letters and
precocious reading behavior. Three of the children had a
Group Differences in Speech Articulation
history of repetitive behavior and interest with letters and
and Receptive Vocabulary
numbers, but none of the children had a history of preco-
cious reading prior to school entry. Group differences were seen for both speech articula-
The majority of the testing was completed in each tion and receptive vocabulary levels in the children with
child’s home; two of the children with autism were seen autism and the TD group of children. The children with
for a testing session in their school when scheduling con- autism had a mean standard score for receptive vocabu-
flicts prevented a home visit. The initial testing session lary on the PPVT-III of 77 (range 66–94) compared to a
focused on assessing the NVIQ, word articulation, and mean standard score of 103 (range 89–120) for the TD
receptive vocabulary. The following session focused on children, t(22) = 5.1, p < .01, d = 2.17. Word articulation,
obtaining the measures of word recognition and phono- as measured by the WA subtest of the TOLD-P, revealed
logical awareness. The investigator is experienced in a mean word articulation standard score of 8 (range
psychometric measurement and was sensitive to the 7–11) for children with autism and a mean standard
attention level and performance by the child. Tangible score of 10 (range 8–12) for TD children, t(22) = 2.5, p
reinforcement in the form of stickers was used across all < .05, d = 1.06. Approximately half (57%, n = 8) of the
children to maintain interest and maximize performance, children with autism received a standard score on the
beginning with continuous reinforcement and changing WA subtest within the average range of performance
to a variable-interval reinforcement schedule, to main- (e.g., standard score > 8), whereas the remaining chil-
tain interest and maximize performance by each child. If dren (43%, N = 6) scored one standard deviation below
needed, a break in the testing session was provided to the expected standard score of 10 (standard score = 7).
ensure ongoing attention to the tasks presented. Examination of articulation errors made by the children
The two measures of phonological awareness, coun- with autism who scored below average on the WA
terbalanced to control for any possible order bias, pre- subtest indicated that the majority of the errors were sub-
ceded assessment of word recognition skills. Following stitution of w/r, distortion of vocalic –r, substitution
standard procedure, word recognition was assessed first of f/th, or cluster reduction on medial context of –sk
for identification of real words (WID) followed by the blend. The degree of overall intelligibility of the children
presentation of pseudowords for decoding (WATTK). with autism was judged via clinical observation by the

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Smith Gabig / Reading by Children With Autism 75

Table 1
Characteristics of Children With Autism and Typically Developing Children
Autism (n = 14) Typical (n = 10)

Variable M SD M SD t df p

Age 6 years 5 months 8.59 (months) 6 years 8 months 10.7 (months) 1.1 22 .479
NVIQa 96 8.0 106 9.5 3.0 22 < .01
PPVTb 77 13.5 103 10.9 5.1 22 < .01
WAc 8 1.4 10 1.9 2.5 22 < .05
SCQd 23 6.5 2 1.5 10.2 22 < .01

a. Nonverbal intelligence score, Differential Abilities Scale (Elliott, 1983).


b. Peabody Picture Vocabulary Test–Revised (Dunn & Dunn, 1997).
c. Word Articulation subtest of the Test of Language Development (Newcomer & Hammill, 1997).
d. Social Communication Questionnaire (Rutter, Bailey, & Lord, 2003).

Table 2
Group Statistics: Mean Standard Scores for Word Recognition and Phonological Awareness in Children
Autism (n = 14) Typical (n = 10)

Variable M SD M SD t df p

WRa
WID 115 10.3 111 15.3 0.755 22 > .05
WATTK 104 11.2 107 11.9 0.480 22 > .05
PAb
ELI 6 3.4 10 1.98 3.25 22 < .01
BLW 8 2.7 11 2.48 2.78 22 < .05

a. Word recognition: WID = word identification; WATTK = decoding nonwords. Standard scores based on a mean of 100, SD = ±15.
b. Phonological awareness: ELI = elision task; BLW = sound blending. Mean standard scores based on a mean = 10, SD = ±3.

investigator to be very good, with speech sound errors t = .755(22), p > .05, d = .33. Similarly, children with
noted only occasionally in continuous speech. Table 1 is autism scored similarly to TD children on nonword read-
a summary of the characteristics of the children included ing, receiving a mean standard score of 104 compared to
in the study. a mean score of 107 for the TD children, with no
between-group difference, t = .480(22), p > .05, d = .21.
Levels of Word Recognition This finding is consistent with previously reported
research indicating age-appropriate sight word and non-
The children in the two groups were able to complete
word reading for children with autism (Frith &
both measures of word recognition, word identification
Snowling, 1983; Minshew et al., 1994).
and decoding of nonwords, from the WRMT-R
(Woodcock, 1988). Mean standard scores for the two
measures of word recognition were within the average Variability in Reading Words Versus Nonwords
range for both the children with autism and the age- Although scoring similarly to age-matched, TD chil-
matched, TD children. As can be seen in Table 2, chil- dren on accuracy of word recognition, a question
dren with autism performed similarly to age-matched, remained whether children with autism demonstrated a
TD children for both sight word identification and pattern of variability in reading accuracy between the
decoding of nonwords. For sight word identification, identification of sight words and the decoding of non-
children with autism had a mean standard score of 115, words. A paired samples t test investigating the possible
similar to the TD children who had a mean score of 111, unevenness in performance on the two measures of word
and there was no significant between-group difference, recognition indicated that the children with autism

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76 Communication Disorders Quarterly

performed better when reading real words than when Table 3


decoding nonwords, t = 3.75(13), p < .01, d = 1.05, a Pearson Correlations for Phonological Awareness
result considered to be a large effect (Cohen, 1988). TD (ELI, BLW)a and Word Recognition
children did not demonstrate variability in performance (WID, WATTK)b
between the two reading measures, performing similarly Autism (n = 14) Typical (n = 10)
on both WID and WATTK, t = 1.18(9), p > .05. This find-
ing differed from results reported by Minshew et al. Variable ELI BLW ELI BLW
(1994) for high-functioning adolescents with autism who WID .18 .02 .41 .19
showed a statistical advantage in nonword reading over WATTK .05 .17 .75* –.38
sight word identification, suggesting a heightened ability
a. Phonological awareness: ELI = elision task; BLW = sound
to apply phonetic analysis skills to decode nonwords. blending.
Moreover, Nation et al. (2006) reported that many of the b. Word recognition: WID = word identification; WATTK = decoding
children with autism in her study struggled with reading nonwords.
nonwords even when their sight word reading was devel- *p < .05.
opmentally adequate for age. A closer investigation of
the individual word recognition profiles of each child
with autism in the present study revealed that 60% (n =
9) struggled while reading nonwords, characterized by that 43% (n = 6) of the children scored below average on
slow and labored decoding attempts that often were not both measures of PA; 26% (n = 4) showed average per-
accurate. Two of the children (22%) attempted to parse formance on the sound blending task but not the elision
the individual graphemes/phoneme relationship and task. It appears that children with autism are delayed in
sound out the nonword but could not blend the individ- their acquisition of phonological awareness relative to
ual phonemes into a whole. The remaining two children TD children matched for age but some children are capa-
(22%) were able to decode the nonwords rapidly and ble of blending syllables and phonemes into words.
efficiently. Isolating and manipulating the phonemes within words
during an elision task appears to be significantly difficult
Phonological Awareness for children with autism.
Both groups of children completed the two measures
Phonological Awareness and Word
of phonological awareness: the elision and sound blend-
ing tasks from the CTOPP (Wagner et al., 1999). Recognition in Single Word Reading
Children with autism scored below average on both mea- To investigate whether phonological awareness was
sures of phonological awareness compared to age- related to accuracy in word recognition for children with
matched, TD children, who received standard scores for autism and the TD control group, correlations were com-
age within expected performance levels. As noted in puted between the two measures of phonological aware-
Table 2, children with autism scored more than one stan- ness, elision (ELI) and sound blending (BLW), and the two
dard deviation below average on the elision task of measures of word recognition (WID and WATTK). For the
phonological awareness (mean standard score = 6) and children with autism, no relationship was found between
low average on the sound blending task (mean standard either measure of phonological awareness and measures of
score = 8). Significant differences in performance reading accuracy for word recognition. However, a strong
between children with autism and TD children were seen positive relationship was found between the elision task
for the elision task, t = 3.25(22), p < .01, d = 1.4, and for and the decoding of nonwords for the TD, age-matched
the sound blending task, t = 2.78(22), p < .01, d = 1.2, children (r = .75, p = .01). Table 3 contains the correlations
both results are considered to be large effect sizes between the measures of phonological awareness and word
(Cohen, 1988). recognition for the two groups of children. It appears from
The majority of the children with autism (71%, n = these results that phonological awareness was not related to
10) scored below average on one or both measures of PA, accuracy in word recognition for the children with autism,
the remaining 4 children (29%) scored within the aver- yet TD age-matched children showed a strong relationship
age range on both measures of PA. Investigation of pat- between these abilities, in agreement with previously
terns of performance within the 10 children who scored reported studies on the link between phonological aware-
below average on one or both measures of PA revealed ness and accuracy in word decoding in children (Adams,

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Smith Gabig / Reading by Children With Autism 77

Table 4
Discrepancy Between Word Recognition (WID, WATTK)a and Ability in Phonological Awareness
(ELI, BLW)b by Children With Autism
Lesser Groupc (n = 9) Greater Groupd (n = 5)

Child WID WATTK ELI BLW WID WATTK ELI BLW

1 115 104 Below Below


2 122 117 Below Average
3 118 109 Below Average
4 97 94 Average Average
5 123 115 Below Below
6 120 94 Below Below
7 99 97 Average Average
8 131 115 Above Above
9 104 108 Below Average
10 108 79 Below Below
11 112 107 Below Below
12 112 109 Below Average
13 126 94 Average Average
14 125 117 Below Below

Note: Word recognition scores are standard scores, mean = 100, SD = ±15.
a. Word recognition: WID = word identification; WATTK = decoding nonwords.
b. Phonological awareness: ELI = elision task; BLW = sound blending.
c. Lesser: < 10-point discrepancy between WID and WATTK.
c. Greater: > 10-point discrepancy between WID and WATTK.

1992; Brady, Shankweiler, & Mann, 1983; Stanovich, task, whereas the sound blending task is considered a
1982; Vellutino & Scanlon, 1987; Wagner, 1986; Wagner phonological synthesis task. Research has shown that
& Torgesen, 1987). phonological analysis tasks are more difficult and
Children with autism clearly showed a preference develop later in children (Torgesen et al., 1992) and are
toward the sound blending task of phonological aware- more closely related to word reading skill, especially the
ness, with 57% (n = 8) of the children with autism able phonological analysis of onsets and rimes within sylla-
to score in the average range in this task. More than two bles (Stahl & Murray, 1994, 1998).
thirds (71%, n = 10) of the children with autism were Results from this study clearly indicate that children
below average on the more difficult elision task requiring with autism in the early stages of learning to read and
analysis of the onsets-rimes of syllables; only 29% (n = recognize single words may not have the fully developed
4) of the children were able to complete and score in the underlying phonological awareness skills necessary for a
average range for chronological age on the elision task. full analysis of orthography and orthographic patterns
One explanation for this trend may be found in the dif- necessary for skilled word reading, especially for unfa-
ferences between the two tasks of phonological aware- miliar orthographic sequences or patterns. Clearly, the
ness. Researchers have noted that phonological majority of the children were not able to engage in
awareness tasks are related to two distinct but associated the phonological analysis of syllables at the level of the
factors: phonological analysis and phonological synthe- onsets-rimes. The ability to engage in phonological analy-
sis (Torgesen, Morgan, & Davis, 1992; Wagner, sis at the level of onsets-rimes with syllables requires the
Torgesen, Laughon, Simmons, & Rashotte, 1993). ability to shift from the whole of the stimulus word to
Phonological analysis tasks require segmentation of the focus on one or more parts of the word, an ability linked
word into syllables at the level of onsets and rimes and to the concept of decentering, a metacognitive achieve-
individual phonemes. Phonological synthesis requires ment associated with the Piagetian stage of concrete
the blending of syllables or phonemes into words. The operations that begins between 5 and 7 years of age
elision task used in this study is a phonological analysis (Fowler, 1991). Future research should focus on the

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78 Communication Disorders Quarterly

relationship between cognitive development and develop- The remaining three children in the greater group had
mental changes in phonological awareness and achieve- average to above-average single word identification. Two
ment in children with autism to better understand the of the children demonstrated average ability in nonword
relationship between these critical areas of development. reading, whereas the third child showed significant
It is yet to be documented whether children with autism below-average performance on nonword reading. All
develop average ability in phonological analysis or seg- three of the children were below average on both mea-
mentation at a later chronological age than TD children. sures of phonological awareness, suggesting deficient
To better examine the possible relationship between development for both skill in phonological analysis and
level of phonological awareness development and skill in phonological synthesis. Deficits in phonological aware-
word reading ability, the children with autism were ness may have contributed to an insufficient ability to
grouped according to whether they showed greater than engage in full analysis of the orthographic structure of
a 10-point discrepancy (greater group) between single unfamiliar printed words.
word identification and nonword reading and less than a Within the lesser group, three children (33%) scored
10-point discrepancy (lesser group) between these two above average (e.g., +1 SD) for both the WID and
measures of word reading. As can be seen in Table 4, five WATTK tasks of single word reading but did not demon-
children (36%) met the criteria of greater than a 10-point strate the expected phonological awareness ability for
discrepancy for standard scores between WID and age. Two of the children showed average single word
WATTK; nine children (64%) had standard scores on reading for both real and nonwords and average phono-
word reading for real versus nonwords within less than a logical awareness ability for both the elision and sound
10-point discrepancy. blending tasks. The remaining children scored with the
Of the five children in the greater discrepancy average range for real and nonword reading, yet one of
group, 40% (2 of 5) had superior word identification these children was below average on both tasks of
skills and average to above-average nonword decod- phonological awareness.
ing. Both of these children demonstrated adequate Clearly, skill in single word recognition and non-
phonological awareness ability on both the elision and word reading was not related to phonological analysis
sound blending tasks of phonological awareness, sug- abilities for the children with autism in this study. It
gesting well-developed knowledge of onsets and rimes may be that the small number of children included in
within syllables and adequate phoneme segmentation the study may have influenced possible trends in the
ability seen when children engage in a full analysis of data that could be seen. Future research on word
written words (Ehri, 1992, 1995; Stahl & Murray, recognition profiles within a larger number of children
1994, 1998). Examination of each child’s clinical his- with autism may be able to determine the exact rela-
tory was absent any information that may inform us tionship between these cognitive-linguistic areas of
about his or her strong word recognition ability. One of development.
the children was a boy, age 6 years 1 month, the other,
a girl, age 5 years 7 months. Neither child had a his- Influence of Nonverbal Intelligence and
tory of precocious reading prior to kindergarten. The
Oral Language on Word Recognition
boy had an intense preoccupation with letters and
and Phonological Awareness
numbers prior to kindergarten, the girl, with colors. No
information was available regarding the amount of The possibility that NVIQ, receptive vocabulary
time parents spent reading with each child. It may be (PPVT), and speech articulation (WA) may have influ-
that superior single word recognition and average to enced the children’s performance on the word recogni-
above-average nonword reading in some children with tion and phonological awareness tasks were examined
autism is associated with adequate or even above-aver- though correlation analyses. Table 5 contains the corre-
age phonological awareness ability for age. Because lations for both groups of children among the standard
only two of the children with autism demonstrated this scores for NVIQ, PPVT, and WA with the standard
word reading and phonological awareness profile, there scores from the tasks of single word recognition (WID
is not enough evidence from this study to assume and WATTK) and phonological awareness (ELI and
specific conclusions between superior or even above- BLW). For children with autism, NVIQ was not related
average word recognition accuracy and ability in phono- to either measure of word recognition or phonological
logical awareness for children with autism. awareness. In contrast, for the TD children, NVIQ

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Smith Gabig / Reading by Children With Autism 79

Table 5
Pearson Correlations Among Nonverbal Intelligence (NVIQ), Receptive Vocabulary (PPVT)a, and
Word Articulation (WA) With Tasks of Word Recognition (WID, WATTK)b and Phonological
Awareness (ELI, BLW)c
Autism (n = 14) Typical (n = 10)

Variable NVIQ PPVT WA NVIQ PPVT WA

WID –.15 –.16 .12 .45 .02 .78∗


WATTK –.30 –.46 –.05 .65∗ .50 .55
ELI –.13 .62∗ .11 .89∗∗ .63 .33
BLW –.23 .44 –.09 –.13 –.08 .37

a. Peabody Picture Vocabulary Test–Revised (Dunn & Dunn, 1997).


b. Word recognition: WID = word identification; WATTK = decoding nonwords.
c. Phonological awareness: ELI = elision task; BLW = sound blending.
∗∗
p < .01. ∗p < .05.

was significantly related to the phonetic decoding of The question is: What underlying reasons could explain
nonwords (r = .65, p < .01) and the elision task of phono- why children with autism demonstrated relatively better
logical awareness (r = .89, p < .01). sight word reading relative to nonword reading in this
Receptive vocabulary was significantly related to per- study?
formance on the elision task of phonological awareness Skilled word recognition involves various strategies,
for the children with autism (r = .62, p < .01), although no including reading words by visual memory or sight,
relationship was found between receptive vocabulary and analogy to other known spelling patterns of words, pre-
either measure of phonological awareness for the TD chil- diction through cues in the text, and applying a decoding
dren. Finally, word articulation was not related to word strategy (Ehri & Snowling, 2004). In this study, sight
recognition or phonological awareness for the children word recognition was assessed by presenting single
with autism, but a moderate positive relationship was words out of context, thus the use of text cues would not
found between word articulation and sight word identifi- be possible when identifying and pronouncing the writ-
cation (WID) for the TD children (r = .78, p < .01). ten word. Because the children with autism showed a sta-
tistical preference for real word recognition over
Discussion nonword reading, it is reasonable to assume that the chil-
dren may have learned a rote memorization of visual
One objective of this study was to investigate accu- forms of words and can quickly recall from memory the
racy in single word recognition in reading by children spelling pattern and corresponding pronunciation of the
with autism relative to a group of age-matched TD chil- word. However, research has challenged the notion that
dren. The majority of the children with autism demon- sight word reading is simply a rote visual memory of
strated average to above-average ability in single word whole shapes of words or spelling patterns (Ehri, 1987,
reading and nonword reading relative to age-matched, 1992, 1998; Share, 1995, 1999).
TD children. However, children with autism showed a According to Ehri (1987, 1992, 1998), children learn to
statistical performance bias for single word reading over recognize words through a connection-forming process of
nonword reading, a pattern not seen in the TD children. linking printed forms of words to their pronunciations and
Although scoring within the average range of expected meanings. Initially, connections are formed between the
performance for age, clinical observation of nonword graphemes in the printed word and the corresponding
reading indicated that the children with autism struggled phonemes by applying grapheme/phoneme correspon-
more with reading nonwords than real words, suggest- dence rules available to the child through his or her cogni-
ing a divergence in ability between the direct lexical tive knowledge of the alphabetic principle and how print
route to reading words and the indirect, nonlexical route works (Ehri, 1998). As children progress in their recogni-
involving a phonological recoding of an unfamiliar, tion and storage of spelling patterns or orthographic
written word (Coltheart, 2006; Coltheart et al., 2001). sequences of words, the spelling patterns of larger

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80 Communication Disorders Quarterly

orthographic sequences become cognitive-functional units consolidated phase in word reading is the most advanced
that can be recognized as parts of other words, such as phase word reading. Readers in this phase are able to use
common vowel-consonant endings such as –ight or mor- knowledge of larger units of grapheme-
pheme ending such as –ing (Ehri & Snowling, 2004). The syllable relationships and grapheme-morphology relation-
children in both groups demonstrated sight word reading at ships to decode unfamiliar words and accurately store
appropriate performance levels for age, suggesting that the these representations in lexical memory.
orthographic sequences and patterns contained in the writ- A miscue analysis of the types of errors made by the
ten words on the WID task had been encountered by all of children when attempting to read nonwords was not a
the children previously in reading, activating the spelling focus of this study. Such an analysis of reading errors
and pronunciation pattern immediately in memory, either may inform us about the phase or phases of word recog-
through recognition of the visual shape, by a process of nition employed by the children in each group. For
word analogy, or through phonetic decoding. example, we do not know from this study whether chil-
Nonword reading was relatively more difficult for the dren with autism are at an earlier phase of word analysis
children with autism, even though they scored within skill than TD children of a similar chronological age.
age-expected levels on the nonword reading task. Another objective of this study was to examine ability
Children with autism demonstrated a performance bias in phonological awareness and the relationship between
for sight word recognition over nonword reading, sug- this ability and skill in single word reading for both real
gesting that the indirect, nonlexical route to word read- and nonwords. Phonological awareness was measured in
ing may be less developed. An indirect, nonlexical route this study using two tasks: an elision task and a sound
relies on well-developed word analysis skills for the blending task. As predicted, the children with autism
explicit phonological recoding of unfamiliar ortho- scored below group age-matched, TD children on both
graphic patterns to accurately recognize and pronounce tasks of phonological awareness. Moreover, there was no
an unfamiliar word (Coltheart, 2006; Coltheart et al., correlation between measures of phonological awareness
2001; Ehri & Snowling, 2004; Stahl & Murray, 1998). and measures of word recognition for either real word
The development of a full analysis of a word’s spelling identification or nonword reading for the children with
pattern into its corresponding phonological pronunciation autism, unlike the TD similar age cohort group that
progresses slowly in children learning to read (Ehri, 1995; demonstrated a strong relationship between phoneme
Ehri & Snowling, 2004; Stahl & Murray, 1998). Ehri segmentation ability on the elision task and phonetic
(1995) proposed four phases in the progression of word decoding of unfamiliar nonwords. Research on TD chil-
reading skill based on the reader’s understanding and dren has shown a strong and predictive relationship
use of the alphabetic principle in reading words. These between phoneme awareness and word reading ability
four phases are: (a) a pre-alphabetic phase, (b) a partial (Liberman et al., 1974; Vellutino & Scanlon, 1987;
alphabetic phase, (c) a full alphabetic phase, and (d) a Wagner & Torgesen, 1987). In addition, research on the
consolidated alphabetic phase. The first two phases, pre- degree and depth of phonological awareness ability nec-
alphabetic and partial alphabetic, are characterized by a essary for word reading has shown that skill in manipu-
transition from a lack of knowledge of the relationship lating onsets and rimes within syllables is most strongly
between the alphabet and speech sounds (e.g., pre- related to word reading and skill in analysis of the alpha-
alphabetic phase) to a basic understanding of the alphabetic betic orthography (Stahl & Murray, 1994, 1998). Ehri
system and its relationship to speech (e.g., partial alpha- (1992, 1995) noted that phoneme segmentation ability is
betic phase). Readers in the transitional, partial alphabetic evident in children who possess a working knowledge of
stage use a strategy called phonetic cue reading where the the major grapheme-phoneme units beyond individual
reader uses some of the letters in the word, usually the letters to include syllable and morpheme units in word
first few letters, to generate a pronunciation of the word analysis, a characteristic of the full alphabetic phase of
(Ehri, 1995; Stahl & Murray, 1998). During this phase of word reading ability.
word reading development, only partial letter-sound corre- Although not a direct focus of the study, the possibil-
spondence rules are used in word decoding attempts, ity of other cognitive-linguistic factors influencing
resulting in inaccurate word reading and incomplete the performance by the children with autism on tasks of
mental representations of words in lexical memory. During single word reading and phonological awareness
the full alphabetic phase, a reader has full knowledge of remained. No relationship was found for measures of
the grapheme-phoneme correspondence rules and is able NVIQ and speech articulation with measures of word
to apply this knowledge when reading unfamiliar words. A recognition or phonological awareness, yet a strong

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Smith Gabig / Reading by Children With Autism 81

positive relationship was found between receptive of phonological awareness by the TD children was unex-
vocabulary levels and performance on the elision task for pected. Research on the relationship between intelligence,
the children with autism. The positive relationship phonological awareness, and reading has noted an associa-
between receptive vocabulary score and ability on the tion between verbal IQ (not NVIQ), phonological process-
elision task for the children with autism suggests that ing, and reading achievement (Badian, 2001; Scarborough,
reduced vocabulary size may hinder and delay the devel- 1998), although other research has noted that overall intel-
opment of more cognitively demanding phonological ligence scores become more correlated with reading
analysis skills by the children with autism. There is increas- achievement over time, especially after second grade
ing evidence that vocabulary size and phonological similar- (Naglieri, 1996). Again, the observed correlation between
ity among words in the lexicon helps to explain individual NVIQ and performance on the phonetic decoding of non-
differences in aspects of phonological awareness in TD words and the elision task by the TD children may reflect
children (Metsala, 1997, 1999; Metsala & Walley, 1998; the trend noted in the literature of the relationship between
Rvachew, 2006; Service, 2006). reading and intelligence in children beginning at second
Evidence for this theoretical framework is seen in stud- grade and beyond.
ies that demonstrate that TD children are sensitive to the
phonotactic probability of nonwords (Edwards, Beckman,
& Munson, 2004; Munson, Edwards, & Beckman, 2005). Conclusion, Clinical Implications, and
Phonotactic probability refers to the likelihood that sublex- Future Directions for Research
ical sequences of sounds may occur in a lexical item and is
related to stored phonological representations and abstrac- This study highlighted that word recognition is well
tions of lexemes in the lexicon. As children’s vocabulary developed in children with autism and comparable to TD
increases, their stored representations of possible phonetic age-matched cohorts, but a clear performance bias is
sequences become more robust and defined, facilitating the noted for between-word identification and phonetic
phonological parsing words. In this study, the children with decoding of nonwords. It appears that full word analysis
autism had lower overall receptive vocabulary scores than skills are less developed for the children with autism
the TD children, consistent with the extant research demon- than for TD children. Clinical observation noted more
strating reduced vocabulary size for age (Kjelgaard & struggling and hesitation in the children with autism dur-
Tager-Flusberg, 2001; Tager-Flusberg, 2003). This limita- ing the reading of nonwords. Robust word analysis skills
tion in oral language functioning may have had a significant require an explicit phonological recoding of unfamiliar
impact on the development of phonological awareness abil- orthographic patterns. Miscue analysis of reading errors
ity in the children. Future research should address the pos- and latency measures of nonword reading between chil-
sible links between levels of phonological awareness ability dren with autism and TD children may shed some addi-
and vocabulary size in children with autism. tional information regarding the observed performance
TD children showed no relationship between vocabu- bias for real word reading versus nonword reading by
lary knowledge and phonological awareness, indicating children with autism seen in this study.
that performance on the phonological awareness tasks was Results from this study clearly demonstrate that
developmentally independent of vocabulary size and stored phonological awareness is less developed for the children
lexical representations for their age. However, a strong pos- with autism than for TD children of the same age. We are
itive relationship was seen between speech articulation and unable to determine from this study whether this is a
single word identification in reading (but not nonword developmental delay and whether the children with
reading) and between NVIQ and nonword phonetic decod- autism will eventually acquire the cognitive understand-
ing and performance on the elision task by the TD children. ing of words and syllable structure at the level of onset-
Research on the concurrent and longitudinal relationship of rimes. However, the difference in phonological awareness
articulation accuracy and word reading has shown that ability may explain why more difficulty was observed in
word reading is mediated by phonological awareness and the phonetic decoding of nonwords by the children with
speech perception, not articulation accuracy (Rvachew, autism. Vocabulary size was found to be related to the
2007). The correlation between speech articulation and sin- more cognitively challenging phonological awareness
gle word identification by the TD children may be a spuri- task of elision, suggesting that understanding of word and
ous finding due to the limited number of children in the syllable onsets-rimes may be dependent on stored sublex-
sample. The positive association between NVIQ and pho- ical knowledge in this group of children with autism.
netic nonword reading and performance on the elision task However, children with autism clearly have knowledge of

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82 Communication Disorders Quarterly

the alphabetic principle and the relationship between comparison of standard scores achieved by children with
print and speech as evidenced by their average to above- autism and TD children on these tasks. As expected, TD
average ability for age for word identification and pho- children demonstrated developmentally appropriate word
netic decoding of nonwords, even in the face of disparate recognition and phonological awareness skills on the stan-
skill between these two aspects of word recognition. dardized tasks for age. The children with autism scored
Moreover, the children with autism in this study were below average on the standardized tasks of phonological
able to engage in a phonetic synthesis task (e.g., sound awareness and within average to above-average expected
blending), requiring some apprehension of the relation- performance for age on the word reading measures. The
ship between speech sounds and words. Future research only between-group difference for the dependent variables
should explore the developmental hierarchy of levels of under study was seen on performance on measures of
ability in phonological awareness and its relationship to phonological awareness for the two groups. However, the
reading achievement, vocabulary, and cognitive develop- small number of children in the TD group may have influ-
ment by children with autism. enced the correlation analyses, as was seen in the possibly
The clinical implications of this research are twofold. spurious positive relationship between word articulation
The first is that a reliance alone on standard scores for and for the TD group of children.
children with autism on measures of single word reading Another limitation of the study was the recruitment
and nonword decoding may not reveal subtle underlying process that yielded more boys than girls in the sample
difficulty with word analysis skills necessary for suc- of children with autism. Children with autism were not
cessful comprehension in reading. Clinicians are encour- recruited from a developmental center or hospital serv-
aged to also engage in the clinical observation of single ing a large and comprehensive population of children
word and nonword reading ability by children with with autism and their families; rather, the children were
autism and note behaviors suggestive of subtle difficulty recruited via parent response to research notice postings
with word analysis skills such as hesitations or phonetic on parent support groups’ Web pages. This may have
cue reading where the child uses some of the initial lat- skewed the number of boys versus girls in the study.
tés of the word to guess at its pronunciation (Ehri, 1992, The identification of verbal ability by parent report
1995). Second, the inclusion of assessment and instruc- and confirmed through clinical observation as a criterion
tion in levels of phonological awareness for children for entry of children with autism in the study is weak.
with autism is critical. As children progress through the However, determination of functional language at the
educational system, adequate and robust word reading phrase or sentence level often relies on skilled clinical
ability by all children is the foundation for more observation because the use of other traditional sponta-
advanced ability in reading comprehension (Kahmi, 2007; neous language indices such as mean-length of utterance
Perfetti, 1985; Perfetti & Hagoboam, 1975). Careful and (MLU) would not by itself differentiate appropriate
systematic assessment of phonological awareness across pragmatic function.
a developmental hierarchy of skills, including skill in The reliance of parent report, well-child pediatric
rhyming, blending segmenting, and phoneme manipula- screenings, and educational documentation of hearing sta-
tion (Chafouleas, Lewandowski, Smith, & Blachman, tus of the children is a limitation of the study. However,
1997; Gillon, 2004), can and should lead to appropriate because the majority of the children were seen in their
clinical and classroom intervention to help support the homes and not recruited through a comprehensive medical
development of robust word analysis ability in reading. center or seen at a university clinic, the reliance on the this
documentation of normal hearing status was accepted.
The group differences in NVIQ, vocabulary size (i.e.,
Study Limitations
PPVT), and skill in word articulation was also a limitation
There are several limitations to the study. One limitation of the study although no relationship was seen for the chil-
involves the unequal number of children in the two groups, dren with autism between NVIQ and word articulation
with only 10 age-matched TD children in the control group and measures of single word reading or phonological
and 14 children in the group of children with autism. awareness. However, vocabulary size was noted to be
Because tasks chosen to measure single word reading and related to the more difficult metalinguistic task of elision
phonological awareness were chosen from norm- of onsets-rimes within syllables. Vocabulary size should
referenced standardized tests, the large normative sample be a carefully controlled variable in future research on
of children used in the development of these standardized phonological awareness and word reading for children
measures also served as an inherent control group for with autism.

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Smith Gabig / Reading by Children With Autism 83

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