Programa de interveção fonoarticulatória e fonológica em crianças com dislexia : elaboração e aplicação

Abstract

Introduction: The objective of this study was to evaluate the effect of a phono-articulatory awareness (PAA) stimulation intervention on phonological awareness (PA) and reading performance in dyslexic children. We developed an experimental intervention using a structured phono-articulatory program, and a control intervention, using a phonological intervention program. The role that PA plays in learning to read and write has been extensively referenced in the literature. It is one of the strongest predictors of early literacy skill development. Phonological awareness training - specifically phonemic awareness - helps to develop the phonological representation of words for children learning to read and can help children with developmental dyslexia improve their reading. Stimulating the PA is no easy endeavor. The sounds (phonemes) that are represented by letters have abstract and fragile aspects. Part of phonological awareness is the ability to manipulate the sounds within words. It has been shown that verbal subvocalization is associated with the maintenance and rehearsal of information in working memory, and with better performance in PA tasks. Phono-articulatory stimulation involves conscious and directive stimulation of language sounds, and it has been demonstrated to favor the development of PA skills, and to support the learning of associations among phonemes and graphemes. Developmental dyslexia is associated with persistent and unexpected difficulty to learn to read, and with an impairment in the phonological component of language; therefore, the investigation of intervention programs that favor the learning and automatizing phoneme-grapheme associations may help develop more effective, targeted programs for dyslexic children. Material and methods: We conducted an intervention study with experimental groups, active control and control and sample for convenience and blind evaluation, approved by the Ethics Committee of the Pontifical Catholic University of Rio Grande do Sul/RS, under registration 79243417.7.0000.5336. The study included children with developmental dyslexia evaluated at the Brain Institute (convenience sample) with three groups (control, active control and experimental) and blind assessments. The sample included 26 children (mean age 11,57, SD = 1,17; 7 girls) who were diagnosed with developmental dyslexia at our pro bono reading clinic. Families were invited following the diagnosis established by our umbrella project. Evaluations were carried out pre and post intervention using a standardized reading test in Portuguese (word reading speed and accuracy, text comprehension). The participants were divided into control group (G1), experimental group - PAA (G2), and active control group - PA (G3). The experimental group (G2) participated in the phonological and phono-articulatory remediation program designed for this study, which consisted of 18 sessions of PA skills stimulation with PAA support. The active control group (G3) participated in a published phonological remediation program (SILVA; CAPELLINI, 2011), which also consisted of 18 sessions of PA skills stimulation; the control group did not participate in any intervention. Results: The results show that the posttest measures for the experimental group showed significantly greater improvements in word reading accuracy, speed, text comprehension and phonological awareness relative to either the active control groups or control groups. In word reading accuracy, showed gains 7% in the control group (G1), 16% in the experimental group (G2), and 12% in the active control group, indicated significant difference (G1: p< 0,017; G2: p< 0,006; G3: p< 0,048). In reading speed, post-test evaluations showed (G1) had an increase of 3.4 words per minute not significant (p< 0,524, (G2) of 17.5 WPM that was statistically significant (p<0,030), and (G3) of 5.9 WPM, not significant (p<0,387). For text comprehension, (G1) showed a 5.7% increase not significant (p<0,168) in correct answers, (G2) a 20% increase statistically significant (p<0,021), and (G3), 5.5%, not significant (p<0,303). In PA and PAA tests, only the intervention groups achieved increase in performance. In the PA tasks there was an improvement of 10% in (G2) and 8.7% in (G3); PAA tasks saw an improvement of 12.4% in (G2) and 16.9% in (G3). The gains in phonological abilities were statistically significant (PA: G2 p<0,009, G3 p<0,032; PAA: G2 p<0,055, G3 p< 0,011). Conclusion: The results suggest that phono-articulatory intervention allows for greater gains in reading accuracy, speed and text comprehension and phonological abilities relative to phonological awareness intervention alone or business as usual (controls).