AJSLP Research Article What Factors Place Children With Speech Sound Disorders at Risk for Reading Problems? Jason L. Anthony, a Rachel Greenblatt Aghara, a,b Martha J. Dunkelberger, b Teresa I. Anthony, a Jeffrey M. Williams, a and Zhou Zhang a Purpose: To identify weaknesses in print awareness and phonological processing that place children with speech sound disorders (SSDs) at increased risk for reading difficulties. Method: Language, literacy, and phonological skills of 3 groups of preschool-age children were compared: a group of 68 children with SSDs, a group of 68 peers with normal speech matched on receptive vocabulary, and a group of 68 peers with normal speech and language. Results: The SSD group demonstrated impairments in expressive phonological awareness (t s = 3.45 to 8.17, p s < .001, effect size [ES] = 0.51 to 1.04), receptive phono- logical awareness (z s = 2.26 to 5.21, p s ≤ .02, ES = 0.39 to 0.79), accessing phonological representations (z s = 3.34 to 5.83, p s < .001, ES = 0.59 to 0.91), quality of phonological representations (z s = 2.35 to 13.11, p s ≤ .02, ES = 0.44 to 1.56), and word reading (t s = 2.48 to 4.42, p s ≤ .01, ES = 0.22 to 0.54). Analyses of covariance found that lower performances of the SSD group on tests of phonological awareness and word reading could be explained by their weaknesses in quality and accessibility of phonological representations. Conclusions: The present study makes a significant theo- retical contribution to the literature as the first study, to our knowledge, that has tested the hypothesis that weaknesses in representation-related phonological processing may underlie the difficulties in phonological awareness and reading that are demonstrated by children with SSDs. Key Words: speech sound disorders, articulation, phonological awareness, phonological representation, reading C hildren with speech sound disorders (SSDs) dem- onstrate delayed acquisition of developmentally appropriate speech sounds, resulting in reduced intelligibility of their speech. SSDs are limited to disorders of speech sound production, exclusive of speech disfluen- cies. Idiopathic SSDs are not caused by known etiological factors, such as cleft palate or cleft lip, hearing loss, or cranio- facial or dental abnormalities. Instead, SSDs are hypothesized to reflect a central cognitive and neurological deficiency in how phonemes are represented and organized within the language system (Fey, 1992; Grunwell, 1987). SSDs are heterogeneous (Leitão & Fletcher, 2004; Raitano, Pennington, Tunick, Boada, & Shriberg, 2004), inclusive of developmental speech delay and patterns of speech errors that do not follow developmental norms. In clinical practice and the professional literature, SSDs have also been referred to as articulation disorders, phonological disorders, expressive phonological impairment, and deficient output phonology. Children with SSDs are at increased risk of having dif- ficulties learning to read (Bird, Bishop, & Freeman, 1995; Bishop & Adams, 1990; Carroll & Snowling, 2004; Catts, 2001; Larivee & Catts, 1999; Raitano et al., 2004; Roberts, 2005; Snowling, Bishop, & Sothard, 2000). In fact, between 30% and 77% of children with SSDs struggle with reading (Bird et al., 1995; Larrivee & Catts, 1999; Lewis, 1996; Nathan, Stackhouse, Goulandris, & Snowling, 2004). Chil- dren with SSDs have as high a risk of developing a reading disability (RD) as children with a family history of RD (Carroll & Snowling, 2004), which is remarkable in light of heritability estimates for RD that range from 40% to 70% (e.g., Friend, Defries, & Olson, 2008; Pennington, 1989). The risk of children with SSDs having literacy problems increases with comorbid language disorders (Nathan et al., 2004; Raitano et al., 2004), severity of the SSD ( Nathan et al., 2004), persistence of the SSD (Nathan et al., 2004; Raitano et al., 2004), and patterns of articulation errors that do not follow developmental trajectories (Leitão & Fletcher, 2004; Leitão, Hogben, & Fletcher, 1997; Mann & Foy, 2007; a University of Texas Health Science Center, Houston b University of Houston Correspondence to Jason L. Anthony: jason.l.anthony@uth.tmc.edu Editor and Associate Editor: Laura Justice Received June 2, 2010 Revision received December 22, 2010 Accepted March 3, 2011 DOI: 10.1044/1058-0360(2011/10-0053) American Journal of Speech-Language Pathology • Vol. 20 • 146–160 • May 2011 • A American Speech-Language-Hearing Association 146 Complimentary Author PDF: Not for Broad Dissemination