Brain and Language 88 (2004) 21–25
www.elsevier.com/locate/b&l
Effect of intensive training on auditory processing and reading skills
John A. Agnew, Courtney Dorn, and Guinevere F. Eden*
Center for the Study of Learning, Georgetown University Medical Center, USA
Accepted 27 May 2003
Abstract
This study assessed the ability of seven children to accurately judge relative durations of auditory and visual stimuli before and
after participation in a language remediation program. The goal of the intervention program is to improve the childrenÕs ability to
detect and identify rapidly changing auditory stimuli, and thereby improve their language-related skills. Children showed improved
accuracy on a test of auditory duration judgement following the intervention without analogous improvements in the visual domain,
supporting the assertion that intensive training with modified speech improves auditory temporal discrimination. However, these
improvements did not generalize to reading skills, as assessed by standard measures of phonological awareness and non-word
reading.
Ó 2003 Elsevier Inc. All rights reserved.
Keywords: Language; Specific language impairment; Dyslexia; Reading; Temporal processing; Remediation
1. Introduction
der Lely & Christian, 2000) and others that the deficit is
specific to grammar (Bishop, 2000; Sahlen, Reuterski-
It has been proposed that training with acoustically
old-Wagner, Nettelbladt, & Radeborg, 1999). The role
modified speech can improve the auditory language
of audition has also been examined in developmental
skills of individuals with specific language impairment
dyslexia, a reading disorder that affects 5–10% of the
(SLI) and dyslexia (Habib et al., 1999; Tallal, Merze-
population. Individuals with dyslexia fail to achieve
nich, Miller, & Jenkins, 1998; Tallal et al., 1996). SLI is
normal reading skills despite adequate intelligence, ed-
generally characterized as a difficulty with age-appro-
ucational opportunities, and socioeconomic status
priate use of expressive and receptive language without
(Shaywitz, Shaywitz, Fletcher, & Escobar, 1990). Sev-
other cognitive impairments and is thought to affect 3–
eral studies have reported that children with SLI and
10% of children (Bishop, 1994). In addition to their
dyslexia cannot differentiate between rapidly changing
linguistic difficulties, individuals with SLI are often
consonant–vowel (CV) syllables when presented at
found to also have deficits in non-linguistic domains
normal speed (Tallal, Miller, & Fitch, 1993; Tallal et al.,
such as planning complex oral-motor patterns, working
1996). It has been suggested that this ability is important
memory, sound perception, and visual imagery (Joanisse
for language acquisition and the development of pho-
& Seidenberg, 1998).
nological awareness and reading skills (Talcott et al.,
According to some research, approximately 50% of
2000; Tallal et al., 1993) and that deficits in this domain
children with specific language impairment have reading
may result in impaired language facility including
problems when tested in second and fourth grades
reading.
(Catts, Fey, Tomblin, & Zhang, 2002). Although the
The intervention program studied here attempts to
cause of SLI remains controversial, some suggest that it
address such deficits by modifying normal speech in
is due to a deficit processing input in the auditory do-
such a way that the most rapidly changing components
main (Skipp, Windfuhr, & Conti-Ramsden, 2002; van
are extended in time by 50% and amplified by up to
20 dB (Nagarajan et al., 1998; Tallal et al., 1996). These
*
increases in duration and volume are designed to en-
Corresponding author. Fax: 1-202-687-6914.
E-mail address: edeng@georgetown.edu (G.F. Eden).
hance the salience of the fastest-changing components of
0093-934X/$ - see front matter Ó 2003 Elsevier Inc. All rights reserved.
doi:10.1016/S0093-934X(03)00157-3

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22
J.A. Agnew et al. / Brain and Language 88 (2004) 21–25
speech, facilitating their perception by the listener. This
These results suggest that training with modified
modified speech is embedded in computer games that
speech improves receptive language and phonological
are presented to children over the course of the training,
skills in children. However, it has not yet been deter-
which usually lasts about 6 weeks. During training, the
mined whether these improvements in oral language are
speed and volume of the CV syllables are gradually re-
due to an increased ability to accurately perceive and
turned to the levels found in normal speech. Hence, at
process auditory stimuli or if they might be better ex-
the end of training, the speech presented by the program
plained by other mechanisms. For example, the intense
is almost the same as normal speech in terms of volume
monitoring of stimuli on the computer screen might lead
and rate of presentation (Tallal et al., 1996).
children to attend more effectively. A related question,
This program has been studied in a laboratory set-
which pertains to all intervention programs, is whether
ting, exposing children with SLI to the acoustically
the improvements are specific to the particular tasks that
modified speech for three hours a day, five days a week
comprise the program or if the observed gains generalize
for four weeks (Merzenich et al., 1996; Tallal et al.,
to other skills, such as reading.
1996). Following training, the children improved by
This study addressed two questions: first, can the
approximately 2 years on standardized measures of
original findings from a laboratory setting reported by
speech discrimination and language processing, im-
Tallal et al. (1996) be reproduced in a clinical setting?
provements that endured at least 6 weeks after training
Specifically, are there measurable gains in auditory
(Tallal et al., 1996). In a second experiment, conducted
processing that are not directly trained by the inter-
by the same investigators, children with SLI were re-
vention program? Second, does training with acousti-
cruited and divided into two groups. One group received
cally modified speech result in reading gains? To address
training with the modified speech while the other re-
the first question, subjects were recruited from and tes-
ceived equal training using unmodified speech. After 4
ted at a local clinic. Although this allowed for less
weeks of training, both groups showed improvements on
stringent inclusion/exclusion criteria for the subject
measures of receptive language skills, but the group that
population and administration of the intervention pro-
received training with the modified speech showed sig-
gram, it more accurately represented the environment in
nificantly greater improvements (Merzenich et al., 1996;
which the intervention program was delivered to these
Tallal et al., 1996).
children. To address the question of the specificity of
Reading skills, including non-word decoding, and
training, a task measuring the ability of participants to
phonological awareness were not assessed by these
accurately judge relative duration in both the auditory
studies (Merzenich et al., 1996; Tallal et al., 1996). Al-
and the visual domain was administered to children
though additional investigations have been performed
participating in the program. Previous studies have used
outside the laboratory in clinics and classrooms, en-
measures of oral language skill, but not reading
rolling individuals diagnosed with SLI, attention deficit
achievement, as outcome measures (Tallal et al., 1996).
disorder, autism, and dyslexia (Tallal, 2000; Tallal et al.,
Further, these language outcome measures and the ac-
1998), reading gains have not been reported to date.
tual intervention program share many common features,
Language skills, however, were assessed by professionals
so that improvement in these tasks is not unexpected. In
in the clinics and the authors reported that significant
the present study, the tasks were designed to be an in-
improvements were observed on standardized measures
dependent measure of auditory duration judgement not
of speech and language, regardless of which measures
specifically trained. The visual modality was chosen as a
were used by the various clinics. Results from these
control condition in which improved performance is
studies have led the authors to conclude that the Fast
expected if the intervention induces general changes in
For Word program is effective for individuals with a
attention (or other) processes and not in auditory pro-
range of language and communication disorders (Tallal
cesses per se. It was hypothesized that subjects would
et al., 1998; Tallal, 2000).
improve on the auditory duration judgment task but not
Further support for acoustically modified speech as
on the visual task. It was further hypothesized that in-
an effective intervention comes from an investigation in
tervention would improve skills associated with non-
12 children diagnosed with pure phonological dyslexia
word decoding and phonemic awareness, skills related
(Habib et al., 1999). Experimenters subdivided their
to reading acquisition.
population into an experimental group that received
intervention using the modified speech and a control
population that received training using normal speech.
2. Methods
Their results indicated that after 5 weeks of training, the
experimental group showed significantly greater im-
2.1. Intervention
provements on a phonological task in which they had to
identify the non-rhyming word in a set of four words
All subjects participated in the intervention program
than did the control group (Habib et al., 1999).
Fast
ForWord
(Scientific
Learning
Corporation,

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J.A. Agnew et al. / Brain and Language 88 (2004) 21–25
23
Berkeley, CA) until they had achieved accuracy scores
Seven subjects (four male, three female) were re-
of 90% correct on five of the seven tasks that comprise
cruited and had a mean age of 8.07 years (SD ¼ 1:19).
the program. This criterion is defined as completion of
They were tested on the duration judgement tasks at the
the training and achievement of good temporal pro-
beginning and completion of training. During these two
cessing skills. Children participated in the intervention
testing sessions, subjects were also given two measures
for 100 min a day, five days a week for approximately
of phonological awareness, the Word Attack subtest
4–6 weeks.
(Form A and B) of the Woodcock Diagnostic Reading
Battery (Woodcock, 1997), which tests non-word read-
2.2. Judgement of duration
ing, and the Phoneme Deletion subtest of the Phono-
logical Awareness Test (Robertson & Salter, 1997). A
Each task (auditory and visual) was broken into four
second form of this test was generated for post-inter-
blocks, each of which lasted approximately 4 min and
vention testing by matching the words on the original
the entire experiment, including both components, las-
form for word length and frequency using the MRC
ted 30–40 min. Trials were presented via SuperLab v. 1.0
Psycholinguistic Database (Culling, 1990). The average
(Cedrus Corporation, San Pedro, CA) on a Macintosh
standard score on the Word Attack subtest before
Powerbook 1400c (Apple Computer, Cupertino, CA).
training was 108 (SD ¼ 29) and it was 85 (SD ¼ 21) on
Data on duration judgment accuracy and response time
the Phoneme Deletion subtest.
were acquired.
Practical considerations led to the selection of the
The auditory task contained a fixation point that was
two tests of reading-related skills: both have been nor-
present at the center of the screen for the entire experi-
malized so that data from this study could be compared
ment. For each trial, an 800 ms tone was followed by an
with a large reference population. Second, they could be
inter-stimulus interval of 500 ms and then a tone of
performed quickly using pencil and paper and within a
variable duration. The duration of this tone differed
time frame acceptable to the private clinic setting.
from the first tone by between 10 and 3200 ms. The
Third, the phoneme deletion task assesses sublexical
order of presentation was pseudorandom and a staircase
processing and hence provides a measure of phonemic
procedure was not used. Following the second tone,
awareness. Phonemic awareness serves as a strong pre-
subjects responded by pressing one of two marked keys
dictor of reading ability (Wagner & Torgesen, 1987)
to indicate whether the second tone was longer or
and has not been assessed in previous studies investi-
shorter than the first. After responding, subjects auto-
gating the outcomes of acoustically modified speech
matically advanced to the next trial; no feedback was
intervention.
provided. After every seventh trial, a picture of an ani-
mal appeared on the screen for 2 s to make the task more
stimulating. All tones were presented at 1000 Hz via
3. Results
headphones at a level of 78 dB.
In the visual form of the experiment, the timing was
Data collected from the duration judgment study
the same but the auditory tone was replaced with a
were analyzed using a 2 Â 2 repeated-measures ANOVA
yellow smiley face subtending 2° of visual angle and
(Modality  Day) to examine both accuracy and reac-
placed at the center of a white background on the
tion time. For accuracy, there was a significant main
computer screen. As with the auditory experiment,
effect of day (F ð1; 12Þ ¼ 6:36; p < :05), indicating that
subjects had to judge whether the second stimulus was a
subjects performed more accurately after training than
longer or shorter duration than the first stimulus. Visual
before training. There was also a significant interaction
stimuli were presented on a computer monitor 0.4 m
of day by modality (F ð1; 12Þ ¼ 6:36; p < :05). Post-hoc
from the subject.
paired t tests indicated that subjects were significantly
more accurate on the auditory task after training than
2.3. Subjects
before
training
(73%
correct
vs.
61%
correct;
tð6Þ ¼ 3:27; p < :05) but not on the visual task (60%
Subjects were recruited from a group of children who,
correct vs. 60% correct; tð6Þ ¼ 0, n.s.), as shown in Fig. 1.
for a fee, were receiving the modified speech intervention
There were no significant effects for the reaction time
program at a private suburban clinic. The selected
data. After training, the average standard score on the
population is therefore representative of the sample
Word Attack task was 110 (SD ¼ 27) and 90 (SD ¼ 20)
typically enrolled for intervention in terms of back-
on the Phoneme Deletion subtest. This represented no
ground, age, and language ability. The children attended
significant improvement from the pretest values on ei-
the clinic over the summer and their participation re-
ther the Word Attack (tð6Þ ¼ 0:53, n.s.) or Phoneme
sulted from one or several factors, such as clinicianÕs
Deletion (tð6Þ ¼ 1:14, n.s.) tasks. Hence, gains in the
recommendation, parental concern or poor academic
ability to perceive auditory durations did not generalize
performance.
to changes in skills related to reading.

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24
J.A. Agnew et al. / Brain and Language 88 (2004) 21–25
reading skills, as assessed by tests of phonemic awareness
and non-word reading. Only one child showed a minor
improvement on a standardized non-word decoding task
while the rest remained unchanged. This apparent con-
tradiction of previous findings may be resolved in future
studies, which could recruit more subjects, obtain more
extensive behavioral measures, including measures of
reading comprehension and receptive and expressive
language and obtain long-term, follow-up data.
The results of the current study indicate that some
children who undergo training with acoustically modi-
fied speech do show improvement on the judgement of
Fig. 1. Group accuracy data for auditory and visual modalities. There
auditory durations. However, these changes are not
is a significant difference between pre- and post-training for the audi-
accompanied by improvements on standardized mea-
tory modality (p < :05) but not for the visual modality.
sures of reading, illustrating the need for further re-
search to establish the relationship between reading and
4. Discussion
auditory temporal processing. Recently, some re-
searchers have questioned the assertion that the lin-
In these studies, the effect of an intervention program
guistic difficulties observed in children with SLI and
using acoustically modified speech on the judgement of
dyslexia result from a temporal processing deficit in the
non-linguistic sensory information in the auditory and
auditory system. Instead, these authors argue that the
visual modalities was measured. If performance had
ability to detect the changes in pitch that characterize
improved on both the auditory and the visual duration
the formant transitions of phonemes is not a temporal
judgment tasks following training, it could be concluded
processing task at all, but a sensory processing task that
that the training affected a general system (such as at-
must be accomplished rapidly. Instead of an ‘‘auditory
tention). Our results from a small group of children
temporal processing deficit,’’ they suggest that there is a
suggest that improvements were limited to the auditory
specific deficit in the phonological representations in
system, tentatively supporting the proposition that the
individuals with SLI and dyslexia (Mody, Studdert-
program improves the ability to perform fine discrimi-
Kennedy, & Brady, 1997: Studdert-Kennedy, Mody, &
nation only in the auditory modality. Previous studies of
Brady, 2000) and a weakness in the ability to identify
training using modified speech have reported improve-
similar phonemes (Adlard & Hazan, 1998). Our results
ments on phonological tasks with groups of only six
in this study support this assertion, as improvements on
subjects (Habib et al., 1999), supporting the view that
a task in which subjects improved in their ability to
the effect detected in the current study of seven subjects
accurately perceive auditory durations did not general-
is genuine and not an artifact of small sample size.
ize to improvements on reading skills.
A second hypothesis of this study was to explore
To our knowledge, the present study is the first in-
possible relationships between auditory temporal pro-
dependent demonstration of the effects of training with
cessing skills and reading in children undergoing inter-
modified speech on sensory perception conducted in a
vention training in a private clinic setting. Although the
clinical setting. More studies are necessary to charac-
initial studies of the Fast ForWord program by Tallal
terize the exact relationship between performance on
et al. (1996) and Merzenich et al. (1996) did not assess the
auditory temporal processing, reading skills and reading
effect of training on reading skills, their subsequent work
remediation.
suggests that the program can assist individuals with
developmental dyslexia (Tallal, 2000; Tallal et al., 1998).
Studies by Habib et al. (1999) identified improvements in
Acknowledgments
phonological awareness following training with acous-
tically modified speech. Another study identified a sig-
We wish to acknowledge the staff of the National
nificant positive correlation between reading skills and
Speech and Language Therapy Center, especially Sabra
sensitivity to changing auditory and visual stimuli (Tal-
Gelford and Betty Soret.
cott et al., 2000), suggesting that improvements in au-
ditory duration judgement might be correlated with
improvements in readings skills. The results of the
References
present study did not support this hypothesis. Although
subjects successfully completed the intervention program
Adlard, A., & Hazan, V. (1998). Speech perception in children with
and demonstrated improvements on an auditory dura-
specific reading difficulties (dyslexia). Quarterly Journal of Exper-
tion judgement task, they did not show improvement on
imental Psychology, 51A(1), 153–177.

---

J.A. Agnew et al. / Brain and Language 88 (2004) 21–25
25
Bishop, D. V. (2000). How does the brain learn language? Insights
Shaywitz, S. E., Shaywitz, B. A., Fletcher, J. M., & Escobar, M. D.
from the study of children with and without language impair-
(1990). Prevalence of reading disability in boys and girls. Journal of
ment. Developmental Medicine and Child Neurology, 42(2), 133–
the American Medical Association, 264(8), 998–1002.
142.
Skipp, A., Windfuhr, K. L., & Conti-Ramsden, G. (2002). ChildrenÕs
Bishop, D. V. M. (1994). Is specific language impairment a valid
grammatical categories of verb and noun: A comparative look at
diagnostic category? Genetic and psycholinguistic evidence. Philo-
children with specific language impairment (SLI) and normal
sophical Transactions of the Royal Society of London, Series B, 346,
language (NL). International Journal of Language & Communica-
105–111.
tion Disorders, 37(3), 253–271.
Catts, H. W., Fey, M. E., Tomblin, J. B., & Zhang, X. (2002). A
Studdert-Kennedy, M., Mody, M., & Brady, S. (2000). Speech
longitudinal investigation of reading outcomes in children with
perception deficits in poor readers: A reply to DenenbergÕs critique.
language impairments. Journal of Speech Language and Hearing
Journal of Learning Disabilities, 33(4), 317–321.
Research, 45(6), 1142–1157.
Talcott, J. B., Witton, C., McLean, M. F., Hansen, P. C., Rees, A.,
Culling, J. (1990). UWA Psychology: Psycholinguistic Database (Dict.
Green, G. G. R., & Stein, J. F. (2000). Dynamic sensory sensitivity
Interface) [Online]. Retrieved 4 April, 2000, from the World Wide
and childrenÕs word decoding skills. Proceedings of the National
Web: http://www.psy.uwa.edu.au/MRCDataBase/uwa_mrc.htm.
Academy of Sciences, USA, 97(6), 2952–2957.
Habib, M., Espesser, R., Rey, V., Giraud, K., Braus, P., & Gres, C.
Tallal, P. (2000). Experimental studies of language learning impair-
(1999). Training dyslexics with acoustically modified speech:
ments: From research to remediation. In D. V. M. Bishop, & L. B.
Evidence of improved phonological performance. Brain and
Leonard (Eds.), Speech and language impairments in children:
Cognition, 40(1), 143–146.
Causes, characteristics, intervention and outcome (pp. 131–155).
Joanisse, M. F., & Seidenberg, M. S. (1998). Specific language
Hove, UK: Psychology Press.
impairment: A deficit in grammar or processing? Trends in
Tallal, P., Merzenich, M. M., Miller, S., & Jenkins, W. (1998).
Cognitive Sciences, 2(7), 240–247.
Language learning impairments: Integrating basic science, technol-
Merzenich, M. M., Jenkins, W. M., Johnston, P., Screiner, C., Miller,
ogy, and remediation. Experimental Brain Research, 123, 210–219.
S. L., & Tallal, P. (1996). Temporal processing deficits of language-
Tallal, P., Miller, S., & Fitch, R. H. (1993). Neurobiological basis of
learning impaired children ameliorated by training. Science, 271,
speech: A case for the preminence of temporal processing. In P.
77–81.
Tallal, A. M. Galaburda, R. R. Llinas, & C. von Euler (Eds.),
Mody, M., Studdert-Kennedy, M., & Brady, S. (1997). Speech
Temporal information processing in the nervous system: Special
perception deficits in poor readers: Auditory processing or phono-
reference to dyslexia and dysphasia (Vol. 682, pp. 27–47). New
logical coding? Journal of Experimental Child Psychology, 64, 199–
York: New York Academy of Sciences.
231.
Tallal, P., Miller, S. L., Bedi, G., Byma, G., Wang, X., Nagarajan, S.
Nagarajan, S. S., Wang, X., Merzenich, M. M., Schreiner, C. E.,
S., Schreiner, C., Jenkins, W. M., & Merzenich, M. M. (1996).
Johnston, P., Jenkins, W. M., Miller, S., & Tallal, P. (1998). Speech
Language comprehension in language-learning impaired children
modifications algorithms used for training language learning-
improved with acoustically modified speech. Science, 271, 81–84.
impaired children. IEEE Transactions of Rehabilitation Engineer-
van der Lely, H. K., & Christian, V. (2000). Lexical word formation in
ing, 6(3), 257–268.
children with grammatical SLI: A grammar-specific versus an
Robertson, C., & Salter, W. (1997). The phonological awareness test.
input-processing deficit? Cognition, 75(1), 33–63.
East Moline, IL: LinguiSystems, Inc.
Wagner, R. K., & Torgesen, J. K. (1987). The nature of phonological
Sahlen, B., Reuterskiold-Wagner, C., Nettelbladt, U., & Radeborg, K.
processing and its causal role in the acquisition of reading skills.
(1999). Non-word repetition in children with language impair-
Psychological Bulletin, 101(2), 192–212.
ment—pitfalls and possibilities. International Journal of Language &
Woodcock, R. W. (1997). Woodcock diagnostic reading battery. Itasca,
Communication Disorders, 34(3), 337–352.
IL: Riverside.

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Document Outline

• Effect of intensive training on auditory processing and reading skills
  • Introduction
  • Methods
    • Intervention
    • Judgement of duration
    • Subjects
  • Results
  • Discussion
  • Acknowledgements
  • References

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