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Scoping review of the question: "How is communication between health care provider and patient/caregiver linked to health outcomes?"

Few studies exist concerning multisyllabic word development, yet researchers suggest that evaluation of long words is essential for phonological assessment of school-aged children (e.g. Holm, Farrier, & Dodd, 2008; James, 2006). Furthermore, multisyllabic word (MSW) production may be related to literacy development (Carroll & Snowling, 2004). The goal of this thesis therefore was to further study the phonological acquisition of MSWs. The dissertation begins with a meta-analysis (Chapter 2) that examines factors related to word level literacy skills in children with and without protracted phonological development (PPD). Fifty-two eligible studies were evaluated that had measured at least one word level literacy construct. Sixty-four independent samples were generated for evaluation of: Phonological awareness, Decoding, Fluency, Nonword decoding and Spelling. A mean mixed weighted d was compared on the Q-statistic using a random effects model. MSW evaluation was a relevant moderator of literacy for children with PPD as expected and motivated the remainder of the thesis. A pilot study (Chapter 3) evaluated a new MSW metric based on nonlinear phonological and language processing frameworks. Six MSWs were analyzed for ten English-speaking typically developing (TD) 5-year-olds, and eight French-speaking 3- to 4-year-olds with PPD. Mismatches were tallied and ranked, and compared with tallies from Phonological Mean Length of Utterance (Ingram, 2002) and Percent Consonants Correct (Shriberg, Austin, Lewis, McSweeny, & Wilson, 1997). The number of different ranks was significant and systematically higher with the new metric. Chapter 4 examines production of 20 MSWs in three sub-studies: (a) longitudinal: 44 TD children at ages 5 and 8 to 10 years; (b) cross-sectional by age: twelve age-matched 8- to 10-year-olds with and without PPD; and (c) cross-sectional by group: 62 TD 5-year-olds and the 12 8- to 10-year-olds with PPD. Lexical and phonological tallies decreased significantly between ages 5 and 8 years for the TD children. The 8- to 10-year-olds with PPD showed overall scores equivalent to those of the TD 5-year-olds although some different mismatch (error) patterns. In summary, the thesis further examines the link between MSWs and literacy and provides both a new whole-word metric for MSWs and phonological data for school-aged children.