This study investigated the effectiveness of a phonological awareness intervention for 4-year-old children with Down syndrome. Seven children with Down syndrome who attended an early intervention centre participated in the intervention. Their performance on measures of phonological awareness (initial phoneme identity), letter name and sound knowledge, and print concepts pre-intervention and post-intervention, was compared with that of a randomly selected group of age-matched peers with typical development. The intervention involved print referencing techniques whereby the children's parents were instructed to bring the children's attention to targeted letters and sounds within words and to draw their attention to the initial phonemes in words during daily shared book reading activities. The intervention was presented for a 6-week period. The results indicated a significant treatment effect on phonological awareness and letter knowledge for the children with Down syndrome. Additionally, above-chance performance on the initial phoneme identity task was contingent on letter knowledge of the particular phoneme. Individual profiles of the children with Down syndrome pre-intervention and post-intervention are presented, and implications for the management of preschool children approaching the age of integration into mainstream primary schools are discussed. (Contains 3 tables and 2 figures.)