Phonological awareness is taught from preschool onwards because of its impact on later reading skills. Numerous assessments and training sessions are available to guide childcare professionals. Most of them offer phonological sessions based on the use of pictures or visual aids. However, only few studies have shown the benefits of using this type of material on the phonological performance of young children and only on a limited number of phonological skills. Therefore, these results cannot be generalized. The aim of the present study was to measure the effects of item modality (i.e., word, word-picture) on phonological skills of children aged 4 to 6 years. To this end, a test covering a wide range of eight phonological skills of increasing difficulty was developed, ranging from epiphonological tasks (i.e., discrimination) to metaphonological tasks (i.e., manipulation). 187 French children divided into two groups (i.e., auditory vs. auditory–visual) took part in the study. The results show no difference between the children’s phonological performance in the auditory and auditory–visual conditions. Thus, phonological awareness can be measured and taught using words and word-picture items, the latter having no proven facilitating or disruptive effect.