Improving Literacy Skills in Students with Complex Communication Needs Who Use Augmentative/Alternative Communication Systems

A structured intervention package including direct, scaffolded, instructional lessons was implemented using an error correction learning system and a picture book-based phonological and phonemic awareness activity for four participants with complex communication needs, ranging from 12 to 15 years, in a junior high school setting. Although variability in participant results was noted, a functional relationship between the structured literacy intervention package and sound to letter matching ability was found. Results of this investigation indicate that this intervention package appears promising for facilitating learning of sound-toletter matching skills in students with complex communication needs who use augmentative/alternative communication systems. However, due to the nature of single-subject research, generalizability of results is in question. Additionally, further research is needed to determine the effect of this intervention on word decoding and reading comprehension skills. One of the primary goals for the education of all students, including those with complex communication needs (CCN) who use alternative and augmentative communication (AAC), is the development of literacy. As clearly stipulated by the No Child Left Behind (NCLB) Act and the Individuals with Disabilities Education Improvement Act ([IDEIA] IDEIA, 2004; NCLB, 2004), instruction and assessment of reading and literacy skills must be addressed for children with disabilities. The IDEIA specifically requires “consideration” of assistive technology (AT) devices, which include AAC and services when developing Individualized Education Plans [IEPs; 20 U.S.C. § 1401(1)-(2)]. For students who are AAC users, literacy takes on heightened importance. For students with developmental disabilities, literacy can foster new experiences and for students with severe physical limitations the acquisition and demonstration of literacy skills may be their primary entry into the job market (Smith & Blischak, 1997). Literacy development for students who use AAC is a complex issue, since their language development, their opportunities to practice skills associated with reading, and their ability to produce oral reading can be impaired or extremely limited. Components of Literacy Literacy requires knowledge of language components, such as phonology, morphology, syntax, semantics, and pragmatics (Strum & Clendon, 2004). Specific skills associated with these components include those that have been identified as preliteracy skills. These include components of phonemic awareness, alphabetic principle, fluency, concepts about print, vocabulary development, and comprehension (Clay, 1975; National Reading Panel, 2000; Teale & Sulzby, 1986). Collectively, these skills provide the foundation for the development of reading which is fundamental for independence in our society (International Reading Association [IRA] & National Association for the Education of Young Children [NAEYC], 1996). Typically developing children begin to learn preliteracy skills very early through exCorrespondence concerning this article should be addressed to Rita L. Bailey, Department of Communication Sciences and Disorders, Campus Box 4720, Illinois State University, Normal, IL 617904720. Education and Training in Autism and Developmental Disabilities, 2011, 46(3), 352–368 © Division on Autism and Developmental Disabilities 352 / Education and Training in Autism and Developmental Disabilities-September 2011 posure to language and print, which includes story reading and observing adult literacy activities. Preliteracy skills begin to develop when children understand the relationship between word and print, are able to identify phonemes in words, and are able to actively practice this knowledge through speech (Hetzroni, 2004). Language is the vehicle through which literacy is learned, refined, and mastered. Language development in children with CCN can be severely impaired due to accompanying intrinsic deficits, such as cognitive, physical, perceptual, or sensory impairments (Smith & Blischak, 1997) and significantly different language learning opportunities (Sturm & Clendon, 2004). Students with CCN may have restricted access to their environments, limited interactions with communication partners, and fewer opportunities to communicate (Light & Drager, 2007; Sutton, Soto, & Blockberger, 2002). Not only may these opportunities be limited, but when they do occur, the quality may also be significantly altered due to variables associated with the child, the environment, the communication partner, and the mode or lack of expression. Children with CCN who use AAC may not have the opportunity to experience language as children without speech impairments (Sutton et al., 2002). If language is delayed or impaired, development of literacy will also be affected. Language and literacy skills do not develop in isolation but over time and are dependent on students’ skills as well as environmental exposure and demands (Scherz & Hart, 2002). Students with CCN may face access barriers to developing literacy due to limited speech, lack of conversational opportunities, and/or concomitant sensory, cognitive, or motor disabilities (Hetzroni, 2004). Barriers that may affect literacy development are limited opportunities to ask questions or provide input to vocabulary selection, limited practice with books, and low literacy expectations from education professionals (Hetzroni, 2004; Light & Drager, 2008; Sturm & Clendon, 2004). These obstacles in language and literacy acquisition are not faced by typically developing children (Blockberger & Johnston, 2003). Research focusing on students with CCN who use AAC has highlighted the discrepancy between their cognitive abilities and predicted literacy skills (Dahlgren Sandberg, 2001; Dahlgren Sandberg & Hjelmquist, 1996; Foley, 1993; Sutton, Soto & Blockberger, 2002). Therefore, it is incumbent on professionals who work with students with CCN to identify appropriate AAC to promote literacy and to develop effective strategies that foster acquisition of skills necessary for literacy development. Phonological Awareness Phonological awareness, which is awareness of the sound structure of spoken language, has been identified as vitally important to reading and an unequivocal predictor of successful reading ability (Adams, 1990; Dahlgren Sandberg, 2001). Adams identified three levels of phonological awareness: (a) words in sentences, (b) syllables in words, and (c) sounds in syllables and words. The term phonemic awareness refers to the segmenting and manipulating of phonemes (Blischack, Shaw, Lombardino, & Chiarella, 2004) and these two skills are vital to developing reading ability. Segmentation strongly correlates with word reading and comprehension. Manipulation involves the ability to segment a word and then to manipulate one or more of the phonemes in that word. An example of this would be asking a student to identify the sounds in cat and then replace the first phoneme with a different one such as /m/ to create a new word, mat. AAC users, who may not have the ability to produce speech, face unique challenges in the development of phonological awareness skills (Smith & Blischak, 1997). Recently, research has empirically validated strategies for teaching phonological and phonemic awareness skills to children with CCN who are AAC users (Blischak et al., 2004; Fallon, Light, McNaughton, Drager, & Hammer, 2004, Johnston, Buchanan, & Davenport, 2009). Blischak et al. used a single-subject multiple baseline design to investigate the effect of a literacy intervention with three students, ages 7.0, 5.0, 6.2, with severe speech impairment. The intervention taught students phoneme-grapheme awareness followed by instruction in segmenting, manipulating, and encoding consonant-vowel-consonant (CVC) pseudowords. Two of the participants met the criterion on the grapheme-phoneme awareImproving Literacy Skills / 353 ness tasks after three instructional sessions. One student had repeated difficulty and was not able to be advanced to segmenting, manipulating, and encoding CVC pseudowords. Interestingly, this is the one student who was using an AAC device. He was also the youngest participant in the investigation, which may have affected learning rate and/or amount. The two students who received instruction in segmenting, manipulating, and encoding CVC pseudowords met criterion and retained these abilities during maintenance probes. In Fallon et al.’s (2004) investigation, instruction in phonemic awareness and phonics was implemented using 3-in. 3-in. laminated picture cards that were created using Boardmaker Software version 3.5. These instructional tools were successfully used to teach single-word reading skills to five children, ages 9.5 to 14.0 years, with severe speech impairments. Within this program, phonemic awareness and phonics instructional lessons were taught using multiple instructional strategies that included scaffolding instructional tasks to promote errorless learning and direct instruction (Ellis, Worthington, & Larkin, 1994). Results of Fallon et al.’s investigation indicated improvements in reading target words, novel words, and generalization to book contexts. Although pictures were paired with consonant-vowel-consonant (CVC) words as a stimulus for reading tasks in the Fallon et al. investigation, contextualized instruction using books and/or stories was not a feature of instruction. Two recommendations for modifications for future investigations made by the researchers included “increased phonological awareness instructional time” and “the addition of written words during phonological awareness activities” (p. 1436). Johnston, Buchanan, and Davenport (2009) investigated the rate of letter-sound acquisition with two preschoolers with autism spectrum disorder (ASD). An alternating treatments design was used and the target letters were presented in two conditions; (a) gradual array and (b) fixed array. In the gradual array condition the target letter was presented in isolation and seven distracter letters were gradually added. In the fixed array condition seven letter distracters were presented with the target letter. Results were that acquisition of letter-sound correspondence was faster when the letter was presented in the fixed array condition for both participants. The authors contend that the fixed array condition was more efficient for letter-sound acquisition and call for more research on effective strategies that teach literacy skills to children with CCN. Recently, Strasser and Seplocha (2007) described the importance of using picture books to facilitate literacy instruction in young children. Picture books plus printed words have been reported to be effective in helping children gain general knowledge, practice cognitive thinking, and learn about the rhythms and conventions of written words (Neuman, 1999). Picture books also expose children to a rich vocabulary (Strasser & Seplocha). Use of picture books may provide a contextualized basis for phonological awareness instruction that facilitates phonemic awareness, awareness of alphabetic principle, phonics, and even recognition of sight words. Use of picture book-based reading interventions may be similarly important for children with CCN. There has been a call in the literature to further investigate literacy acquisition in students with CCN who use AAC (Dahlgren Sandberg, 2001; Hetzroni, 2004; Johnston, Buchanan, & Davenport, 2009; Sturm & Clendon, 2004; Sturm, Erickson, & Yoder, 2002). Unfortunately, few published reports have measured the efficacy of instructional programs in preliteracy and literacy skills of these students. This information is needed to help professionals determine the most effective and efficient instructional programs in literacy for students with CCN who use AAC. The purpose of this investigation was to determine the effects of a structured intervention package on junior high school students’ sound-to-letter matching skills and decoding of novel words. The structured intervention package included direct, scaffolded, instructional lessons that were implemented using an error correction learning system. Additionally, a picture book-based phonological and phonemic awareness component was added to each instructional lesson. The primary goal of the investigation was to determine the effects of this intervention package on the preliteracy and literacy skills of students with CCN who use AAC. 354 / Education and Training in Autism and Developmental Disabilities-September 2011