An estimated 2 million Americans have significant communication disabilities and require augmentative and alternative communication (AAC). Literacy skills are extremely important to these individuals because these skills provide a channel for educational assessment and learning, enhance vocational opportunities, promote self-expression, and facili tate independent living.
Literacy skills also provide access to increased generative capacity and vocabulary access via AAC systems such as alphabet boards and computer-based speech-generating devices. Finally, literacy skills facilitate access to mainstream technologies such as the Internet that may be used to bypass communication limitations in face-to-face conversations, enhance education, and expand employment opportunities (e.g., tele-employment).
Given the critical importance of literacy skills for individuals who require AAC, it is of great concern that most individuals who require AAC experience difficulties in literacy development. Their skills lag behind those of typically developing peers, and these problems persist into adulthood. Clearly, intervention is essential to improve literacy outcomes for individuals with significant speech impairments who require AAC.
Although formal instruction in reading and writing is typically not initiated until children reach school, it is now well recognized that important foundations for literacy development are established well before school starts. During this stage of emergent literacy, children are introduced to books and learn about print; they develop language skills that are fundamental to later literacy development; and they learn early phonological awareness skills and may be introduced to sound-symbol associations. This stage of emergent literacy development is crucial for individuals who require AAC to ensure that they are well prepared for more formal reading and writing instruction.
Emergent Literacy Experiences
Children who require AAC tend to have literacy materials and models in their homes similar to those of their typically developing peers. However, they have significantly less access to printed materials and seldom engage in early "writing " or drawing activities. Furthermore, early intervention programs for children who require AAC seldom emphasize early literacy experiences.
Most early literacy experiences are embedded in social interactions mediated by literate adults, such as story reading. These interactions have been widely recognized as natural contexts for language and literacy learning for young children. During the interactions, adults provide children with opportunities to develop vocabulary, discourse, comprehension, and pre-literacy skills. With repeated readings of familiar stories, children have the opportunity to develop competence in talking about the story and taking meaning from the text, and they gradually assume more active roles in storybook interactions.
However, research suggests that children who use AAC have qualitatively different experiences that may affect their development of emergent literacy skills. Their adult partners (e.g., parents, teachers, aides) often do not naturally provide supportive opportunities for these children to develop their skills within story-reading interactions. Adults typically dominate the interactions and provide few opportunities for children to take communicative turns. They often do not provide the children with access to their AAC systems during these interactions, and they tend to emphasize the more mechanical aspects of book reading (e.g., turning pages, lifting flaps) rather than the meaning of the text. Therefore, intervention targeting the interaction skills of adult partners is a critical component of emergent literacy programs for children who use AAC.
Current research suggests that it is possible to teach these adult partners to modify their interaction patterns to better support the development of emergent literacy skills by children who require AAC.
Jennifer Kent-Walsh is currently conducting a research study at The Pennsylvania State University to evaluate the effectiveness of an intervention program designed to teach appropriate interaction skills to adult partners (specifically classroom aides) of children who use AAC during interactive storybook reading. The goal of this program is to modify the interaction strategies used by the adult partners to increase the children's participation and facilitate their development of language and emergent literacy skills. Specifically, the adult partners are taught to:
• Model use of the child's AAC systems while reading the text (e.g., to sign key words as they read or to point to AAC symbols representing key concepts on the child's communication board or speech output system)
• Pause and wait expectantly for the child to participate
• Ask appropriate open-ended questions that are related to the book and the child's experiences, while modeling use of the AAC system
• Respond appropriately to the communication attempts made by the child
Initial results of this study suggest that the adult partners were able to master use of these interaction strategies with 3–5 hours of individual instruction. When adult partners use these strategies, the children's rates of communication turn taking increase dramatically. Before intervention, the children who required AAC were taking a mean of only three turns in 10-minute story-reading interactions (range 1–10 turns). After adult partners implemented the interaction strategies, the children increased their rates of turn taking to a mean of 40 turns in 10 minutes (range 18–59).
The adult partners were able to generalize use of the strategies to other classroom activities (e.g., art activities) in which children showed similar gains in rates of turn taking. Their increased rates of participation provided the children with significantly increased opportunities to enhance their language and literacy skills.
The children also showed obvious increases in the range of semantic concepts that they expressed during storybook reading. Before instruction, they expressed a mean of three different concepts in 10 minutes of story reading. After instruction with the adult partners, the children expressed a mean of approximately 30 different concepts in the 10-minute interactions (range 11–64). Educational assistants and parents reported high levels of satisfaction with this instructional program. The program is relatively easy and efficient to implement, and is highly effective in increasing the participation of children who require AAC.
In addition to these story-reading interventions, it is also important to ensure that children who require AAC have greater access to early reading and writing experiences by:
• Making print materials accessible (e.g., adding tabs to storybooks, moving book shelves so that books are accessible, or introducing books on CD-ROM)
• Incorporating print in play activities (e.g., grocery store)
• Adapting standard writing materials to allow use by children with motor impairments
• Providing early access to computers (e.g., early writing and drawing experiences)
• Encouraging regular story-reading activities with books chosen by the children
• Ensuring access to AAC systems within early literacy activities
During the period of emergent literacy development, children acquire important lexical and syntactic knowledge that supports their later literacy. Children who require AAC are at risk for delayed semantic, syntactic, and morphological development. They often have a limited experiential base as a foundation for lexical development. The language input they receive may be quantitatively and qualitatively different from that of typically developing peers. They may not have a means of expression for various lexical or morphological concepts, and they may have limited ways to test their developing competencies in oral language since they cannot produce spoken words themselves. Furthermore, there is a difference or asymmetry between the input language (e.g., the spoken language[s] of the family and community) for children who use AAC and the output modes (e.g., AAC symbols, some speech approximations) accessible to the children.
Concerted intervention will be required to support children who require AAC in developing their competencies in the oral language(s) of the family and broader social community and the "language code(s)" of the AAC system (e.g., the line drawings, symbols). Story-reading interactions are one important venue for this type of language intervention.
Little is known about how AAC symbols may affect literacy development. The use of graphic symbols (e.g., line drawings, symbols) may facilitate the awareness that print carries meaning, an important development in this stage of emergent literacy. It also may facilitate an understanding of the directionality of print (i.e., that we read and write from left to right). However, the impact of AAC symbols on other aspects of emergent literacy development is less clear (e.g., the understanding that speech is mapped onto conventional print, the knowledge that letters have different shapes, and the knowledge that letters represent sounds). It is important that future research investigates these issues.
Phonological Awareness Skills
Phonological awareness skills are fundamental to the development of literacy skills. Phonological awareness refers to an understanding or awareness of the sound structure of language. It involves the ability to notice, think about, and manipulate the phonemes in words. Phonological awareness is evidenced in tasks such as rhyming, segmenting initial or final sounds of words, and blending individual sounds to form words.
The development of phonological awareness skills is highly correlated with reading achievement. Since individuals who use AAC have limited access to speech, it may be reasonable to expect that they will be at risk for the development of phonological awareness skills since they cannot manipulate the sound structure of language.
Research suggests that individuals with significant speech impairments can develop phonological awareness skills despite limited access to speech; however, many individuals demonstrate impairments in this domain. There is evidence that individuals who require AAC can acquire reading skills despite impaired phonological awareness and limited speech production. Preliminary research suggests that access to even limited articulatory ability or to AAC systems with speech synthesis may facilitate phonological awareness skills and decoding.
Appropriate instruction has been used to enhance phonological awareness skills with other populations of children at risk for literacy development. Unfortunately, most of these interventions rely on oral responses and therefore are not appropriate for children with significant speech impairments who require AAC. These instructional programs must be adapted to support participation by children who require AAC and use alternate response modes.
For example, Karen Fallon developed an intervention program for individuals who require AAC that targeted phonological awareness skills such as initial phoneme matching and sound blending as well as single-word reading skills. The program provided systematic, explicit, direct instruction. All phonological awareness tasks were adapted to eliminate the need for oral responses, accommodate alternative non-oral responses, and provide external scaffolding support in the early stages of instruction. For example, in the initial phoneme-matching task, the children were presented with four pictures and asked to indicate by pointing or eye pointing the one that started with the target sound that was presented orally by the instructor. Similar procedures might be used in a final phoneme-matching task in which the child would be asked to listen to a sound produced by the instructor and then indicate the picture from a group of four that ended with the sound.
In the sound-blending task, the instructor presented the individual sounds of a word continuously for a duration of 1–2 seconds (e.g., man = mmmmmm-aaaaaa-nnnnnn) and asked the child to blend the sounds and indicate the picture from four options that represented the resulting word. Similar procedures were used to teach single-word decoding skills. The instructor presented written single words, incorporating the sounds and letters previously taught, and asked the child to read the word and then point to the correct picture representing the word from a group of four pictures (one correct and three incorrect or foils).
The foils for these tasks were selected systematically to allow the instructor to easily identify error patterns and provide focused instruction to remediate these difficulties. For example, in the single-word decoding task, if the written word was "map," one foil represented an initial sound substitution (e.g., nap), one represented a final sound substitution (e.g., mat), and one represented a medial vowel substitution (e.g., mop).
The intervention systematically taught sounds (and later sound-letter correspondences) starting with those that were most common and easy to discriminate. New sounds were introduced incrementally as the children acquired proficiency with each target sound. Previously taught sounds were regularly reviewed to ensure maintenance of learning.
Fallon demonstrated the effectiveness of this intervention in increasing the phonological awareness skills of five children with significant speech impairments. All of the children demonstrated improvements in their phonological awareness skills and their single-word reading skills with 50 trained words. Four of the five children generalized their reading skills to new book-reading contexts. Three of the five children generalized their reading skills to new words, demonstrating that they had "cracked the code."
Diane Millar used similar types of task adaptations to successfully teach children who require AAC beginning writing skills. Specifically, she taught phonological awareness skills in segmenting and selecting initial letters or final letters of words. She also provided opportunities for the children to use these skills during meaningful, scaffolded writing activities, such as a writer's workshop.
The development of literacy skills is one of the most empowering developments in the lives of individuals with significant communication disabilities who require AAC. Literacy skills provide access to increased educational and vocational opportunities, improved access to mainstream technologies, and greater options for independent living. The foundations for successful literacy development are established long before formal reading and writing instruction in school. In the stage of emergent literacy development, children learn about print and books and develop the language and phonological awareness skills to support literacy development.
The emergent literacy experiences of children who require AAC are quantitatively and qualitatively different from those of their typically developing peers. They are at risk for the development of emergent literacy skills. Concerted intervention is required to maximize the emergent literacy development of children who require AAC. The research demonstrates that, with appropriate intervention, children who require AAC can participate actively in story-rea ding interactions, develop important language skills to support literacy development, develop phonological awareness skills, and learn early reading and writing skills. The challenge is to ensure that every child who requires AAC receives effective instruction to maximize emergent literacy skills and lay the foundation for later literacy.