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by Martine Smith
Nearly 20 years after David Koppenhaver and David Yoder put the topic of literacy and augmentative and alternative communication (AAC) firmly on the research agenda, what have we learned? We have laid to rest the myth that children and adults who use AAC cannot learn to read and write (Sturm & Clendon, 2004). We recognize the complexity of developing skills in reading and writing, in devising assessments that effectively tap underlying skills, and in constructing intervention programs that meet the needs of those who use AAC. We do not have all the answers, but our questions are becoming more focused.
Although many individuals who use AAC find reading and writing difficult, this struggle is not directly the result of speech impairment. Becoming a successful reader-writer involves many factors, and the resources the learner brings are important.
Individuals who use AAC face multiple challenges and potential barriers in learning to read and write. Probably the most significant yet poorly understood component relates to language skills and AAC. The links between spoken language skills and literacy development are well-documented. All aspects of language, including syntax, morphology, semantics, pragmatics, and meta-linguistic skills (especially phonological awareness), are important in learning to read and write. What is less clear is how use of aided communication influences language development (von Tetzchner & Grove, 2003), and hence literacy attainment.
Many children who use aided communication start the formal process of reading and writing when they are at the early stages of using formal systems of expressive language. Their experiences in speaking are very different from their peers and accessing many aspects of language may be constrained. Certainly the cognitive challenges of accessing language structure are far greater than for their speaking peers. Children using aided communication cannot easily match the levels of interaction of speaking children.
Identifying possible communication barriers is a necessary step. Using communication systems with combined potential at an early age allows children more opportunities to construct their own language systems. The result is refocused attention on the importance of language to the whole process of literacy learning.
Some skills involved in both reading and writing do not depend solely on learner resources. Unlike spoken language skills, these skills are linked closely to specific experiences and rely on explicit instruction. Interest in and research on effective reading instruction has exploded over the past four decades (Snow, Burns & Griffin, 1998). Two things are now clear. One is that good literacy instruction is good for all children. No evidence demonstrates that children who are struggling to read require radically different teaching approaches from their peers, although instruction may require more intensity. For children using AAC, we may need to adapt materials and presentation, but the fundamental principles of effective instruction do not change. Second, learning needs change over time.
Early literacy experiences that allow children to become familiar with the form and purpose of print—through shared reading, storytelling, creation of text, familiarity with letters, and early sound-play games—are critically important for children who use AAC (Light & Kelford-Smith, 1993). Progressing to the next stage of reading requires explicit instruction. Strong evidence suggests that this instruction should include specific attention to the sound structure of language (Snow et al., 1998). It should make explicit the links between sound patterns and written forms, as typified in a phonics approach, and supported by access to voice output. However, it is not at all clear that all children access or use these skills in the same way, or to the same extent. Children may have access to strategies that they do not use in their reading and writing. Children and adults who use AAC may be predisposed or biased to pay attention to visual forms at least as much as to analytic strategies. Fluent readers and writers have access to a range of skills. Individuals who use AAC need at least the same opportunities to develop a full repertoire of skills.
Literacy proficiency is attainable—but that does not make it easy. We are still at the early stage of developing intervention programs that meet the needs of children and adults using AAC while also accommodating the educational opportunities and challenges implicit in service delivery models. Approximately 8% of all children are estimated to present with specific reading difficulties. Unfortunately the presence of one disability, such as dysarthria, does not provide immunity against other difficulties, such as dyslexia. It is important to recognize that a sizeable minority of individuals using AAC face additional challenges acquiring literacy skills that may be unrelated to their use of AAC. If these individuals were speaking, the difficulties likely would be identified. The need to use AAC does not cause these difficulties—but it does make the identification process much more complex!
Finally, we can gain some insights from successful AAC users. Erickson, Koppenhaver, & Yoder (2002) and Fried-Oken & Bersani (2000) present essays by or with augmented communicators reflecting on their journey to literacy. A number of key characteristics of successful intervention programs are common across many of the writings:
- Integrating all aspects of communication, and encouraging independent communication from an early stage
- Harnessing motivation of all participants and stakeholders, and raising expectations that literacy can
be achieved
- Providing intensive input over extended periods of time in functional, real, and meaningful activities
- Integrating reading, writing, spelling, and communication across activities and goals
- Using voice output and other technologies
- Having a willingness to adapt, take risks, use trial-and-error, and maintain an open and questioning attitude to intervention.
These are sound principles for all our interventions. As we embrace the challenge of building the evidence base to guide our practice, these principles provide a good starting point.
Martine Smith is a senior lecturer in speech-language pathology at Trinity College Dublin. She is past president of the International Society for Augmentative and Alternative Communication, and author of Literacy and Augmentative and Alternative Communication. Contact her at mmsmith@tcd.ie.
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