Making Words Count Why do some AAC users miss out on rich literacy instruction? And how can SLPs help get them the reading support they need? Features
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Features  |   July 01, 2015
Making Words Count
Author Notes
  • Susan Berkowitz, MS, CCC-SLP, is a private practitioner in San Diego who specializes in AAC. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education, and 12, Augmentative and Alternative Communication. She blogs at http://kidzlearnlanguage.blogspot.com. berkowitzs@hotmail.com
    Susan Berkowitz, MS, CCC-SLP, is a private practitioner in San Diego who specializes in AAC. She is an affiliate of ASHA Special Interest Groups 1, Language Learning and Education, and 12, Augmentative and Alternative Communication. She blogs at http://kidzlearnlanguage.blogspot.com. berkowitzs@hotmail.com×
Article Information
Augmentative & Alternative Communication / Normal Language Processing / Features
Features   |   July 01, 2015
Making Words Count
The ASHA Leader, July 2015, Vol. 20, 52-58. doi:10.1044/leader.FTR2.20072015.52
The ASHA Leader, July 2015, Vol. 20, 52-58. doi:10.1044/leader.FTR2.20072015.52
Andrew is a functionally nonverbal 7-year-old boy in a special day class for students with autism. His IEP indicates he has minimal emergent literacy skills, and that this is an area of need. His identification of letters and recognition of sight words are inconsistent, and he struggles with tasks involving fine-motor skills, like accurately forming letters.
Now his IEP team has dropped writing skills objectives from his IEP because team members say he lacks the prerequisite skills.
What’s not being considered is that Andrew can find vocabulary in his augmentative and alternative communication (AAC) system (he uses an iPad with Proloquo2Go’s core vocabulary page set in a 5 x 5 grid). When asked, he can find the symbols needed to answer basic questions in class. In fact, when his AAC system changed significantly last year, he quickly figured out how to use the new version, demonstrating his ability to learn.
In another classroom, Josh, also nonverbal, is a 6-year-old boy missing out on literacy instruction. During reading time, he and his classmates listen to a book on tape from their desks, while the teacher holds up the book and turns the pages from afar—too far away for them to see much. When the tape is finished, so is “reading” time. Students move on to other work.
How is it that Andrew and Josh are missing out on reading and writing instruction in this way? And why are they, sadly, not alone?
A passive model
Prominent AAC researcher David Yoder, past chair of the Department of Allied Health Sciences at the University of North Carolina-Chapel Hill, said it all when he said, “No student is too anything to be able to read and write.” Yet walk into almost any classroom for students who are nonverbal, read almost any IEP for a student who can’t talk, and look for the literacy instruction. Chances are, it isn’t there. Or it is limited to learning the letters of the alphabet, usually during a 15-minute literacy center rotation.
Evidence-based practice calls for reading instruction for 90 minutes per day for general education students. Struggling readers often get an additional 30 to 60 minutes per day of intensive instruction. Compare this amount with an absence of such instruction often seen for students who use AAC and have complex communication needs.
This isn’t to say that reading to students is not important. Books are a singularly encompassing way to introduce students to vocabulary and ideas they would not normally encounter. Reading to students provides motivation for them to want to learn to read, teaches them about processes for reading, provides experiences with books they cannot read independently, and portrays the meaningfulness of written language.
But those readings need to be interactive, not passive. Talking about stories encourages thinking and language skills and facilitates further reading comprehension. Shared reading has been shown to be one of the best influences on later vocabulary development and reading skills. Having conversations around the story generates vocabulary knowledge and develops higher- order thinking skills—when the right types of questions are asked.
Some educators may not realize that children with robust, comprehensive AAC devices actually can “talk about” stories they hear—as long as they can effectively operate those devices, whether they be core word systems, pragmatically organized dynamic display books, or any other style of AAC book or device.
An unmet need
Part of the problem may be underestimating all that users can do with their AAC devices. These students can do much more than answer “what” questions that require little or no thinking and limit language production to identifying nouns and verbs. They need to answer a variety of “wh” questions, using increasingly complex phrases and sentences, showing the sequence of events, and describing, comparing and contrasting characters or settings. And they need experience with retelling stories.

These students need to answer a variety of “wh” questions, using increasingly complex phrases and sentences, showing the sequence of events, and describing, comparing and contrasting characters or settings.

As we apply Bloom’s Taxonomy for higher-order thinking with the new Common Core State Standards, we need to move children who use AAC devices beyond the first rung (knowledge) to higher rungs such as application, analysis and synthesis. Bloom’s Taxonomy identifies the hierarchy of questions educators use to have students demonstrate understanding. Many AAC users are never taught to respond beyond the basic level of demonstrating factual knowledge—answering “what” questions. But students need to learn the skills to interpret (comprehension), solve problems (application), analyze (analysis), plan (synthesis) and eventually judge (evaluation) what they learn. We educators need to see how far we can move them along this continuum of skills and provide the scaffolding they need to do so.
Students need to demonstrate skills in working with the content of the curriculum, not just demonstrate knowledge of it by recalling facts. AAC users need the same types of interactions with books as their verbal peers. They need to be able to develop the same sets of higher-order thinking skills as their typical peers. What we do in intervention with these students isn’t really much different from what we do with other students. What’s changed is the mode of expression and the addition of a step: identifying needed vocabulary in the AAC system.
AAC users who have motor or sensory impairments will likely not experience life in the same way as their peers: Children who cannot dress themselves may never have experienced playing dress-up. Some may never have gone on a picnic or ridden a bike or a horse. Some students in wheelchairs may never have been to the beach. Some may be unable to see the range of colors or experience seeing their world in images uninterrupted by cortical vision impairments.

AAC users need the same types of interactions with books as their verbal peers. They need to be able to develop the same sets of higher-order thinking skills.

Because of these different experiences, we need to build their background knowledge a little differently, to give them some familiarity with the settings and actions of the stories they are hearing or reading. To do this, we can, for example:
  • Weave some of these experiences into classroom activities.

  • Offer them sand to feel.

  • Stage a picnic in the classroom.

  • Hold a wheelchair race across the playground so they can feel an experience close to that of moving on a bike.

Image Not Available

Courtesy of Tobii Technology

We need to recognize that interacting with stories is as close as some of these children may get to certain life experiences. Just like typically developing children, AAC users benefit from storytelling and re-telling. Too often these students hear books read only once or twice. In an attempt to expose them to many types of books, we read many different books without stopping to let them experience the same book multiple times.
Children need to listen to the same stories over and over, then practice re-telling them to their stuffed animals, dolls and younger siblings. With this approach, they build the narrative practice that is necessary for conversations and literacy.
What we can do
Speech-language pathologists know the importance of teaching literacy and are uniquely positioned to build language skills that these students otherwise may miss. We are well-versed in teaching nonverbal students about semantic relationships and helping them find the words they seek in their AAC systems.
One of my go-to examples for building literacy in AAC users involves a book about a zoo trip. As we do a picture-walk through the book, we make predictions based on the cover and title, find the illustrations, and ask students to talk about categories: “Let’s find where the animals are on your communication system. What types of animals are these? Are the zoo animals on a different page from the farm animals or sea animals? Now let’s find where describing words are kept on your device. Describe this animal. Compare these two animals. Where are the describing words in your AAC system?”

SLPs are well-versed in teaching nonverbal students about semantic relationships and helping them find the words they seek.

We find that nonverbal students can do all of this, given an appropriate AAC system. (For specific guidance on teaching phonological awareness skills to nonverbal students, see these resources from Pennsylvania State University AAC researchers Janice Light and David McNaughton, which comply with the National Reading Panel’s findings on reading instruction.)
Really, reading skills are the same no matter whom we are teaching. All students need instruction in initial or final sounds in words, rhyming words and word families, and syllabication. It’s just that AAC users point to pictures rather than verbalizing words.
Image Not Available

Courtesy of Tobii Technology

So when working with students, we can, for example, challenge them to find a word that rhymes with “mat”: “How about cat, rat, bat? Wait, these are also all animal words. Where do you find the animal words in your AAC system? Need a word that rhymes with ‘shoe?’ How about ‘blue?’ That’s a describing word. Where are describing words in your AAC system?”
Light and McNaughton provide SLPs and teachers with their entire literacy program, with specific examples and materials to walk users through the breadth of their curriculum. The Reading Foundation skills of sound blending, phoneme segmentation and letter-sound correspondence are covered, as is information on shared reading, sight-word recognition and reading comprehension skills. They provide definitions of each skill, background on the importance of each, sample goals, instructional task directions, materials examples, videos of students and troubleshooting pointers.
The strategies for teaching literacy skills to AAC users are definitely there. Let’s use them—and let’s teach others in the schools how to use them. And most of all, let’s teach our students how to access them. Everyone deserves to learn to read.

The strategies for teaching literacy skills to AAC users are definitely there. Let’s use them—and let’s teach others in the schools how to use them. Most of all, let’s teach our students how to access them. Everyone deserves to learn to read.

Sources
Erickson, K., & Koppenhaver, D. (2007). Children with disabilities: Reading and writing the four-blocks way. Carson-Dellosa Publishing Co, Inc.
Erickson, K., & Koppenhaver, D. (2007). Children with disabilities: Reading and writing the four-blocks way. Carson-Dellosa Publishing Co, Inc.×
Westby, C. (1991). A scale for assessing children’s pretend play, in Schaefer, C., Gitlin, K., & Sandrund, A. (eds.), Play Diagnosis and Assessment. John Wiley & Sons Inc.
Westby, C. (1991). A scale for assessing children’s pretend play, in Schaefer, C., Gitlin, K., & Sandrund, A. (eds.), Play Diagnosis and Assessment. John Wiley & Sons Inc.×
Yoder, D. (2000). DJI-AbleNet Literacy Lecture. ISAAC. (Found in Farrall, J., Literacy for ALL Students.)
Yoder, D. (2000). DJI-AbleNet Literacy Lecture. ISAAC. (Found in Farrall, J., Literacy for ALL Students.)×
1 Comment
August 7, 2015
Anne Page
Thank you!
Thank you for sharing your experience and knowledge Susan. I really appreciate your insight and the links to further information. It breaks my heart to see so many students are deprived of the gift of stories. You also gave me some fresh insight into the lack of play experiences for our students in wheelchairs. I am going to get some wheelchair races going at our school.
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July 2015
Volume 20, Issue 7