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How do we help students who require AAC to read aloud connected text in books?
This research was developed out of a desire to create an easier way for students who require AAC to learn to read aloud the connected text in mainstream books through AAC design. Research into developing literacy skills for students who require AAC is still a relatively new field. However, there is consensus that these students are at risk of not developing functional literacy and experiencing associated disadvantages:
- students who require AAC are at risk of not acquiring functional literacy skills, even with average or above average intellectual abilities (Dahlgren & Sandberg, 2001; Foley & Pollatsek, 1999; McNaughton, 1993)
- only 10% of individuals who require AAC have reading comprehension above a grade 2 level, which is well below the attainment of functional literacy skills (Erickson, 2003)
- poor literacy outcomes increase the risk of social, academic and vocational disadvantage (Foley, 1993; Koppenhaver, Evans & Yoder, 1991)
- poor literacy skills also limit students’ abilities to effectively communicate on their AAC devices by restricting them to pre-programmed vocabulary and phrases (Fallon, Light, McNaughton, Drager & Hammer, 2004; Millar, Light & McNaughton, 2004; Blischak, Shah, Lombardino & Chiarella, 2004; Nelson, 1992)
Several factors may contribute to students being at risk of poor literacy outcomes including:
- severe communication impairments are often associated with poorer literacy outcomes (Foley, 1993; Foley & Pollatsek, 1999)
- different learning opportunities during preschool years due to the impact of comorbidities (sensory, physical and learning disabilities) contributing to less opportunity to play, explore the environment and engage in early literacy activities (Light & Kelford Smith, 1993; Smith, 2005; Koppenhaver, Foley & Williams, 2009)
- students who require AAC process symbol based graphic representation systems rather than an oral representational system for spoken words – it is not known how this impacts on their ability to acquire the phonological processes necessary to learn to decode words (McNaughton & Lyndsay, 1995)
- different language learning experiences when acquiring language using AAC systems (McNaughton & Lyndsay, 1995)
When students reach school age, speech pathologists and educators face a dilemma of how to teach literacy skills to students who require AAC:
- current best practice is to apply the recommendations for students with natural speech to students who require AAC and make minimal modifications when necessary (Erickson, Hatch & Clendon, 2010)
- phonics based instructional approaches are effective methods of teaching literacy skills, particularly for students at risk of, or with identified reading difficulties (Adams, 1990; Carnine, Silbert, Kameénui, Tarver & Jungjohann, 2006; National Institute of Child Health & Development, 2000)
- the challenge is that phonics instructional techniques often assume students can use natural speech during the instructional process
Alternate methodologies for teaching students who require AAC have been developed for:
- phonological awareness skills
- letter to sound correspondences
- decoding single words/recognising single words as sight words
These skills are essential foundational literacy skills and are correlated with positive literacy outcomes for students, so it is unsurprising that these have been the initial focus of research.
Learning to read connected text in books is the important next step in instruction to support the transition from a cognitive focus on decoding text to reading with more automatic word recognition and a greater focus on reading comprehension. Supporting students to take this next step through reading aloud connected text in books is the focus of this research.
Although the ultimate goal for all students, including students who use AAC, is to read silently, reading aloud is an important instructional stage for students as they are developing reading proficiency because:
- development of subvocal speech is a difficult skill for students with severe communication impairments to acquire (Erickson, Clendon, Cunningham, Spadorcia, Koppenhaver, Sturm, & Yoder, 2008)
- reading aloud is overt and therefore provides opportunity for a more direct approach to assessment, error correction and guiding further instruction
High tech AAC systems consisting of voice output combined with dynamically configured grids appear to be the most logical AAC choice for this task, however, existing vocabulary layouts in AAC systems are not optimised for reading aloud:
- symbol navigation is too slow for reading fluently
- symbol navigation (particularly for new vocabulary) requires too much cognitive load when the learning focus should be on decoding the text
- books contain a high proportion of fringe vocabulary
- dilemma of where to put new vocabulary - scatter or use topic pages
- entering book vocabulary is time consuming and not scalable
- existing AAC systems do not enable students to sound out unfamiliar words
Developing an efficient vocabulary layout is critical to AAC design for reading. When reading, students who require AAC have the additional processing demands of translating text into meaning to select the correct symbol whilst their peers with natural speech can initially only focus on translating text to sound (Erickson et al., 2008). This means that students who require AAC must attend to both decoding and comprehending the word simultaneously even when they are just starting to learn to decode. Symbol navigation must therefore be designed to be as effortless as possible so that all the student’s cognitive resources can be applied to the complex task of reading the text. Positive early experiences of reading success are critical for motivating students to persevere with reading, particularly in the early stages when the process is effortful.
Of equal importance is the ease of vocabulary entry. Without a better method of entering vocabulary there is a danger that the task of entering book vocabulary will be abandoned and students will miss out on valuable opportunities to practise their reading skills using the connected text in books.
Stanovich (1986) describes the Matthew effect where students who enjoy reading read more and become more proficient whilst students who dislike reading read less and have a slower rate of improvement. This becomes a vicious cycle and the gap in abilities between the two types of students widens. Avoiding the negative path of the Matthew effect for students who require AAC, necessitates the development of AAC methodologies to effectively support reading aloud a variety of texts without burdening caregivers and educators with time-consuming vocabulary entry.
This research describes the development of a new AAC system specifically designed to meet the communication and vocabulary demands of reading aloud connected text in books.
Searching the Literature
A literature review was conducted to examine how AAC was being incorporated into literacy instruction, with a particular emphasis on examining how AAC systems with speech output technology were being utilised to inform future AAC design.
The following databases were searched:
- Education Resources Information Centre (ERIC)
- Cumulative Index of Nursing and Allied Health Literature (CINAHL)
- Education Research Complete
- Medline PsychINFO
- Linguistics and Language Behaviour (LLBA)
- ProQuest Dissertations and Theses
The search terms were “augmentative and alternative communication” AND
- “reading instruction”
- “literacy instruction”
- “phonological awareness instruction”
- “phonemic awareness instruction”
- “reading fluency instruction”
- “decoding instruction”
- “reading comprehension”
The original search period was articles up to the year 2014. An additional hand search of the Augmentative and Alternative Communication (AAC) Journal from 1985 to 2014 was also completed. An ancestor search of all included articles was also conducted. For each dissertation a computer search was also conducted of the author’s name to determine whether there was a published journal article.
- study is written in English
- empirical study of literacy intervention
- at least one participant uses aided AAC (low or high technology)
- at least one participant has a severe communication impairment (SCI)/ severe speech impairment (SSI) that is congenital or acquired in the first 6 years of life prior to commencing formal literacy instruction
- purpose of study specifically relates to literacy instruction in areas of phonological awareness, phonemic awareness, decoding, reading fluency and reading comprehension
If a journal article and dissertation were located on the same topic by the same author, the dissertation was excluded as the journal article had been subjected to peer review.
The methodology for determining inclusion/exclusion was:
The search yielded 39 journal articles, of which 10 met the inclusion criteria:
- Blischak, Shah, Lombardino & Chiarella (2004)
- Coleman-Martin, Heller, Cihak & Irvine (2005)
- Fallon, Light, McNaughton, Drager & Hammer (2004)
- Hanser & Erickson (2007)
- Heller, Fredrick, Tumlin & Brineman (2002)
- Johnston, Buchanan & Davenport (2009)
- Johnston, Davenport, Kanarowski, Rhodehouse & McDonnell (2009)
- Millar, Light & McNaughton (2004)
- Swinehart-Jones & Heller, 2009
- Truxler & O’Keefe (2007)
The search yielded 355 dissertations , of which seven met the inclusion criteria:
- Banajee (2007)
- Benedek Wood (2010)
- Fallon (2001)
- Hanser (2008)
- Harwood (1996)
- Millar (2001)
- Truxler (2005)
Subsequently 4 were excluded because the content also appeared in a journal article:
There were 42 participants across the studies, 26 (62%) had speech output technology. The age range was 4-21 years. All participants were classified as having severe communication impairments (SCI).
Two studies made their participants’ speech output technology available for communication and responses during intervention:
One study explicitly incorporated their participant’s speech output technology into instruction:
Review of the included studies revealed three broad approaches to adapt literacy instruction:
Adapt input and output methods:
- the majority of studies incorporated this approach (Blischak et al., 2004, Banajee, 2007; Benedek Wood, 2010; Fallon et al., 2004; Harwood, 1996; Johnston, Buchanan et al, 2009; Johnston, Davenport et al 2009; Millar et al, 2004; Truxler & O’Keefe, 2007)
- the most common adaption in the included studies involved changing the task demands so that an instructor provided a verbal model and then the student gave a non verbal response by identifying the corresponding word, picture or letter
- adaptations for oral responses in phonological awareness tasks included the use of gestures, eye gaze, manual signs/finger spelling, switch activation, and selecting vocabulary items on communication boards
- in word recognition tasks, adaptations involved presenting a written word and then presenting a picture array, or, presenting the student with a spoken word and then requiring them to identify the printed word from an array
Nonverbal reading approach:
- the nonverbal reading approach uses a systematic direct instruction technique to explicitly teach students to develop the meta-cognitive ability to use internal speech (Heller, 2002; Coleman-Martin et al., 2005)
- when teaching single word recognition tasks, three specific steps are taught (Coleman-Martin et al., 2005):
- students individually say the single sounds in words using internal speech with an oral model from a teacher/computer
- students learn to blend the sounds together using internal speech whilst being provided with an oral model by the teacher/computer
- students are instructed to say the sounds fast using internal speech while the computer/teacher says the word
- three studies applied this technique to literacy instruction (Heller et al., 2002; pp. 19-35; Coleman-Martin et al., 2005; Swinehart-Jones et al., 2009)
Integrate the participant’s speech output technologies into instruction:
- integrate SGDs as an educational tool for reading and language instruction rather than viewing them purely as an alternative input or output method
- only one study used this approach - Hanser and Erickson (2007)
- used the Literacy Through Unity: Word Study program (Erickson, 2006)
- teaches word identification, spelling and communication skills and is designed for use with SGDs using the Unity communication application program
- three types of scripted lessons: word wall, making words with letters and making words with icons.
- word wall lessons teach students automatic word recognition for high frequency words
- the making words with letters lessons focus on teaching students to create words and learn early spelling patterns by listening to and manipulating sounds using their SGD
- teaching with icons lessons teach students to use and understand the rules underlying the multi-meaning icons in Unity communication systems to extend their expressive language skills
Since completing this research in 2014, there have been additional papers published with a greater emphasis on using technology including AAC systems to support literacy skills (Ahlgrim-Delzell, Browder, & Wood, 2014), and incorporating iPad apps into literacy instruction (Ahlgrim-Delzell, Browder, & Wood, 2016). In addition, there have been papers specifically examining the redesign of AAC systems to support sight word acquisition (Caron Light, & McNaughton 2020; Caron, Light, & McNaughton, 2021). Mandak, Light and Boyle (2018) and Yorke, Gosnell Caron, Pukys, Sternad, Grecol, & Shermak (2020) also provide a summary of current literature on the efficacy of literacy intervention for students who require AAC in their recent systematic reviews. These reviews examined the efficacy of approaches to support single word reading (Mandak et al., 2018) and a broader review of early reading interventions (Yorke et al., 2020). Both these papers include a review of several articles published after this literature review was completed. Despite the increase in research, the focus is predominantly on supporting reading at a single word level or sentence level rather than investigating how the process of reading connected text in books can be facilitated.
Accepting that we had to create a completely new design
The current literature provides valuable insights into how to successfully adapt literacy tasks for students who use AAC, but little guidance on how to address vocabulary configuration for reading connected text in books. Our next task was to draw on this knowledge base of existing literacy intervention and AAC design and then figure out how to adapt it to meet the communication and instructional demands of reading aloud connected text.
Based on our research we knew we needed a system where:
- vocabulary selection is quick and easy
- vocabulary grid placement is consistent across books
- vocabulary entry doesn't burden caregivers/educators
- students can sound out unfamiliar words and learn non-decodable words
- students can pre-learn symbols for new words and their grid placement prior to reading books
- there is flexibility to support students to achieve a range of literacy goals from early participation in reading stories to independently decoding the book text
- the system design supports reading all types of books including story books, decodable readers, levelled readers and plays
When considering how to speed up vocabulary access and vocabulary entry, it occurred to us that we have one distinct advantage over AAC systems used for spoken conversation – we always know what word will be spoken next because all the words are presented in order in the book text.
The key to the AAC system design was to develop a method of parsing the text in the books so that that the AAC system always knows the current word, and the meaning of the word in the context of the current sentence of the text.
Parsing the text of the book provides several advantages:
- it enables the base word to be displayed on the grid, reducing the cognitive load of navigation and speeding up symbol selection to maximise reading fluency
- it enables each word to be correctly sounded out because the semantic meaning of the word in the context of the sentence is known
- it enables all the vocabulary for each book to be pre-entered and for semantically appropriate symbols for the context of the sentence to be displayed
- it enables the system to determine when a word in a new book is new vocabulary for the student and pre-teach the symbol and the symbol position in the grid prior to the student reading the book
- in plays it enables the system to read the other parts of the play and the student to read aloud their part
- it enables the development of an error correction process when the student makes an incorrect symbol selection
Once we had successfully developed a methodology to parse the text in books, the next challenge was how to optimise the symbol layout for the text. The goal was to always display the base symbol for the word on the grid.
Drawing on our knowledge of existing grid layouts in AAC systems, our initial attempt involved:
- a fixed core vocabulary that remained constant regardless of the book being read
- remaining words in specific books were subdivided into high frequency and low frequency words based on frequency of occurrence of the word within the book
- high and low frequency words were displayed in different grid sections that dynamically changed at intervals depending on the vocabulary content for the current book
- there was an emphasis on maintaining consistent cell positions throughout the book for the high frequency words
Although this methodology initially looked promising when using books with a limited amount of text, the methodology failed when applied to texts with larger passages of text:
- there was inadequate grid space to maintain our goal of consistent grid location for high frequency words
- we were also uncomfortable with the inconsistency of symbol position across texts that occurred with this system
At this point we had to suspend our preconceptions of vocabulary layout which were constrained by existing AAC technologies, primarily designed for effective communication in conversation.
For reading, a completely new way of displaying vocabulary was required.
Through prototyping and repeated testing with book data we determined that the sheet layer model was the best method of storing and displaying vocabulary for reading:
- each word is assigned a fixed position in a cell within a grid layer based on word type when it is entered as a new word into the dictionary (i.e. when the book is parsed)
- the position of every word remains constant, regardless of the book being read
The cell position assigned to a word is determined by three factors:
- the Fitzgerald classification of the word (Fitzgerald, 1929)
- the semantic relationship of the word to other words
- the similarity of the symbol to existing symbols on the grid (similar symbols occupying different cells in close proximity is undesirable)
In the AAC Reading System the Fitzgerald classification of words is represented by a series of layers which includes a verb layer, noun layer, adjective and adverb layer, pronouns and people layer and a miscellaneous layer for all other words that do not fit within the other layers.
The following process is used to assign words to cells:
- each word is assigned to a specific sheet layer based on its word class (e.g. noun, verb, adjective etc)
- the cell position that the new word will occupy within the layer is assigned by the relationship between the new word and existing words within the dictionary
- words are positioned in cells (which correspond to display positions) within sheets and across layers so that words that are related in meaning but have different word classes (Fitzgerald types) occupy the same cell on multiple layers
For example, the words “use”, “user” and “useful” are all semantically related words but have different word classes so the words appear on different layers but occupy the same cell position. The sheets and layers displayed dynamically change on a word-by-word basis as the student reads the text of the book.
Grouping related words in the same cell position and in their grammatically correct layers reduces learning load by ensuring similar words appear in a single predictable location. The sheet and layer data structure and the predictable nature of the text enables the Reading System to present every word in the English language (and most other languages) in a way that is accessible in one or two button presses, with most words accessible with one button press. Combined with the consistency of location for each word this substantially improves reading fluency.
This system also makes it possible to display a symbol that is semantically congruent with the meaning of the word in the context of the sentence, for example the different meanings of words in different word classes such as the noun ‘spy’ (the person) and the verb ‘spy’ (the act of watching another person’s actions).
Provision of semantically congruent symbols enhances reading fluency by providing symbols that make sense in the context of the sentence which reduces the symbol search time. It also supports reading comprehension and vocabulary expansion by providing an accurate depiction of the meaning of the word in the specific context of the current sentence.
We are currently working on programming the system to have an overlay layer displaying symbols adjacent to the target symbol, that contain similar graphemes to the target word. So for example, next to cat you might also have cot, bat and cab. This will reduce the temptation to only decode the first grapheme in a word and then guess. It will also provide information about error patterns for the student which may guide further instruction.
Many factors contribute to students who require AAC being at risk of literacy difficulties. Difficulty participating in instruction is a factor that can be addressed through both instructional design and design of AAC systems. This research sought to extend the existing literature to examine how AAC systems could be redesigned to support reading aloud the connected text in books. Through redesign it was possible to develop a system that will enable students to read aloud whilst minimising the cognitive load associated with symbol navigation.
There is still considerable research needed to examine the efficacy of this approach for students, however we hope that this presentation will stimulate research and discussion on how AAC design may be adapted to ensure that we maximise the ability of students who require AAC to participate in instruction.
Watch the video...
Watch a short (3 minute) video showing Aacapella Read in action.
On completion of the research and development phase, this research will become a commercial product.
We promise not to annoy you with endless emails, but we will let you know about things that might be really important to you, such as the launch date for read by aacapella
read by aacapella
We would also like to thank the following businesses for their support:
Symbols Worldwide Limited, UK, for the use of their Widgit symbol set
Acapela Group S.A., Belgium, for the use of their synthesised voices