Early Literacy Support for Students With Physical Disabilities and Complex Communication Needs

Abstract

Jessie is a 5-year-old student with cerebral palsy who attends an inclusive kindergarten classroom. Jessie’s hearing and vision are within normal limits, and her communication modes include natural gestures, an intelligible yes/no response, approximately five spoken words that are intelligible to familiar listeners, and using her finger to point to 2” × 2” symbols in a communication book that includes black-and-white line drawings with the words printed beneath. Jessie’s parents and educators are not sure how to proceed with regard to designing and implementing an intervention that supports her acquisition of literacy skills.

The ability to use written language to communicate receptively (i.e., reading) and expressively (i.e., writing) is important in school, work, and independent living. Students who struggle early with reading have difficulty catching up with their peers as they move through school and in academic areas that rely on reading proficiency (Cunningham & Stanovich, 1997; Juel, 1988; Pfost, Hattie, Dörfler, & Artelt, 2014). Many positive outcomes are associated with higher levels of reading and writing skills, whereas poorer academic, employment, and life outcomes are associated with lower competency levels in these areas (Rudd, Kirsch, & Yamamoto, 2004; Snyder & Dillow, 2012; Sum, Kirsch, & Yamamoto, 2004).

Individuals with disabilities who are unable to effectively and efficiently use oral speech may benefit from augmentative and alternative communication (AAC) to facilitate early literacy development. AAC includes “all of the ways we share our ideas and feelings without talking” (American Speech-Language-Hearing Association, 2018, “About AAC” section, para. 2). Because individuals with disabilities who use AAC may rely on reading and writing skills for expressive communication, instruction in reading and writing is particularly important (Connor, Alberto, Compton & O’Connor, 2014).

Prior research indicated that, in the past, AAC users were taught to read through memorization of sight words (Browder, Ahlgrim-Delzell, Flowers, & Baker, 2012; Joseph & Seery, 2004). However, relying solely on sight-word instruction put students who used AAC at a disadvantage because they did not develop decoding strategies for approaching new words (Barker, Saunders, & Brady, 2012). Thus, when students who use AAC are taught to read, they need to receive systematic instruction in the range of skills that contribute to word-level reading (Ahlgrim-Delzell et al., 2016). Over the last several decades, increased attention has been given to identifying effective strategies for supporting the literacy needs of individuals with disabilities, including students with intellectual and/or physical disabilities (e.g., Barker et al., 2012; Lemons, Allor, Al Otaiba, & LeJuene, 2016). A great deal of early literacy instruction that leads to word-level decoding relies heavily on oral speech (Carnine, Silbert, Kame’enui, Slocum, & Travers, 2017; Honig, Diamond, & Gutlohn, 2013); therefore, teachers may experience unique challenges when designing and implementing interventions to support the acquisition of these skills for students with physical disabilities and complex communication needs (PDCCN) who use AAC.

Identify the Skills to Be Taught

To identify the skills to be taught, teachers need to understand the range of skills that contribute to beginning literacy, including concepts about print, phonemic awareness, letter-sound correspondence, and decoding. Concepts about print include an understanding of print forms (e.g., b is a letter; 2 is a number), print conventions (e.g., English print is read from left to right and top to bottom), and book conventions (e.g., books have titles; books have a front and back; Lovelace & Stewart, 2007). Phonemic awareness includes the ability to identify and manipulate sounds in words. Sound-letter correspondence includes the ability to associate a spoken sound with a written letter. Finally, decoding includes the ability to say the sound for each letter or letter combination and then blend the sounds to identify a whole word. Table 1 summarizes guidelines for instruction for students without disabilities for these important beginning literacy skills. Although it is not the focus of this article, reading fluency, vocabulary, and reading comprehension are also crucial literacy skills that instructors will need to integrate into literacy instruction for students with PDCCN who use AAC (see Smith, 2005).

Table 1.

Guidelines for Beginning Literacy Instruction

Literacy Skills	Guidelines for Instruction^a
Concepts about print	Teach concepts: title, cover (front, back), words vs. letters vs. pictures, directionality of reading English (left to right, top to bottom), author, illustrator, etc.
Phonemic awareness	Teach segmenting: Teacher says whole word; students say sounds in word separately. Start with continuous sounds first.
	Teach blending: Teacher says word parts or sounds (separated or “stretched”); students say whole word.
	Teach rhyming: Teacher says target “rime”; teacher asks students to rhyme with the first word: “We are going to rhyme with /at/.” “First you will say /s/ then rhyme with /at/.” “What will you say first?” (Students: “/s/”) “Then what will you say?” (Students: “/at/”) “Rhyme with /at/.” (Students: “sat”)
Letter-sound correspondence	Introduce letters in recommended sequence, one letter at a time (then include mastered letters as acquired): a, m, t, s, i, f, d, r, o, g, l, h, u, c, b, n, k, v, e, w, j, p, y, t, x, q, z
	Introduce lowercase letters first, with the exception of letters with visual similarity (e.g., cC, uU, kK, oO).
	Teach the most common sound for each letter first. For example, /a/ as in fat /c/ as in can /e/ as in bet /g/ as in got /i/ as in sit /o/ as in not /u/ as in cut
	Introduce a new letter after two or more consecutive sessions of 100% correct responding for the first five letters.
	To build memory of the new letter-sound correspondence, touch under each letter in the following sequence: new letter, one known letter, new letter, two known letters, new letter, three known letters, etc.
	Recommended script: Teacher: “This letter makes the /a/ sound. What sound?” Student: “/a/”
	Discrimination practice: Show students multiple fonts and colors of the same letter after initial instruction. Include letters that have been mastered when introducing a new letter.
Decoding	Once student has mastered letter-sound correspondence for four to six letters, decoding can be taught.
	Begin by teaching decoding VC and CVC combinations that include continuous sounds—sounds that can be said for several seconds (e.g., if, man, sun.) Student sees words, says sounds for each letter, then blends into whole word.
	Introduce CVC words that have “stop” sounds—sounds that cannot be said for several seconds (e.g., /t/, /d/, /c/, /p/ in “tad” and “cap”)—as decoding skills improve.

Note. The examples provided are for illustration purposes. Additional effective instructional examples can be found in textbooks (e.g., Carnine et al., 2017; Honig et al., 2013; Moats, 2009) and websites (e.g., fcrr.org, intensiveintervention.org, interventioncentral.org, readingrockets.org, readwritethink.org). CVC = consonant-vowel-consonant; VC = vowel-consonant.

Carnine, Silbert, Kame’enui, Slocum, and Travers (2017); Honig, Diamond, and Gutlohn (2013); Lovelace and Stewart (2007).

Assessment is an essential step in identifying which early literacy skills to teach. In some cases, when assessing students with PDCCN who use AAC, teachers may be able to use relevant assessments as designed because they do not rely on verbal responses from the student. For example, the Comprehensive Test of Phonological Processing–2’s sound matching subtest allows for pointing as a selection response (Wagner, Torgesen, Rashotte, & Pearson, 2013). Similarly, assessment with the Nonverbal Reading Approach prompts the student to use internal speech to decode a word; then, the teacher verbally provides four choices of words from which the student can nonverbally make a selection (Heller, Fredrick, Tumlin, & Brineman, 2002). However, other assessment tasks do rely on verbal responses from students and therefore may need to be adapted for AAC users (Barker et al., 2012). Table 2 presents common assessment procedures for beginning reading skills and corresponding adaptations that were made in research studies for AAC users (for additional information, see Barker et al., 2012; Smith, 2005). As noted in this table, when assessment procedures are adapted for AAC users, changes may need to be made to how the assessment tasks are presented and/or the how the AAC user responds during the assessment. Note that in many cases, these adaptations change the skills that are being assessed (e.g., being able to say a word that rhymes with “dog” requires different skills than being able to point to a picture that rhymes with “dog” in an array of pictures). Although the skills being assessed do change, use of these adaptations still results in important information about a student’s literacy strengths and areas of need (Barker et al., 2012).

Table 2.

Standard Assessment Practices and AAC Adaptations for Beginning Reading Skills

	Standard		Adapted for AAC user
Skill	Presentation	Response	Presentation	Response
Phonemic awareness
Sound matching (e.g., CTOPP^a)	Target picture; three-picture array; assessor names target picture and asks student to choose the picture with the same first or last sound	Student names or points to picture with matching sound	No adaptation needed	Student selects^b picture
Phoneme segmentation (e.g., DIBELS^c)	Assessor says word	Student says sounds in word separately	No adaptation needed	Student indicates sounds by moving a token for each sound (note: becomes phoneme counting task)^d
Phoneme blending	Assessor says word parts or sounds separately	Student says whole word	No adaptation needed	Student selects^b picture of target word from diagnostic array (e.g., target word plus distractors with same first sound, same middle sound, same final sound)^e
Letter-sound correspondence	Written letter	Student says sound of letter	Assessor says sound	Student selects^b written letter from array of letters (note: becomes encoding task)^f
Decoding or word reading	Written word	Student sounds out, says whole word	No adaptation needed	Student selects^b picture of target word from diagnostic array (e.g., target word plus distractors with same first sound, same middle sound, same final sound).^e OR: Assessor says multiple possible words and asks the student to indicate (e.g., yes/no) correct pronunciation of word^g
	Written word	Student sounds out, says whole word	Assessor says word (no written word presented)	Student selects^b written word from an array of words^h

Note. The citations in this table direct readers to sample references. AAC = augmentative and alternative communication; CTOPP = Comprehensive Test of Phonological Processing; DIBELS = Dynamic Indicators of Basic Early Literacy Skills.

Wagner, Torgesen, Rashotte, and Pearson (2013).

Selection may include direct selection or indirect selection methods.

Good and Kaminski (2011).

Blischak et al. (2004).

Fallon, Light, McNaughton, Drager, and Hammer (2004).

Johnston, Davenport, Kanarowski, Rhodehouse, and McDonnell (2009).

Heller, Fredrick, Tumlin, and Brineman (2002).

Truxler and O’Keefe (2007).

Based on the information derived from assessments, individualized education program (IEP) teams can determine IEP goals related to literacy skills. In addition to identifying the literacy skills that will be taught, the team will need to identify adaptations for AAC users with PDCCN. Specifically, teams will need to determine (a) how the student will demonstrate skills that are taught, (b) how sufficient opportunities for instruction will be provided, and (c) how to enhance the AAC system to include needed vocabulary.

Assessment information reveals that Jessie consistently and independently demonstrates concepts about print and phonemic awareness (e.g., segmenting, rhyming) but does not yet demonstrate letter-sound correspondence or decoding skills. Given this information, the team decides to design an intervention focused on teaching letter-sound correspondence and the spelling of consonant-vowel-consonant words. The team discusses each guideline for instruction (see Table 1). Based on this discussion, the initial sounds selected for instruction are /m/, /t/, /s/, and /a/ (as in “mat”). Following the acquisition of these target sounds, nine consonant-vowel-consonant combinations (e.g., “mat,” “sat”) can be created and taught. The team recognizes that to support Jessie’s skill acquisition, it will need to make decisions regarding how Jessie will demonstrate skills that are taught, how to ensure that Jessie receives sufficient opportunities for instruction, how to enhance Jessie’s AAC system to include needed vocabulary, and what instructional strategies will be used.

Determine How the Student Will Demonstrate Skills

For students who communicate verbally, speaking and reading aloud typically play large roles in literacy instruction. For example, when teaching phonemic awareness, educators may ask students to say words that begin with the sound /m/ (e.g., Honig et al., 2013). When teaching letter-sound correspondence, educators may point to the letter “s” and ask students to say the sound that the letter makes. Finally, when teaching decoding, educators may ask a student to sound out and then read the word aloud (e.g., Carnine et al., 2017).

Educators who support students with PDCCN will need to consider ways to adapt the instruction to eliminate the need for a verbal response while providing a way for those students to demonstrate skills. To make this adaptation, teachers first identify the student’s selection technique—the manner in which the student accesses the AAC system. Johnston and Feeley (2012) classified selection techniques in terms of direct and indirect selection. Direct selection refers to situations when a student directly indicates a selected symbol (e.g., touching a symbol with a finger, using a head stick to point to a symbol, or using eye gaze or an optical pointer to select a symbol). Indirect selection involves waiting for an intermediary step (e.g., a communication partner, device menus options), after which the student indicates his or her choice using a discrete response (e.g., making a specific sound/movement, activating a switch to indicate selection). When the selection technique is being determined for a student with PDCCN, the goal is to provide students with accurate and efficient ways to demonstrate skills.

Researchers have found that it is possible to provide students with PDCCN ways to demonstrate skills in the context of early literacy instruction. Examples include the following:

Selecting a written letter from an array when presented with its spoken phoneme (e.g., Ahlgrim-Delzell, Browder, & Wood, 2014; Benedek-Wood, McNaughton, & Light, 2016; Hanser & Erickson, 2007; Johnston, Davenport, Kanarowski, Rhodehouse, & McDonnell, 2009)

Selecting a written word/syllable from an array when presented with its spoken label (e.g., Ahlgrim-Delzell et al., 2014; Hanser & Erickson, 2007; Truxler & O’Keefe, 2007)

Selecting a picture from an array when presented with its spoken and/or written label (e.g., Ahlgrim-Delzell et al., 2014; Fallon, Light, McNaughton, Drager, & Hammer, 2004; Light, McNaugton, Weyer, & Karg, 2008)

Selecting letters from an array to spell words that are presented orally (e.g., Hanser & Erickson, 2007; Johnston et al., 2009; Sandberg, Smith, & Larsson, 2010)

Selecting a picture from an array after an interventionist says a letter name/phoneme, speaks the name of each picture in the array, and asks which picture starts with the letter name/phoneme (e.g., Fallon et al., 2004; Sandberg et al., 2010; Truxler & O’Keefe, 2007)

Selecting a letter from an array when asked to identify the letter that a spoken word began with (Browder et al., 2012; Millar, Light, & McNaughton, 2004)

Nonverbally selecting a sound/word when provided with verbal choices (Heller et al., 2002; Heller, Fredrick, & Diggs, 1999)

To date, the majority of the research designed to teach literacy skills to students with PDCCN has included participants who used direct selection techniques. However, a limited number of investigations taught literacy skills to students with PDCCN who used indirect selection techniques (e.g., Hanser & Erickson, 2007; Millar et al., 2004). This suggests that as long as students have an efficient and effective way to demonstrate skills, literacy skills can be taught to students with PDCCN who use either direct or indirect selection techniques.

Jessie’s IEP team discusses how Jessie will demonstrate skills that are taught. Given Jessie’s difficulties with regard to orally producing letter sounds/words, the team recognizes that having Jessie respond vocally/verbally will not be a viable option. Observation of Jessie with her AAC system (a 12-page printed communication book with an array of 32 symbols per page) reveals that she accurately accesses symbols via direct selection by touching the symbols with her finger. The IEP team decides to use this same access strategy to demonstrate skills that are taught in the context of literacy instruction. Specifically, in the context of instruction for letter-sound correspondence and decoding, the teachers decide that they will voice a sound or word, and then Jessie will use direct selection to indicate the corresponding letter or letter sequence from an array of printed options.

Plan for Ample Opportunities for Instruction

Ensuring active and meaningful opportunities for instruction is another important consideration for AAC users with PDCCN who are learning literacy skills. Researchers found that students who use AAC have fewer opportunities to learn literacy skills than their peers without disabilities (Beukelman & Mirenda, 2013; Machalicek et al., 2010). Furthermore, when they are provided with opportunities to learn literacy skills, AAC users often engage in those opportunities in ways that are less active and meaningful (Binger, Kent-Walsh, Berens, Del Campo, & Rivera, 2008). Thus, teachers need to find ways to increase opportunities for instruction and meaningful engagement for students who use AAC.

Machalicek and colleagues’ (2010) review of research revealed that the majority of studies that resulted in the successful teaching of literacy skills to AAC users included embedded opportunities within one-to-one, shared storybook reading activities. Although these studies resulted in positive outcomes, it is important to recognize that one-to-one instruction may not be feasible in all environments (e.g., child care settings, inclusive classrooms). Furthermore, shared book reading may not be a motivating activity for some students, or teachers may struggle to create a sufficient number of opportunities for skill acquisition if all instruction is embedded into only one activity. Therefore, teachers should consider ways to embed opportunities for instruction into small group activities as well as into activities that go beyond shared book reading.

Several resources are available to teachers who are searching for evidence-based literacy activities that can accommodate more than one student and that go beyond shared book reading (e.g., textbooks such as Carnine et al., 2017; Honig et al., 2013; Moats, 2009; websites such as fcrr.org, intensiveintervention.org, interventioncentral.org, readingrockets.org, readwritethink.org). Note, however, that these resources are not likely to provide specific information related to adapting the activities for AAC users with PDCCN. Therefore, the strategies discussed in this article (e.g., determining how the student will demonstrate skills, enhancing the AAC system to include needed vocabulary) need to be considered to ensure that activities are appropriate for students with PDCCN.

Jessie’s team discusses that her teacher is seeking ways to create opportunities for Jessie to participate in activities that can support small group, rather than one-to-one, instruction. Furthermore, the team notes that to increase motivation, Jessie will benefit from opportunities across a variety of activities, rather than repeated use of only one activity. The team identifies a variety of activities that meet these criteria and decides to implement two activities per day. The activities will vary from day to day and will include (a) letter-sound BINGO during large group instruction (the teacher says a letter sound, and students place tokens over the corresponding letter on a card with an array of letters); (b) tall towers during small group instruction (the teacher says a letter sound, and students take turns choosing the block with the corresponding letter, from an array of blocks with letters attached with Velcro, and adding that block to a tower); and (c) letter-sound basketball during gross motor/gym (a trash can and an array of bean bags with letters attached with Velcro are placed on the floor. The teacher then says a letter sound and students take turns choosing the bean bag with the corresponding letter and tossing it into the trash can).

Ensure Appropriate Vocabulary and Symbols Are Available Through AAC

The ability to communicate efficiently and effectively for AAC users who are preliterate (have not yet learned to read or write) is highly dependent on ensuring that appropriate vocabulary is included on their AAC system. Given that students who are preliterate are unable to generate novel utterances by spelling out words and phrases, IEP teams must be diligent in ensuring that vocabulary is available to meet their needs. An AAC system for preliterate students should include vocabulary that is needed to communicate necessary messages (e.g., to express needs and wants, to share information, and to develop friendships and relationships) as well as vocabulary that is needed to develop language skills (Beukelman & Mirenda, 2013).

One strategy for ensuring that the appropriate vocabulary is available and accessible to preliterate AAC users is to create separate displays for specific activities and environments (Beukelman & Mirenda, 2013; Downing, Hanreddy, & Peckham-Hardin, 2015). For example, one activity-specific display might be created for mealtimes, another for swimming, and another for an upcoming trip to the theater. Activity-specific displays can be low tech (e.g., a printed communication board, a page in a communication book) or high tech (e.g., a linked page on a speech-generating device, laptop, or tablet).

Activity-specific displays may be particularly well suited for literacy instruction for students with PDCNN who use AAC because they allow the IEP team to create displays for specific literacy activities that include vocabulary that is essential for communication during the activity, as well as vocabulary that is needed to develop literacy skills. For example, consider a Hop on Pop rhyming activity, where students step on squares of Bubble Wrap taped to the floor as they identify words that rhyme with a word the teacher says. If needed, adaptations for students with physical disabilities can be made to this activity by providing physical assistance to walk/hop or having students use their hands to pop the bubbles. An activity-specific display for this game might include vocabulary that is essential for communication during the activity, such as I, you, more, help, go, hop, pop, not, and rhyme, as well as pictures of vocabulary items that do and do not rhyme with the words spoken by the teacher.

Including pictures on the display of items that do not rhyme with the words spoken by the teacher is an important consideration. If all of the items rhyme with the words that are spoken, it will not be possible to determine if the student is discriminating between rhyming and nonrhyming words, because any picture that the student selects will be a correct response. Therefore, when vocabulary is selected to support literacy instruction, it should include the correct responses as well as distractors (sometimes called foils). This concept was illustrated in an investigation by Fallon et al. (2004) when the interventionists showed students a printed word (e.g., map) and then asked them to match it to its corresponding picture when presented with an array of four pictures (i.e., one target and three foils). Picture foils included one with a different initial consonant (e.g., cap), one with a different vowel (e.g., mop), and one with a different final consonant (e.g., man). Similarly, when teaching sound-letter correspondence, Johnston et al. (2009) created displays that included an array of eight letters, which ensured that as letters/sounds were targeted for instruction, there was always one correct response and seven foils.

When teams decide how many foils to present in an array, they need to consider students’ motor, vision, and cognitive skills/abilities. Barker et al. (2012) and Johnston, Reichle, Feeley, and Jones (2012) raised additional points to consider regarding the number of foils to include for any given task. Specifically, if a display is created that includes only two choices (one correct and one foil), then 50% of the responses will be correct even if the student guesses; if a display is created that includes four choices (one correct and three foils), then 25% of the responses will be correct even if the student guesses; and if a display is created that includes eight choices (one correct and seven foils), then 13% of the responses will be correct even if the student guesses.

It is important to note that when using pictures, photos, or visual symbols on displays, teachers need to ensure that the AAC user not only knows what the picture represents but is also nonverbally labeling the picture the same as the teacher. For example, when a student is asked to point to a picture that rhymes with cat when presented with an array of choices that includes a picture of a hat, it will be important to ensure that the student is not nonverbally labeling that picture a cap.

Another consideration in the creation of displays for literacy instruction relates to ensuring that students engage in responses by discriminating among available options as opposed to engaging in responses due to position bias (i.e., making selections based on the location of the symbol on the display; Reichle & Wilkinson, 2012). Position-biased responses can be avoided during early stages of instruction by randomizing and changing the location of the symbols, letters, and words presented (e.g., Fallon et al., 2004; Johnston et al., 2009).

Jessie’s IEP team creates activity-specific displays for the literacy related activities where instruction will occur. The displays include vocabulary that is essential for communication during the activity as well as vocabulary for literacy instruction. Instructional materials (e.g., letters on BINGO cards, blocks/beanbags with letters) are presented in randomized arrays to prevent position bias during the early stages of instruction.

Systematic Instruction

Reviews of the literature demonstrate that AAC users with PDCCN benefit from systematic instruction to teach literacy skills (Barker et al., 2012; Machalicek et al., 2010). Instructional strategies to teach early literacy skills to AAC users include the following:

Teacher or peer modeling of target skills (e.g., Fallon et al., 2004; Johnston et al., 2009; Light et al., 2008; Truxler & O’Keefe, 2007)

Guided practice by providing the student with opportunities for practice with some assistance from the teacher (e.g., Coleman-Martin, Heller, Cihak, & Irvine, 2005; Fallon et al., 2004; Heller et al., 2002; Heller & Coleman-Martin, 2007; Light et al., 2008)

Verbal prompts for the student to use subvocal rehearsal by saying sounds/words in their head while the teacher says them aloud (e.g., Coleman-Martin et al., 2005; Heller et al., 2002)

A most-to-least prompt hierarchy that progresses from a full prompt, to partial prompts, and then to no prompt (e.g., Millar et al., 2004)

Stimulus prompts, such as highlighting of the letters targeted for instruction on a keyboard (e.g., Millar et al., 2004)

Independent practice opportunities for the student to use skills across a variety of contexts (e.g., Fallon et al., 2004; Johnston et al., 2009; Light et al., 2008)

A time delay prior to a teacher prompt to allow the student an opportunity to respond without assistance (e.g., Johnston et al., 2009)

Teacher correction when a student makes an error response (e.g., Coleman-Martin et al., 2005)

Two additional instructional strategies (gestural and physical prompts) may be worthy of consideration when teaching literacy skills to students with PDCCN. Gestural prompts include looking expectantly at individuals to prompt them to use their AAC systems and tapping on or near students’ communication boards to encourage them to point to a symbol. One gestural prompt that might be useful in the context of literacy instruction is a flashlight cue (Goossens, Crain, & Elder, 1992). With a flashlight cue, the teacher prompts the student’s behavior (e.g., using the AAC system to communicate) by shining a flashlight on the instructional materials and/or AAC system. Depending on the level of prompt needed, a teacher might use the flashlight to either direct the student to communicate (wave the beam of the flashlight back and forth across the AAC system to signal the need to respond) or explicitly indicate the required behavior (focus the beam of the flashlight on the letter “m”). Goossens et al. (1992) noted that a flashlight cue is advantageous because it allows the teacher to prompt the student from a distance. This might be particularly useful for teaching literacy skills in the context of group activities where the teacher is not consistently in close proximity to the student.

Although not used in the context of research designed to teach literacy skills, physical prompts were used effectively with AAC users (e.g., Rabideau, Stanton-Chapman, & Brown, 2018). A common physical prompt that is implemented for teaching the use of an AAC system is hand-over-hand guidance (i.e., the teacher places his or her hands on top of the student’s hands to guide behavior). However, teachers might also consider hand-under-hand guidance as a physical prompt strategy (i.e., the teacher places a hand under the student’s hands to guide behavior). Hand-under-hand guidance is most often discussed in the context of teaching students who are deafblind (e.g., Miles, 2017). However, it may be useful for literacy instruction in that it allows students to exert more control and to observe their own bodies engaging in the desired behavior (e.g., pointing to the letter “m” on a communication display, pointing to pictures that rhyme with “hat”).

Jessie’s teachers discuss the need to use systematic instruction when teaching Jessie. The team decides that instruction will including modeling (e.g., the teacher will model the correct response by touching the correct letter) and a most-to-least prompting hierarchy with a flashlight cue. That is, the teacher will initially use the flashlight by focusing the beam directly on the correct response and will gradually fade the prompt by waving the beam of the flashlight back and forth across the instructional materials to signal the need to respond.

Summary

Literacy skills are crucial in school, work, and community settings. Students with PDCCN who use AAC can benefit from literacy instruction that is adapted to meet their unique needs. Creating meaningful early literacy instruction requires teachers to engage in modified assessment procedures, determine students’ response modes, ensure that AAC systems facilitate instruction, and systematically plan for instructional opportunities.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Susan S. Johnston, Professor, Breda V. O’Keeffe, Associate Professor and Kristen Stokes, Doctoral Student, Department of Special Education, University of Utah, Salt Lake City.

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