New Directions in Reading Instruction for Adolescents With Significant Cognitive Disabilities

Abstract

This article reports findings from a literature review on literacy instruction for adolescents with significant cognitive disabilities. Nineteen empirical studies published between 1975 and 2011 were included in the review and analyzed based on characteristics of interventions. The results were examined to determine whether the state of research in this area indicates a comprehensive approach to literacy for adolescents with significant cognitive disabilities. Results indicate that vocabulary instruction through sight word acquisition is still prevalent, instruction is not comprehensive, and instruction does not address recommendations from the field for adolescent literacy. However, innovative approaches to literacy instruction for this population are beginning to be explored. The current state of research on reading practices for adolescents with significant cognitive disabilities, implications for practice, and suggestions for new directions in research are discussed.

Keywords

reading instruction evidence-based practice low-incidence disabilities exceptionalities middle/junior high special education high school special education

Educational policies within the last decade have emphasized reading as a skill of fundamental importance in our society (Lyon, Shaywitz, Shaywitz, & Chhabra, 2005). Policies such as the Elementary and Secondary Education Act (ESEA; 1965), known currently as the No Child Left Behind Act (NCLB, 2002), the Reading First initiative (NCLB, 2002), and the Individuals With Disabilities Education Improvement Act (IDEIA; 2004) state that all students should be provided instruction allowing them to work toward grade-level standards, including grade-level standards in reading. While the majority of literacy research is situated in early literacy development, comprehensive reports such as Reading Next (Biancarosa & Snow, 2006) and Adolescents and Literacy (Kamil, 2003) underscore the importance of high standards and access to high-quality instruction for adolescent readers. Although there is evidence to suggest struggling adolescents can benefit from interventions focused on word reading and fluency (Scammacca et al., 2007), there are relatively few published studies focused on interventions targeting such skills when compared with the multitude of interventions that focus on comprehension for struggling adolescent readers (Joseph & Schisler, 2009).

These reports also advocate for high-quality reading instruction for all readers, including students with disabilities. This increased emphasis on accountability for the progress of all students resulted in a change in the focus and structure of reading instruction, particularly for students with disabilities. Although the passage of the Education for All Handicapped Children Act (EAHCA) of 1975 ensured all children had access to education, NCLB laid the foundation for increased accountability in this education. Schools are now held accountable for all students’ progress toward grade-level standards in reading, ostensibly via high-quality reading instruction.

Unfortunately, students with significant cognitive disabilities may not be afforded the same opportunities to gain literacy skills as their peers without disabilities. The term significant cognitive disabilities, as defined by Browder, Wakeman, Spooner, Ahlgrim-Delzell, and Algozzine (2006), encompasses “students classified as having moderate or severe mental retardation [now referred to as cognitive or intellectual disability] who may have additional disabilities such as autism or physical disabilities” (p. 392). Despite what is known about the components of high-quality reading instruction, reading instruction for students with significant cognitive disabilities has traditionally lacked a clear focus and overemphasized functional reading skills such as sight words necessary for daily living, safety, and independence (Browder et al., 2006; Kliewer, 1998). Research in reading instruction for students with significant cognitive disabilities lacks the comprehensiveness advocated for by the National Reading Panel (NRP; Browder et al., 2006; Erickson, Hanser, Hatch, & Sanders, 2009; NRP, 2000) and the Reading Next report (Biancarosa & Snow, 2006). Comprehensive approaches to reading instruction provide more authentic exposure to the general curriculum (Erickson et al., 2009). Comprehensive approaches also incorporate instruction in all five elements of reading as recommended by the NRP (i.e., phonemic awareness, phonics, fluency, vocabulary, and comprehension), writing instruction, and opportunities for interaction with a wide variety of texts (Erickson et al., 2009). Instead, the majority of reading interventions for students with significant cognitive disabilities focus on direct instruction and repetition of skills such as sight word identification related to life or functional skills that are disconnected from the comprehensive, evidence-based reading approaches we use with typically developing children (Erickson et al., 2009).

Adolescents with significant cognitive disabilities are a subpopulation for whom research and teacher preparation have not kept pace. They often remain in the early stages of reading well into adolescence (Erickson & Koppenhaver, 1995). Unfortunately, many teachers do not provide instruction promoting reading growth beyond the emergent literacy phase and therefore instruction fails to move students toward more conventional literacy skills that encompass reading and writing (Erickson et al., 2009). This could be due to low expectations for students with significant disabilities (Kliewer, Biklen, & Kasa-Hendrickson, 2006). These low expectations, coupled with a dearth of examples of fully literate adults with significant cognitive disabilities, reinforce such problematic low expectations (Erickson et al., 2009). As a result, parents and teachers often promote more functional reading curricula for adolescents with significant cognitive disabilities as opposed to advocating for high-quality reading instruction that provides access to the general curriculum and facilitates individuals with significant disabilities becoming literate (Erickson et al., 2009). Although proficient reading skills are necessary to be successful in and out of school (Kamil, 2003), there is limited research on the critical components of reading instruction for adolescents with significant cognitive disabilities. The lack of attention to the body of evidence surrounding high-quality, comprehensive reading instruction when teaching students with significant disabilities may be explained, at least in part, by historical trends related to instruction for students with significant cognitive disabilities.

Reading Instruction for Students With Significant Cognitive Disabilities

Historically, curriculum trends in instruction for students with disabilities, including students with significant cognitive disabilities, have shifted foci as a result of philosophical and legislative changes (Browder et al., 2003). Briefly, these trends began with a developmental model where students with significant cognitive disabilities were instructed in curriculum meant for very young children and have moved through various phases including a focus on functional skills, social inclusion and self-determination, to the present era where access to the general curriculum is a priority (Browder et al., 2003). More detailed discussions of these trends can be found in the literature (e.g., Browder et al., 2003). The current era, in which access to the general curriculum is mandated, demonstrates the field’s recognition that higher quality academic instruction is necessary for all students, including those with significant cognitive disabilities. This new focus has heightened attention to the quality of reading instruction currently provided to students with significant cognitive disabilities, which has led to the dissemination of several reviews of the literature.

Prior Reviews of Reading Instruction for Students With Significant Cognitive Disabilities

Since the passage of the EAHCA (1975), seven published literature reviews have addressed reading instruction specifically for students with significant cognitive disabilities. The two earlier reviews focused specifically on sight word instruction for students with significant cognitive disabilities (i.e., Browder & Lalli, 1991 and Browder & Xin, 1998). The more recent reviews, conducted since 2000, have had a variety of foci. One focused on time-delay procedures used to implement literacy instruction (i.e., Browder, Ahlgrim-Delzell, Spooner, Mims, & Baker, 2009), one focused on phonics instruction (i.e., Joseph & Seery, 2004), one focused on the components of reading instruction as identified by the NRP for students with significant disabilities (i.e., Browder et al., 2006), and one specifically focused on literacy interventions for students with significant disabilities who use augmentative and alternative communication (AAC) devices (i.e., Machalicek et al., 2010). The most recent review by Hudson and Test (2011) specifically looked at the evidence base on shared story reading in literacy instruction for students with significant disabilities.

Although these reviews have made important contributions to the area of reading instruction for students with significant disabilities, they do not focus on the comprehensiveness of reading instruction for adolescents with significant cognitive disabilities. To our knowledge, there is no published literature review addressing the state of literacy instruction for adolescents with significant cognitive disabilities. This is problematic because adolescents with significant cognitive disabilities have unique needs related to their disability and adolescence that should be accounted for by professionals in reading instruction. In light of the highlighted focus on adolescent literacy (e.g., Biancarosa & Snow, 2006; Kamil, 2003), it seems logical that the state of reading instruction for this population be investigated.

Therefore, the purpose of this literature review is threefold. First, we describe the literature on reading interventions for adolescents with significant cognitive disabilities. Second, we evaluate the characteristics of each intervention to determine whether they represent the comprehensiveness recommended by Erickson et al. (2009) and recent reports focusing on improving reading instruction for adolescents. Third, we discuss implications of these results for current reading practices for adolescents with significant cognitive disabilities and discuss potential promising instructional practices that warrant further exploration.

Method

Literature Search and Selection

We used several inclusion criteria to synthesize the literature on reading instruction for adolescents with significant cognitive disabilities. First, articles had to be published in peer-reviewed journals in English between 1975 and 2011. The year 1975 represents the passage of the EAHCA. Second, we only included empirical intervention studies. We used the What Works Clearinghouse (WWC) definition of an intervention as, “an educational program, product, practice, or policy aimed at improving student outcomes” (U.S. Department of Education, 2012). Using Creswell’s (1994) principles of research design as a guiding framework, we defined empirical studies as those that reported findings from an analysis of data. To be included in the review, articles identified as empirical intervention studies had to (a) include solely adolescent participants (i.e., ages 13–21) or students in a specified secondary setting (i.e., middle school or high school) with either moderate or severe intellectual disability or autism, and (b) have one or more elements of reading instruction as the dependent measure. Because the main purpose of this review was to evaluate reading instruction for adolescents in schools, studies focused on reading interventions for adults with significant cognitive disabilities or with participants who did not receive the intervention in an educational setting were excluded.

These inclusion and exclusion criteria were used to conduct an extensive search of the literature. First, we searched the Academic Search Premier, Educational Resource Information Clearinghouse (ERIC), ProQuest and PsychINFO databases using a combination of the following search terms: reading, literacy, severe disabilities, cognitive disabilities, significant disabilities, adolescen*, secondary, policy, and disability. Second, we used the same databases to search specific journals that focus primarily on significant cognitive disabilities. The following journals were searched paired with the search term read*: (a) Education and Training in Autism and Developmental Disabilities, (b) Education and Training in Mental Retardation and Developmental Disabilities, (c) Focus on Autism and Other Developmental Disabilities, (d) Journal of Applied Behavior Analysis, (e) Remedial and Special Education, and (f) Research and Practice for Persons with Severe Disabilities. Third, as we retrieved articles, if three or more articles authored by the same author or groups of authors emerged, we searched the databases for these author names paired with the terms read* and lit* to identify any additional articles written by individuals who currently publish or have published prominently in this area. This resulted in searches of the following author names: Diane Browder, Belva Collins, David Gast, Kathryn Heller, Frans Hoogeveen, Linda Mechling, Judy Singh, Nirbhay Singh, Paul Smeets, and Mark Wolery. Finally, we conducted ancestral searches of relevant existing literature reviews and hand searched issues published from 2008 through 2011 in the aforementioned publications to ensure that articles of relevance had not been overlooked. Articles encountered through other avenues, such as related readings or from recommendations from colleagues, were also included if they met the inclusion criteria.

Coding Procedures

Once the included studies were identified, they were coded for characteristics. To evaluate individual study characteristics, studies were coded to identify the following: (a) component of reading targeted; (b) instructional materials; (c) intervention reading content (i.e., functional and/or academic); (d) research design; (e) participant demographics, including gender, socioeconomic status, age, and ethnicity; (f) intervention setting; (g) duration of intervention; (h) implementer; and (i) treatment and findings.

Results

A total of 19 empirical intervention studies met the inclusion criteria and were included in this review. Journal articles from 10 different journals were included. Table 1 displays the results of the coding of characteristics of each study.

Table 1.

Characteristics of Intervention Studies.

Study	Intervention	Intervention reading content^a	Design	Participants and setting	Duration	Implementer	Outcome
Bradford, Shippen, Alberto, Houchins, and Flores (2006)	Systematic decoding instruction using Corrective Reading Program, Decoding A	Phonics and fluency; academic content; Corrective Reading Program, Decoding A materials	Pretest–posttest with criterion-referenced performance measures	Three male students ages 12, 14, and 15 with IQs ranging from 46 to 55 in a self-contained classroom in a public middle school in a large urban area	45- to 55-min lessons 2 to 3 days a week for 6 months for a total of 65 lessons	Teacher researcher	By the end of the study, all three participants were able to identify letter sound associations, decode regularly and irregularly spelled words, and read sentences and short-leveled passages at the second-grade level.
Browder and Shear (1996)	Interspersal drill sequence of known words to teach functional sight words related to weather and clothing	Vocabulary; functional content; sight word flash cards	Single-case multiple probe across participants	Three students (1 male, 2 female) ages 16, 12, and 13 with IQs ranging from 42 to 45 in a self-contained classroom in a public middle school	55 daily sessions	Two classroom teachers	All participants learned 10 new words after 2 to 6 weeks.
Browder, Trela, and Jimenez (2007)	Task analytic shared story lessons using systematic prompting, feedback, and time delay	Comprehension; academic content; adapted stories	Single-case multiple probe across participants	Six students (3 male, 3 female) ages 12 to 14 with IQs under 50 with varied verbal abilities; three teacher participants in a self-contained classroom in a public middle school in a large urban area	Daily lessons for 16 to 26 sessions	Classroom teachers	All students increased their ability to independently respond to teacher prompts around print awareness and comprehension questions.
Collins, Branson, and Hall (1995)	Key word approach to generalization	Vocabulary and comprehension; functional content; sight word flash cards and various cooking products	Single-case multiple probe across word sets	Four students (2 male, 2 female) ages 16 to 18 with IQs ranging from 36 to 57 in a self-contained classroom in a secondary public school in a rural area	Daily sessions one period per day	General education peer tutors	All students improved their ability to read and apply cooking vocabulary after peer instruction.
Collins, Hager, and Galloway (2011)	Integration of functional content during core content instruction	Vocabulary and comprehension; functional and academic content; sight word flash cards for language arts, cooking materials and flash cards for science, and a calculator and flash cards for math	Single-case multiple probe across behaviors	Three students (2 male, 1 female) ages 14 to 15 with IQs ranging from 41 to 55 in a self-contained classroom in a public middle school	65-min daily sessions September to April	Classroom teacher	Students made progress in functional and academic content goals in reading/language arts, science, and math although results were variable. This study demonstrated that core content can be integrated in a more functional and meaningful way.
Conners (1990)	Computer-assisted word learning comparing low and high discrimination and overlearning conditions	Vocabulary; functional content; computer-assisted instructional program	Pretest–posttest across three conditions	25 students (16 male, 9 female) with intellectual disability ages 12 to 22 with IQs ranging from 29 to 64. Seventeen students were Hispanic, 3 were African American, 3 were White, and 2 were biracial in a segregated secondary school in an urban area.	Three sessions of all six versions of computer-assisted instruction.	Computer	There was an interaction between participants’ cognitive abilities and specific treatment variables when identifying sight words.
Cuvo and Klatt (1992)	Community-based, videotaped, and flash card instruction	Vocabulary; functional content; sight word flash cards	Single-case multiple baseline across participants	Six students (4 male, 2 female) ages 13 to 17 with IQs ranging from 45 to 65 in a self-contained classroom in a public middle school and community settings	18 to 28 sessions	Researcher	All participants were able to learn and generalize the words regardless of the approach used. Overall, the combination of approaches led to successful generalization in the community.
Doyle, Gast, Ault, and Farmer (1990)	Observational and incidental learning occurring during small-group instruction using constant time delay	Vocabulary and comprehension; functional content; fact question flash cards	Single-case multiple probe across behaviors	Four students (2 male, 2 female) ages 16 to 18 with IQs ranging from 45 to 61 in a self-contained classroom in a public high school in a rural area	85 twenty-min sessions	Classroom teacher	Students learned their target facts using the constant time-delay procedures as well as incidental information through their small group.
Farmer, Gast, Wolery, and Winterling (1991)	Observational learning occurring during small-group instruction using progressive time delay	Vocabulary; functional content; sight word flash cards	Single-case multiple probe	Four students (1 male, 3 female) ages 15 to 19 with moderate to severe disabilities in a self-contained classroom in a public high school	Two daily sessions for 5- to 15-min for a total of 109 sessions	Classroom teacher	Participants learned their target words and two of the four students also learned some of their peers’ target words by being included in the small group.
Karsh, Repp, and Lenz (1990)	Task demonstration (fading) compared with the standard prompting hierarchy (least to most prompts)	Vocabulary; functional content; sight word flash cards	Single-case alternating treatments	Six students (3 male, 3 female) ages 17 to 20 with IQs ranging from 36 to 44 in a school in a large suburban area	Not specified	Researcher	The task demonstration model was more effective and produced fewer errors in each of all three phases: acquisition, generalization, and maintenance.
Kyhl, Alper, and Sinclair (1999)	Videotaped instruction	Vocabulary; functional content; sight word flash cards and videos	Single-case multiple baseline across participants	Three students (1 male, 2 female) ages 16 to 19 and IQs ranging from 40 to 55 in a self-contained classroom in a rural area and in a local grocery store	25 to 38 sessions	Teacher researcher	All students learned the targeted words in the classroom and generalized to the grocery store and maintained them for a 5-month follow-up.
McDonnell, Johnson, Polychronis, and Risen (2002)	Embedded instruction using constant time delay, error correction, and social reinforcement	Vocabulary; academic and functional content; sight word flash cards	Single-case multiple baseline across behaviors	Four male Caucasian students ages 13 to 15 with IQs ranging from 46 to 57 in a general education classroom in a public middle school in an urban area	17 sessions	Researchers and paraprofessionals	Students successfully learned their targeted word groups.
Mechling, Gast, and Thompson (2009)	SMART Board instruction and flash card instruction	Vocabulary; functional content; sight word flash cards and SMART Board	Single-case adapted alternating treatments	Three high school students (1 male, 2 female) with moderate cognitive disabilities in a self-contained classroom in a high school transition program located at a public university	Two sessions per day (one SMART Board and one flash card) for a total of 17 sessions	Not specified	Instructional SMART Board instruction and flash card instruction were effective at teaching students grocery sight words. However, the SMART Board instruction was more effective in increasing students’ observational learning of sight words.
Miracle, Collins, Schuster, and Grisham-Brown (2001)	Peer instruction compared with teacher instruction using constant time delay	Vocabulary; functional content; sight word flash cards	Single-case adaptive alternating treatment	Four male students ages 14 to 20 with moderate to severe cognitive disability; 3 had IQs of 40 and 1 had a mental composite of 43; self-contained classroom in a public secondary school	Two lessons per day (one with peer and one with teacher) for 20 to 30 sessions	Classroom teacher and general education peers	Students were instructed in functional sight words necessary for grocery shopping. Teacher- and peer-administered interventions proved effective, although teacher delivered instruction proved more efficient.
Mosley, Flynt, and Morton (1997)	Classroom instruction using constant time delay compared with community-based instruction	Vocabulary; functional content; sight word and picture flash cards	Pretest–posttest with two groups	Eight students ages 13 to 17 with IQs ranging from 37 to 50 in a self-contained classroom in a public school in an urban area and in a community grocery store	6 to 8 sessions for classroom training and 8 sessions of community training for each group	Classroom teacher	Participants were able to read the word on the list and find the item in the grocery store. Both methods proved effective, and neither one showed superiority over the other.
Singh (1990)	Word supply error correction compared with sentence repeat error correction	Fluency; academic content; books from Story Box series	Single-case alternating treatments	Three students (1 male, 2 female) ages 13 to 15 with IQs ranging from 39 to 54 in a classroom in a segregated school for students with disabilities	15-min daily sessions for 30 days	Classroom teachers	Both procedures were more effective than the control condition where no error correction procedures were used. However, sentence repeat was more effective at reducing oral reading errors than word supply.
Singh, Singh, and Winton (1984)	Positive practice overcorrection on oral reading	Fluency; academic content; books from the Reading to Read and Story Box series	Single-case alternating treatments	Four female students ages 14 to 16 with IQs ranging from 39 to 54 in a classroom in a segregated school for students with disabilities	5-min sessions three times per day for 30 days	Researcher	Compared positive practice used alone and positive practice used with positive reinforcement to a control condition. All subjects decreased uncorrected oral reading errors and increased self-corrections when using the overcorrection procedures. Pairing it with positive reinforcement increased the effectiveness.
Singleton, Schuster, Morse, and Collins (1999)	Antecedent prompt and test compared with simultaneous prompting procedures used to teach sight words	Vocabulary; functional content; sight word flash cards, grocery lists, newspapers, and grocery items	Single-case adapted alternating treatments	Four students (3 male, 1 female) ages 15 to 19 with moderate cognitive disabilities in a self-contained classroom in a public high school in a rural area	Not specified	Classroom teacher	All procedures were effective although antecedent prompting and test procedures were more efficient for acquisition of sight words while simultaneous prompting was more efficient for generalization.
Smith, Schuster, Collins, and Kleinert (2011)	Simultaneous prompting to teach functional restaurant words	Vocabulary; functional content; sight word flash cards	Single-case multiple probe across behaviors and replicated across participants	Four secondary students (3 male, 1 female) with moderate to severe disabilities in a self-contained classroom in the public high school	Twice daily sessions for 35 sessions	Researcher	All participants acquired the targeted sight words and the nontarget information using simultaneous prompting and maintained it over time.

Intervention reading content refers to the component of reading targeted as defined by the NRP (i.e., Phonemic Awareness, Phonics, Fluency, Vocabulary, and/or Comprehension); the primary content of the intervention (i.e., functional and/or academic); and the instructional materials used during the intervention.

Interrater Reliability

A second coder, a doctoral student in special education, coded seven randomly selected studies from those reviewed (i.e., 37%) to ensure accuracy of the coding. Six single-case studies and one group design were randomly selected, proportionately reflecting the composition of the 19 studies. The second coder ensured the studies met the inclusion criteria and then she coded the study characteristics. The number of agreements and disagreements was recorded by comparing the results of each category per study and interrater reliability was calculated by dividing the number of agreements by the number of agreements plus disagreements. The second rater agreed that all of the studies (100%) met the inclusion criteria. The mean interrater reliability for study characteristics was 96% overall with a range of 80% to 100% across the individual studies. When there were discrepancies in coding, those discrepancies were discussed and resolved.

Characteristics

Publication date and design

Examination of publication dates can provide evidence of trends. The studies were denoted by the decade in which they were published. The breakdown follows: (a) no studies published from 1975 to 1980, (b) 5 studies published from 1981 to 1990, (c) 7 studies published from 1991 to 2000, and (d) 7 studies published from 2001 through 2011. Sixteen of the 19 studies (84%) utilized single-case design. The following variations of single-case designs were used: (a) multiple probe, (b) multiple baseline, (c) alternating treatments, and (d) adapted alternating treatments. Three studies (16%) used a group design. All of the group designs utilized pre- and posttest measures though some studies were single-group studies and others had multiple groups.

Characteristics of participants, setting, and implementer

A total of 101 student participants were included in the studies. Many of the studies included participants with moderate and severe cognitive disability. Five of the studies included at least one participant with an IQ in the mild cognitive disability range. However, these studies were included because the majority of the participants had a moderate or severe cognitive disability and the average IQ of participants was still in the moderate to severe disability range, indicating that the focus of the study was on students with more significant cognitive disability. Fifty-four (53%) of the student participants were male and 39 (39%) were female. The study by Mosley, Flynt, and Morton (1997) did not specify student gender. Only two studies (i.e., Conners, 1990; McDonnell, Johnson, Polychronis, & Risen, 2002) included student ethnicity (see Table 1).

Studies spanned across a variety of settings. Twelve (63%) of the interventions took place in self-contained special education classrooms in schools that taught students with and without disabilities. Three (16%) of the interventions took place in segregated schools specifically for students with disabilities. One study (5%) took place in a general education classroom. One study (5%) took place in a self-contained classroom and a community grocery store. One study (5%) took place in a self-contained classroom and a transition center at a local university. The final study (5%) indicated the setting as a secondary school and no other details were specified. Five of the studies (26%) took place in an urban area, four (21%) took place in a rural area, one took place in a suburban area (5%), and the remaining nine studies (47%) did not specify the setting demographics.

Out of the 19 studies, the teacher implemented reading intervention in 8 (42%) cases. Researchers implemented the intervention in 4 (21%) of the studies. In 2 studies (11%), the researcher, who was also the classroom teacher, delivered the intervention. In 1 study (5%), the intervention was delivered via a computer and 1 study (5%) utilized peers as interventionists. Two studies (11%) had more than one interventionist and used the following combinations of individuals or tools to implement the intervention: (a) teacher and peers and (b) researcher and paraprofessional. The remaining study (5%) did not specify who implemented the intervention.

Interventions used

Although each study utilized a slightly different approach to reading instruction, some instructional similarities emerged. Most studies used a combination of instructional strategies. First, constant or progressive time-delay procedures were used in 11 (58%) of the studies. Four studies (21%) utilized varying forms of technology to teach reading skills, including computer-based instruction, videotaped instruction, or SMART Board technology. Three studies (16%) used observational learning and three studies (16%) utilized community-based instruction. Two studies (11%) used peer interventions, two (11%) used prompting procedures, and two (11%) used overcorrection of oral reading errors. Other strategies used that do not fall into the previous categories include use of a commercial reading intervention (i.e., Corrective Reading), combining functional and academic content, adapting literature, and use of embedded instruction.

Characteristics of intervention content

To determine the focus of the intervention content, we coded each intervention based on various characteristics pertaining to reading. This included examining the (a) dependent measures, (b) general content (i.e., functional and/or academic), and (c) instructional materials.

Dependent measures

To characterize the dependent measures, we coded each study based on which of the component(s) of reading instruction (from the five recommended by NRP) it addressed. Vocabulary, the dependent measure in 12 studies (63%), was the most frequent component of reading addressed in the reading interventions. Two studies (11%) addressed fluency and only 1 (5%) addressed comprehension. None of the 19 studies addressed phonemic awareness skills. Three of the studies (16%) addressed vocabulary and comprehension and 1 study (5%) addressed phonics and fluency.

Instructional content

Studies were also coded based on whether they targeted functional or academic content based on the core curriculum. Functional content refers to content that solely focuses on the skills necessary for participation in daily living environments such as the home, job, or community (U.S. Office of Special Education Programs, 2006). Often this includes content related to daily living skills in domains such as safety, food, transportation, and personal care. Academic content is content incorporating access to the general education curriculum or aligned with grade-level content standards (U.S. Office of Special Education Programs, 2006). Out of the 19 studies, 13 (68%) of the interventions targeted functional reading content and 4 (21%) targeted academic reading content from the core curriculum. Two (11%) targeted academic and functional content.

Instructional materials

The use of authentic text can enhance literacy instruction (Honeyghan, 2000). For purposes of this article, authentic text refers to real literature, stories, or environmental print such as newspapers, grocery lists, or magazines. Authentic literacy materials are materials that a reader would actually use or encounter in their literate lives. Because the use of authentic text can be a motivating and effective tool to provide meaningful literacy experiences, articles were coded based on the materials they used to determine whether they reflect the use of authentic text. The majority of the studies (n = 9, 47%) used flash cards to display target words for instruction. Three studies (16%) utilized commercially made materials (i.e., created for use with commercial curricula, including Corrective Reading, Ready to Read, and Story Box) and three (16%) utilized a combination of flash cards and actual grocery items or cooking products. Two studies (11%) utilized flash cards paired with a form of technology (i.e., computer, video, SMART Board). Finally, one study (5%) utilized teacher-adapted literature and one study (5%) solely utilized computer-delivered instruction.

Discussion

Results of this literature review raise important considerations for researchers, teacher educators, and practitioners who work in the area of literacy instruction for students with cognitive disabilities. Specifically, the results allow us to (a) evaluate the characteristics and comprehensiveness of literacy research for adolescents with significant cognitive disabilities and its implications for the field, (b) identify potential promising literacy practices for students with cognitive disabilities for further research, and (c) identify areas in need of further research. We discuss each of these in the sections below.

The State of Literacy Research for Adolescents With Significant Cognitive Disabilities

It is apparent from this review that there is a significant gap in research on the literacy skills of adolescents with significant cognitive disabilities. Only 19 studies have been published since 1975 with a focus on this specific population. The characteristics of the 19 studies suggest literacy interventions lack the comprehensiveness mandated by policy and advocated for by the field. As discussed previously, Erickson et al. (2009) describe comprehensive literacy instruction as, “approaches that reflect the general curriculum, include instruction in a variety of word identification strategies, vocabulary, comprehension, fluency, writing, and opportunities to independently read a wide array of texts” (p. 8). Therefore, we will frame our discussion of comprehensiveness using these elements.

Access to the general curriculum

Since the 1997 amendments to IDEA (1997), which mandate students with disabilities have access to the general education curriculum, teachers have been under increased pressure to provide instruction in academic and functional content. In this review, each study was coded as targeting academic content, functional content, or a combination of both. Academic content includes opportunities to access content from the general curriculum. Only 6 (32%) of the 19 studies identified for the literature review included academic content and access to the general curriculum. Four of these 6 studies (i.e., Bradford, Shippen, Alberto, Houchins, & Flores, 2006; Browder, Trela, & Jimenez, 2007; Collins, Hager, & Galloway, 2011; and McDonnell et al., 2002) were published after the 1997 amendments to IDEA. The earlier two studies (i.e., Singh, 1990; Singh, Singh, & Winton, 1984) involved adapting grade-level text to use during intervention.

Two of the studies (i.e., Collins et al., 2011; McDonnell et al., 2002) integrated access to the general curriculum with functional content. In the study by Collins et al. (2011), the researchers selected core content standards from language arts, math, and science and then created individualized functional applications of each standard for adolescents with moderate disabilities. Both goals were targeted and assessed during each instructional session to prioritize teachers’ instructional time. The integration of both types of content also allowed for generalization probes based on the students’ alternate assessment goals. The study was a multiple baseline study and, although the researchers ran out of time and students did not have the opportunity to master the science and math goals, all three adolescents in the study mastered their language arts content area and functional goals and performed well on generalization probes. This study demonstrated that when literacy instruction is well structured and purposefully planned, academic and functional content can be emphasized.

The study by McDonnell et al. (2002) was coded as focusing on functional and academic content because although the words students learned were functional words related to cooking, they were drawn from the vocabulary list for the general education cooking class and instruction was embedded into the general education class. All of the participants learned to read and define their target words within the general education classroom. This study is important to the field because it demonstrates adolescents with significant cognitive disabilities can learn academic content in inclusive settings. In fact, of all the studies incorporating academic content into instruction, the study by McDonnell et al. is the only study where the setting was an inclusive general education classroom. The remaining 13 studies solely focused on functional content and did not provide access to the general education curriculum.

Instruction

Comprehensive literacy instruction includes instruction in a variety of elements of reading, including the 5 elements advocated for by the NRP and the 15 elements of effective adolescent literacy programs identified in Reading Next (2006), as well as instruction in writing. Although the report by NRP (2001) provides recommendations for reading instruction at the elementary level, many adolescents with significant cognitive disabilities are still at the early literacy phase, so recommendations from both sources are relevant.

Unfortunately, based on the coding of the 19 reviewed studies, the literacy interventions present in the field for adolescents with significant cognitive disabilities do not appear to be comprehensive in nature. As Browder et al. (2006) identified in their previous literature review, the majority of studies (n = 12) focused on vocabulary instruction. The primary focus of reading instruction evident in the research is on vocabulary instruction through sight word acquisition. Although comprehension was addressed in 4 studies (21%), it was most often addressed through the receptive identification of a previously learned sight word as opposed to comprehension of an authentic text. While it is encouraging to see that phonics (n = 1 study) and fluency (n = 3 studies) have been emphasized with this population, emphasis on these skills is not as frequent as vocabulary instruction. Phonemic awareness was not addressed in any of the studies.

Comprehension instruction—recommended by Reading First and Reading Next—has not traditionally been emphasized for adolescents with significant cognitive disabilities in a meaningful way. As stated earlier, most comprehension instruction in the studies reviewed was not comprehension of authentic text in meaningful literacy tasks. Of the four studies addressing comprehension, three studies (i.e., Collins, Branson, & Hall, 1995; Collins et al., 2011; Doyle, Gast, Ault, & Farmer, 1990) involved the identification of learned sight words. The remaining study by Browder et al. (2007) had students answer comprehension questions on authentic literature that had been modified by the teachers and researchers. This is clearly a more authentic and meaningful comprehension task. This scarcity of research on comprehension indicates that researchers must continue to identify innovative ways to assess adolescents with significant cognitive disabilities’ understanding of what they read beyond simply demonstrating an understanding of sight words.

These findings also indicate that despite the recommendations that instruction for emergent readers span all five components and include a variety of word reading strategies—research has not emphasized all of the components equally. What are the implications? It is concerning that so little research is being conducted in areas of reading outside of vocabulary. This, despite the fact that studies included in the review that did address those other areas with adolescents with significant cognitive disabilities, proved fruitful at increasing their reading skills.

Writing instruction is another component of comprehensive literacy programs with intensive writing instruction recommended in the Reading Next report. Unfortunately, none of the reading interventions identified for this review included a writing component. Although we did not search specifically for writing interventions, comprehensive literacy should include reading and writing tasks. It is apparent that literacy interventions in the literature for adolescents with significant cognitive disabilities lack this comprehensiveness.

Text exposure

Comprehensive literacy instruction also includes exposure to and interaction with a wide variety of texts. While some studies incorporated modified or authentic texts such as newspapers or grocery lists into instruction (n = 5 studies), most studies (n = 10) relied solely on simple materials such as flash cards with target words written on them. Only 2 studies (11%) attempted to combine authentic text with sight word instruction and 2 studies (11%) combined text presented via the computer or videos with sight word flash cards. To what extent do these studies represent a diversity of text? Although sight words are an important component of reading instruction for this population, specifically when they relate to personal safety, additional formats of texts must be utilized to motivate and interest students. Adolescents with significant cognitive disabilities should not be denied exposure to engaging fiction and nonfiction grade-level text simply because they lack the skills to read them independently. Instead, researchers and educators must strive to find innovative ways to expose these students to such materials. Literacy instruction for adolescents with significant cognitive disabilities should utilize a variety of formats of text just as high-quality literacy instruction for students without disabilities does.

Potential Promising Practices

Although the dearth of research in this area limits our ability to develop a comprehensive understanding of literacy instruction for adolescents with significant cognitive disabilities, findings from this review suggest that there are several practices that are promising and warrant further research.

Sight word instruction

First, results from this review indicate sight word instruction using time-delay procedures continues to be the most widely researched and utilized strategy for students with significant cognitive disabilities, including adolescents within that population. Time-delay procedures to teach word and picture recognition are supported by a large body of literature demonstrating its effectiveness (see Browder et al., 2006; Browder & Lalli, 1991; Browder & Xin, 1998). Furthermore, it is the only strategy in this review empirically validated as a method for teaching word recognition to individuals with significant cognitive disabilities based on Horner et al.’s (2005) criteria for establishing evidence-based practices through single-case research.

A variety of functional words were targeted in the studies included in this review, including words related to food, cooking, or grocery shopping (e.g., Collins et al., 1995; Miracle, Collins, Schuster, & Grisham-Brown, 2001; Mosley et al., 1997; Smith, Schuster, Collins, & Kleinert, 2011); words relating to personal safety (e.g., Cuvo & Klatt, 1992); and other environmental print within the community (e.g., Farmer, Gast, Wolery, & Winterling, 1991). Although sight word instruction using time-delay procedures is used most often with adolescents to teach functional reading (Bradford et al., 2006; Browder & Xin, 1998), two studies have attempted to use the procedures to teach words directly from the academic curriculum (i.e., Collins et al., 2011; McDonnell et al., 2002).

Integrating functional and academic content

An additional promising practice is the integration of functional and academic content into reading instruction. Since the 1997 amendments to IDEA mandating students with disabilities have access to the general education curriculum, teachers have been under increased pressure to provide instruction in academic and functional content. The two aforementioned studies (e.g., Collins et al., 2011; McDonnell et al., 2002) have shown how functional and academic content can be integrated into reading instruction so teachers can better prioritize instructional time and balance the presentation of academic and functional content to adolescents with significant cognitive disabilities.

Although only two such studies have attempted to explicitly demonstrate the efficacy of integrating academic and functional content into reading instruction for adolescents with significant cognitive disabilities, the results of these studies suggest this practice has promise. Integrating functional and academic content into reading instruction for this population has the potential to improve the reading skills of students and also provides teachers with a strategy for prioritizing instructional time while providing access to the general education curriculum and simultaneously preparing adolescents for transition.

Incorporating technology

Another promising practice in teaching adolescents with significant cognitive disabilities to read is incorporating technology in instruction. Several of the studies reviewed incorporated technology instruction (i.e., Conners, 1990; Cuvo & Klatt, 1992; Kyhl, Alper, & Sinclair, 1999; Mechling, Gast, & Thompson, 2009). These studies used a variety of approaches to integrate technology instruction, including computer-assisted instruction (i.e., Conners, 1990), videotaped instruction (i.e., Kyhl et al., 1999), and multimedia instruction incorporating computer instruction and other forms of technology such as audio and video recordings or interactive whiteboards (e.g., Cuvo & Klatt, 1992; Mechling et al., 2009).

With the exception of Conners (1990), all of the studies incorporating technology focused on functional reading skills such as the identification of survival words or words related to grocery shopping. All of the studies integrating technology into reading instruction focused on improving student vocabulary and all of the interventions implemented in the studies were successful in improving the students’ reading skills as identified by measurement of the dependent variable. These results indicate integrating technology into instruction may be effective at improving the reading skills of adolescents with significant cognitive disabilities.

Modifying grade-level authentic text

Two studies by Singh and colleagues in the 1980s and 1990s attempted to use leveled classroom reading materials to increase fluency (i.e., Singh, 1990; Singh et al., 1984). However, since 2000, only one study specifically focusing on adolescents attempted to incorporate authentic, grade-level text into reading instruction for this population (i.e., Browder et al., 2007).

Browder et al. (2007) successfully modified grade-level literature for use in a story-based lesson for adolescents with significant cognitive disabilities. The modifications included modifying the reading level and shortening the text, adding picture symbols, adding a repeated story line, and putting the story into a three-ring binder with pages that were easy for participating students to turn. The goal of the study was to increase student engagement and independent responses in story-based lessons and to train teachers to follow task-analyses to implement the lessons. The study was effective in improving the performance of teachers and students and corroborates other work with elementary aged students that has demonstrated that utilizing modified grade-level text leads to increases in the reading ability of students with significant cognitive disabilities (e.g., Browder, Lee, & Mims, 2011; Browder, Mims, Spooner, Ahlgrim-Delzell, & Lee, 2008; Mims, Browder, Baker, Lee, & Spooner, 2009).

The results of this literature review indicate secondary students who are beginning readers are not being taught the basics of reading using comprehensive, evidence-based approaches. While some may argue that at the secondary level, less time should be spent on learning to read and more time on interacting with text, based on promising results of research demonstrating success when attempting to address academic and functional content (e.g., Bradford et al., 2006; Collins et al., 2011), we believe that both goals can be addressed. Even if adolescents have not fully mastered the basics of reading, that need not prevent them from receiving instruction in basic reading skills while also engaging in meaningful literacy activities such as shared stories and read-alouds of adapted literature (e.g., Browder et al., 2007). We propose there can be a balance and that comprehensive literacy instruction encompassing functional and academic literacy instruction can be effectively provided to adolescents with innovative approaches. Recent studies are attempting to address this issue and merge both priorities (e.g., Bradford et al., 2006; Collins et al., 2011). The challenge is to ensure the integration is meaningful and authentic, contributing to an increased quality of life while also providing access to literacy experiences with actual authentic text. More research in this area is needed so practitioners have access to an array of evidence-based strategies combining functional and academic reading goals.

Based on findings of the current review, it is clear research being conducted in schools does not appear to be coordinated or comprehensive. As noted by previous authors, instruction has traditionally had a limited focus and overemphasized functional sight words (Browder et al., 2006; Kliewer, 1998). These results suggest that if practitioners rely on research for identification of evidence-based practices, they do not have many comprehensive approaches from which to choose. Research within the last 5 years integrating functional and academic content shows that researchers are attempting to address this issue. The field needs to continue to address such issues in future research so that adolescents with significant cognitive disabilities are afforded the same high-quality and comprehensive literacy instruction as their peers in general education.

Implications for Practice and Areas for Further Research

Upon examination of the 19 studies, it is evident that while reading instruction for adolescents with significant cognitive disabilities has dramatically changed over the last 30 years, research on instruction within the last decade has remained relatively consistent. Since 2000, published studies addressing reading instruction for adolescents with significant cognitive disabilities have predominantly focused on vocabulary—more specifically, sight word—instruction using time-delay procedures. This issue was highlighted by Browder et al. (2006) for students with significant cognitive disabilities across grades and appears to be particularly salient for adolescents. While vocabulary instruction, and sight word instruction specifically, can be integral components of reading instruction, they should not be the sole focus. The literature is saturated with such research and needs to be expanded. A recent survey by Durando (2008) indicates that most educators self-report they are already implementing these practices effectively. Instead of continuing to research practices already used in the field, we recommend researchers focus on additional methods of teaching reading to this population of students—outside of sight word instruction—that are more comprehensive in nature and will be beneficial in practice.

Despite the aforementioned issues, there are many commendable qualities of recent research in this area. First, studies within the last decade are attempting to integrate technology in meaningful ways (e.g., Mechling et al., 2009). In such studies, students utilized technology to access and interact with text. In a society where it is commonplace to communicate via technology, such instruction can provide students with an authentic way to interact with text and their community. Familiarity with such technology will assuredly be beneficial.

In addition, only recently have researchers begun modifying grade-level texts for adolescents with significant cognitive disabilities, allowing them access to the general curriculum (e.g., Browder et al., 2007). Interventions using modified text allow students to engage in a meaningful literacy experience with authentic text. In addition, they allow students with disabilities to access content similar to that accessed by their peers in general education. Modifying texts is a promising practice that has been more fully explored in elementary settings (e.g., Browder, Gibbs, et al., 2009; Coyne, Simmons, Kame’enui, & Stoolmiller, 2004; Justice & Kaderavek, 2002) and needs further investigation in secondary settings and in more inclusive settings.

After reviewing reading interventions for adolescents with significant cognitive disabilities since 1975 and then further examining recent research investigating instruction in this area since 2000, it is evident that procedures such as sight word instruction and an emphasis on functional content have made up the majority of research in this area. New and innovative approaches—while present—are scarce. Teachers of this population identify a need for more strategies to utilize with their adolescent students that allow them to balance functional and academic content (Roberts & Leko, 2011). We recommend researchers work to address this gap.

Limitations and Future Research

First, because the purpose of our literature review was to evaluate the comprehensiveness of the literature base on literacy instruction for adolescents with significant cognitive disabilities, no effect sizes were calculated. Therefore, the impact of the gains made by participants in each study cannot be compared. Furthermore, because of the scarcity of research in this area, studies were not evaluated for quality. Evaluating studies for effect size and quality would be an important next step in the field.

The limited number of studies including only adolescents with significant cognitive disabilities begs the question: “Why are there so few studies of literacy instruction for this population?” One explanation is that the field is still attempting to find evidence-based strategies to use with all students with significant cognitive disabilities and research has not yet matured to the point of being able to look at specific groups within this population. Another possibility is that because the reading skills of adolescents with significant cognitive disabilities are often viewed as on par with elementary age students, it is assumed interventions that work with younger students will be equally effective with older students who have similar instructional needs. We recommend the field look specifically at the needs of adolescents with significant cognitive disabilities separately from their elementary counterparts, because upon adolescence, it is important to consider students’ emerging independence and affective needs.

Findings from this review indicate literacy instruction for adolescents with significant cognitive disabilities is a multifaceted and complicated endeavor. Researchers and practitioners must balance multiple needs including (a) students’ individual needs, particularly the need for literacy skills that will support their independence in the community; (b) the need to provide students with disabilities access to the general education curriculum; and (c) the need to provide students with disabilities opportunities to engage in meaningful and enriching literacy experiences. These needs, coupled with multiple policy agendas, situate research and practice in a challenging context that often interferes with our ability to develop a comprehensive and coordinated plan of action. Although limited in number, we are encouraged by the recent emergence of research studies that aim to understand literacy instruction for adolescents with significant cognitive disabilities from various perspectives and for multiple purposes. The bottom line is that there is still much to be learned, but by better understanding the trends and gaps in research in this area, we believe that the door to productive discussions will be open and the time will be right for new directions in research that will help improve literacy outcomes for adolescents with significant cognitive disabilities.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

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

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