Improving Literacy Outcomes in Children who use AAC

Project Summary Individuals with severe disabilities who cannot use speech to communicate and use augmentative and alternative communication (AAC; pointing to pictures, using a speech-generating device) are at high risk for life-long health issues that are exacerbated by illiteracy and limited communication skills. Over 90% of these individuals leave high school illiterate, resulting in reduced communication skills and a higher probability of life-long health issues. Our long-term goal is to improve literacy outcomes in individuals who use AAC, and in doing so, improve health and well-being outcomes. Daily instruction in literacy practices that are evidence-based have the potential to change the current poor outcomes, yet limited effectiveness research exists related to literacy interventions that include phonics-based tasks that are adapted specifically for individuals who use AAC. To improve reading outcomes, it is essential to explicitly teach how sounds in words work (phonemic awareness) and how those sounds connect to letters they see in print (phonics). Yet, the majority children who use AAC are provided literacy instruction solely in sight words using memorization strategies. The ALL (Accessible Literacy Learning) technology has the potential to improve early literacy skills. It is an evidence-informed literacy curriculum that includes literacy instruction specifically adapted for individuals who use AAC. Research using components of the ALL curriculum have been conducted, yet prior to our pilot studies, no research has been conducted with the ALL technology. There is a critical need to understand the effectiveness of literacy interventions that are specifically adapted for individuals who use AAC. The objective of this application is to examine the efficacy and feasibility of the ALL technology on a larger-scale through these aims: (1) Assess the effectiveness of the ALL technology on six early literacy skills for children ages 4-10 who have intellectual and developmental disabilities and use AAC, and, (2) Assess the acceptability, feasibility, and adoptability of literacy lessons using the ALL technology to evaluate components that are helpful or hindering to adoption of the ALL technology. The proposed research will make important advances in the science associated with teaching children who use AAC how to learn to read. This project is innovative in three ways: (1) the ALL technology provides phonemic and phonics- based literacy instruction to a population that does not typically receive this instruction due to their inability to speak; (2) the intervention targets multiple literacy skills, which may contribute to better literacy outcomes. Teaching multiple skills during a lesson could potentially improve both the rate and the amount of literacy skills acquired; and, (3) the ALL technology uses automated data-driven decision making with materials adapted for individuals who use AAC – addressing many implementation challenges documented by service providers. The expected outcomes of the project include efficacy of the ALL technology, as well as sufficient data in six early literacy skill areas; foundational for a future R01 that improves the provision of evidenced-based literacy and maximizes literacy outcomes for children who use AAC.