Enhancing Orthographic Communication and Literacy Outcomes for AAC Learners

Literacy skills enhance public health outcomes (employment, safety, well-being, and social engagement). Additionally and critically, for individuals who cannot speak and use augmentative and alternative communication (AAC; pointing to pictures, using a speech generating device), literacy skills support precise communication by allowing individuals to spell the exact words they wish to communicate. However, over 90% of AAC users leave high school illiterate. The long-term goal for this project is improve language and literacy outcomes in individuals who use AAC, consequently improving health and well-being outcomes. While recent research underscores the importance of explicit literacy instruction that integrates decoding and encoding, encoding is rarely taught to AAC users, and it is not yet known if this approach will yield better language and literacy outcomes among AAC users. The focus of the current proposal is to teach decoding and encoding using an integrated approach to instruction with an existing literacy curriculum, ALLSTAR. ALLSTAR and approaches using the ALL app have resulted in learning across all AAC users, with large to very large effect sizes observed (Tau-U ranges: .63 - 1.0) and large gains (+44% on pre-post ELA assessment).

The project goal is to: (1) adapt and evaluate the effect of an integrated approach in an AAC literacy intervention on CVC decoding and encoding using an iterative single subject design; (2) evaluate the effect of adding the integrated "spell-to-read" approach to ALLSTAR using an RCT (N=60); and (3) assess the acceptability, feasibility, and adoptability of the literacy lessons by practitioners, in order to understand the barriers and facilitators that influence their uptake, ultimately increasing the use of evidence-based literacy instruction for AAC users. Data measurements related to the respective aims above, include: (1) percent gains and intervention effectiveness, (2) gains on Pre, Mid, and Post scores on Early Literacy Assessment (letter-sounds, sound blending, phoneme segmentation, decoding, irregular sight words, and encoding); and (3) thematic analysis and scores on the Feasibility Adoption Acceptability Questionnaire (FAAQ), completed at three timepoints throughout each study. Our expected outcome is the development of an effective and adoptable literacy intervention for children who use AAC.

The significance of this work is that it will advance a new intervention paradigm for AAC users that capitalizes on an explicit connection between literacy and communication to foster AAC users who can communicate orthographically and ultimately more precisely what they wish to express. This proposal is timely, in that it is responsive to NIDCD's mission and responsive to and collaborative with AAC users. The project has the potential for high clinical impact in changing poor literacy outcomes for a population that is unjustly denied evidence-based literacy instruction.

Inclusion criteria

• Have complex communication needs and use AAC,
• are ages 5-12,
• per report can follow two-step directions,
• symbolic communicators with at least 75 words on the CDI and mean length of utterance greater than 2
• can match letters and words with greater than 90% accuracy,
• can identify letter-sound correspondences from a field of 4 with greater than 70% accuracy
• can identify common photographs used to represent words in the study (e.g., touch the picture of a hat, touch hot) with greater than 80% accuracy,
• can sit to work in a minimum of 5 min. intervals
• decoding or encoding at less than 40% accuracy based on parent or provider report and screening results;
• demonstrate functional vision and hearing

Exclusion criteria

• • Do not have complex communication needs / can speak and do not need AAC,

• Younger than 5 or older than 12 years of age,
• Can not follow two-step directions,
• Are not symbolic communicators with at least 75 words on the CDI and not combining at least 2 symbols
• Can not match letters and words with >90% accuracy,
• Can not identify letter-sound correspondences from a field of 4 with greater than 70% accuracy
• Can not identify common photographs used to represent words in the study (e.g., touch the picture of a hat, touch hot) with greater than 80% accuracy,
• Can not attend to work for 5 mins.
• decoding or encoding at more than 40% accuracy based on parent or provider report and screening results;
• Do not have corrected or functional vision and hearing