AAC, Literacy, & the SLP

In the last few weeks, there has been an uptick in social media posts about how symbolated text is not an evidence-based practice for teaching learners with significant disabilities, including AAC users, to read. Why is this important for us as speech-language pathologists working with AAC users? Let’s first define what symbolated text is and is not. Symbolated text is when all or most words in a text or book are paired with corresponding images or pictures to symbolize or represent the words. Here is an example from an article by Jane Farrell (Farrell, 2013)

In contrast, illustrations are not symbolated text. Symbols with text on an AAC device to represent words that an AAC user is using to communicate are not symbolated text. Illustrations and picture books are a critical component of early literacy instruction, and symbols paired with text as a part of a communication system help AAC communicators (both those who are literate and not yet literate) more quickly locate a word on their communication system.

Let’s also define print literacy. In Comprehensive Literacy for All, Teaching Students with Significant Disabilities to Read and Write, Erickson and Koppenhaver define print literacy as “reading and writing traditional orthography (or alphabet letters) for meaningful purposes” (2021). They further go on to describe emergent literacy as all of the reading and writing behaviors and understandings that precede and develop into conventional reading and writing. Finally, Erickson and Koppenhaver discuss the journey to conventional literacy as one that includes:

• capabilities to communicate with symbols (e.g., letters) sophisticated messages that are widely understood,

• spelling abilities that enable composing beyond the limits of AAC systems with graphic symbols,

• conventional reading abilities that allow readers to learn about the world or escape into a fictional one, and

• conventional writing abilities that support complex problem solving, processing of experiences, and wide communication through evolving technologies.

Let me tell you a bit about my journey to understand and become passionate about literacy. As a school based SLP, I was actually required by my district to take a reading course, but this really didn’t give me the depth of knowledge that an elementary education teacher has, and so when I began working as an AAC specialist with students with complex communication needs, consulting with classroom teachers on how to support their learners across the curriculum, I began learning more about literacy and reading instruction. Back in the day (early 2000s), my assistive technology team did a lot of adapting text with symbol supports, thinking at the time that if we added symbols to books and other texts, AAC users would see the symbols, match them to their communication devices, and “read”. We also figured that symbol supported text would help all of our learners with significant disabilities--they might not be able to read the word, but if they knew the symbol, it would help them figure it out. Unfortunately this assumption turned out to be wrong, and actually the use of symbolated text does not help readers, and in fact may significantly hinder the development of reading skills (SWAAAC, 2020). As my team learned more about teaching reading to learners with significant disabilities we changed our practice.

I have since moved on from my role on the assistive technology team, becoming a curriculum writer, a school district administrator and finally back to my SLP roots as the Director of Educational Programs with LessonPix, but I have continued to expand my knowledge of reading instruction for both learners without disabilities and learners with reading disabilities, including those with complex communication needs and/or intellectual disabilities. I have followed the work of Karen Erickson and David Koppenhaver who have researched methods for teaching learners with significant disabilities how to read and write. I have learned about the importance of explicit reading and writing instruction, including evidence-based practices such as systematic sequential phonics instruction. As a former elementary school assistant principal, I explained to my Kindergarten teachers why teaching using a Letter of the Week approach is outmoded and ineffective (McKay and Teale, 2015). I have advocated that the company that I currently work for NOT make it easier for our customers to symbolate text, even though it is a requested feature. Being a proponent of evidenced-based reading instruction and supporting that in all that I do as an SLP is part of my personal code of ethics, as well as the code of ethics that I subscribe to as a member of ASHA.

So, what does evidence-based reading instruction look like? This is not something that can be covered in one paragraph, but here are some key features to keep in mind. It includes many components, including direct instruction on alphabetic knowledge, phonemic awareness, phonics, and word knowledge. It looks like shared reading and writing, lots of access to books and other text, including books that learners with complex bodies can access independently. It includes opportunities to engage in independent writing, even if that means scribbling with a physical or virtual pencil. It looks like open-ended discussion about pictures, letters, words, and books, including for learners with complex communication needs. It includes the use of picture books and illustrations to support comprehension, but not to support decoding (Spear-Swerling, 2006). Struggling readers, in particular “require intensive, highly skilled instruction in word analysis, as well as in many other important reading abilities, such as vocabulary and the use of comprehension strategies” (Spear-Swerling and Sternberg, 2001). It does not include the use of symbolated text.

What are some options for addressing language and communication while supporting emergent literacy skills? Let’s start with these recommendations. First, provide the use of graphic symbols to communicate about what you are reading, rather than to read. Tar Heel Shared Reader https://www.sharedreader.org/ was developed developed by the Center for Literacy and Disabilities Studies at the University of North Carolina at Chapel Hill to provide quality professional development, materials, and technology that support the implementation of shared reading for learners with significant cognitive disabilities (SCD) who are not yet reading connected text with comprehension above a 2nd grade level. Tar Heel Shared Reader provides learners with the ability to access a wide variety of emergent level texts paired with communication supports that allow a reader to talk about the text. It does not include symbolated text, but instead integrates the 36 highly flexible core words from Project Core into a dynamic web based reading and communication system.

Tar Heel Shared Reading with core vocabulary to support communication

with a text from Tar Heel Reader.

Then, whether using Tar Heel Shared Reader, or any other text or book, provide aided language stimulation during shared reading to support and model use of an AAC system. This can include directing attention by commenting about the content of the book (I like that), making print references (I see a D, like in your name, David), and reading text directly from the book using symbols that are on an individual student's communication device. Kim Rankin shares how she does exactly this with her son in this video of her reading with him.

These are just a few ways to support language and literacy as an SLP. These and other evidence-based strategies are far more effective than the use of symbolated text.

Why am I telling you this? Because it is important for all SLPs who work with learners with complex communication needs and significant disabilities to understand what evidence-based literacy instruction looks like and be able to support it with their clients and students. This is based on my personal belief that literacy and communication success are intertwined and is supported by the ASHA position statement “that speech-language pathologists (SLPs) play a critical and direct role in the development of literacy for children and adolescents with communication disorders, including those with severe or multiple disabilities.” (ASHA, 2001) and the inclusion of literacy (reading, writing and spelling) in a speech-language pathology service delivery area (ASHA, 2016). While SLPs may not have the amount of training (or even any required continuing education in the area of literacy) that a classroom teacher has, it is still within our scope of practice to make it a part of our work. As a part of our work with learners we have an obligation to keep up with current research on literacy and to promote the use of only evidence-based practices in reading, writing and spelling instruction. And when we know better, or course, we do better.

If you want to learn more about evidence-based practices in literacy and the role of the SLP, I have compiled a reading list below.

American Speech-Language-Hearing Association. (2001). Roles and responsibilities of speech-language pathologists with respect to reading and writing in children and adolescents [Position Statement]. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of Practice]. Available from www.asha.org/policy/.

Erickson, Karen A., and David A. Koppenhaver. Comprehensive Literacy For All, Teaching Students with Significant Disabilities to Read and Write. Brookes, 2021.

Farrell, Jane. “Symbol Supported Text: Does it Really Help?” Jane Farrall Consulting, 13 July 2013, https://www.janefarrall.com/symbol-supported-text-does-it-really-help/. Accessed 1 April 2021.

McKay, Rebecca, and William H. Teale. No More Teaching a Letter a Week. Heinemann, 2015.

Spear-Swerling, Louise. “The Use of Context Cues in Reading.” Reading Rockets, WETA Public Broadcasting, 2006, https://www.readingrockets.org/article/use-context-cues-reading. Accessed 1 April 2021.

Spear-Swerling, L. & Sternberg, R.J. (2001). What Science Offers Teachers of Reading. Learning Disabilities Research & Practice, 16, 51-57. Reprinted on Reading Rockets https://www.readingrockets.org/article/what-science-offers-teachers-reading

Spracher, Mary M. “Learning About Literacy: SLPs Play Key Role in Reading, Writing.” ASHA Leader, ASHA, 1 April 2000, https://leader.pubs.asha.org/doi/10.1044/leader.SCM.05082000.1. Accessed 1 April 2021.

“SWAAAC Evidence-Based Practice Symbol-Supported Text for Students with Complex Communication Needs and/or Intellectual Disability.” SWAAAC.org, SWAAAC, https://static1.squarespace.com/static/57c86c3cff7c506bc7a8fdbf/t/5ebee7f74adcd72e57891908/1589569527518/EBP_Picture+Supported+Text_PaigeV2.pdf?fbclid=IwAR0o7BU9ccRLlxxw73FVp2M42tK4Jvf0kSehNaa_VWg7Jba_P7Ul6HXsJII. 2020, Accessed 1 April 2021.

About the Author

Beth Poss, M.A., CCC/SLP, M.S, Education, is a speech/language pathologist, educational and technology consultant, accessibility advocate, and former assistant principal. She is currently the Director of Educational Programs for LessonPix. She is also a volunteer board member of Aaccessible.org. Beth is passionate about designing educational environments that support all students in accessing a rigorous curriculum and meeting educational outcomes. In her work with school districts, universities and national and state level organizations she focuses on how Universal Design for Learning (UDL) is an essential component in designing equitable and inclusive learning environments. Areas of special interest include Augmentative and Alternative Communication(AAC), Coaching to Build Educational Success, the Use of Technology in Early Childhood, Designing Inclusive Learning Environments, Supporting Social-Emotional Learning to Promote Academic Success, and Culturally Responsive Teaching. She is one of the authors of Inclusive Learning 365: EdTech Strategies for Every Day of the Year, due out in May 2021. She can be found on Twitter at @possbeth, on Instagram at @bethposs or reached via email at possbeth@gmail.com