March 27, 2023

Emergent and conventional literacy integrated techniques with verbal communicators can feel natural and instinctive to SLPs; particularly when we compare it to the literacy instruction of nonverbal or non-speaking communicators. For verbal communicators, expressive language and functional communication is established prior to emergent literacy skills. Occasionally, for students with severe disabilities or non-speaking communicators, emergent literacy skills can develop prior to the emergence of an established communication system (Erickson, 2017). This relatively recent data undercuts the commonly held notion that first we must communicate – then we can establish literacy. It therefore undercuts the misconception that AAC users are not ideal candidates for literacy integrated therapy.

Which begs the question – how do we, as SLPs, support our AAC users and bolster their literacy skills?

AAC users are a widely varied group, and to simplify this community without taking time to delve into disorder specific variations would be a disservice. non-speaking individuals may use AAC as a primary or supplementary mode of communication due to the presence of disorders (such as autism), motoric inability to form verbal speech (such as severe apraxia), or simply due to choice. Discovering the reason that an individual uses AAC is paramount for determining the ideal literacy intervention strategies. This is nothing revolutionary – as SLPs we all know that the best therapy is that which is most individualized.

There are most certainly elements of literacy integrated therapy that can serve clients of all backgrounds, which we will be discussing below.

Shared Reading Experiences

Engaging in shared reading experiences with all children helps foster emergent literacy skills. When we tell stories, we are modeling appropriate articulation, prosody, conversation, and outline the value of reading books (they offer a chance to connect, learn, and be absorbed into a whole new world!). For our non-speaking communicators, it is also a wonderful opportunity to model key words using their augmentative communication device. In a perfect world, it’s recommended to use books that are of particular interest to your clients and involve frequent word repetition for optimal retention. But in a pinch, you can focus on single core vocabulary words such as “turn.” Modeling “turn the page” on an AAC device while encouraging your client to turn the pages of a book you are reading together is a functional communication target, offers the opportunity for a shared experience, and encourages our clients to actively engage with the book while we are reading it.

Visual Supports

Visual supports are an excellent tool in all elements of therapy but can be especially helpful in building concrete understanding of abstract language in learners that have difficulties processing verbal language, transitions, or struggle attending to tasks (Zangari, 2013). Use of a visual schedule (for the session, the book, or both), visual representations of target words, or prepared visual supports for identifying story elements are all beneficial for not only supporting receptive language abilities, but also for fostering emergent literacy skills. Visual support can additionally increase our clients’ confidence in their tasks and thereby boost engagement as well. It’s difficult to be enthusiastic about things we don’t fully understand, and visual supports help make reading and other literacy-based experiences more tangibly accessible for our students who have multiple disabilities or are AAC users.

Phonological Awareness Tasks

A curriculum has been developed through Penn State University which directly outlines literacy curriculum for individuals with severe communication abilities (Parker, 2014). Phonological awareness abilities are still a foundational component of literacy skills, including the literacy skills of AAC users who may not make sounds verbally. The curriculum developed by Penn State offers a visual response system to phonological awareness tasks so as not to rely on verbal communication. For example, when working on phoneme segmentation, this curriculum recommends showing a field of 2-4 visuals for a response field. So, if you are working on segmentation of the phoneme /m/, you can show a picture of “milk” and a “bat” and have your client point between the two. This curriculum, linked below, has different visually based phonological awareness tasks for a myriad of skills including sound blending, letter sound correspondences, and segmentation.

Guided Reading

Now let’s put it all together with guided reading! The purpose of guided reading is to direct your client’s attention to specific information (the setting, the characters, etc.). You can use all elements of literacy integrated therapy that have been discussed so far in your guided reading sessions. One of my favorite ways to start a guided reading session is to preview the book before you actually read it. You can do this with any book, but using books from Tar Heel Readers (https://tarheelreader.org/find/?search=&category=Anim&reviewed=R&audience=E&language=en&page=1 makes this especially natural. You can identify pictures and objects beforehand, make predictions regarding the story line, or draw comparisons between what you see on the page and what you see all around you (For example: “The ladybug is red and so is your shirt! How fun!”). I also recommend reading the same book multiple times and identifying new words or story elements each time you read the book for a more layered understanding of the story elements you’re targeting in your sessions. AssistiveWare has an excellent piece on guided reading elements and is linked below.

Most SLPs I’ve met love reading, and love using books in therapy sessions. While the path to literacy for non-speaking communicators may seem less intuitive, the research and resources our therapeutic community has created help bridge that gap between theoretical therapy plans and practical session activities. What are your favorite books to read in therapy? Comment below!

Read more from this series:

SLPs and Literacy and Reading Specialists – Where is the Overlap?

SLPS in Literacy Series: Literacy and Articulation

SLPS in Literacy Series: Literacy and Language Disorders

References & For Further Reading

Erickson, K. A. (2017). Comprehensive literacy instruction, interprofessional collaborative practice, and students with severe disabilities. American Journal of Speech-Language Pathology, 26(2), 193–205. https://doi.org/10.1044/2017_ajslp-15-0067

Harrison-Harris, O. L. (2002). AAC, literacy and bilingualism. The ASHA Leader, 7(20), 4–17. https://doi.org/10.1044/leader.ftr2.07202002.4

Integrating Comprehensive Literacy instruction. AssistiveWare. (n.d.). Retrieved February 23, 2023, from https://www.assistiveware.com/learn-aac/integrating-comprehensive-literacy-instruction

Lanter, E., & Watson, L. R. (2008). Promoting literacy in students with ASD: The basics for the SLP. Language, Speech, and Hearing Services in Schools, 39(1), 33–43. https://doi.org/10.1044/0161-1461(2008/004)

Parker, R. (2014, March 10). More robust literacy instruction for people who use AAC. PrAACtical AAC. Retrieved February 23, 2023, from https://praacticalaac.org/strategy/more-robust-literacy-instruction-for-people-who-use-aac/

Zangari, C. (2013, September 20). Literacy lessons for beginning AAC learners. PrAACtical AAC. Retrieved February 23, 2023, from https://praacticalaac.org/strategy/literacy-lessons-for-beginning-aac-learners/

About the Author

Marisa Julius is a speech-language pathologist that has worked in both public and private school settings with a focus in pediatric augmentative and alternative communication therapy. She currently works for a private specialized school setting with children 5-21 with complex communication needs and a variety of disorders including Autism Spectrum Disorder, Down Syndrome, Childhood Apraxia of Speech, Language Delays, Reactive Attachment Disorder, and more. She is a Missouri native and earned two Bachelor degrees from Truman State University in Communication Disorders and German Studies. She received her M.A. in Communication Sciences and Disorders from Saint Louis University. She considers herself a lifelong learner, and is thrilled to be writing for SLP Toolkit, if only for an additional excuse to read more. In her free time, you can find her cooking, reading, hiking, or showing everyone unsolicited pictures of her dog.