PrAACtical Research: Profiles of Students with Significant Cognitive Disabilities

In today’s post, we welcome Dr. Kathy Howery who will be appearing here periodically to review some of the AAC research that is published in journals around the world. Kathy joins us from Alberta, Canada, and has worked in the field of assistive technology and special education for over three decades. Most recently she has completed her doctoral studies where she used phenomenological methods to seek understanding of the lived experience of speaking with/through a speech generating device. Kathy is currently working as consultant to schools and school districts across Alberta focusing primarily on children and youth with complex communication needs.

In this first post, she helps us understand a study by Drs. Karen Erickson and Lori Geist published in the AAC journal last year.

Enjoy!

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Erickson, K. A. & Geist, L. A. (2016). The profiles of students with significant cognitive disabilities and complex communication needs. Augmentative and Alternative Communication, 32(3), 187-197.

What this article is all about? What is the focus of this research?

Erickson and Geist asked the question ‘do students with significant cognitive disabilities who use aided AAC and/or sign as an alternative to speech differ in their motor, sensory, language, and literacy abilities from their peers who use speech to communicate?

In essence they were seeking to understand how the ability to speak, even to some extent, distinguishes students with significant cognitive disabilities from their peers who rely exclusively on AAC systems.

Students with significant cognitive disabilities were defined based on the language used by the U.S. Department of Education (2005) to describe which students would be eligible for ‘participation in an alternative assessment based on alternative achievement standards rather than the general assessments that are mandated for all students in public schools at various grade levels’ (p.187).

How they gathered their information:

The information was pulled from surveys completed by some 38,367 special education teachers (98.4% of responders) from 14 states in the United States between the period of November 1, 2012 and May 1, 2013. The survey asked questions about student demographics; in what type of educational setting the student was being served; how the student communicated e.g. their use of speech, aided AAC, and sign; whether the student had sensory and/or motor disabilities; the complexity of expressive and receptive language the student was able to demonstrate; and the student’s literacy skills.

What the authors learned from their study:

Speech matters for where you will be placed to learn!

• Student who used speech (regardless of whether they augmented that speech with aided AAC) were more than twice as likely to be placed in settings where they were educated alongside their peers without disabilities at least 40% of the school day. … In contrast, students without speech, even if they used aided AAC, were three times more likely to be placed with their peers in separate schools where they had no access to or interaction with peers without disabilities (p.194).

There is an important relationship between co-occurring motor impairments that needs attention!

While the authors recognize that it is not surprising that to find that students with significant cognitive disabilities who use aided AAC also have co-occurring motor and/or sensory impairments, they point to several reasons why this finding deserves more attention:

• While commercial technologies (such as iPads and tablet computers) may serve the population of students with significant cognitive disabilities with CCN in general, additional attention must be paid to design, access and implementation for the population of students who have motor and sensory impairments as well.

For example, to date most of the indirect access methods available to people with motor impairments have a high cognitive demand, these then are problematic for students with significant cognitive disabilities and motor challenges. And, most alternative symbolic representation of language is via graphic representations. Such representations may not be meaningfully accessible if a student is visually impaired.

• The combination of needs calls for an inter-professional approach to intervention, bringing together the speech-language pathologist, audiologist, teacher of the deaf and hard of hearing, special and general educator, occupational therapist, and physical therapists to work in concert with family members to maximize student outcomes (p. 195).

While teaming has long been a focus in the world of AAC, most often the teams have been focused around allied health professionals and not always professionals whose expertise lies in the field of sensory impairment. This study suggests the team around students with significant cognitive disabilities needs to stretch given the reality of this populations needs.

There are more students than previously thought who have significant cognitive disabilities and complex communication needs.

• Previous studies estimated that between 37 to 39% of students with significant cognitive disabilities also had complex communication needs. This study suggests the percentage is quite a bit higher, with 50% of students with significant cognitive impairment having complex communication needs.

This increase in the numbers was attributed to the richer information that was gleaned from the survey. The fact that half of students with significant cognitive disabilities were identified as having complex communication needs, suggests that more attention needs to be paid to providing AAC supports and services for this population. It may be that the legacy of the candidacy model of AAC, long since discredited, may still have been seen at least tacitly when it comes to students with significant cognitive disabilities.

Speech matters for language development!

• Erickson & Geist found a dramatic difference in syntactic complexity between the group of student who used speech regularly vs the students who used non-speech modes. ‘While 68% of the students who used speech regularly combined three or more words to achieve a range of communicative purposes, only 10% of students who used aided AAC and 6% of students who use sign regularly combined three of more symbols or signs to achieve a range of communicative purposes (p.195). This vast discrepancy, the authors suggest, requires much greater effort in helping special education teachers to design and deliver instruction that helps students develop and use language.

Oral language is the language of instruction. Therefore students who can speak are at a distinct advantage in that they have constantly models of language with vast exposure to various syntactical structures. Research supports the value in providing immersive experiences in the aided language the child is expected to use (von Tetzchner & Stadskleiv, 2016; Romski & Sevcik, 1996). This study underlines the need for teacher to provide rich aided language experiences.

Speech matters for literacy development!

• Finally there was a dramatic difference in reading ability between the students who did and did not use speech, regardless of AAC use. For students who used speech, 36% read with comprehension and 62% read individual words. Compare this to students who used AAC as an alternative to speech where only 3% read with comprehension, and only 12 % read individual words. And the study found that only 4 % of students who used aided AAC or sign language but no speech were reported to construct simple messages using spelling and writing. There is a critical need to design and promote reading and writing interventions targeting students with significant cognitive disabilities who use AAC.

In Alberta, the English Language Arts program of studies suggests that oral language is the foundation of literacy (click here for more information) . And while certainly this is true for students for whom oral language is available for use, it would also be true for students who are augmented speakers. Children learn language through the use of language in an immersive and supportive language environment (Stadskleiv, 2017). And from that language development, through appropriate instruction students gain literacy skills. The finding in this paper suggest that far more attention needs to be paid to the aided language and therefore the literacy development of aided speakers who have significant cognitive disabilities.

Why is this article important for practice?

This article focuses our attention on the ‘power’ of speech for students with significant cognitive disabilities. The students who use speech (even if it was augmented with AAC supports) suggest better outcomes in nearly ever area addressed by the survey. So why is this important for practice? In my opinion it is important on many levels:

• It shines the light on the fact that we must put far greater focus on providing rich and robust AAC supports and interventions for students with cognitive disabilities who do not use speech as their symbolic means of expression. There has been a long history of recognizing the need for rich AAC supports and rigorous instruction for students require AAC but who are not identified as having significant cognitive disabilities. It would equal focus needs to be on students identified with significant cognitive disabilities. Of interest is the fact that while books written on teaching students with intellectual disabilities (Wehmeyer & Shogren, 2017) and severe disabilities (Browder & Spooner, 2006) either do not address aided AAC supports and services, or do so in a vary limited fashion.
• It tells us in the field of AAC what many of us already know – that our students’ challenges often come in multiples. The need for teams and teaming around the design of and support for symbolic means of communication for children with significant intellectual disabilities is great. We need to cross-pollinate the fields of AAC, special education, vision, hearing, and motor disabilities if our children with the most significant needs are going to learn and grow in the ways they may be capable of.
• It tells me that there is work to do in presuming competence of students with significant cognitive disabilities who use aided AAC or sign without speech. Presuming competence is the first step towards seeking out and then delivering appropriate supports for and instruction in symbolic communication. Our task then is to seek out instructional approaches and spend time addressing language, reading and writing in a comprehensive, integrated way for every child, perhaps most particularly those in this population who use AAC as an alternative to speech.
• It shines a very bright light on the absolute necessity of doing more to teach our students with significant cognitive disabilities to read and write. This population of students may be the most vulnerable to abuse and maltreatment, yet without the ability to spell they may not have the words in their system to tell anyone what is happening to them. As Erickson & Geist suggest ‘without spelling and writing skills, these students will never be able to communicate what they want, when they want, to any partner they choose’ (p. 195). What is more important than teaching students with significant cognitive disabilities to read AND write, nothing, because literacy is a life skill (Kluth, 2014).
• Finally, studies like this give us evidence we can use to back-up/support things that we know from our clinical/educational experiences. While many of us may already ‘know’ or believe these things, as is pointed out by the authors, people want and need evidence that goes beyond our own experience.