DISABILITY AND REHABILITATION, 2004; VOL. 26, NO.
21/22, 1305–1312
AAC and literacy
O. E. HETZRONI*
Department of Special Education, Faculty of Education, University of Haifa, Haifa, Israel
Abstract
Purpose: To review current research on the use of augmenta-
tive and alternative communication (AAC) for prompting
literacy in children with special educational needs.
Method: Research studies relevant to emergent literacy and
AAC use are reviewed. Studies focused on acquisition of
literacy across various populations of children with special
needs are reviewed.
Results: Existing literature suggests that AAC may provide
strategies and systems to compensate for impairments and
disabilities of individuals with severe communication disorders.
Conclusion: AAC may support literacy learning in children
with special educational needs.
Introduction
Literacy is the condition or quality of being literate,
especially the ability to read and write. Reading is a
process in which one creates meaning from written
language.1 It is a complex skill that requires incorporat-
ing basic decoding and organization of knowledge from
various sources. Writing, on the other hand, is an encod-
ing process in which one puts meaning into written text.
Writing is also a complex skill that requires incorporating
basic encoding and many specific skills such as spelling,
writing mechanisms, word selection, syntax, and creating
combinations between words to generate meaning.2, 3
Literacy is defined as the ability to read and write in a
designated language. It is used in everyday life, and yet
encompasses a multidimensional and a highly complex
cultural framework.4 Literacy is currently viewed as a
multifaceted product of psycho-socio-linguistic factors,
tied to language, cognitive development, and to socio-
cultural influences. Literacy enables access to knowl-
edge, to meaningful ideas and thoughts, and expands
on language and communication.
* Author for correspondence; Department of Special Educa-
tion, Faculty of Education, University of Haifa, Haifa, 31905,
Israel. e-mail: hetzroni@construct.haifa.ac.il
Disability and Rehabilitation ISSN 0963–8288 print/ISSN 1464–5165 online # 2004 Taylor & Francis Ltd
http://www.tandf.co.uk/journals
DOI: 10.1080/09638280412331280334
Literacy is a tool for achieving cultural and social
power, and for people with disabilities it might be the
primary channel to language, knowledge, and communi-
cation with the world. Yet, children with significant
disabilities are often faced with barriers that prevent
them from literacy experiences.3, 5 The purpose of this
paper is to examine the literature on the development
of literacy and inspect the relative role of AAC on the
process.
DEVELOPMENT OF LITERACY
The development of literacy emerges almost from
birth.6 Infants exposed to language and print develop
emergent literacy skills that enhance the ability to learn
to read and write later in life. Toddlers learn to under-
stand stories through exposure to books, by feeling
them, and listening to them. They learn while obser-
ving adult literacy activities. They learn to hold the
books, follow the text, see the pictures, and relate them
to the words spoken to them.6 They learn to enjoy joint
story-time, identify written materials surrounding
them, and create links between printed materials and
the world of concepts evolving and developing around
them.
In order to learn reading and writing, one needs to
develop an understanding about the relationship
between words and the referents they represent. Usually
this process develops through an understanding of the
relationship between the orthographic symbols
combined into words and the sounds they make. This
understanding develops through phonological skills
developed prior to the development of reading and writ-
ing. Research has found that phonological skills are of
critical importance for acquiring literacy (e.g.,7 – 9).
Phonological skills encompass the understanding that
words are composed of discrete units (phonemes), and
that they have a specific structure with a beginning,
middle and an ending. For example, the ability of a child
 O. E. Hetzroni
to separate between the beginning and the end of a
word, the ability to find similar endings of words (i.e.,
understanding of rhyming), and the ability to find words
that start with the same sound, are all phonological
skills. Those abilities develop through exposure to the
four modes of literacy (i.e., listening, speaking, reading,
and writing).
The development of literacy occurs through the use of
language. Listening and speaking are important for the
development of reading and writing. Through the expo-
sure to all four modes, the child learns to relate and
connect between them. Exposure to literacy such as
written text in various forms enables the child to attach
meaning to text and learn to relate between listening,
speaking, reading and writing. Through the exposure
to those modes, a child can become competent in
literacy. Literacy competence is relative and dynamic.
It depends on the adequacy and functionality of reading
and writing, as well as on the knowledge and judgment
of using it. Literacy develops over time and the level of
competency develops along a continuum depending on
the child’s skills and the environmental demands.10 Chil-
dren with significant communication disorders often
face difficulties in producing language, and often lack
sufficient opportunities to be exposed to literacy. As a
direct consequence, they face barriers that restrict their
competence in literacy.
In the process of literacy acquisition those children
face both access and opportunity barriers while learning
to read and write. They face obstacles that result from
their physical, sensory, and/or language disabilities, as
well as difficulties that result from their learning disabil-
ities. These disabilities are often a result of several causes
and affect various areas. Thus, children with special
needs often find it hard to acquire literacy skills.
Research findings demonstrate that use of augmentative
and alternative communication (AAC) and assistive
technology (AT) may support the process of literacy
learning and in the realization of their potential.
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
AAC incorporates theory and practice aimed to assist
persons with communication difficulties. AAC is the
supplementation of natural speech using aided and/or
unaided symbols and the related means of selection
and transmission of such symbols.11 The symbols used
in AAC may include graphic symbols, gestures, sign
language, pictures, and objects. Graphic symbols refer
to all printed symbols other than words (i.e., ortho-
graphic symbols). AAC also refers to the use of strate-
gies and processes used during that practice.
1306
AAC users usually develop natural ways to substitute
and augment their communication.11 They usually use
unaided communication and often supplement it with
aided communication facilitated or taught by others.
Most of the use of aided communication is applied by
assistive technology.
Assistive technology refers to the tools used to assist
people with difficulties in their activities and functions.12
Those tools can be unique and complex as well as simple
and ordinary. Simple communication boards and
folders accompanied with line drawings and pictures
could be used for enhancing communication. Unique
technologies such as voice output communication
devices, switches, speech synthesis and word recognition
software can assist children with physical and language
impairments. Assistive technology can act as a compen-
satory or a support system for impaired abilities and as a
mechanism to facilitate the learning process.13 Such
technologies can assist in improving the abilities of chil-
dren with multiple disabilities, increasing access to their
close environment, and enhance their opportunities to
acquire literacy skills. Research results show that tech-
nologies such as computers, word processors, and
spell-checkers can assist children with learning, physical,
and cognitive disabilities. For children with severe and
multiple disabilities, assistive technology can be the only
avenue to literacy.
The introduction of AAC to children with communi-
cation difficulties requires a multidisciplinary approach
and an understanding of the unique needs of the poten-
tial AAC user. Communication competencies required
from AAC users include in addition to linguistic, social,
and strategic competencies, also operational ones, as
each user needs to learn to use their aided and unaided
systems and devices.14 Those four competencies are
dynamic and relative in their nature. They develop over
time with new acquisition of word knowledge and with
the development of new needs and demands.
AAC AND EMERGENT LITERACY
Children who use AAC systems are often at risk of
being restricted in their access to literacy. The risk is
caused by the limited use of speech, lack of opportu-
nities to interact in conversations, and the limited access
to print. Children are often faced with limited opportu-
nities to interact with language, leading to a narrow
world of concepts and limited vocabulary. Access
barriers could be caused by motor and sensory disabil-
ities. Often times AAC users endure reduced expecta-
tions, have limited opportunities to ask questions and
to inquire about missing information or words. They
 AAC and literacy
have limited guidance and limited opportunities to prac-
tice with books. However, an argument has been made
that the exposure to graphic symbols, may impact on
reading acquisition and comprehension.1, 15
At young ages, AAC users who require the assistance
of aided communication systems may need to use
objects, pictures, and graphic symbols such as line draw-
ings to represent ideas. Through the use of graphic
symbols they learn to connect between their thoughts
and the symbols presented in front of them. This process
is similar to the understanding of printed matter, in
which the readers learns to foster skills that allow them
to decode words and comprehend them. However,
beginning readers use spoken language to decode writ-
ten text,16 while AAC users have limited understanding
and awareness of the sound as they cannot produce it
and do not have opportunities to practice with it.5 This
could, in fact present a difficulty in understanding
whether AAC users develop phonological skills neces-
sary for learning to read.
Recent research conducted with children who have
hearing impairments has found that reading skills were
not acquired differently by students with and without
phonemic awareness.17, 18 Children with prelingual deaf-
ness using only oral speech and children with prelingual
deafness using only sign language demonstrated differ-
ent phonological skills, but similar reading abilities.
Thus, one possible approach could be that even without
phonological skills and without the ability to produce
spoken words, children can develop reading skills.
IMPACT OF GRAPHIC SYMBOLS ON LITERACY
Graphic symbols appear usually alongside with the
printed word describing them. Sentences constructed
with symbols maintain similar syntax as written text,
they keep the directionality of text, and when presented
on a display of speech output devices they appear as
written text-based sentences. Strickland and Cullinan19
introduced the basic concepts that children learn from
exposure to print through emergent literacy activities.
Thus, graphic symbols, used by AAC users can present
an opportunity for children to develop ‘print aware-
ness’.1 For example, AAC users can produce single
sentences using their voice output communication
devices and then they can see and hear them being
produced on the machine.
The knowledge about written material, about the
forms and functions of print is a strong predictor of
the development of literacy.6 Bishop and associates1
indicated that several of those concepts could be
obtained from exposure to graphic symbols. For exam-
ple, children learn through exposure to written text that
print conveys a meaning. Young AAC users have to
learn to associate the graphic symbol with an idea. They
learn that each graphic symbol can have a meaning, and
they learn to use the symbols as a means to communi-
cate their thoughts. The children also learn that different
symbols represent different ideas that can be presented
as words, sentences or phrases. An additional concept
relates to the directionality of print. Children often
add several symbols when they attempt to convey a
complex message. As they attach several symbols to
each other, they learn to keep the message in a constant
way and present it in a consistent direction. The
arrangement of the graphic symbols in the same direc-
tion as printed material might facilitate learning of
directionality. Directionality has been found to be a
predictor for emergent literacy.
A third concept, that there is a relationship between
print and words, sounds and letters could also be facili-
tated through several opportunities. First, graphic
symbols are often attached to traditional orthography.
The graphic symbols printed for the AAC user have also
the printed term in words above or below the symbol.
This constant exposure can also enhance the association
between the idea, the graphic symbol and the printed
word. Each time the child sees the symbol, there is an
opportunity to observe written material and connect it
to the symbol and the referent. Second, some of the
AAC graphic symbols such as Rebus incorporate print
into the graphic symbols. Blissymbols, another system
of graphic symbols represent ideas by adding elements
and combining them into compounds. This concept
introduces the idea that combining a few symbols
together can create a new meaning. However, Blissym-
bols are a meaning based system, with elements repre-
senting referents. Thus, the concept of letter-sound
understanding would not be applied in this case. Yet,
it could facilitate an understanding that combining
symbols together can produce sentences.
READING AND WRITING
Emergent literacy serves as a predictor for learning to
read and write. However, unlike speaking, which is
usually expected to be acquired without formal instruc-
tion, reading and writing require formal instruction. For
children to learn to read, there must be structured
instruction that will teach them the direct relation
between sound and the letters that produce them.16
Research has demonstrated repeatedly that phonologi-
cal skills are a critical factor for learning print–sound
association, and the pattern of the written form of the
1307
 O. E. Hetzroni
language. However, prelingual deaf children who sign
and do not use sound have been found to learn to read
and write with little understanding of phonemic aware-
ness.17, 18 Thus, children who were natural signers
seemed to depend on their visual skills to read with only
residual dependency on phonological skills.
Orthographic symbols (i.e., words) are often placed
above or below the graphic symbols. This presentation
is often done to facilitate the understanding of the
messages by the communication partner.1 This informa-
tion can present a visual clue and an initial indicator to
the relation between the symbol and the word. However,
the degree to which a child will learn to understand that
the printed word can also represent an idea is dependent
on the facilitation of the concept. Even when the graphic
symbol and the word are paired, it does not mean that
the child has become a reader.1 Creating a relationship
between a word, the symbol and the idea it represents
does not imply that learning to read could occur without
specific letter-sound instruction. However, graphic
symbols do play a critical role in developing literacy
skills. They present the user with the potential for devel-
oping linguistic competence.14, 20 The introduction of
graphic symbols to AAC users can assist in expanding
word knowledge, which later assists in writing and in
reading comprehension.
Word knowledge and the development of vocabulary
of typical children occur through practice and interac-
tion with words (i.e., speaking and listening). The child
interacts with others and uses language. Through
communication with others, children learn and try new
words, hear other people, maintain a conversation, give
and get feedback. For acquiring word knowledge, AAC
users need to practice with their graphic symbols, inter-
act in conversation and develop new vocabulary. Inter-
acting with new vocabulary can facilitate interactions
with writing while using graphic symbols. Graphic
symbols can be used for enhancing writing experiences
and increase literacy competence.
As children develop word knowledge and an under-
standing of the relationship between the graphic
symbols and the ideas they represent, AAC users can
practice in initial writing experiences. In a study investi-
gating the impact of a voice output device on the literacy
skills of a young AAC user, a child learned to use the
graphic symbols and combine them to sentences that
developed into stories.21 Each sentence maintained
grammatical rules and demonstrated the abilities of
the child to convey a written product combined of
symbols and words representing ideas and thoughts of
the writer.21 These experiences do not imply that the
child has also become a competent reader, or that an
1308
AAC user that expresses thoughts and ideas through
the use of graphic symbols could be identified as a
competent writer; however, it could enhance experiences
of literacy, especially gaining knowledge in writing.
It has been argued that for a reader to become compe-
tent, one needs the ability to understand morphemes
and syntax, in addition to knowledge in semantics and
pragmatics. AAC users who use graphic symbols often
use a limited number of symbols to represent several
possible words associated with the basic symbol. Thus,
the development of syntax could be cluttered, as one
symbol represents a complex chain of referents. It is
questioned therefore, if use of graphic symbols facili-
tates reading comprehension. An extensive review of
the topic addresses the influences of graphic symbols
on reading comprehension.15 In their article Rankin
and associates conclude that it would be difficult to fore-
cast that such systems could actually facilitate vocabu-
lary growth (p. 277). In the same token, it is difficult
to evaluate the impact of graphic symbols on the
production of complex language and use of multilevel
syntax. As the symbol system or set created for each
AAC user is influenced by the cognitive demands, it
would be hard to conclude its impact on reading
comprehension. On the other hand, it seems as if the
use of meaningful messages presented by AAC users
using graphic symbols may facilitate the development
of word knowledge. Practice in creating sentences (i.e.,
writing) using graphic symbols can assist in developing
syntax awareness. For the children to engage in active
participation in language experiences involving graphic
symbols, they would need access to aided forms of
communication, namely, assistive technology.
ASSISTIVE TECHNOLOGY AND LITERACY
The use of assistive technology can be conducted in
two ways. First it could be used as a source for support
or a scaffolding tool in educational processes and as a
facilitator while acquiring competencies. Second, assis-
tive technology could be used as a substitute or as a
compensatory tool for deficits and disabilities. The tools
could be unique and specific or ordinary and seemingly
available.
Assistive technology can assist students facing difficul-
ties in learning and bring them closer to success in
acquiring emergent literacy as well as reading and writ-
ing skills. Technology can enhance the child’s abilities
and enable success.22 AAC users can use a computer-
based program to increase exposure to graphic and
orthographic symbols for learning to identify symbols
(e.g.,23). Switches and other control mechanisms can be
 AAC and literacy
used to increase opportunities to interact actively in
reading experiences and increase opportunities to inter-
act with print (e.g.,24, 25). A systematic program geared to
enhance reading and writing with use of assistive tech-
nology can enhance the learning process in a whole
classroom full of children who are AAC users.26
Through the use of assistive technology, children and
teachers alike can interact with technology to enhance
opportunities and expand on experiences of literacy.
AAC users often face barriers that prevent them from
participating in class and other life activities. Assistive
technology can compensate for specific disabilities and
use various systems to bypass limitations hindering the
learning process.27 AAC users can use switches and
other control systems to choose messages and convey
ideas.21, 28 Assistive technologies are available for
compensating for sensory losses. For example, increas-
ing letters presented on a computer screen or voicing
the whole text presented on a screen can assist a vision
impaired child, while a hearing impaired child can read
spoken messages transferred from speech to text. Assis-
tive technology serves as an amplifier enhancing the
opportunities to learn. Children who have limited or
no access due to their physical difficulties can use
switches and other control devices to scan or to select
directly the graphic symbols representing their ideas
and thoughts. Using speech output devices to voice
out their selection enhances the opportunity for them
to learn and recall the symbols.29 Speech synthesis can
amplify exposure to written text, thus, enhancing the
opportunities of people with disabilities to access text,
and to listen to their own production echoed after writ-
ing the text.
TOOLS FOR ENHANCING LITERACY
For children with physical, developmental and/or
language disabilities, literacy can become a bridge to
the world, assisting them to communicate with family
and friends in the community. Assistive technology
can enhance their opportunities in acquiring basic skills
as well as accessing materials needed to learn. The
following section of the article will address various types
of assistive technologies used and investigated for
increasing emergent literacy, reading and writing by
users.
Emergent literacy skills
Children with physical disabilities encounter many
opportunity barriers. One of the difficulties preventing
them from developing emergent literacy is limited expo-
sure to print.26, 30 Physical and logistic difficulties are
only some of the problems they face that prevents them
from interactions with books. In an attempt to investi-
gate the effects of an interactive exposure to print mate-
rials, a computer-based children’s favorite book was
introduced to children with physical disabilities.25 The
computer provided a set of screens depicting traditional
book pages with expanded text and active buttons to
move the pages. In addition, there were a set of words
implemented to investigate the ability to learn to recog-
nize selected words in the story. The purpose of the
multimedia program was to foster active participation
and interaction with print. The buttons were switch-acti-
vated to enable opportunities to interact with the elec-
tronic book even by children with severe difficulties.
Results of the study revealed that children increased
their emergent literacy skills; they learned to identify
the directionality of the story; they could identify the
main characters; they were able to predict and identify
selected words from the book.25 Following this interac-
tion, they all requested more opportunities to interact
with electronic books and repeatedly mentioned how
much they enjoyed this experience.
Graphic symbol acquisition
Learning and understanding the meaning of relation-
ships between graphic symbols and the ideas they repre-
sent are of importance for beginning AAC users. Several
studies have investigated types of symbol sets and
systems across specific qualities of graphic symbols, such
as translucency and complexity, size, and colour (see 11,
chapter 6 for a review of the literature). Assistive tech-
nology can assist in increasing opportunities to attach
meaning to the symbol-learning process. For example,
in a study investigating acquisition of graphic and
orthographic symbols by girls with Rett syndrome, the
use of a multimedia programme equipped with switches
was used to increase opportunities to interact with
symbols.23 The selected referents were chosen based on
information provided by significant communication
partners, based on their knowledge of the girls’ prefer-
ences. The study attempted to teach the girls to identify
the selected symbols. The referents were chosen from a
repertoire of words representing songs, books, food
items, names of people they know, and basic communi-
cation words. The girls learned to identify many of the
orthographic and graphic symbols. Some of them were
also able to use them for communication and choice
making during class activities after intervention termi-
nated. They learned to use the symbols for academic
and communication purposes in the classroom. One of
1309
 O. E. Hetzroni
the girls, for example, learned to approach the book
stand, touch a speech output communication device
placed on the wall by the books and request her favour-
ite book during reading activity. Another child used the
symbols to choose a song from a selection presented to
her.
Over the years some of the children who use graphic
symbols learn to use orthographic symbols for repre-
senting their ideas and thoughts. For example, one study
investigated the ability of AAC users who were using
line drawn graphic symbols to identify orthographic
symbols.31 Students with autism who were AAC users
used graphic symbols represented as line drawings and
as commercial logos for their communication in the
classroom. A computer-based fading programme was
developed to teach those students to recognize ortho-
graphic symbols as representations instead of the logos.
The fading process presented a slow process that offered
opportunities to interact with the items presented in
traditional orthography.31 The students learned to iden-
tify the words presented to them over the computer
screen as part of a fading procedure. The fading proce-
dure included symbols presented as logos with a written
word as part of the logo. The fading procedure included
several steps in which the surrounding of the logo was
eliminated both in colour and in graphics. At the end
of the procedure they learned to attach the word to a
picture representing the item itself, and match it at the
end of the process to a word written in traditional ortho-
graphy. At the end of the study the children were able to
apply the skills learned to classroom activities as part of
their curriculum, in a matching word to picture identifi-
cation task. That task was part of their reading and writ-
ing class activity in school.
Syntax acquisition
Acquiring syntax represents a great difficulty for AAC
users. Expanding their knowledge and moving from
single word presentations to sentences are difficult espe-
cially as often messages presented on the voice output
devices express a sentence, while on the display it
appears as a single graphic symbol. Line drawings were
used to teach children with autism the rules of syntax.32
The students learned to write correctly sentences with
5 – 6 words after exposure to a computer program
designed especially to teach them syntax rules. In
another study, children with autism were taught to use
an interactive multimedia programme to enhance read-
ing and communication skills.33 Results of this study
demonstrated that although children with normal abil-
ities did not demonstrate any differences in their reading
1310
and communication abilities, students with autism and
students with other disabilities increased their achieve-
ments in vocabulary acquisition, word reading, general-
ization to other sentences, phonological skills and in
reading competencies. The computer was also chosen
as a favourite teaching tool by both groups alike.
Pragmatic and semantic acquisition
Children learning to expand their vocabulary and
acquire word knowledge may need to actively interact
with a system that will enable them to expand their
vocabulary. A multimedia program was used for coach-
ing AAC users with cognitive disabilities.34 The students
were exposed to a simulation depicting grocery shop-
ping. The programme was equipped with texts and
pictures that assisted the children towards their new
experience with reading the grocery shopping list. The
programme assisted in introducing the new vocabulary
and the products they represent. The programme
presented them with the appropriate terms and the
sentences needed to be used in the grocery store. Results
indicated that all students acquired the new words, they
managed to learn the sentences and the conversation
needed and used them in the store. They were also able
to apply it at the store, while reading from the list as
needed.
The need to expand on the word knowledge and
experience new words in new conditions was also the
target of a case study investigating literacy acquisition
by a child with physical disabilities and vision impair-
ment. The child learned to use a scanning device and
used it to compose stories.21 A computer-based speech
output device attached two types of digitized voices
for the child to use. One of the voices served as a scan-
ning device that produced all the possible selections for
him, while the other voice served as his own voice recit-
ing and expressing his ideas and written compositions.
At the beginning of the process he could produce one
to two word utterances, while at the end of the process
he composed lengthy stories all produced with one
switch and a scanning device programmed into the
computer.
Reading and writing
AAC users who have acquired basic reading and writ-
ing skills may practice conversation and investigate if
their writing efforts were successful by using a speech
synthesis. Speech synthesis presents a compensatory tool
that enables the computer to read aloud the written
attempts of the AAC user.35 In a study investigating
 AAC and literacy
the effects of assistive technology on the academic
achievements of AAC users there was a significant
difference in the academic abilities of students based
on the level of technologies used.36 Children who could
compensate for their difficulties with technologies
achieved higher results in reading and writing activities.
One of the children used a power-controlled wheel-
chair, a voice-output device, and a personal computer
to participate in class activities. Other children used
voice-output devices that assisted the students and
served as substitutes for their disabled functions. With
the assistance of their technologies, the students were
able to fulfil class assignments, write and read their writ-
ten products as required.36 Results of another study
investigating the effects of a computer-based speech
synthesis on the writing skills of children with autism
demonstrated that they improved their writing skills
and reduced spelling mistakes.33 When used as a feed-
back, speech synthesis increased their abilities to spell
more words presented to them.35 This method was used
effectively also with individuals with learning disabil-
ities.37
Conclusions
AAC and assistive technology can have a strong
impact on empowering capabilities and competencies
of AAC users. Research has demonstrated that those
strategies and technologies are possible. Assistive tech-
nology has an important role in the development of such
abilities with AAC users. Assistive technology can be a
compensatory or a scaffolding tool across learning
processes and for everyday life activities. The increasing
improvements of assistive technology that have been
accelerated recently can provide an appropriate solution
for including AAC users in the regular classroom. Assis-
tive technology can transform the academic environ-
ment into a user friendly one, an environment
accessible for students with significant difficulties. These
technologies enable one to separate between the impair-
ment and the disability. This opportunity expresses the
ability of the user to use the technologies to repair,
enhance and assist, as well as to compensate or substi-
tute a difficulty, and open a door to learning successfully
using the full potential. New technologies involving the
internet have also become available. Expanded text and
speech to text have become available for internet use. A
preliminary investigation on the use of the internet has
found that surfing the net has increased literacy and
appropriate communication among children with
autism.38 Other uses of the internet include use of e-mail
services and chat for enhancing written forms of
communication by children with developmental disabil-
ities.
Despite the extensive development of these technolo-
gies, and the variety of the devices that exist in the
world, research still demonstrates that there is only a
limited use of those resources for enhancing literacy
among children with special needs. Lack of knowledge
amongst professionals as well as financial and technical
difficulties prevent optimal use of these technologies for
reading and writing development. Developing new tech-
nologies, reducing their price, and exposing them to
experts and advocates might enhance the use of those
technologies across populations and for a variety of
usages.
An AAC user, a person with significant physical
disabilities, who uses assistive technologies for almost
all his daily activities, has commented that since the
development of internet and e-mail services, he has
turned from a person with disabilities that needs the
assistance of others for every move he makes, into an
independent man. He admits he needs more time than
others to accomplish each task, but he can fulfil most
of his wishes using AAC and assistive technology. He
has control over the environment, and with use of
literacy and the internet he can send messages and
converse using switches and a joystick for manipulating
his wheel-chair. AAC and assistive technology have
presented him with the ability to acquire knowledge,
expand his horizons, compensate for impaired abilities
and for him, made him like any other human being.
References
1 Bishop K, Rankin J, Mirenda P. Impact of graphic symbol use on
reading acquisition. Augmentative and Alternative Communication
1994; 10: 113 – 125.
2 Gillam RB, Johnston JR. Spoken and written relationships in
language/learning impaired and normally achieving school-age
children. Journal of Speech and Hearing Research 1992; 35: 1303 –
1315.
3 Smith MM, Blischak DM. Literacy. In: LL Lloyd, DR Fuller, HH
Arvidson (eds) Augmentative and Alternative Communication.
Boston, MA: Allyn & Bacon, 1997; 414 – 444.
4 Reinking D, McKenna MC, Labbo LD, Kieffer RD. Handbook of
Literacy and Technology: Transformations in a Post-Typographic
World. Mahwah, NJ: Lawrence Erlbaum, 1998.
5 Koppenhaver DA, Yoder DE. Classroom literacy instruction for
children with severe speech and physical disabilities (SSPI): What is
and what might be. Topics in Language Disorders 1993; 13: 1 – 15.
6 Clay MM. The Early Detection of Reading Difficulties (3rd edn).
Portsmouth, NH: Heinemann, 1979.
7 Hempenstall K. The role of phonemic awareness in beginning
reading: A review. Behavior Change 1997; 14: 201 – 214.
8 Share DL. Phonological recoding and self-teaching: Sine qua non
of reading acquisition. Cognition 1995; 55: 151 – 218.
9 Stanovich KE. Matthew effects in reading: Some consequences of
individual differences in the acquisition of literacy. Reading
Research Quarterly 1986; 21: 360 – 406.
1311
 O. E. Hetzroni
10 Light J, Binger C, Kelford Smith A. Story reading interactions
between preschoolers who use AAC and their mothers. Augmenta-
tive and Alternative Communication 1994; 10: 255 – 268.
11 Lloyd LL, Fuller DR, Arvidson HH. Augmentative and Alternative
Communication. Boston, MS: Allyn & Bacon, 1997.
12 King TW. Assistive Technology: Essential Human Factors. Need-
ham Heights, MA: Allyn & Bacon, 1999.
13 Raskind MH, Higgins EL. Assistive technology for postsecondary
students with learning disabilities: An overview. Journal of
Learning Disabilities 1998; 31: 27 – 40.
14 Light J. Toward a definition of communication competence for
individuals using Augmentative and Alternative Communication
systems. Augmentative and Alternative Communication 1989; 5:
137 – 144.
15 Rankin JL, Harwood K, Mirenda P. Influence of graphic symbol
use on reading comprehension. Augmentative and Alternative
Communication 1994; 10: 269 – 281.
16 Adams MJ. Beginning to Read: Thinking and Learning About Print.
Cambridge, MA: MIT Press, 1990.
17 Miller P. Communication mode and the Information processing
capacity of Hebrew readers with prelingually acquired deafness.
Journal of Developmental and Physical Disabilities 2001; 13: 83 – 96.
18 Miller P. Communication mode and the processing of printed
words: Evidence from reading with prelingually acquired deafness.
Journal of Deaf Studies and Deaf Education 2002; 7: 312 – 329.
19 Strickland D, Cullinan B. Afterword. In: MJ Adams (ed) Beginning
to Read: Thinking and Learning About Print. Cambridge, MA: MIT
Press, 1990; 425 – 433.
20 McNaughton S. Graphic representational systems and literacy
learning. Topics in Language Disorders 1993; 13: 58 – 75.
21 Blischak DM. Thomas the writer: Case study of a child with severe
physical, speech, and visual impairments. Language, Speech, and
Hearing Services in Schools 1995; 26: 11 – 20.
22 Lewis RB. Assistive technology and learning disabilities: Today’s
realities and tomorrow’s promises. Journal of Learning Disabilities
1998; 31: 16 – 26.
23 Hetzroni OE, Rubin C, Konkol O. Use of a computer-based
intervention for teaching girls with Rett syndrome to identify
symbols. Journal of Intellectual and Developmental Disability 2002;
27: 57 – 71.
24 Kinsley TC, Langone J. Application of technology for infants,
toddlers, and preschoolers with disabilities. Journal of Special
Education Technology 1995; 12: 312 – 324.
25 Hetzroni OE, Schanin M. Emergent literacy in children with severe
disabilities using multimedia interactive stories. Journal of Devel-
opmental and Physical Disabilities 2002; 14: 173 – 190.
1312
26 Mike DG. Literacy and Cerebral Palsy: Factors influencing literacy
learning in a self-contained setting. Journal of Reading Behavior
1995; 27: 627 – 642.
27 Hunt-Berg M, Rankin JL, Beukelman DR. Ponder the possibilities:
Computer supported writing for struggling writers. Learning
Disabilities Research & Practice 1994; 9(3): 169 – 178.
28 Locke PA, Mirenda P. A computer-supported communication
approach for a child with severe communication, visual, and
cognitive impairments: A case study. Augmentative and Alternative
Communication 1988; 4: 15 – 22.
29 Schlosser RW, Belfiore PJ, Nigam R, Blischak D, Hetzroni O. The
effects of speech output technology in the learning of graphic
symbols. Journal of Applied Behavior Analysis 1995; 28: 537 – 549.
30 Foley BE. The development of literacy in individuals with severe
congenital speech and motor impairments. Topics in Language
Disorders 1993; 13: 16 – 32.
31 Hetzroni OE, Shalem U. From logos to orthographic symbols: A
multi-level fading computer program for teaching non-verbal
children with autism. 2004. Manuscript submitted for publication.
32 Yamamoto J, Miya T. Acquisition and transfer of sentence
construction in autistic students: Analysis by computer-based
teaching. Research in Developmental Disabilities 1999; 20: 355 – 377.
33 Heimann M, Nelson KE, Tjus T, Gillberg C. Increasing reading
and communication skills in children with autism through an
interactive multimedia computer program. Journal of Autism and
Developmental Disorders 1995; 25(5): 459 – 480.
34 Mechling LC, Gast DL. Multi-media instruction to teach grocery
word association and store location: A study of generalization.
Education and Training in Mental Retardation and Developmental
Disabilities 2003; 38: 62 – 76.
35 Schlosser RW, Blischak DM, Belfiore PJ, Bartley C, Barnett N.
Effects of synthetic speech output and orthographic feedback on
spelling in a student with autism. Journal of Autism and
Developmental Disorders 1998; 28: 319 – 329.
36 Hutinger P, Johanson J, Stoneburner R. Assistive technology
application in education programs for children with multiple
disabilities: A case study report on the state of practice. Journal of
Special Education Technology 1996; 13; 16 – 36.
37 Raskind MH, Higgins EL. Effects of speech synthesis on the
proofreading efficiency of postsecondary students with learning
disabilities. Learning Disability Quarterly 1995; 18: 141 – 158.
38 Davis DK, Stock SE, Wehmeyer ML. Enhancing independent
internet access for individuals with mental retardation through use
of a specialized web browser: A pilot study. Education and Training
in Mental Retardation and Developmental Disabilities 2001; 36:
107 – 113.