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A Systematic Literature Review of Reading Instruction for Students with Complex Communication Needs

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Title: A Systematic Literature Review of Reading Instruction for Students with Complex Communication Needs
Language: English
Authors: Sarah E. Hudler (ORCID 0009-0008-8714-5056), Genevieve Hurlburt (ORCID 0009-0005-4424-8424), Matthew E. Brock (ORCID 0000-0001-7197-2120)
Source: Research and Practice for Persons with Severe Disabilities. 2025 50(4):305-321.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 17
Publication Date: 2025
Document Type: Journal Articles
Information Analyses
Education Level: Early Childhood Education
Preschool Education
Elementary Secondary Education
Adult Education
Descriptors: Reading Instruction, Students with Disabilities, Communication Problems, Communication Disorders, Severe Disabilities, Decoding (Reading), Phonemes, Sight Method, Intervention, Task Analysis, Prompting, Augmentative and Alternative Communication, Intellectual Disability, Multiple Disabilities, Autism Spectrum Disorders, Speech Impairments, Preschool Education, Elementary Secondary Education, Adult Education
DOI: 10.1177/15407969251333963
ISSN: 1540-7969
2169-2408
Abstract: Most approaches for teaching reading involve students reading aloud and receiving feedback. These approaches are not feasible for nonspeaking students, and teachers need alternative strategies that do not require speech. To provide guidance about effective strategies, we conducted a systematic review of 51 experimental studies within 36 journal articles that evaluated reading interventions for students with significant disabilities and complex communication needs. The most common intervention components included task analytic instruction, a gradual release model (i.e., model-lead-test), systematic prompting, and incremental rehearsal. Positive effects were most often reported for decoding outcomes (92%; n = 11), phoneme segmentation (87%, n = 2), and sight words (92%, n = 11). Reading comprehension was only targeted in one study, and fluency was not targeted at all. These findings provide insight into targeting some components of reading, but further research is needed that allows teachers to provide more comprehensive reading instruction for this population.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1491610
Database: ERIC
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  Value: <anid>AN0189237526;myx01dec.25;2025Nov13.05:05;v2.2.500</anid> <title id="AN0189237526-1">A Systematic Literature Review of Reading Instruction for Students With Complex Communication Needs </title> <p>Most approaches for teaching reading involve students reading aloud and receiving feedback. These approaches are not feasible for nonspeaking students, and teachers need alternative strategies that do not require speech. To provide guidance about effective strategies, we conducted a systematic review of 51 experimental studies within 36 journal articles that evaluated reading interventions for students with significant disabilities and complex communication needs. The most common intervention components included task analytic instruction, a gradual release model (i.e., model-lead-test), systematic prompting, and incremental rehearsal. Positive effects were most often reported for decoding outcomes (92%; n = 11), phoneme segmentation (87%, n = 2), and sight words (92%, n = 11). Reading comprehension was only targeted in one study, and fluency was not targeted at all. These findings provide insight into targeting some components of reading, but further research is needed that allows teachers to provide more comprehensive reading instruction for this population.</p> <p>Keywords: complex communication needs; augmentative and alternative communication; literacy; intellectual disability; autism</p> <p>The report of the [<reflink idref="bib48" id="ref1">48</reflink>] states that there are five critical components of reading, which include phonemic awareness, phonics, reading fluency, vocabulary, and reading comprehension. Phonemic awareness is the ability to hear and manipulate the individual sounds within words. Phonics is the process of linking the orthographic letter to the sound that includes letter-sound correspondence. Decoding means the analysis of the letters in a word to determine its pronunciation. Vocabulary is understanding the meaning of individual words and its impact on reading comprehension. Reading fluency is the rate of correct words or sounds read. Finally, reading comprehension is the act of drawing meaning from text and being able to answer questions from the text ([<reflink idref="bib48" id="ref2">48</reflink>]). These five components interact with one another, and a focus on all five is critical to the success of literacy instruction. A common analogy to illustrate the interdependence of these skills is to visualize five interwoven strands of a rope ([<reflink idref="bib56" id="ref3">56</reflink>]).</p> <p>One way to conceptualize how these components interact is the Simple View of Reading, which posits that a student's ability to comprehend text relies on both their decoding and understanding the meaning of words ([<reflink idref="bib35" id="ref4">35</reflink>]). A student must decode individual words accurately from their graphic to their linguistic form (i.e., phonics), understand the meaning of these words (i.e., vocabulary), and decode at a fast enough rate (i.e., fluency) that they are able to process a sentence in their working memory and make sense of it (i.e., comprehension). The Simple View of Reading posits that while reading is a complex skill, it can be conceptualized more simply as the interplay between decoding and linguistic comprehension ([<reflink idref="bib35" id="ref5">35</reflink>]).</p> <p>Most approaches for teaching the five components of reading hinge on students speaking, and then teachers providing feedback on their performance ([<reflink idref="bib9" id="ref6">9</reflink>]). Spoken language is almost always the default basis for measuring student progress and assessment for student achievement ([<reflink idref="bib17" id="ref7">17</reflink>]). For instance, typical assessments of phonemic awareness ask students to identify and articulate the sounds at the beginning, middle, and end of words (e.g., Dynamic Indicators of Basic Early Literacy Skills [DIBELS], [<reflink idref="bib26" id="ref8">26</reflink>]). Phonics assessments often involve students decoding a word by sounding it out (e.g., DIBELS Phoneme Segmentation Fluency [PSF], [<reflink idref="bib26" id="ref9">26</reflink>]). Fluency assessments generally require students to read a passage aloud (e.g., DIBELS Oral Reading Fluency [ORF], [<reflink idref="bib26" id="ref10">26</reflink>]). For comprehension, students are usually asked to retell the content they have just read in their own words (e.g., Oral Passage Understanding Scale [OPUS], [<reflink idref="bib14" id="ref11">14</reflink>]). In all these examples, a teacher's ability to gauge student performance and design future instruction is completely dependent on the student's speech. Similarly, the most widely used literacy curricula all assume that teachers will be able to use curriculum-based measures that hinge on students reading text aloud and using speech to answer questions about what they read (e.g., Houghton Mifflin Harcourt <emph>Into Reading</emph>, [<reflink idref="bib36" id="ref12">36</reflink>]). None of these assessments or curricula were developed with students who have complex communication needs (CCN) in mind, leading many teachers to attempt to either heavily adapt these materials or create their own ([<reflink idref="bib54" id="ref13">54</reflink>]).</p> <p>While speech plays a central role in teaching literacy to most students, not all students can speak sounds and words. This presents a unique challenge for teachers of students with significant disabilities and CCN ([<reflink idref="bib63" id="ref14">63</reflink>]). Students with significant disabilities include students who receive special education services below a label of intellectual disability, autism, or multiple disabilities and are eligible for their state's alternate assessment for students with significant cognitive disabilities ([<reflink idref="bib40" id="ref15">40</reflink>]). A subset of students with significant disabilities are nonspeaking, speaking either no words or very few words. These students often rely on alternative and augmentative communication (AAC) to meet their communication needs. Forms of AAC are often categorized as unaided, or communication that does not require materials (e.g., vocalizations, gestures, sign language), and aided, communication that requires materials (e.g., Picture Exchange Communication System, speech generating devices; [<reflink idref="bib59" id="ref16">59</reflink>]).</p> <p>Five existing literature reviews provide some insight into how to design effective literacy intervention for students with significant disabilities and/or CCN ([<reflink idref="bib1" id="ref17">1</reflink>]; [<reflink idref="bib6" id="ref18">6</reflink>]; [<reflink idref="bib9" id="ref19">9</reflink>]; [<reflink idref="bib44" id="ref20">44</reflink>]; [<reflink idref="bib63" id="ref21">63</reflink>]). First there are three reviews that focused on the broader category of students with significant cognitive disabilities who are both speaking and nonspeaking (i.e., [<reflink idref="bib1" id="ref22">1</reflink>]; [<reflink idref="bib6" id="ref23">6</reflink>]; [<reflink idref="bib9" id="ref24">9</reflink>]). An important conclusion across these reviews is that students with significant disabilities can make progress on early literacy skills specifically in the areas of vocabulary, comprehension, phonemic awareness, fluency, engagement, and listening comprehension ([<reflink idref="bib6" id="ref25">6</reflink>]; [<reflink idref="bib9" id="ref26">9</reflink>]). Effective instructional strategies included direct instruction, repeated trials, read alouds, and systematic prompting procedures including time delay and least-to-most prompting ([<reflink idref="bib1" id="ref27">1</reflink>]; [<reflink idref="bib9" id="ref28">9</reflink>])–as well as task analytic lessons, and graphic organizers ([<reflink idref="bib6" id="ref29">6</reflink>]).</p> <p>In another review, [<reflink idref="bib44" id="ref30">44</reflink>] focused specifically on students with CCN, but within the broader category of students with physical and developmental disabilities who may or may not have significant disabilities. This group of students intersects with a subset of students with CCN and significant disabilities. Machalicek et al. focused their review on children younger than 14 years of age and identified 18 studies that included 37 participants. A small subset of six participants had moderate to profound intellectual disability. Most of the studies (61%) reported using non-experimental research designs, and therefore it was not possible to confidently attribute growth on reading outcomes to the interventions that were studied. Machalicek et al. found that students with significant physical and developmental disabilities who use aided AAC devices often benefited from direct instruction, scaffolding, and systematic prompting hierarchies. They found promising evidence that these strategies may improve skills such as letter-sound correspondence, tasks that require phonemic awareness (i.e., word segmentation), and word reading tasks.</p> <p>Finally, one existing review focused exclusively on teaching early literacy skills to students with significant disabilities who use AAC (i.e., [<reflink idref="bib63" id="ref31">63</reflink>]). Yorke et al. focused on phonological awareness skills, letter-sound correspondences, and decoding interventions in experimental conditions for individuals who use AAC. In their review, Yorke et al. identified 22 publications with a total of 24 experiments. Instructional approaches included experiments modeled after Accessible Literacy Learning (ALL) Curriculum ([<reflink idref="bib43" id="ref32">43</reflink>]), Early Reading Skills Builder (ERSB; [<reflink idref="bib3" id="ref33">3</reflink>]), the Nonverbal Reading Approach (NRA; [<reflink idref="bib29" id="ref34">29</reflink>]), storybook reading, or shared reading. The ALL curriculum uses direct instruction and a gradual release model to teach letter-sound correspondence, matching written words to pictures, and phonemic awareness (e.g., selecting a picture that represents two sounds blended; [<reflink idref="bib43" id="ref35">43</reflink>]). ERSB is a comprehensive reading program that teaches sight word reading, letter-sound correspondence, phonemic awareness, and phonics using systematic prompting and time delay, as well as listening comprehension of a text ([<reflink idref="bib3" id="ref36">3</reflink>]). The NRA uses guided practice in which the teacher sounds out the word along with the student, then shows the word in its entirety pointing to each letter, saying it aloud while encouraging the student to say it aloud, then prompts the student to say it in their head, while the teacher says the sounds aloud ([<reflink idref="bib29" id="ref37">29</reflink>]).</p> <p>Across these five existing reviews of the literature, there is evidence that students with significant cognitive disabilities and CCN are capable of learning skills including letter-sound correspondence, phonological awareness, and vocabulary. However, there are limitations to the previous reviews. First, four of the five reviews focused on broader categories of students, making it difficult to draw conclusions about what approaches are effective specifically for nonspeaking students with significant cognitive disabilities. Second, some reviews restricted their focus to only a subset of reading components, and it is unclear what research exists that focus on other aspects of reading (i.e., [<reflink idref="bib63" id="ref38">63</reflink>]). Third, some reviews included studies did not meet quality indicators for internal validity of experimental research (e.g., Council for Exceptional Children [CEC]; [<reflink idref="bib16" id="ref39">16</reflink>]), making it impossible to confidently attribute student progress to independent variables (i.e., [<reflink idref="bib44" id="ref40">44</reflink>]; [<reflink idref="bib63" id="ref41">63</reflink>]). Fourth, the most current of these reviews (i.e., [<reflink idref="bib63" id="ref42">63</reflink>]) included studies published through early 2019; however, more recent research has been published since then.</p> <p>This review was designed to address the aforementioned limitations. First, we focused exclusively on students with both significant disabilities and CCN. Second, we aimed to identify interventions that focused on any of the five components identified by the NRP rather than restricting to a subset of components. Third, we focused only on studies that met CEC's standards for evidence-based practices in special education's nine quality indicators for internal validity, increasing our ability to make stronger conclusions about the effectiveness of interventions ([<reflink idref="bib16" id="ref43">16</reflink>]). Fourth, we included 4 years of research that had not been included in any prior review. Specifically, we aimed to address the following research questions:</p> <p></p> <ulist> <item> What instructional formats and strategies have been used to teach reading to individuals with moderate to severe disabilities and complex communication needs?</item> <p></p> <item> What reading outcomes have been targeted for individuals with moderate to severe disabilities and complex communication needs?</item> <p></p> <item> What are the effects of intervention studies on reading outcomes for students with moderate to severe disabilities and complex communication needs?</item> </ulist> <hd id="AN0189237526-2">Method</hd> <p></p> <hd id="AN0189237526-3">Study Eligibility Criteria</hd> <p>To be included in this review, we required studies to meet the following four criteria: students must have (a) been described as having significant disabilities, (b) been nonspeaking, (c) used augmentative alternative communication, and (d) met experimental design criteria to teach at least one reading component recommended by NRP. First, the author had to state that the student had a significant disability–or that the participant had a label of intellectual disability, multiple disabilities, or autism along with an IQ score listed below 70. Second, participants must have been nonspeaking, defined by the authors describing the students to be nonverbal, or nonspeaking, using no more than two-word utterances, being echolalic or using scripting, using less than 100 functional words unprompted, or using AAC. Studies were excluded when nonspeaking student data could not be disaggregated from speaking student data (e.g., [<reflink idref="bib23" id="ref44">23</reflink>]). Third, studies had to target one of the five NRP reading skills. Finally, the studies had to employ an experimental design such as randomized control trial (RCT), quasi-experimental design (QED), or a single-case design (SCD) that met CEC criteria for internal validity ([<reflink idref="bib16" id="ref45">16</reflink>]). Specifically, RCT and QED studies must have had data analysis techniques appropriate for comparing change in performance of two or more groups and SCD studies must have included three opportunities to demonstrate and replicate effects.</p> <hd id="AN0189237526-4">Search Strategy</hd> <p>We used multiple search strategies to identify all studies meeting the aforementioned criteria. These strategies included a search of electronic databases, checking reference lists from studies meeting eligibility criteria, conducting citation searches of studies meeting eligibility criteria, and hand searching of <emph>Augmentative and Alternative Communication</emph> and <emph>Research and Practice for Persons with Severe Disabilities.</emph> In July 2023, we searched three electronic databases: APA PsycINFO, Education Resource Information Center (ERIC), and Social Sciences Abstracts (H.W. Wilson). We did not include any date limiters. Search terms included literacy, complex communication, disability, and experimental terms. The search string was (literacy OR read* OR phonics OR fluency OR comprehension OR decoding OR "sight words" OR vocabulary) AND ("augmentative and alternative communication" OR "augmentative communication device" OR AAC OR PECS OR "picture exchange" OR "limited verbal" OR "nonspeaking" OR "minimally verbal" OR "nonverbal" OR "complex communication needs" OR CCN AND "significant disabilities" OR "complex support needs"' OR "intellectual disabilit*" OR "severe developmental disabilities" OR "moderate intellectual") AND (experimental OR "single case" OR "single subject" OR randomized OR "multiple baseline" OR "multiple probe" OR probe OR "pilot study" OR "alternating treatment").</p> <p>The search resulted in 2,038 hits. After duplicates were removed, the first author screened the title and abstracts of 1,737 articles to see whether they included (a) students with disabilities and (b) targeted reading. After screening the studies in the search of the aforementioned databases, a citation search was conducted for all included articles and the previous reviews ([<reflink idref="bib9" id="ref46">9</reflink>]; [<reflink idref="bib44" id="ref47">44</reflink>]; [<reflink idref="bib63" id="ref48">63</reflink>]) through Google Scholar, which resulted in five additional articles to read the full text. Finally, a forward search was conducted by searching for any articles that the included authors may have written, resulting in six additional articles to read the full text. This resulted in 36 articles that met all eligibility criteria. Figure 1 displays a flow diagram outlining all search procedures, including the number of articles identified by each strategy.</p> <p>Graph: Figure 1. Overview of Article Identification Procedures.</p> <hd id="AN0189237526-5">Data Collection and Variables</hd> <p>We coded four categories of variables: (a) research design, (b) participants, (c) instructional strategy, and (d) reading outcome. We selected variables that would provide context for understanding reading instruction and enable moderator analysis. To ensure reliability, the first two authors independently coded these variables. Of the 2,038 initial hits, the second author screened titles and abstracts of 20% of articles (<emph>n</emph> = 317) for intercoder agreement, which was 91.2%. The second coder also conducted visual analysis for 100% of articles (<emph>n =</emph> 34) that met eligibility criteria after full coding. Average agreement for visual analysis was 92%. The second author also coded all other variables for 20% of articles (<emph>n</emph> = 57) eligible for full-text coding and an average agreement for all other variables was 96%. Agreement within research design variables was 100%, within participants was 97.2% (<emph>n</emph> = 35), within instruction strategy was 100%, and within reading outcome was 88.9% (<emph>n</emph> = 32). All disagreements were resolved through discussion and consensus.</p> <hd id="AN0189237526-6">Study Design and Threats to Internal Validity</hd> <p>We classified study designs as RCTs if the authors reported randomly assigning participants to experimental and comparison groups. Studies in which participants were nonrandomly assigned to experimental and comparison groups were classified as QEDs. For SCDs, we coded if the design provided three opportunities to demonstrate and replicate effects, and whether there were at least five data points within each condition.</p> <hd id="AN0189237526-7">Participant and Setting Characteristics</hd> <p>We coded individual participants by age or grade, gender, ethnicity (if reported), disabilities, IQ, and communication modes for nonspeaking students in the study. Two studies had participants that met inclusion criteria, but we could not disaggregate their data; therefore, we reached out to the listed author and were unable to ascertain the needed information. We attempted to code classrooms as special education classrooms or general education classrooms. If the authors did not state whether a classroom was a special education classroom or general education classrooms, we coded it as classroom–unspecified.</p> <hd id="AN0189237526-8">Instructional Strategy</hd> <p>We coded whether interventions were implemented in a one-to-one, small group (i.e., at least two participants), or whole group context. All included studies were conducted in either one-to-one or small group instruction. We coded the strategy being used during the intervention: task analytic instruction, time delay, prompting hierarchy (e.g., least-to-most, most-to-least prompting), corrective feedback, gradual release model (i.e., model-lead-test), or interactive reading. Task analytic instruction was used if during the study the authors systematically broke down reading outcome concepts (i.e., systematically taught letter-sound correspondence, taught beginning sound, then middle sound, then ending sound in three letter words; [<reflink idref="bib2" id="ref49">2</reflink>], [<reflink idref="bib3" id="ref50">3</reflink>]; [<reflink idref="bib4" id="ref51">4</reflink>]). Corrective feedback was coded if studies involved modeling to students for error correction (i.e., [<reflink idref="bib5" id="ref52">5</reflink>]). We also coded for instructional materials that included flashcards, books (e.g., teacher made or trade books), published curriculum, or visual scene display. Visual scene display is the use of technology to have dynamic text embedded in a photo or image that has hotspots the individual will activate, when pressing that shows the word and provides audio ([<reflink idref="bib10" id="ref53">10</reflink>]). These codes emerged as articles were reviewed. As we read the studies, we formed categories that captured the authors' descriptions of their instructional methods. For example, if a study reported breaking down the letter sounds taught in a systematic way, we coded this as task analytic teaching.</p> <hd id="AN0189237526-9">Reading Outcome</hd> <p>We recorded the reading outcome that was measured in each study. We used the NRP's five components: phonemic awareness, phonics, vocabulary, reading comprehension, and fluency. Phonemic awareness was either phoneme segmentation (PS; e.g., match a picture for a word after being said aloud by adult "match a picture of sun to /s/ /u/ /n/" or "match a picture to what you get when you have block and take away the /b/, 'lock'") or syllable segmentation (SS; clapping the syllables in words or moving chips to show syllables in words). We kept letter-sound correspondence (LSC; selecting a letter to match a voiced phoneme) as its own category. Phonics included sound blending (SB) to read words (selecting a written word to match a voiced word that was stretched) or decoding with picture support (DWPS; the student read a word and selected a picture for that word). Vocabulary consisted of word meanings (WM), where students matched pictures of words read to demonstrate understanding of the word. Sight words were kept as a separate category because the student did not use phonics to read the word, but identified a spoken word. These subcategories arose as we reviewed the studies so we could see whether there were any patterns to what form of the five pillars were being instructed. Reading comprehension was coded if the participant read the text independently and demonstrated understanding in some way (e.g., answering questions or completing a step in a recipe).</p> <hd id="AN0189237526-10">Analytic Strategies</hd> <p>For analytic strategies of RCTs or QEDs, we used an online effect size calculator ([<reflink idref="bib55" id="ref54">55</reflink>].). This calculated Cohen's <emph>d</emph> for the group design studies by taking the means and standard deviations the authors reported for the intervention and control group. We used the commonly accepted criteria of <emph>d</emph> =.20 as a small effect,.50 as a medium effect, and.80 as a large effect ([<reflink idref="bib15" id="ref55">15</reflink>]). For SCDs, we did a visual analysis of the graphs and calculated success estimates by comparing baseline and intervention data points, looking for a change in trend, variability, and magnitude ([<reflink idref="bib42" id="ref56">42</reflink>]). Originally proposed by [<reflink idref="bib52" id="ref57">52</reflink>], a success estimate represents the ratio of demonstrations of effect to opportunities for demonstration of an effect. This metric emphasizes the replication of experimental effects and allows the reader to judge whether adequate replications have been demonstrated to conclude a functional relation exists between the independent and dependent variables. We chose this metric because (a) it is based on established visual analysis methods and does not depend on the controversial assumptions of other quantitative metrics (e.g., percentage of non-overlapping data; [<reflink idref="bib57" id="ref58">57</reflink>]) and (b) we were primarily interested in improvement, rather than magnitude, of effects. We calculated the total number of experimental effects on the primary student outcome (numerator) over the total number of times the author planned an opportunity to demonstrate an experimental effect on the primary student outcome (denominator). Because reading is a cumulative learning task, some overlap was allowed as intervention was introduced; however, if the magnitude of the slope of the trend did not increase or the last five data points were not above the baseline trend, then it was determined that there was no success in the intervention.</p> <hd id="AN0189237526-11">Results</hd> <p>Thirty-six articles met inclusion criteria for review, some of which had multiple experiments, resulting in 51 experimental studies. Two studies involved RCTs and the remaining 34 used SCDs. Although multiple-probe-across participants (<emph>n</emph> = 10, 31%) or conditions (<emph>n</emph> = 8, 25%) were the most common design; multiple-baseline-across-participants (<emph>n</emph> = 8, 25%), alternating treatments designs (<emph>n</emph> = 3, 9%) and multiple-baseline across conditions (<emph>n</emph> = 1, 3%) were also used. Of these 34 studies, 15 measured generalization and maintenance, 10 measured only maintenance, and five measured only generalization. Four collected neither generalization nor maintenance data. The participant demographics, instructional strategies used in interventions, reading outcomes targeted, and the success estimates for the interventions are described in Tables 1–3. Some experimental studies used multiple instructional strategies or targeted more than one reading outcome in their experiments.</p> <p>Table 1. Demographic Information (n = 168).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th align="left">Characteristic</th><th align="center"><italic>n</italic></th><th align="center">%</th></tr></thead><tbody><tr><td colspan="3">Gender</td></tr><tr><td> Male</td><td>101</td><td>60.5%</td></tr><tr><td> Female</td><td>38</td><td>22.8%</td></tr><tr><td> Not reported</td><td>28</td><td>16.8%</td></tr><tr><td colspan="3">Grades</td></tr><tr><td> Pre-K (ages <6)</td><td>11</td><td>6.6%</td></tr><tr><td> Elementary (K-5, ages 6–11)</td><td>103</td><td>61.3%</td></tr><tr><td> Middle school (grades 6–8, ages 12–14)</td><td>27</td><td>16.1%</td></tr><tr><td> High School (grades 9–12, ages 15–22)</td><td>17</td><td>10.1%</td></tr><tr><td> Adult (ages > 22)</td><td>9</td><td>5.4%</td></tr><tr><td> Not reported<xref ref-type="table-fn" rid="tfn1">a</xref></td><td>1</td><td>0.6%</td></tr><tr><td colspan="3">Disability Description</td></tr><tr><td> Autism spectrum disorder</td><td>35</td><td>20.8%</td></tr><tr><td> Autism spectrum disorder & Intellectual Disability</td><td>28</td><td>16.7%</td></tr><tr><td> Cerebral Palsy</td><td>2</td><td>1.2%</td></tr><tr><td> Cerebral Palsy and Orthopedic Impairment</td><td>10</td><td>6%</td></tr><tr><td> Developmental Delay</td><td>16</td><td>9.5%</td></tr><tr><td> Down Syndrome</td><td>5</td><td>3%</td></tr><tr><td> Down Syndrome and Intellectual Disability</td><td>13</td><td>7.7%</td></tr><tr><td> Intellectual Disability</td><td>28</td><td>16.7%</td></tr><tr><td> Multiple Disabilities</td><td>5</td><td>3%</td></tr><tr><td> Orthopedic Impairment</td><td>1</td><td>0.6%</td></tr><tr><td colspan="3">Spoken Communication</td></tr><tr><td> Limited verbal (up to three-word utterances)</td><td>66</td><td>39.3%</td></tr><tr><td> Vocalizations</td><td>25</td><td>14.9%</td></tr><tr><td> Unspecified<xref ref-type="table-fn" rid="tfn1">b</xref></td><td>77</td><td>45.8%</td></tr><tr><td colspan="3">Forms of Alternative Augmentative Communication (AAC)<xref ref-type="table-fn" rid="tfn1">c</xref></td></tr><tr><td> Gestures</td><td>52</td><td>31%</td></tr><tr><td> Manual signs</td><td>33</td><td>19.6%</td></tr><tr><td> Picture symbols</td><td>41</td><td>24.4%</td></tr><tr><td> Aided AAC</td><td>32</td><td>19.1%</td></tr><tr><td> Eye gaze</td><td>5</td><td>3%</td></tr><tr><td> Switch</td><td>3</td><td>1.8%</td></tr><tr><td> Unreported</td><td>51</td><td>30.4%</td></tr></tbody></table> </ephtml> </p> <p>1 One study had a missing participant on the demographic table ([<reflink idref="bib4" id="ref59">4</reflink>]). <sups>b</sups>Participant was described as nonspeaking but no description of communication behaviors was listed ([<reflink idref="bib4" id="ref60">4</reflink>]; [<reflink idref="bib37" id="ref61">37</reflink>]; [<reflink idref="bib49" id="ref62">49</reflink>]). <sups>c</sups>Some participants were identified as using more than one AAC mode so percentages total more than 100%.</p> <p>Table 2. Instructional Strategies and Reading Outcomes With Success Estimates and Effect Sizes (n = 51).</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th /><th /><th /><th /><th /><th align="center" colspan="8">Reading outcome</th></tr><tr><th /><th align="center" colspan="5">Instructional strategy</th><th align="center" colspan="2">PA</th><th align="center">AP</th><th align="center" colspan="2">Phonics</th><th align="center" rowspan="2">SightWord</th><th align="center">Voc.</th><th align="center" rowspan="2">Reading Comp</th></tr><tr><th align="left">Study</th><th align="center">TA</th><th align="center">GRM</th><th align="center">SP</th><th align="center">CF</th><th align="center">IR</th><th align="center">PS</th><th align="center">SS</th><th align="center">LSC</th><th align="center">SB</th><th align="center">DWPS</th><th align="center">WM</th></tr></thead><tbody><tr><td><xref ref-type="bibr" rid="bibr2">Ahlgrim-Delzell et al., 2014</xref></td><td>x</td><td>x</td><td>x</td><td>x</td><td /><td /><td /><td>3/3</td><td>3/3</td><td>3/3</td><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr3">Ahlgrim-Delzell et al., 2016</xref></td><td>x</td><td /><td>x</td><td /><td /><td /><td /><td>1.12</td><td>0.51</td><td>0.88</td><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr4">Ainsworth et al., 2016</xref></td><td>x</td><td>x</td><td /><td /><td /><td /><td /><td>3/4</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr5">Akcin, 2013</xref></td><td /><td /><td>x</td><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr7">Bailey et al., 2011</xref></td><td>x</td><td>x</td><td>x</td><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td>0/3</td><td /><td /><td /><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /><td /><td /><td /></tr><tr><td> Exp. 3</td><td /><td /><td /><td /><td /><td /><td /><td>1/3</td><td /><td /><td /><td /><td /></tr><tr><td> Exp. 4</td><td /><td /><td /><td /><td /><td /><td /><td>1/3</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr8">Benedek-Wood et al., 2016</xref></td><td>x</td><td>x</td><td>x</td><td>x</td><td /><td /><td /><td>3/3</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr10">Caron et al., 2018</xref></td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>5/5</td><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr11">Caron et al., 2020</xref></td><td /><td>x</td><td>x</td><td>x</td><td /><td /><td /><td /><td /><td>5/5</td><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr12">Caron et al., 2021</xref></td><td /><td>x</td><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /><td /></tr><tr><td> Exp. 3</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr13">Caron et al., 2023</xref></td><td /><td>x</td><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /><td /><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr18">Crowley et al., 2013</xref></td><td>x</td><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td>6/6</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr19">Dean, 2020</xref></td><td /><td /><td>x</td><td /><td /><td /><td /><td>3/3</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr20">Fallon et al., 2004</xref></td><td>x</td><td>x</td><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td /><td>5/5</td><td /><td /><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td /><td>5/5</td><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr21">Farmer et al., 1991</xref></td><td /><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr22">Finn et al., 2023</xref></td><td>x</td><td /><td>x</td><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>2/3</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr24">Fiscus et al., 2002</xref></td><td /><td /><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>1/3</td></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>2/3</td></tr><tr><td><xref ref-type="bibr" rid="bibr25">Frates et al., 2022</xref></td><td>x</td><td>x</td><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr27">Hansen et al., 2014</xref></td><td /><td /><td>x</td><td /><td /><td>3/3</td><td>0/3</td><td>0/3</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr28">Hanser & Erickson, 2007</xref></td><td>x</td><td>x</td><td /><td /><td /><td /><td /><td>0/3</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr30">Hetzroni & Shalem, 2005</xref></td><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>6/6</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr32">Holyfield et al., 2019</xref></td><td /><td /><td>x</td><td>x</td><td /><td /><td /><td /><td /><td /><td>2/3</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr33">Holyfield et al., 2020</xref></td><td /><td /><td>x</td><td>x</td><td /><td /><td /><td /><td /><td /><td>3/6</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr31">Holyfield, 2021</xref></td><td /><td /><td>x</td><td>x</td><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/4</td><td>4/4</td><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>3/4</td><td>4/4</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr34">Holyfield et al., 2023</xref></td><td /><td /><td>x</td><td /><td>x</td><td /><td /><td /><td>2/3</td><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr37">Hunt et al., 2020</xref></td><td>x</td><td /><td>x</td><td /><td /><td /><td /><td>0.28</td><td>0.25</td><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr38">Hyer & Cooper-Duffy, 2019</xref></td><td>x</td><td /><td>x</td><td /><td>x</td><td /><td /><td /><td /><td /><td /><td>3/3</td><td /></tr><tr><td><xref ref-type="bibr" rid="bibr41">Jameson et al., 2007</xref></td><td>x</td><td /><td>x</td><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>4/4</td><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /><td>4/4</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr45">Mandak et al., 2020</xref></td><td /><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td>2/3</td><td /></tr><tr><td><xref ref-type="bibr" rid="bibr46">Mechling & Gast, 2003</xref></td><td /><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr47">Millar et al., 2004</xref></td><td>x</td><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td /><td /><td>2/3</td><td /><td /><td /><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td /><td /><td>2/3</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr49">Naylor, 2013</xref></td><td /><td /><td>x</td><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Exp. 1</td><td /><td /><td /><td /><td /><td>2/3</td><td /><td>0/3</td><td /><td /><td /><td /><td /></tr><tr><td> Exp. 2</td><td /><td /><td /><td /><td /><td>3/3</td><td /><td>0/3</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr50">Oliveira et al., 2018</xref></td><td /><td /><td>x</td><td /><td /><td /><td /><td>2/3</td><td /><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr53">Rivera et al., 2016</xref></td><td /><td /><td>x</td><td /><td /><td /><td /><td /><td /><td /><td /><td>3/3</td><td /></tr><tr><td><xref ref-type="bibr" rid="bibr60">Truxler & O'Keefe, 2007</xref></td><td /><td>x</td><td /><td /><td /><td /><td /><td>4/4</td><td>1/3</td><td /><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr61">Westover & Martin, 2014</xref></td><td>x</td><td /><td>x</td><td>x</td><td /><td /><td /><td>3/3</td><td>3/3</td><td>3/3</td><td /><td /><td /></tr><tr><td><xref ref-type="bibr" rid="bibr62">Wright et al., 2022</xref></td><td>x</td><td /><td>x</td><td>x</td><td /><td /><td /><td>2/2</td><td /><td /><td /><td /><td /></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note.</emph> TA = Task-analytic teaching, GRM = Gradual Release Model, SP = Systematic prompting, CF = Corrective Feedback, IR = Interactive Reading, VSD = Visual Scene Display, PA = Phonemic Awareness, PS = Phoneme segmentation, SS = Syllable segmentation, AP = Alphabetic Principal, LSC = Letter sound correspondence, SB = Sound blending, DWPS = Decoding with picture support, Voc. = Vocabulary, WM = Word meanings. Some studies participants did not meet experimental control. All fractions are success estimates of number of observed successes over opportunities to show success. Whole numbers = Cohen's <emph>d</emph> effect sizes (≤.2 = small effect,.5 = medium effect,.8 = large effect).</p> <p>Table 3. Success Estimates for Instructional Strategies by Reading Outcome.</p> <p>Graph</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="center" colspan="2">Phonemic awareness</th><th align="center">Alphabetic principle</th><th align="center" colspan="2">Phonics</th><th align="center">Sight</th><th align="center">Vocabulary</th><th align="center" rowspan="2">Reading comp.</th><th align="center" rowspan="2">Overall</th></tr><tr><th align="left">Instructional strategy</th><th align="center">PS</th><th align="center">SS</th><th align="center">LSC</th><th align="center">SB</th><th align="center">DWPS</th><th align="center">Words</th><th align="center">WM</th></tr></thead><tbody><tr><td>Task Analytic Teaching</td><td>-</td><td>-</td><td>23/36</td><td>16/16</td><td>6/6</td><td>31/32</td><td>3/3</td><td>-</td><td>79/93</td></tr><tr><td /><td /><td /><td><italic>d</italic> = 1.12,.28</td><td><italic>d</italic> =.51,.25</td><td>d =.88</td><td /><td /><td /><td><italic>d</italic> =.25–1.12</td></tr><tr><td>Gradual Release Model</td><td>-</td><td>-</td><td>24/35</td><td>14/16</td><td>17/17</td><td>6/6</td><td>-</td><td>-</td><td>61/74</td></tr><tr><td>Systematic Prompting<xref ref-type="table-fn" rid="tfn4">a</xref></td><td>8/9</td><td>0/3</td><td>25/44</td><td>8/9</td><td>26/28</td><td>50/55</td><td>8/9</td><td>-</td><td>124/154</td></tr><tr><td /><td /><td /><td><italic>d</italic> = 1.12,.28</td><td><italic>d</italic> =.51,.25</td><td><italic>d</italic> =.88</td><td /><td /><td /><td><italic>d</italic> =.25–1.12</td></tr><tr><td>Corrective Feedback</td><td>5/6</td><td>-</td><td>17/23</td><td>16/16</td><td>17/19</td><td>32/37</td><td>-</td><td>3/6</td><td>87/101</td></tr><tr><td>Interactive Reading</td><td>-</td><td>-</td><td>5/12</td><td>2/3</td><td>6/8</td><td>8/8</td><td>3/3</td><td>-</td><td>24/34</td></tr><tr><td>Overall<xref ref-type="table-fn" rid="tfn4">b</xref></td><td>13/15</td><td>0/3</td><td>94/150</td><td>56/60</td><td>71/78</td><td>127/138</td><td>14/15</td><td>3/6</td><td>-</td></tr><tr><td /><td /><td /><td><italic>d</italic> =.28–1.12</td><td><italic>d</italic> =.25–.51</td><td><italic>d</italic> =.88</td><td /><td /><td /><td /></tr></tbody></table> </ephtml> </p> <ulist> <item>3 <emph>Note.</emph> PS = Phoneme Segmentation, SS = Syllable Segmentation, LSC = Letter/Sound Correspondence, SB = Sound Blending; DWPS-Decoding with Picture Support, WM = Word Meaning.</item> <item>4 Includes time delay, least-to-most prompting, and most-to-least prompting. <sups>b</sups>Regardless of strategy, this shows the effectiveness of reading outcome.</item> </ulist> <hd id="AN0189237526-12">Participant Demographics</hd> <p>Across experiments, 168 participants met criteria as nonspeaking students with significant disabilities. Their demographics are summarized in Table 1. Participants may have been identified as having multiple diagnoses; if so, we reported the multiple diagnoses of the participants. Most participants were male (60%) and had autism (21%). The participant demographic information of one study ([<reflink idref="bib37" id="ref63">37</reflink>]) was difficult to disaggregate. This review was focused only on students who had CCN. Twenty-four students were identified as being nonspeaking, while all students either had autism or intellectual disabilities. It was noted that 13 of the students had autism and intellectual disabilities. These participants were grouped in the "not reported" section, along with one participant that was not included on a demographic table ([<reflink idref="bib4" id="ref64">4</reflink>]). Most reported ages of participants fell in the elementary school range (61%). For race, 56% was not reported; however, of the participants where race was reported, 21% were Caucasian, 13% were African American, 6% were Latino, 1% were Asian, 2% were Middle Eastern, and 2 % were Pacific Islander. While most participants used multiple modes of communication, those whose communication behaviors were not described were coded as unspecified. Participants mostly used a combination of communication modes with 69% using some form of AAC.</p> <hd id="AN0189237526-13">Instructional Strategies</hd> <p>Researchers conducted the interventions in 22 of the 36 articles. Special education teachers implemented interventions in 11 of the articles and paraprofessionals, parents, or an intern implemented in the remaining three articles. The interventions were conducted individually for participants in 81% of the experimental studies (<emph>n</emph> = 29), while 11% (<emph>n</emph> = 4) were conducted in small groups; two experimental studies used both instructional groupings (<emph>n</emph> = 2, 5%). One article did not describe student grouping. Location of interventions occurred in special education classrooms (<emph>n</emph> = 22, 61%), or unspecified classroom (<emph>n</emph> = 5, 14%). The other locations included general education classrooms (<emph>n</emph> = 3, 8%), therapy rooms (<emph>n</emph> = 3, 8%), or home (<emph>n</emph> = 3, 8%).</p> <p>Instructional strategies that were used during the intervention included task analytic teaching (<emph>n</emph> = 18), time delay (<emph>n</emph> = 25), prompting hierarchy (<emph>n</emph> = 13), and gradual release model (<emph>n</emph> = 8). Twenty-five experimental studies used some form of time delay with a range of 0–30 s wait time. Two prompting hierarchies were used; 10 experimental studies used least-to-most prompting, while three experimental studies used most-to-least prompting. Gradual release model was used for instruction in eight experimental studies. Interactive reading to teach the target skill was used in five experimental studies. Of the 36 studies, 25 used more than one instructional strategy. Flashcards were used in 16 experimental studies and paired with task analytic teaching or systematic prompting instructional strategy. Books were used in nine experimental studies–six used teacher created books and three used trade books—and were paired with a gradual release model or systematic prompting. Boxed curricula were used in five studies and were paired with task analytic teaching and systematic prompting. Visual scene displays were used in seven experimental studies and were paired with systematic prompting or a gradual release model. See Table 2 for a breakdown of coded variables by experimental studies.</p> <hd id="AN0189237526-14">Reading Outcomes</hd> <p>The [<reflink idref="bib48" id="ref65">48</reflink>] report described five components necessary for reading: phonemic awareness, phonics, vocabulary, comprehension, and fluency. Of the 36 studies, 4% targeted phonemic awareness through either phoneme segmentation (2%, <emph>n</emph> = 1) or syllable segmentation (2%, <emph>n</emph> = 1). Letter-sound correspondence was targeted in 44.4% of the studies (<emph>n</emph> = 16). Decoding was targeted in 30.6% of the studies (<emph>n</emph> = 11), with sound blending to read words (19.4%, <emph>n</emph> = 7), decoding with picture support (19.4%, <emph>n</emph> = 7). Three studies targeted both sound blending and decoding with picture support ([<reflink idref="bib2" id="ref66">2</reflink>]; [<reflink idref="bib3" id="ref67">3</reflink>]; [<reflink idref="bib61" id="ref68">61</reflink>]), sight words was targeted in 30.6% (<emph>n</emph> = 11), vocabulary was targeted in 8.3% (<emph>n</emph> = 3) of the studies, and finally, reading comprehension was measured in 2% (<emph>n</emph> = 1) of the studies. Fluency was not measured in any experiment.</p> <hd id="AN0189237526-15">Success Estimates</hd> <p>For each SCD study, we used a success estimate–or a ratio of the number of effects detected through visual analysis over the total number of opportunities–to summarize the effectiveness of the intervention ([<reflink idref="bib51" id="ref69">51</reflink>]). See Table 3 for a breakdown by study on reading outcome. Two experimental studies targeted phonemic awareness and had 72% success. Phoneme segmentation and syllable segmentation were targeted infrequently, but were 100% successful for phoneme segmentation and 0% successful for syllable segmentation in the experiments that targeted them. Twenty-two experimental studies targeted letter-sound correspondence with 62.7% success. Regarding decoding, sound blending was 93.3% successful, while decoding with picture support was 91% successful. Experiments targeting sight words were 92% successful. Three experimental studies targeted vocabulary, specifically word meanings and had 93.3% accuracy. Reading comprehension was targeted in one experimental study with 50% success. Phonics was targeted in the two RCT studies. For LSC, the effects small to large (<emph>d</emph> =.28–1.12). For sound blending, the effects were small to medium (<emph>d</emph> =.25–.51). For decoding with picture support, the effects were large (<emph>d</emph> =.88)</p> <p>When looking at which instructional strategies were successful in teaching certain reading outcomes, we found the following results, displayed in Table 3. Task analytic teaching was used to teach letter-sound correspondence, phonics, vocabulary and sight words. This had small to moderate effects for teaching sound blending (<emph>d</emph> =.25–.51) and large effects (<emph>d</emph> =.88) for teaching decoding with picture support. Task analytic teaching had high success for teaching sight words (96.9%) and vocabulary word meanings (100%). The gradual release model was used to teach letter-sound correspondence with 68.6% success estimates, sound blending with 87.5% success estimates, and decoding with picture support and sight words with 100% success estimates for both. Systematic prompting was used to teach phonemic awareness with 75% success estimates, letter-sound correspondence had small to large effects (<emph>d</emph> =.28–1.12) and 56.8% success, phonics (<emph>d</emph> =.25–1.12, 89%), sight words with 90.9% success estimates and vocabulary 88.9% success estimates. Corrective feedback was used to teach phonemic awareness (100%), letter-sound correspondence (73.9%), phonics (94.7%), and sight words (86.5%). Interactive reading was used to teach letter-sound correspondence (41.7%), phonics (70.8%), sight words (100%), and vocabulary (100%).</p> <hd id="AN0189237526-16">Discussion</hd> <p>Most instructional approaches for literacy hinge on students speaking sounds and words, and alternative methods are needed for students with significant disabilities and CCN ([<reflink idref="bib9" id="ref70">9</reflink>]). To provide guidance to teachers about the most effective ways to teach this population, we conducted a systematic literature review of 51 experimental studies in 36 articles. We found that effective interventions often included task analytic instruction, a gradual release model (i.e., model-lead-test), systematic prompting, and incremental rehearsal. The most frequently targeted outcomes were alphabet knowledge and vocabulary, although more recent research is increasingly focused on decoding words using phonics. These findings extend the literature regarding teaching literacy to students with significant disabilities and CCN in several ways.</p> <p>First, the most frequently targeted aspect of reading was letter-sound correspondence (44.4%, <emph>n</emph> = 16), phonics (30.6%) and sight words (30.6%); echoing similar observations in previous reviews ([<reflink idref="bib9" id="ref71">9</reflink>]; [<reflink idref="bib44" id="ref72">44</reflink>]; [<reflink idref="bib63" id="ref73">63</reflink>]). While this research still makes up the bulk of the literature, there has been a shift in recent years to increased focus on decoding words using phonics. Specifically, 11 experiments included phonics-based word reading as an outcome, and nine of these studies have been published recently. This shift represents a critical change from an exclusive emphasis on memorization of letters and complete words to supporting the use of phonics in a way that will support students to decode new words. Furthermore, success estimates for experiments focused on decoding words suggest that students with CCN and significant disabilities can acquire this skill when given the opportunity.</p> <p>In contrast, other components of reading remain understudied with this population. Specifically, reading comprehension was only targeted once and fluency was not targeted at all. Both outcomes may be particularly challenging to measure for this population. Existing measures of reading fluency are not tenable because they depend on measurement of how many words the student decodes and speaks per minute (e.g., ORF [[<reflink idref="bib26" id="ref74">26</reflink>]]). Similarly, commonly used measures of reading comprehension often depend on oral retelling of what a student has read (e.g., ORF). However, one study in this review did present an alternative means of demonstrating comprehension without speech. [<reflink idref="bib24" id="ref75">24</reflink>] had participants use a picture and word recipe and observed whether students could complete each. In addition, it may be feasible for researchers to adapt existing approaches for measuring listening comprehension–an outcome that has been assessed frequently with this population ([<reflink idref="bib9" id="ref76">9</reflink>]).</p> <p>Second, interventions tended to be more consistently effective when they included task analytic teaching, a gradual release model, or corrective feedback. Task analytic instruction was most often used to target alphabet knowledge (<emph>n</emph> = 14, 22/36) and sight words (<emph>n</emph> = 7, 31/32). A gradual release model was most often used to target alphabet knowledge (<emph>n</emph> = 11, 27/39) and decoding with picture support (<emph>n</emph> = 5, 17/17). Corrective feedback was used to target decoding (<emph>n</emph> = 5, 16/19. Interactive reading was the least consistent approach for teaching decoding skills (<emph>n</emph> = 3, 7/11). These strategies were often combined and were not contrasted; therefore, there is no experimental evidence that one is superior to the other. While prior reviews have highlighted each of these practices (i.e., [<reflink idref="bib9" id="ref77">9</reflink>]; [<reflink idref="bib44" id="ref78">44</reflink>]; [<reflink idref="bib63" id="ref79">63</reflink>]) our findings in this review provide a more nuanced picture of how different practices might be used to target specific components of reading.</p> <p>Third, most of the studies instructed participants one-to-one in either a self-contained special education classroom or a separate classroom without other students. However, federal law mandates that all students be educated in the regular education classroom to the maximum extend appropriate ([<reflink idref="bib39" id="ref80">39</reflink>]), In general education classrooms, there is a strong emphasis in comprehensive literacy instruction, including phonics instruction ([<reflink idref="bib58" id="ref81">58</reflink>]). Researchers have demonstrated that with well-designed supports, inclusive regular education classrooms are the best setting for promoting access to the general education classroom ([<reflink idref="bib40" id="ref82">40</reflink>]). Furthermore, a subset of studies in this review demonstrated that it is possible to deliver effective literacy instruction for students with CCN in inclusive settings (e.g., [<reflink idref="bib37" id="ref83">37</reflink>]). With instruction in general education classes in elementary schools aligned with these components, students with CCN and significant cognitive disabilities can receive the same instruction in the general education classroom with adaptations to the presentation of responses ([<reflink idref="bib3" id="ref84">3</reflink>]). Just as the research literature has shifted toward a stronger focus on phonics-based decoding in recent years, we hope that researchers continue a trend toward more research in inclusive settings.</p> <p>Fourth, within the last 20 years, the experimental rigor of research in this area has improved substantially. For all reading outcomes, we included anything that met CEC criteria, of those 23 studies were published within the last 10 years. In previous reviews, authors often resorted to including studies that lacked experimental rigor because of the dearth of high-quality experimental research (e.g., [<reflink idref="bib9" id="ref85">9</reflink>]; [<reflink idref="bib44" id="ref86">44</reflink>]; [<reflink idref="bib63" id="ref87">63</reflink>]). When doing the full-text review, 26 articles were excluded for not meeting experimental quality indicators. Also, 30 of the 34 studies included some form of generalization or maintenance measure; therefore, there was evidence that these interventions last over time or can be generalized to other learning or settings. Because of this increase in rigorous research in recent years, we can draw stronger conclusions than ever before from the research literature. We now have decades of causal evidence that when given the opportunity, students with significant cognitive disabilities and CCN can make progress on reading skills.</p> <hd id="AN0189237526-17">Implications for Practice</hd> <p>Findings from this review have important implications for teachers. First, this review presents clear evidence that students with CCN and significant cognitive disabilities can learn phonemic awareness and decoding skills when taught using task analytic teaching, a gradual release model, and/or corrective feedback. We encourage teachers to use these strategies either by designing individualized instruction or adopting a curriculum that includes these strategies such as Early Literacy Skills Builder (ELSB; [<reflink idref="bib3" id="ref88">3</reflink>]) or Accessible Literacy for All (ALL; [<reflink idref="bib37" id="ref89">37</reflink>]). Second, we recommend that like with all instruction for student with significant disabilities, teachers ensure that they are collecting data and adjusting their instruction based on student performance ([<reflink idref="bib9" id="ref90">9</reflink>]). No instructional strategy in this review was effective every time for every student, so it is possible that adjustments may need to be made for individual students. Third, we recommend that teachers have high expectations for students with significant disabilities and CCN, including an expectation that they are capable of decoding words using phonics-based approaches. Evidence in this review supports the idea that students can learn to decode using phonics. Targeting this skill has the potential to substantially increase the number of words that students can read compared with only memorizing entire words.</p> <hd id="AN0189237526-18">Limitations and Future Directions for Research</hd> <p>While this review contributes to better understanding effective literacy instruction for students with CCN and significant cognitive disabilities, there are limitations. First, we were limited to only including studies that clearly described participants as being nonspeaking; and in some cases, studies were excluded because communication repertoires were not clearly described. In future studies, we recommend that authors clearly identify nonspeaking students and disaggregate their data. Second, we chose to use success estimates to summarize our visual analysis of effects. Although we had a systematic approach and demonstrated high reliability across raters, it is possible that others might have drawn different conclusions through their own visual analysis. Third, we were only able to provide guidance to teachers focused on decoding skills because of the lack of experimental research on reading fluency and comprehension. In future research, we hope that researchers will focus on both developing fluency and comprehension measures that are accessible to students with CCN, and then test interventions that target these outcomes. Finally, we used CEC quality design standards to appraise the internal validity of research studies, but it is possible that others chose different standards (e.g., What Works Clearinghouse [[<reflink idref="bib42" id="ref91">42</reflink>]]). In future reviews, researchers might apply multiple standards to compare the results.</p> <hd id="AN0189237526-19">Conclusion</hd> <p>As shown in this review, literacy has been a focus for individuals with CCN and significant disabilities; however, most work has occurred at the decoding level. While prior research focused more on a sight word or vocabulary topic, more recent works indicated a shift in including phonics instruction. More research needs to be completed that includes reading comprehension and fluency for students with significant disabilities and CCN. To truly teach reading skills, we cannot just focus on one part of the simple view of reading, we must include all components. 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Journal of Developmental and Physical Disabilities, 33, 537–582. https://doi.org/10.1007/s10882-020-09767-5</bibtext> </blist> </ref> <ref id="AN0189237526-21"> <title> Footnotes </title> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> Sarah E. Hudler</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0009-0008-8714-5056 Genevieve Hurlburt</bibtext> </blist> <blist> <bibtext>Graph</bibtext> </blist> <blist> <bibtext>https://orcid.org/0009-0005-4424-8424 Matthew E. Brock</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0001-7197-2120</bibtext> </blist> <blist> <bibtext> Editor-in-Charge: Rob Pennington</bibtext> </blist> </ref> <aug> <p>By Sarah E. Hudler; Genevieve Hurlburt and Matthew E. Brock</p> <p>Reported by Author; Author; Author</p> <p></p> <p>Sarah E. Hudler is a PhD student at Ohio State University in the College of Human Ecology, Special Education Department. Her interests include reading instruction for students with extensive support needs and complex communication needs.</p> <p>Genevieve Hurlburt is a doctoral student at Ohio State University. She studies interventions to promote communication and social outcomes for students with significant disabilities and complex communication needs.</p> <p>Matthew E. Brock is a professor of special education at the Crane Center for Early Childhood Research and Policy at Ohio State University. He studies interventions to promote academic, communication, and social outcomes for students with significant disabilities.</p> </aug> <nolink nlid="nl1" bibid="bib48" firstref="ref1"></nolink> <nolink nlid="nl2" bibid="bib56" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib35" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib17" firstref="ref7"></nolink> <nolink nlid="nl5" bibid="bib26" firstref="ref8"></nolink> <nolink nlid="nl6" bibid="bib14" firstref="ref11"></nolink> <nolink nlid="nl7" bibid="bib36" firstref="ref12"></nolink> <nolink nlid="nl8" bibid="bib54" firstref="ref13"></nolink> <nolink nlid="nl9" bibid="bib63" firstref="ref14"></nolink> <nolink nlid="nl10" bibid="bib40" firstref="ref15"></nolink> <nolink nlid="nl11" bibid="bib59" firstref="ref16"></nolink> <nolink nlid="nl12" bibid="bib44" firstref="ref20"></nolink> <nolink nlid="nl13" bibid="bib43" firstref="ref32"></nolink> <nolink nlid="nl14" bibid="bib29" firstref="ref34"></nolink> <nolink nlid="nl15" bibid="bib16" firstref="ref39"></nolink> <nolink nlid="nl16" bibid="bib23" firstref="ref44"></nolink> <nolink nlid="nl17" bibid="bib10" firstref="ref53"></nolink> <nolink nlid="nl18" bibid="bib55" firstref="ref54"></nolink> <nolink nlid="nl19" bibid="bib15" firstref="ref55"></nolink> <nolink nlid="nl20" bibid="bib42" firstref="ref56"></nolink> <nolink nlid="nl21" bibid="bib52" firstref="ref57"></nolink> <nolink nlid="nl22" bibid="bib57" firstref="ref58"></nolink> <nolink nlid="nl23" bibid="bib37" firstref="ref61"></nolink> <nolink nlid="nl24" bibid="bib49" firstref="ref62"></nolink> <nolink nlid="nl25" bibid="bib61" firstref="ref68"></nolink> <nolink nlid="nl26" bibid="bib51" firstref="ref69"></nolink> <nolink nlid="nl27" bibid="bib24" firstref="ref75"></nolink> <nolink nlid="nl28" bibid="bib39" firstref="ref80"></nolink> <nolink nlid="nl29" bibid="bib58" firstref="ref81"></nolink>
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  Label: Title
  Group: Ti
  Data: A Systematic Literature Review of Reading Instruction for Students with Complex Communication Needs
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Sarah+E%2E+Hudler%22">Sarah E. Hudler</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0008-8714-5056">0009-0008-8714-5056</externalLink>)<br /><searchLink fieldCode="AR" term="%22Genevieve+Hurlburt%22">Genevieve Hurlburt</searchLink> (ORCID <externalLink term="https://orcid.org/0009-0005-4424-8424">0009-0005-4424-8424</externalLink>)<br /><searchLink fieldCode="AR" term="%22Matthew+E%2E+Brock%22">Matthew E. Brock</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-7197-2120">0000-0001-7197-2120</externalLink>)
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Research+and+Practice+for+Persons+with+Severe+Disabilities%22"><i>Research and Practice for Persons with Severe Disabilities</i></searchLink>. 2025 50(4):305-321.
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  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 17
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Information Analyses
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Preschool+Education%22">Preschool Education</searchLink><br /><searchLink fieldCode="EL" term="%22Elementary+Secondary+Education%22">Elementary Secondary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Adult+Education%22">Adult Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Reading+Instruction%22">Reading Instruction</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Problems%22">Communication Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Disorders%22">Communication Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Severe+Disabilities%22">Severe Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Decoding+%28Reading%29%22">Decoding (Reading)</searchLink><br /><searchLink fieldCode="DE" term="%22Phonemes%22">Phonemes</searchLink><br /><searchLink fieldCode="DE" term="%22Sight+Method%22">Sight Method</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Task+Analysis%22">Task Analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Prompting%22">Prompting</searchLink><br /><searchLink fieldCode="DE" term="%22Augmentative+and+Alternative+Communication%22">Augmentative and Alternative Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Multiple+Disabilities%22">Multiple Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Speech+Impairments%22">Speech Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Preschool+Education%22">Preschool Education</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+Secondary+Education%22">Elementary Secondary Education</searchLink><br /><searchLink fieldCode="DE" term="%22Adult+Education%22">Adult Education</searchLink>
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  Label: DOI
  Group: ID
  Data: 10.1177/15407969251333963
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  Label: ISSN
  Group: ISSN
  Data: 1540-7969<br />2169-2408
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Most approaches for teaching reading involve students reading aloud and receiving feedback. These approaches are not feasible for nonspeaking students, and teachers need alternative strategies that do not require speech. To provide guidance about effective strategies, we conducted a systematic review of 51 experimental studies within 36 journal articles that evaluated reading interventions for students with significant disabilities and complex communication needs. The most common intervention components included task analytic instruction, a gradual release model (i.e., model-lead-test), systematic prompting, and incremental rehearsal. Positive effects were most often reported for decoding outcomes (92%; n = 11), phoneme segmentation (87%, n = 2), and sight words (92%, n = 11). Reading comprehension was only targeted in one study, and fluency was not targeted at all. These findings provide insight into targeting some components of reading, but further research is needed that allows teachers to provide more comprehensive reading instruction for this population.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
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  Label: Entry Date
  Group: Date
  Data: 2026
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  Label: Accession Number
  Group: ID
  Data: EJ1491610
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  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/15407969251333963
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 17
        StartPage: 305
    Subjects:
      – SubjectFull: Reading Instruction
        Type: general
      – SubjectFull: Students with Disabilities
        Type: general
      – SubjectFull: Communication Problems
        Type: general
      – SubjectFull: Communication Disorders
        Type: general
      – SubjectFull: Severe Disabilities
        Type: general
      – SubjectFull: Decoding (Reading)
        Type: general
      – SubjectFull: Phonemes
        Type: general
      – SubjectFull: Sight Method
        Type: general
      – SubjectFull: Intervention
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      – SubjectFull: Task Analysis
        Type: general
      – SubjectFull: Prompting
        Type: general
      – SubjectFull: Augmentative and Alternative Communication
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Multiple Disabilities
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Speech Impairments
        Type: general
      – SubjectFull: Preschool Education
        Type: general
      – SubjectFull: Elementary Secondary Education
        Type: general
      – SubjectFull: Adult Education
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      – TitleFull: A Systematic Literature Review of Reading Instruction for Students with Complex Communication Needs
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            NameFull: Genevieve Hurlburt
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            NameFull: Matthew E. Brock
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            – D: 01
              M: 12
              Type: published
              Y: 2025
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            – Type: issn-print
              Value: 1540-7969
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            – TitleFull: Research and Practice for Persons with Severe Disabilities
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