Knowledge is Power: Reading, Writing, and Promoting

Self-Determination among Adolescents with Multiple Disabilities

Andrea L. Ruppar
University of Wisconsin Madison
Madison, WI
Disclosure: Financial: Andrea L. Ruppar has no financial interests to disclose.
Nonfinancial: Andrea L. Ruppar has no nonfinancial interests to disclose.

Abstract
Emergent readers and writers with multiple disabilities, who use augmentative and
alternative communication (AAC), require many opportunities throughout the day to engage in
literacy. The quality of these literacy opportunities is important; to ensure that reading and
writing are consistently motivating and students generalize skills, literacy should always
serve an authentic communicative purpose. As students enter adolescence and prepare to
exit high school, high-priority literacy skills should be targeted and literacy activities must be
age-appropriate. This article provides an overview of emergent literacy for early communicators
with multiple disabilities and explores ways that educational teams can identify authentic
literacy activities for adolescents with multiple disabilities in a variety of inclusive environments.
Teaching an adolescent with multiple disabilities requires flexibility, creativity, and technical
skills (Ruppar, Roberts, & Olson, 2014). The high school general curriculum, as it is typically
conceptualized, requires students to read, write, and communicate with fluency in order to
access content. This presents extreme barriers for students who need extensive instruction and
adaptations to read and write for everyday purposes (Copeland, 2009; Erickson & Clendon, 2009).
For example, the format and content of general education textbooks are not designed to be
accessible to a variety of learners, many high school classes rely heavily on lectures with few
opportunities for hands-on learning, and educators have limited time for collaboration to design
individualized and personally meaningful instruction. These challenges require teams to continuously
innovate in order to support their students access to curriculum content via literacy. Because of
these seemingly insurmountable obstacles, educational teams often choose to segregate students
with multiple disabilities in special education classrooms.
Students with significant disabilities learn best within the contexts where skills will be
used. For literacy learning, this means interacting with natural, age-appropriate communication
partners in everyday communication contexts. Students with significant disabilities spend most of
their time in self-contained, segregated classrooms (U.S. Department of Education, 2013). Because
natural, age-appropriate communication partners and situations are not usually present in selfcontained, segregated classrooms, students with multiple disabilities have few natural literacy
learning opportunities. Moreover, recent research has shown that academic instruction for students
with significant disabilities in self-contained classrooms is characterized by age-inappropriate
materials, little access to grade-level content, and instruction requiring only low depth of knowledge
(Restorff & Abery, 2013). Identifying natural, inclusive opportunities for authentic literacy
instruction continues to be a challenge for many educational teams.

Defining Literacy
Literacy, defined as reading, writing, listening, and speaking for everyday purposes, is
based in the communicative context where information is exchanged and relationships are built
(Teale & Sulzby, 1989). Proficient communicators use a variety of forms of communication to gain
or convey information and relate to others and the development of early reading and writing skills

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emerges within a broader communicative environment (Clay, 1991; Teale & Sulzby, 1989). For
early communicators, teaching reading and writing becomes essential to supporting their skill
development as full participants in inclusive communities. As such, the purposes for reading should
be driven by the communicative context, and, in turn, students writing (and other expressive
communication) should have an effect on the social world.
Inherent in building literacy within a purposeful context is student motivation. This means
that teachers must first identify why a student might want or need to communicate within a
particular situation. By articulating the purpose of reading or writing from the students perspective,
skills and strategies for instruction can then be developed which facilitate the students achievement
of his or her intent. As a result, the context itself should be affecteda change should occur; a
person should respond; a situation should be altered as an outcome of communication. Teachers,
students, and other members of the school community respond to students as communication
partners, building on their literacy skills within everyday communicative exchanges and recognizing
the students with multiple disabilities as active participants in the school culture. This perspective
on literacy maintains self-determination as a key outcome of instruction, and thereby assumes that
students are valued as agentive individuals, students contributions are respected, and students
actions can positively affect their lives and the lives around them.
To translate this perspective into practice, educational teams should first identify the
contexts that (a) provide multiple opportunities for generalizable literacy skills to be addressed
and (b) provide motivating contexts for authentic communication that will enable students agency.
Within these contexts, teams should analyze activities and articulate the specific reading and
writing skills necessary for full or partial participation (Downing, 2010), keeping in mind that
literacy activities can be developed even if opportunities dont currently exist within a particular
context. Once literacy activities are identified, specific skills that will have the most impact on a
students continued access to inclusive contexts should be prioritized for instruction. Instruction
should occur within the communicative milieu (Sturm & Clendon, 2004), and might be supplemented
with intensive, individual instruction at another time. However, the purpose of reading and writing
should always be clear and should be immediately linked to an authentic purpose.
Duke, Purcell-Gates, Hall, and Tower (2006) define authentic literacy activities as those
that replicate or reflect reading and writing activities that occur in the lives of people outside of a
learning-to-read-and-write context and purpose (p. 346). They contrast these activities with texts
written solely for the purpose of teaching reading and writingfor example, spelling lists, worksheets,
or flashcards. This approach lends itself well to the needs of learners with multiple disabilities,
for whom instruction in applied contexts is more likely to lead to skill generalization. The authentic
literacy perspective reflects the principles of functional skill instruction and can be incorporated
into the general curriculuma common concern among teachers who must ensure their students
have involvement and make progress in the general curriculum (Ruppar, Dymond, & Gaffney, 2011).
In the following sections, strategies for supporting and building the reading and writing competence
of students with multiple disabilities within inclusive high school contexts will be discussed.

Reading
Reading allows us to learn about other people, events, or phenomena and to connect with
people or experiences in another time and place. Reading is one means of gaining information,
helping us connect ourselves with the world around us and ultimately allowing us to make sense
of things. Thus, the ability to read is key to cultivating the self-concept and behaviors necessary
to becoming a self-determined individual (Wehmeyer, 2009).
Gaining control over ones own life is achieved through self-determined behavior; in this
way, the ability to gain information through reading is an essential component of self-determination.
While individuals without disabilities engage in varying levels of self-determined behavior, individuals
with multiple disabilities often have very little control over their lives (Copeland, 2009). This

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results in part from low rates of access to communication and ongoing needs for support in most
life areas (National Dissemination Center for Children with Disabilities, 2013). Therefore, the
ability to understand information, make personal choices, and relate these choices to others is
paramount to independence and self-fulfillment among those with multiple disabilities (Copeland,
2009). One teacher explained this perfectly when she explained that she teaches reading to her
students who use AAC because knowledge is power.
Students with multiple disabilities are a highly diverse group, and often have intensive
support needs. Thus, adaptations to conventional reading formats and teaching strategies are
necessary to ensure a match between environmental demands (i.e., reading demands) and individual
support needs (i.e., person-environment fit; Schalock et al., 2010). Text format and text content are
two dimensions that might require adaptation for learners with multiple disabilities. Texts from
general education contexts as well as environmental print and individually designed teaching
materials might be adapted and designed with these two dimensions in mind. Shared reading is
one strategy with an emerging research base that shows promise for the use of adapted texts to
promote comprehension. Careful planning must ensure that supports are faded or brought under
the control of the student so that independence can be achieved.
Adapting Text Through Shared Reading
Shared reading is an intervention that has been developed and implemented at the
secondary level to address comprehension and encourage engagement (Hudson, Browder, &
Wakeman, 2013; Hudson & Test, 2011). In shared reading, students listen to a summarized version
of a text read aloud. Often, the text is based on grade-appropriate literature (Browder, Trela, &
Jimenez, 2007; Mims, Hudson, & Browder, 2012). Supports such as repeated story lines, picture
symbols placed above words, and a controlled vocabulary, are integrated into the simplified version
of the story to promote access. Students are encouraged to interact with the reader in various
ways, including pointing to words, turning pages, making predictions about the text, answering
literal comprehension questions, and identifying vocabulary words (Browder et al., 2007).
For emergent communicators using AAC, several considerations are necessary. Most
importantly, ensuring that communication access is not a barrier to demonstrating knowledge is
essential. Communication instruction should be embedded throughout the lesson to ensure many
opportunities for students to generate their own communicative messages about the text, not just
selecting from teacher-generated vocabulary words. Hudson et al. (2013) recommended think
aloud strategies to promote active engagement and generative communication during shared story
reading. This modeling strategy should be used as a prompt for student-generated communication
related to the social context of reading a given narrative. For example, the teacher might ask the
student to relate the content of the story to their personal experience. If more help is needed, the
teacher might provide a model such as, I feel _________ when that happens to me (Hudson et al.,
2013, p. 22).
Adapting text format. Adapting text by adding pictures above words, adding removable
picture symbols, or incorporating assistive technology can support students access to content
when reading skills are not sufficient to comprehend material. When adapting text, a few cautions
should be noted. First, it is important to carefully consider and assess, if necessary, each individual
learners need for adaptations. It might seem convenient to make one version of an adapted text
and share it among several learners, or purchase one curriculum that uses a standard set of
adaptations. However, some adaptations might not be necessary for every learner, some might act
as a crutch, and someespecially picture symbolcan actually block a students ability to
comprehend the information (Didden, Prinsen, & Sigafoos, 2000). Visual symbols placed over text
are an example of a commonly used adaptation (e.g., Browder et al., 2007; Hudson et al., 2013).
Picture symbols or other icons might be useful to encourage generalization of vocabulary for
students using some forms of AAC. However, for any given learner it is important to carefully
assess how much visual information is necessary to support comprehension prior to implementation
(Glennen & DeCoste, 1996). Iconicity is an important consideration; assessment of whether or not

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the student can identify the symbol without the word present is necessary to gather information
about the potential for that symbol to assist with comprehension. Consider, also, if the student
uses the same symbol for a different word in a different context. If the same picture of a dog
is used to represent the family pet as White Fang, the implicit assumption is that response
generalization will occur. Any type of generalization is likely to be difficult without specific training,
and response generalization is especially challenging to achieve (Alberto & Troutman, 2012). To
build reading skills within communicative contexts, text format adaptations should be individually
accessible and adhere to the maxim, only as special as necessary. The use of visual information
or other adaptations should support text comprehension and symbol use for communication.
Adapting text content. Similar care should be taken when adapting the text content. To
make age-appropriate text more accessible to learners reading at a lower grade level, simplified
text with repeated story lines are often recommended (Hudson et al., 2013). Two cautions should
be taken when modifying text to maintain a high level of engagement. First, ensure that the
text is still enjoyable to read once modifications are made. Repeated lines can encourage active
engagement and some learners find predictability desirable. When these text features are inserted
into a narrative format, however, the effect might be the oppositeas most readers can attest, a
predictable novel is usually dull. A simplified text can sometimes read as a series of events rather
than a cohesive, engrossing story. The purpose of reading a novel is usually for enjoyment, and to
appreciate rich language, interesting characters, and provocative storylines. Reducing the text to a
series of events shifts the genre from narrative to procedural. The purpose of reading is altered,
and as a result, student motivation could decrease. Therefore, to ensure that the text is motivating
and relevant to the communicative context, careful attention should be paid to the style and tone
of the original text (Hudson et al., 2013).
In sum, when considering adaptations and supports for reading, educational teams should
remain cognizant of the purpose of reading for each particular learner. Any student is more likely
to remain engaged in learning when the purpose of the activity is clear and authentic (Duke et al.,
2006). Authentic purposes for reading give students a reason to gain information from text,
enhancing their sense of order and control and encouraging self-determination. Begin planning
with a purpose in mind, considering opportunities for real engagement with peers in age-appropriate
natural activities. Then, carefully consider the supports needed to ensure they are only as special
as necessary and tailored specifically to individual student needs.

Writing
Writing is an essential skill for students with multiple disabilities who use AAC to
communicate because the use of symbols for expression is essential to communication for
individuals who do not use speech. As students learn to arrange letters and sounds into words,
and as they learn to arrange pictures, icons, or words into novel utterances, they reduce their
reliance on other people to program their communication devices. Thus, they are better able to
independently translate their own thoughts into language. This independence allows them to
become self-determined communicators.
Writing and speaking or AAC use are related skills, but are different in some key ways. For
an AAC user, both speech and writing use similar communicative processes. An AAC user might
select icons or words from an AAC device to speak, as well as to write. In this way, the procedures
AAC users must follow for talk and writing are the same. However, writing and speech are used for
different purposes and consumed in different contexts. Speech is a dynamic process, responding
immediately to the partners verbal and nonverbal language, and occurs in the present (Foley,
Koppenhaver, & Williams, 2009). Similar to speech, writing is the use of language for social purposes.
Meaning in writing is likewise co-constructed, as a writer must consider how different people in
different contexts might interpret a message (Foley et al., 2009; Sperling, 1996). Koppenhaver and
Erickson (2003) noted that the development of writing skills is directly related to the availability
of print, tools, models, and writing opportunities.

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Frequent opportunities to write for a variety of purposes, and using a variety of print forms
and functions, are essential for students who use AAC. Through writing opportunities, AAC users
will begin to understand that writing can be used for communication and to support the use of
AAC for various purposes and in many contexts (Foley et al., 2009; Sperling, 1996). While many
varied opportunities for exploring written communication are available in early childhood settings,
as children age, writing becomes much more complex and the writing process is more extensive.
Teams supporting AAC users can capitalize on writing opportunities that promote authentic uses
of language. Some examples include engaging in writers workshops to share writing and give
feedback to others, writing letters or emails for authentic purposes, or creating campaign materials
for a class election. Importantly, reading and writing skills are related and can augment each other.
As students read, they should be encouraged to talk about what they have read, listen to others
ideas about what they have read, and write about the text. All forms of communication can be used
to serve a purpose, and frequent opportunities to communicate in various ways can reinforce and
build skills. By writing for authentic purposes, students with multiple disabilities can affect their
environments and build self-determination.

Identifying Teaching Contexts and Opportunities for Instruction

Research has consistently demonstrated the positive effects of inclusive education on
learners with and without disabilities (Schoolwide Integrated Framework for Transformation,
2014). Students with disabilities are more likely to have access to general education content
within general education classrooms (Wehmeyer, Lattin, Lapp-Rincker, & Agran, 2003). Downing
(2005) noted that while the fast pace, highly abstract curriculum, and emphasis on complex verbal
skills in high school general education classes presents challenges for access, especially for students
with multiple disabilities, careful attention to lesson plans reveals multiple literacy opportunities
through communication using various AAC modes.
Teaching in the natural context of skill use is widely recommended for students with
multiple disabilities. Natural teaching environments also lend themselves to authentic skill
applications. Several benefits of teaching in natural contexts have been noted for learners with
multiple disabilities. First, students with multiple disabilities often demonstrate difficulty in
transferring skills learned in one set of circumstances to another (Westling & Fox, 2008). For
example, if a student demonstrates the ability to identify pictures or answer questions about a
story in a therapy office, the same student might not be able to use those pictures in communication
with a peer or contribute to a classroom discussion about a book. When selecting skills for
instruction, the ultimate context of use should be considered and used as a teaching environment
whenever possible.
At the high school level, there are a variety of learning environments that can be selected
based on student interests and strengths, as well as opportunities to learn, opportunities to
interact with other students, and family preferences (Downing, 2005). Teams should carefully
select instructional environments to ensure that authentic purposes for literacy use are maximized.
An ecological assessment (Downing, 2010) can help teams identify existing opportunities for literacy
as well as opportunities to build literacy activities into naturally occurring routines. A typical
ecological assessment involves identifying all the activities that take place within an environment
and the skills that are needed to complete those activities. Then, teaching opportunities are
selected based on the students support needs and the priority needs of the student across other
environments. For example, identification and response to common environmental print might be
prioritized when changing clothes in the locker room for physical education, as well as when
navigating community environments such as a health club or trying on clothes in a department
store. Completing an internet search might be necessary during technology or English class, and
also at home or at work. In all situations, students need a reason to read, write, and communicate.
Capitalizing on opportunities to connect and communicate with peers might require flexible
use of instructional time in order to ensure instruction is sufficiently explicit to meet students

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needs. Students with multiple disabilities usually experience communication challenges as a

central support need and require extensive instruction to become effective users of written and
verbal language. Some classroom timeespecially times when students are mostly passively
engagedmight be better spent preparing students for authentic communication at another time.
For example, a student might enroll in a public speaking course, but use the time during the
lecture portion of the course to actively work on writing and editing a speech. When class members
practice their speeches in small and large groups, the student can re-join the large group to share
his or her writing with others, gain feedback from other students, and provide feedback to others.
Likewise, collaborative lab activities during science and communication-rich elective courses
with active learning components such as theater, art, or the school newspaper offer many natural
opportunities throughout the day to practice reading, writing, listening, and speaking.
Once the location for instruction has been identified, teams must strategize about how
instruction will be provided. Identifying specific activities within each environment is a helpful
starting point from which instructional supports and delivery can be identified. In the following
section, examples of ways that teams supporting adolescents with multiple disabilities to engage
in authentic literacy instruction in inclusive settings will be provided. Case examples will highlight
decision-making processes in relationship to reading and writing. In addition, a case example of
a team providing literacy instruction under conditions adverse to inclusion will be described.
Supporting Reading in General Education High School Classes
Gabby is a 10th grader who is highly engaged in social situations, but seems much less
motivated to work when she is alone with a teacher. Her team identified Mr. Natales English
class as an active learning environment with many opportunities for group work. The first book the
class will be reading is Romeo and Juliet. Gabbys special education team and speech-language
pathologist meet with Mr. Natale to learn the scope and sequence for the Romeo and Juliet unit.
They identify the small group collaborative drama project as a rich opportunity for Gabby to access
the literature, interact with peers, and target reading and communication skills. They set to the
task of adapting the text, dividing up chapters between them. They also decide to give Gabby an
audiobook version to take home with her, as well as a DVD to watch. This will ensure she has
exposure to the rich language as well as the storyline of the book. During lecture portions of the
class, they target specific reading skills on her IEP.
General education English/language arts classes are an obvious first stop for identifying
reading opportunities. When high school students read a piece of literature, it is fairly typical that,
in addition to reading the text, they also discuss the literature in small groups, conduct research
outside of class, and perhaps even watch a film version of the book. These activities surrounding a
text offer inroads for participation, including addressing emergent reading skills and communication.
Students might engage in shared story reading with a peer mentor, using an adapted version of
the text. A student might also listen to an audiobook version of the text, demonstrating low-level
comprehension through questioning and higher-level comprehension through discussion.
Additional supportive reading activities, such as vocabulary, fluency, phonics, and phonemic
awareness, can be targeted during large-group lecture portions of the class period.
Not surprisingly, there are many other general education high school classes where
reading is specifically required. Strategically selecting classes with a high number of reading
opportunities maximizes students opportunities to learn and generalize skills. In lab-based
science classes, for example, students might target following directions from photos or pictures,
and locating items in labeled cabinets. In art class, a student might read photo directions on an
iPad and request needed items using AAC. Authentic purposes for reading can also be found
outside of the classroom. For example, a student working at a school store might need to identify
his or her own name on a schedule, or match an item to an inventory list for ordering or re-stocking
shelves.

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Supporting Writing in General Education High School Classes

Albert is an 11th grader who can use a single switch to communicate using partner-assisted
scanning and is learning to use two-step switch scanning to access a voice-output communication
aid. He enjoys interacting with other people and his team recognized the need to integrate more
writing into his curriculum. A few informal conversations with other teachers in the school led the
team to Mrs. Kerry, whose U.S. Government students engaged in a service-learning project on voter
turnout each fall. To increase voter turnout, students research current issues and identify reasons
for poor voter turnout. Alberts small group was responsible for writing issue briefs on education,
health care, and the environment. Albert participated in the project by learning five key vocabulary
words, selecting an issue brief to write, and choosing pre-written sentences to include in the brief.
He engaged in the writing process by giving his completed sentences to his group mates for feedback,
and gave feedback on others writing as well. The students then set up a table outside the public
library to distribute the materials to community members and encourage people to vote. Albert used
a single-message voice output device to greet community members and remind them to vote.
Writing for a variety of purposes and audiences occurs across the general curriculum, and
identifying authentic opportunities for writing in many different contexts is one way to support
skill generalization. One challenge when teaching writing to students with multiple disabilities is
ensuring that writing is student-generated, even if students cannot yet independently spell or
select icons, words, or phrases to use in their writing. For this reason, ensuring that students have
sufficient exposure to the necessary background knowledge to complete a writing assignment is
necessary. Self-selected topics offer opportunities for students to write about events in their own
lives, and participating in general education content-area classes provides one source of context
for extending writing skills. Vocabulary instruction should go hand-in-hand with writing, giving
students opportunities to read and hear the words as well as use them for authentic purposes.
At the same time, access to a range of vocabulary gives students the opportunity to engage with
rich language and extends their options for self-expression.
An important distinction between writing and talking is that writing is usually described
as a process. A purpose for writing is clearly defined, and writing is revised through an iterative
process prior to publication. The process provides opportunities for students to communicate with
each other and practice using appropriate vocabulary. Students using AAC should have access
to the appropriate vocabulary during these discussions, as well as words or phrases germane to
the writing process such as, I like your opening sentence, or I need more information about . . .
The text forms associated with various genres also must be explicitly taught.
Non-academic classes also might provide opportunities for writing. For example, Dymond,
Neeper, and Fones (2010) described an inclusive typing class in which students engaged in a
service-learning project. The project provided opportunities for students to practice writing, along
with enhancing interactions and community engagement among all students. In another example,
a student enrolled in a drama class created a program for the performance, matching photos of
the cast members to their names and roles. Depending on student interests and schedules, these
authentic writing experiences might be more motivating and rich than opportunities available in
academic classes.
Supporting Reading and Writing under Adverse Conditions
Sometimes, opportunities for inclusion might not be obvious or available because the
school culture has not yet accepted the philosophy of inclusion for students with multiple
disabilities. Advocacy on behalf of students can occur across various forums, including through
modeling successful interactions and positive effects of teaching in natural contexts (Ruppar et al.,
2014). In the case of literacy, creativity must be used to ensure activities are authentic and
purposeful, offer opportunities for peer interaction, and offer opportunities for school personnel to
see students as successful, contributing members of the school community.

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General education classes are not the only inclusive settings in which learners can benefit
from literacy instruction. Other school environments, such as the lunchroom and hallways, offer
many authentic opportunities for literacy use. In one example, a high school team was struggling to
identify opportunities for a student with multiple disabilities and serious self-injurious behavior
to practice reading and writing. The student experienced a great deal of isolation in school due
to his highly challenging behavior. Team members were nervous to bring him into general
education classes because the environment was unpredictable, and they were yet unsure what
was triggering his behavior. As part of his behavioral assessment, systematic procedures were
used to identify the students reinforcers. The team identified ice cream as one of the students
favorite foods; indeed, he looked forward to any opportunity to eat ice cream. The team decided to
help the student create a homemade ice cream delivery business for the school. On Mondays, the
student printed an ice cream order form, listing the flavor of the week and distributed them to
a different homeroom teachers mailbox each week. During this activity, he practiced reading and
writing using the computer (including typing the flavor of the week using a visual model) as well as
identifying mailboxes where order forms would be delivered. On Tuesdays, he went to the grocery
store to purchase ice cream ingredients. Literacy skills targeted during this activity included
making a list using pictures, identifying the correct bus, locating items in the store, and paying
using a debit card. He also visited the class to remind them to return their order forms, using
a pre-programmed single-message voice output device. On Wednesdays, he collected the ice
cream orders and entered the information into a spreadsheet. He used 2-switch step scanning to
select cells and paste names in the appropriate location, using reading and writing skills. On
Thursdays, he made the ice cream, using a picture recipe and a switch-operated ice cream maker.
On Fridays, he delivered the ice cream to the homeroom and socialized with the students in the
class. Among other communicative exchanges with peers, he explained how he made the ice cream
using a pre-recorded message in his communication device. Through this program, the student
built a reinforcement history for interacting in inclusive environments, paving the way for learning
in the general education environment. Just as importantly, the teachers and staff at the school
witnessed his success and became more open to including this student, and students like him, in
general education activities.

Conclusion
Reading and writing are essential skills that promote self-determination, independence,
and a high quality of life. As students with multiple disabilities enter adolescence, the importance
of literacy is heightened, especially as it relates to AAC use in natural communicative contexts.
When students exit high school, they must be self-determined, have developed literacy skills, and
utilize their AAC systems effectively. Identifying authentic opportunities for reading and writing
within inclusive contexts during high school can ensure that literacy learning is meaningful and
will continue to support a lifetime of communication and active participation for individuals with
multiple disabilities.

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