A CASE STUDY OF LITERACY
ACQUISITION IN AN ADULT WITH
DEVELOPMENTAL DISABILITIES
American Speech-Language-Hearing Association Annual Conference
Philadelphia, PA
November 2004
Monica Gordon Pershey, Ed.D., CCC-SLP
Associate Professor, Department of Communication Sciences and
Disorders
Montclair State University
Upper Montclair, NJ
mgpershey@att.net
Thomas W. Gilbert, M.A., M.Ed.
Clinician, QMRP, Northeast Care Center
North Royalton, OH
tgilbert@necare.org
Case History – Christine
Born:
Education:
Medical:
Cognitive:
Language:
Speech:
Residence:
Occupation:
1956 to uneducated Greek immigrants
No formal schooling, family teaches self-care
Congenital heart defect, developmentally
disabled, functional good health
IQ is 41 or 43
Preschool range of functioning; communicates
in English, also uses limited American Sign
Language and Greek
Dysarthria, apraxia, moderate intelligibility in
known contexts
Family home
County sheltered workshop – light assembly;
helps in family’s mini-mart
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Baseline Literacy Attributes – Pre-Treatment
Slosson Reading Test: Christine read “is” “up”; Wrote
“Christine” and the letters of the alphabet to dictation
Christine is interested in print – she is aware of print as
communication
Christine is interested in the functions of print in multiple
social environments (family, work, peer groups,
community)
Christine has expectations that literacy will engender social
contact (correspondence, reading about the social world)
Christine prepares correspondence (messages, greeting
cards) by asking family to tell her the letters she needs to
write to spell the words she wants to put on paper
Christine asks a habilitation supervisor if she could be
taught to read and write – Tom is assigned to intervene
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Discovering the Literacy Process: Hypothesizing
How to Intervene with Adults with Mental
Retardation and Developmental Disabilities
Hypothesizing functional capabilities needed for literacy:
Interactions beyond parallel play: Need joint purpose
between learner and clinician, the synergy of a
working relationship
Visual skills to see print: Acuity, tracking, processing and
memory
Language skills: Sentence repetition, engage in
conversation, discourse skills (memory, topicality,
story line); ability to determine parts of wholes (e.g.,
the door of the car, subcategories such as foods that
are eaten for lunch in winter)
Patience and persistence – Plan for years of instruction,
not weeks or months
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Discovering the Literacy Process: Hypothesizing
How to Intervene with Adults with Mental
Retardation and Developmental Disabilities
Similarities with Emergent Literacy:
Moving Whole to Part to Whole:
Whole: Logographic recognition - Highly reliant on
context
Part: Alphabetic recognition - See initial letters in
words
Whole: Orthographic reading – Deliberately or
automatically scan letters, syllables,
word parts, and whole words with flexibility
and code awareness
Reading is always a parallel examination of stimulus and
memory (Smith, 1988)
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Discovering the Literacy Process: Hypothesizing
How to Intervene with Adults with Mental
Retardation and Developmental Disabilities
Relevant Literature:
Erickson, Koppenhaver, & Yoder, 1994; Kliewer & Landis,
1999 – Skills mastery delays access to authentic
literacy materials; Advocate contextually-relevant
instruction
Katims, 2000; van Kraayenoord, 1994 - Access
experiential background and metacognitive skills,
such as ability to predict text events and to selfregulate to choose among learning strategies
Ashby-Davis, 1981; Gillette, 1991- Echo reading; Impress
methods
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How to Intervene: Demonstration, Guided Practice,
Independent Practice
Demonstration:
Models of purposeful reading of extended text to
facilitate four roles (Freebody, 1992)
1 - Text Participant: “This text matters to me!” (Funny,
personal, useful)
2 - Text User: “This text was created so that I can _____.”
3 - Text Analyst: “This text reminds me of something I
already know!”
4 - Code Breaker: “I can find some elements of the
written code.” (Logos, whole words, letters, symbols)
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How to Intervene: Demonstration, Guided Practice,
Independent Practice
Guided Practice:
Auditory Impress Reading:
Tom reads word by word, line by line, Christine echoes
Emphasis on flow, sharing, cooperation
A melody of voices
Procedural Input – “This is what readers do”
Auditory Input - Builds “Big Storage” of lengthier text
Iconic Input – “This is what print does” – Connect visual
wholes to spoken language
Discourse Input – “Talking like a book,” Phrasing of
sentences and passages; Sharing meaning allows for
emphasis on code to be introduced later
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How to Intervene: Demonstration, Guided Practice,
Independent Practice
Guided Practice:
Working with Whole Words
Understanding words as parts of the whole text – read
for flow and also read word by word
Use controlled readers, HIGHLY predictable text
(Laubach), simple story line reinforces making
meaning from text
Visual recognition: Are words seen as logos?
Tom and Christine talk about words in text, locate
individual words
Christine builds a bank of reliable sight words
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How to Intervene: Demonstration, Guided Practice,
Independent Practice
Moving Towards Independence:
Clinician’s voice drops out momentarily: Is Christine
reading any of these words? Christine reads and Tom
echoes
Read in unison, not echoing
Listen for Christine’s vocal inflections as she leads
Christine signs words occasionally as she reads,
reinforcing her comprehension
Christine selects texts she wants to read – e.g.,
newsletters for special populations, trip
announcements, flyers at work, greeting cards
Maintain interdependence – Not pushing towards
independence – Avoid breeding frustration
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How to Intervene: Demonstration, Guided Practice,
Independent Practice
Moving Towards Independence:
Echo reading is supplemented with planned and
incidental instruction:
Build a sight word bank
Word skills worksheets – matching, selecting among
choices to show word recognition
Explore letter-sound correspondences
Analogies for onsets – if “bed” begins with /b/, get ready
to say a /b/ word when you see “b” – think of a /b/
word that would make sense here
Analogies for rimes – what word could this be if we see it
ends in “--oon”
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How to Intervene: Demonstration, Guided Practice,
Independent Practice
Moving Towards Independence:
Christine finds satisfaction in communicating through
written language
Eager to create her own texts – Language Experience
Approach (Stauffer, 1970) – Christine dictates text for
Tom to scribe (“Bessie’s Store”)
Christine writes many notes, letters, and greeting cards Christine asks family members to tell her the letters
so she can spell the words she wants to write
Continual experimentation with writing leads to
independent creation of letters, messages, notes,
and greetings using invented spelling
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Improvements in Christine’s Quality of Life
Increased social participation:
Library usage – borrowing books, story hour
Attends weekend school for adults with developmental
disabilities
Recognizing coins and bills, counting money
Better time telling skills
Motivation to try to speak more clearly – more aware of
target sounds and how they compare to her
productions
Personal reading: Prayers, letters, greeting cards
Self-confidence: Volleyball, soccer, summer camp, group
trips, dinner and movie dates
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Documented Accomplishments
Christine and Tom have partner read several books,
including abridged versions of The Wizard of Oz and
The Secret Garden
Christine demonstrates text comprehension by providing
single-word, sign, and gestural responses to questions
about characters, plot, setting, etc.
Christine routinely writes notes to family, friends, workshop
supervisors, and Tom
Full Scale IQ was tested as 55 after five years of reading and
writing interventions, an increase of 14 points from
pretreatment.
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Conclusions
Christine’s literacy capabilities flourished under socially
stimulating conditions. Non-threatening, socially relevant
interactions with Tom facilitated her development.
Literacy was communicatively relevant to Christine. She
viewed literacy as enhancing her ability to communicate
with others.
Cognitively, Christine exhibited self-direction in her learning
and metacognition as she approached literacy tasks.
Thus, Christine experienced many of the social, intellectual,
and behavioral conditions reported in the literature to be
contributing factors in literacy acquisition in adults with
mental retardation and developmental disabilities
(Barudin & Hourcade, 1990; Katims, 2000; Kliewer &
Landis, 1999 van Kraayenoord, 1994).
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Implications
This case study has generated evidence that literacy
instruction for adults with mental retardation and
developmental disabilities can utilize an eclectic, whole
to part to whole approach.
There is a need for further research into literacy acquisition
in adults with mental retardation and developmental
disabilities to explore how literacy acquisition is both a
linguistically mediated social process and a socially
mediated linguistic process.
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Tom’s Discovery of the Literacy Process
Client’s Interest in Print
Client’s Interest in his/her Multiple Social Environments
Desire to Grow Socially, Behaviorally
Desire for Contact: Literacy Serves a Need for
Communication; Expectation of Subsequent Social
Participation
With Insight Comes Joy: Changes in Their Self-Concept,
Rights, Power
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Functional Prerequisites
Beyond Parallel Play: Need Joint Purpose and Synergy
Between Teacher and Learner
Visual Acuity to See Print
Language Skills:
Repeat Sentences
Engage in Conversation and Discourse
(Memory, Topicality, Story Line)
Parts of Wholes
(The Door of the Car; Foods that are Common at Lunch)
Patience and Persistence on the Part of the Teacher and
Learner: Plan for Years of Instruction, Not Weeks
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The Developmental Reading Process:
What Do Typically Developing Readers Do?
Moving Whole to Part to Whole
Logographic Recognition
(This is Probably Sight Word Reading)
COKE
PEPSI
MASTER CARD
VISA
Highly Reliant on Context
Alphabetic Recognition: See Initial Letters of Words then
Surmise what the Word Might Be
Orthographic Reading: Deliberately or Automatically Scan
the Letters, Syllables, and Word Parts throughout an
Entire Word
(hotel)
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Aoccdrnig to rscheearch at Txes M&A
Uinervtisy, it deosn't mttaer in waht oredr the
ltteers in a wrod are, the olny iprmoetnt tihng
is taht the frist and lsat ltteer be in the rghit
pclae. The rset can be a total mses and you
can sitll raed it wouthit a porbelm. Tihs is
bcuseae the huamn mnid deos not raed ervey
lteter by istlef, but the wrod as a wlohe.
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red
green
tan
purple
pink
brown
yellow
blue
tan
blue
brown
yellow
orange
black
red
purple
green
orange
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The Developmental Reading Process:
What Do Typically Developing Readers Do?
Pattern Detection Prepares the Reader for Rule Application
The Heuristic Precedes the Logorhythm
Experimentation with Writing Occurs Concurrently with
these Phases
A Spelling Conscience Develops in the Orthographic Phase
Reading is Always a Parallel Examination of
Stimulus and Memory
Ideally Occurs with Automaticity
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How to do the Teaching
DEMONSTRATION
GUIDED PRACTICE
INDEPENDENT PRACTICE
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How to do the Teaching
Facilitate Four Roles (Freebody, 1992)
Text Participant
This Text Matters to Me!
(Interesting, Funny, Personal, Useful)
Text User
This Text Was Created So that I Could _____
(Read a Story, Receive an Invitation, Take Medicine)
Text Analyst
This Text Reminds Me of Other Texts (Frequent User)
Code Breaker
I Can Find Certain Aspects of the Written Code
(Punctuation, Letters, Words)
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How to do the Teaching
Step 1: Language Listening and Use
Auditory Input Builds “Big Storage” for Lengthier Text
Iconic Input: This is What Print Does
Procedural Input: This is What Readers Do
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How to do the Teaching
Step 2: Connect Visual Wholes to Spoken Language
Logographic Phase: Seeing Word Wholes
Understanding Word Wholes as Part of the Language
Whole
For Some Clients this Constitutes Whole Word
Recognition
For Other Clients, this is Matching “Some Language”
to “Some Logos”
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How to do the Teaching
Step 3: Talking Like a Book
A Melody of Voices: Repetition, Impress
Predictable Phrasing at the Sentence and Passage Levels
Facility with Meaning Allows for Later Emphasis on the Code
The Teacher is Very Involved: The Process is about
Communication with the Learner, Teacher Models
Patience and Concentration, Sharing the Meaning of Text
The Teacher’s Voice Drops Out:
“Are They Reading Anything Yet?”
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How to do the Teaching
Step 4: Reliable Sight Words: Maintain Focus on Instruction
“Interdependence” - Don’t Push for Independence
Learned by Repetition and Connection to Meaning
Might be Function or Content Words
Laubach or Other Repetitive Texts Featuring Story Lines
A Word Keeps Coming Up in the Story and is Reliably
Recognized
The Learner Still Struggles with the Bulk of Text
Independence May Tax a Learner’s Frustration Tolerance
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How to do the Teaching
Step 5: Pattern Detection -- Begin to Teach Letter Recognition
for Letters that Occur at Beginnings of Words
Pair Letters to Sounds
Analogy: If “Bed” Begins with the /b/ Sound,
When You See a “b” Get Ready to Say a Word that
Begins with /b/ -- Then Think of a /b/ Word that
Would Make Sense Here
Stress How Sounds Recur in Different Words - Start a
Personal Dictionary of Sight Words by First
Letter/Initial Sound
Move to Word Families or Spelling Correspondences
-oon: moon, balloon, noon, soon, afternoon
-ch:
lunch, such, batch, pinch
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How to do the Teaching
Step 6: Finding One’s Own Mistakes
Can the Learner Monitor for Miscues? Self-Correct?
Monitoring What We See, What We Say, What We Hear
Ourselves Say, What the Text Means, How Meaning
Changes as We Go Along
Miscues Reveal Three Types of Errors:
Reading the Wrong Symbol (A Visual Error)
Attaching the Wrong Meaning
(Wrong Guess of What the Word is in Context)
Errors Involving Sentence Structure
(Not Accounted for by Dialect)
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How to do the Teaching
Step 7: Word Awareness and Word Study
Finding Similarities and Differences Among Words:
Rhymes, Singular/Plural, Compound, Different by 1 Letter
Taking Words Apart in Any Way
Sounding Out Words
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FAQ’s
When, and how often, do I correct the learner?
Keep corrections to substantial concerns related to text
meaning
About 80% accuracy is sufficient
Ignore dialect errors
Take the learner’s temperament into account
Does the learner want to be corrected or not?
What will help vs. what will aggravate the learner?
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FAQ’s
Is this Whole Language?
No.
But the “wisdom” of whole language has been taken into
account: Readers crack the code by going from whole to
part to whole. Connected text is more meaningful than
flash cards. Letters are only important to people who
have seen the flow of words on a page and want to
crack that code. Learning to read entails a series of
insights.
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FAQ’s
What about Phonics Instruction?
Phonics teaches the rules of English orthography. Learners
are ready for phonics when they have good pattern
detection skills and can apply consistent rules.
Shouldn’t I teach survival words first?
A learner who is capable of reliable identification of sight
words may benefit from supplemental instruction in
survival words presented in isolation. Survival words
might also be detected in text passages. Logographic
readers may recognize some survival words that have
strong visual associations, such as a stop sign.
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FAQ’s
What can I do about learners with autism?
A literacy learner needs to have some interest in his/her
social environments and a desire to grow socially. This
teaching approach requires a high degree of
interpersonal contact, in part provided to nurture the
learner’s desire for contact. Learners with autism who
see literacy as an avenue to communication may engage
in this approach. Literacy is important to clients who
have the expectation of subsequent increased social
participation when they become readers.
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FAQ’s
What can I do with my lowest functioning clients?
Begin by reading aloud to them, directing visual attention to
the print as you read.
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