Don’t judge a book by its cover! Supporting readers with autism who are minimally verbal

Dr. Sharon Arnold presents a case study which shows how pupils who are minimally verbal can be encouraged to develop skills in reading.

Reading is the gateway to all other learning. If you can read, you can learn anything about anything!

Issues around language, and other core features of autism, means that children with autism can be at high risk of experiencing difficulties with reading. When a child with autism is minimally verbal, the situation is further complicated. As they are unable to demonstrate their skills by reading aloud, discovering the reading abilities of a child who is minimally verbal is a major, but worthwhile, challenge.

Paul’s story
“Paul is our least able pupil in the class. He is very disruptive, he breaks everything, he rips everything up. If you are getting ready for a lesson don’t put anything out beforehand, he’ll just wreck it.”

As the new teacher, this was the first piece of information I learned about Paul during handover from his teacher of the previous year. “What about PECS?” 

I was curious to know about his use of the ‘Picture Exchange Communication System’ because Paul was minimally verbal.  He was six years old, and he didn’t have any words that he could say.

“He used to use it. He could exchange a symbol for some stuff like food and drinks, but he stopped. Now he just chews the symbols in his book.”

I soon discovered that the teacher was right about how much mess Paul liked to make! His favourite pastime was tipping out equipment from any box in which it was stored. To try to distract Paul from tipping everything, while still giving him something he liked to do, I provided a box of old books which he was encouraged to ‘tip and then tidy’ whenever he felt the urge. 

Before long, I noticed that rather than just put the books straight back in the box Paul liked to examine the books. I started to make a point of sitting with Paul during these ‘tip and tidy’ sessions and he would grab my finger and point it to words, his face lighting up with joy every time I read it aloud.  

Other behaviours, such as being able to find the file names of favourite videos and pictures (without visual images displayed) and pointing to words on poster displays around the school, made me suspect that Paul may be able to read.  Asking the literacy coordinator for advice, I pointed out that Paul wouldn’t be able to read the words aloud on the test she was giving out.  The advice was that Paul wouldn’t be able to take the test.

It was my concern about Paul’s exclusion from the kind of literacy provision his verbal peers were able to experience that inspired a range of research studies aimed at measuring the reading abilities of children with autism who are minimally verbal.  The results demonstrated that Paul’s situation was far from unique!

Children with autism who are minimally verbal
Children who are minimally verbal make up around 25 – 35% of the ASD population. The term minimally verbal is often used interchangeably with words such as nonverbal and preverbal, all terms which have no real clear definition. However, in practical terms, children with autism who are likely to be classed as minimally verbal are those children who have a very small (if any) number of words at their disposal, and difficulties with making use of language in any kind of functional way.  This includes children who use echolalia, which means that they repeat sounds, words, or even sentences that they hear.  

Speech and Reading
Speech errors while reading aloud can be disruptive, which means that issues with articulation can be a bit of stumbling block for children with speech disorders.  However, when it comes to the ability to read, there is no direct role for speech.  This means that we can’t assume that just because a child doesn’t speak, they won’t be able to read.

Of course, there can be other barriers to reading for children with autism.  Autism itself can be a barrier due to issues around language and social understanding experienced by children on the autistic spectrum, and autism can be accompanied by a learning disability.  However, this can apply to any child with autism and not just those who are minimally verbal.  There are just less challenges involved in knowing the reading ability of someone who is verbal, as opposed to someone who is unable to say the words they see aloud.

Back to Paul and what we did
As part of our research, we presented children with and without autism (verbal and minimally verbal) with a standardised reading test which had been adjusted to remove the requirement to verbalise answers.  Utilising a multiple-choice method would help us to know if children like Paul were able to identify words and understand their meaning. 

Reading is a complex set of skills, which when they interact, enable us to translate into words from which we get meaning.  Word recognition and listening comprehension are important elements of the reading process.  Paul’s word recognition skills were beyond what we expected, what’s more, he could demonstrate his understanding of those words.

Having a new understanding of Paul’s abilities helped us to better understand his behaviours and improve his provision. Paul had stopped using his symbols because he didn’t want to communicate in pictures when he was able to communicate in words!  We introduced Paul to a device and began supporting him to communicate in words, and later, short phrases.

The changes in Paul were obvious and almost instantaneous! As Paul’s frustrations eased, his behaviour improved, and we were able to put things out before lessons without them being destroyed. The following year, all of Paul’s other assessment scores demonstrated dramatic improvement. Not just in literacy but even in maths and science!

Paul continues to communicate his wants, needs, and thoughts by typing words on to a digital screen which then reads the words aloud for others to hear. He sometimes uses symbols on the screen as ‘shortcuts’ and he doesn’t seem to mind this as long as the device says the whole sentence and not just the word for the symbol. For example, if Paul uses the symbol for ‘toilet’ he likes the device to say, “can I go to the toilet please?” and not just the word ‘toilet’. He’s a teenager now, having a say in how he communicates is more important than ever. He accesses books in a way far beyond tipping them out of a box and putting them back again!

Supporting children who are minimally verbal
Paul’s experience teaches a valuable lesson. We cannot assume that a child has no reading skills just because they can’t talk. The research carried out offered clear evidence that Paul was far from an isolated case. This means that you could have a child in your classroom who is minimally verbal, and who can read. If we are to open up that gateway to learning that we know reading can be, we must take the view that every child in our classroom has the potential to be a reader, regardless of their verbal ability!