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21 Solving the Reading and Writing Problems caused by Dyslexia By Mike Matvy

Activities for Reading Comprehension (ARC): An early Reading Comprehension Intervention for Preschool Children on the autism spectrum with Hyperlexia By Dr. Dianne Macdonald

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autism spectrum disorder

Activities for Reading Comprehension (ARC): An early Reading Comprehension Intervention for Preschool Children on the autism spectrum with Hyperlexia Summary: This article will focus on children on the autism spectrum who present with a strength in early word reading known as hy- perlexia. The definition of hyperlexia as a reading comprehension disorder will be discussed. Two theories underlying reading comprehension intervention for this young population will be addressed. The article will then outline a parent-supported, strength-based intervention that targets early reading comprehension skills for these children. Instructions on accessing this free, web-based application will be provided.

STRENGTHS OF CHILDREN ON THE AUTISM SPECTRUM For preschool children on the autism spectrum, early word reading can be both a special interest and a strength. Preschoolers on the autism spectrum can be passionate about reading and some children on the autism spectrum can accu- rately read words as early as 2 or 3 years of age (Grigorenko et al., 2002; Needleman, 1982; Newman et al., 2007; O’Connor & Hermelin, 1994). Despite this strength in early word reading, there is a lack of associated reading comprehension that would typically accompany such a strong level of reading. That is, although some children on the autism spectrum can read words accurately at a very young age, they don’t understand what they are reading. This ability to read words before the age of 5 years in the presence of poor reading comprehension and poor language comprehension is referred to as hyperlexia (Needleman, 1982). Hyperlexia is commonly associated with autism spectrum disorder with a prevalence of 6-20% in chil- dren on the autism spectrum (Ostrolenk et al., 2017).

Hyperlexia is a definite asset and it’s encouraging and impressive to see that a child on the autism spectrum with hyperlexia has such early and strong word reading skills. It’s a sign that they have developed early academic proficiencies that many other children have yet to acquire. It also means that they have learned one of the most important skills taught in school – word decoding. These observations of hyperlexia are worth celebrating. However, it is essential that we remember that the goal of reading is reading comprehension. Without reading comprehension, a child is missing one of the key elements that will expand and enrich all areas of their learning, especially at school. As such, it is critical that children on the autism spec- trum with hyperlexia move beyond word decoding to develop reading comprehension skills as early as possible. THE GAP: READING COMPREHENSION Although reading comprehension is included in early reading instruction, reading comprehension impairments are not fully addressed usually until grade 3 or beyond. This is likely because the standard pattern is children learn to read during

DR. DIANNE MACDONALD is a PhD graduate of the Human Development program in the Department of Educational and Counselling Psychology at McGill University. Her research focuses on strength-based interventions that target a child’s strength to support areas that are challenging. Currently, Dianne is a Postdoctoral Fellow at the University of Toronto’s Ontario Institute for Studies in Education (OISE). Her intervention research on bilingual children with reading impairment is funded by the Social Sciences and Humanities Research Council (SSHRC) and the Fonds de recherche du Québec – Société et Culture (FRQSC). Dianne is also a practicing Speech-Language Pathologist. Her private practice, Communication Works, focuses on children, adolescents and adults with reading impairment.

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THEORETICAL BASIS FOR READING COMPREHENSION INTERVENTION This strength-based, language comprehension and reading comprehension program I created, in collaboration with Brand- Jaws Web Application Development (www.brandjaws.com), is a web-supported application built upon two separate theories: The Simple View of Reading (Hoover & Gough, 1990) and the Dual Coding Theory (Sadoski, 2005). THE SIMPLE VIEW OF READING The Simple View of Reading explains reading compre- hension as an equation. The product of word decoding and language comprehension equals reading comprehension. That is, word decoding X (times) language comprehension = reading comprehension (see Fig.1). Word decoding is defined as the ability to read words by either sounding out and blending the sounds together (phonics-based approach to reading) or reading the word as a whole chunk (sight word approach to reading). Language comprehension or listening comprehen- sion is the ability to understand spoken language. If we apply this equation to the profile of a child on the autism spectrum with hyperlexia we can see that their word decoding is a strength (we can give this a 1). However, their language comprehension is a challenge (we can give this a 0). This leads to the product of 0 or poor reading comprehension (e.g., 1 x 0 = 0, see Fig. 1)

grades 1 and 2 and reading comprehension deficits might only become apparent when children begin reading to learn by grade 3. It also makes sense that reading comprehension challenges aren’t addressed with 2- to 5-year-olds as this is also not a typical profile. However, it’s critical that we begin to understand how to focus on reading comprehension for these young children, not only to support reading comprehension, but to develop their language comprehension, vocabulary development and academic skills in parallel with word reading. It is equally important to leverage these formative preschool years by targeting skills that the child with autism and hyper- lexia requires (reading comprehension and language compre- hension) not that they have already acquired (word reading). Studies have found that the word reading advantage of chil- dren on the autism spectrum with hyperlexia declines with age and is on par with their peers by age 10 (Grigorenko et al., 2002; Newman, et al., 2007). It has been proposed that the reason for this decline in word reading may be the result of a lack of appropriate support. That is, without appropriate support for reading comprehension, the child may lose interest in simply reading words. From this perspective, it is essential to practice reading comprehension skills early and often to sustain their love of reading and to promote the richness of understanding written text. SUPPORTING READING COMPREHENSION The question is, how can we support a child’s reading comprehension at the first signs of early word reading, maybe even as young as 2 or 3 years of age? As a Speech-Language Pathologist, I saw older children (ages 7 years and beyond) on the autism spectrum with hyperlexia. These children had already been reading for some time, often as long as 5 years or more. Yet their reading comprehension and their language skills remained a weakness, despite their strength in early word reading. Clearly, for children on the autism spectrum with hyperlexia, reading comprehension and language skills don’t just develop on their own from reading lots of words. As such, children on the autism spectrum with hyperlexia need support to develop their reading comprehension and their associated language skills. Strength-based approaches to intervention focus on a child’s strength to improve their areas of challenge. Using this type of approach, we can use their strength in word reading to support their reading comprehension and language comprehension. In addition, by targeting the child’s strength in word reading, we make their special interest the focus of intervention. The child is then more engaged, making it easier to work on their chal- lenges, like reading comprehension and language skills.

Simple View of Reading as applied to Hyperlexia

Word Reading

Reading Comprehension

Language Comprehension

Figure 1:The Simple View of Reading applied to Hyperlexia.

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The Simple View of Reading has also been used to explain reading comprehension in those with dyslexia. That is, the profile of a reader with dyslexia is typically weak word decoding (we can give this a 0) in the presence of strong language comprehension (we can give this a 1) which leads to the same outcome of poor reading comprehension, or 0 for reading comprehension (e.g., 0 x 1 = 0; see Fig. 2).

Figure 3: Pairing an Image Plus the Written Word Increases Receptive Vocabulary Learning

Simple View of Reading as applied to Dyslexia

PUTTING THE TWO THEORIES TOGETHER: ACTIVITIES FOR READING COMPREHENSION (ARC) To review, this reading comprehension intervention program, ARC, is grounded in both the Simple View of Reading and the Dual Coding theories. The program was designed to target language comprehension (starting with receptive vocabulary) and reading comprehension at the most basic level, single word-to-picture matching. To illustrate, if you saw the following three words, would you know what they meant (see Fig. 4)?

Word Reading

Reading Comprehension

Language Comprehension

Figure 2:The Simple View of Reading applied to Dyslexia

Taken together, the Simple View of Reading theory suggests that to improve reading comprehension for children on the autism spectrum with hyperlexia, we must improve their language comprehension (change the 0 to a 1). How can we do this for very young children and use their love of reading at the same time? DUAL CODING THEORY We can start by targeting reading comprehension and language comprehension at the single word/vocabulary level. To do so, we refer to the Dual Coding Theory (Sadoski, 2005). The Dual Coding Theory provides a framework for improving receptive vocabulary (listening vocabulary) while incorporating written language (orthography). In brief, the Dual Coding Theory states that concrete words like “rock” or “cat”, that can be associated with an image, are learned more easily in the pres- ence of a dual code – an image + the written word (see Fig. 3). We know that using images with children on the autism spectrum has been successful in teaching various language skills via programs like the Picture Exchange Communication System (PECS; Bondy & Frost, 1995) and the Visualizing and Verbalizing program (Bell, 1991). Additionally, studies have shown that matching a picture to a written word was effective in teaching early vocabulary to 3- to 8-year-olds on the autism spectrum (Bejnö et al., 2018). See Figure 3.

brabeum umbel

snood

Figure 4: Understanding Words without Associated Images

Now if you saw these same three words paired with their corresponding image, is it easier to understand what they mean? Does it help you to understand that brabeum is a prize, umbel is a type of plant and snood is a hairnet? Do you think you might remember if you ever heard these words again. If you practiced matching the word to the picture would this help you remember? (see Fig. 5)?

brabeum umbel

snood

Figure 5: Support for Learning Vocabulary by Adding Images and Words

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WORD-TO-PICTURE MATCHING The ARC web-based app program incorporates a forced- choice, two option, text-to-picture matching activity to facilitate the process for parents, educators, and clinicians. However, this is not the only way to practice word-to-picture matching. Actual picture cards and written words (spoken and read) can also be used in place of this web-based, tablet program. The advan- tage of the web-based program is that it facilitates selecting and modifying words and images to use for a specific child. For example, you can tailor words and images for the child by using pictures of their dog or cat, or their favourite toys taken with your ipad or phone. The vocabulary is based on the MacArthur-Bates Communica- tive Development Inventories Wordbank (Frank et al., 2017) and follows an early developmental sequence. That is, the words chosen are those that a child would first use when they are beginning to use spoken language. Children begin by matching early concrete nouns and progress to verbs then adjectives. Similarly, children progress from single words to 2-word phrases and on to short sentences. This sequence mimics the same way children develop oral language skills and facilitates language comprehension. There are two phases to the app: the Assess- ment phase and the Intervention phase. THE ASSESSMENT PHASE The program begins with the Assessment phase to deter- mine the correct starting point for the child. This also sets a baseline for clinicians or teachers who may be interested in charting progress. The assessment can always be repeated at another time to assess progress. The Assessment phase displays four pictures for a single target word and the child is first asked to choose the correct picture that corresponds to the oral/ spoken word in the initial Listening Comprehension Assess- ment and then the written word in the subsequent Reading Comprehension Assessment. THE INTERVENTION PHASE After the child completes the initial Assessments of Listening and Reading Comprehension, the program proceeds to the Intervention phase. Like the Assessment, ARC first targets Listening Comprehension. That is, the child matches the spoken word (that is supported by the written word) to the image (see Fig. 6). A small “ear” icon shows that the child is practicing Listening Comprehension. Once the child has acquired the word at the Listening Comprehension level, they proceed to match the written word (no spoken word) to the image to prac- tice Reading Comprehension (see Fig. 7). A small “book” icon shows that the child is practicing Reading Comprehension. For both Listening and Reading Comprehension the child must first touch the written word before touching the correct image to draw their attention to the orthography.

Figure 6:The Image Paired with the Written Word and the Spoken Word to Practice Listening Comprehension

Figure 7:The Image Paired with the Written Word (No Spoken Word) to Practice Reading Comprehension

It is important to note that only two images (the correct image and the incorrect or distractor image) are used during the intervention phase (as opposed to four images during the assessment phase). Using fewer images during intervention reduces distractions and facilitates choosing the correct option, as the intervention phase is meant to teach not test. Additional images can be added for the same word, for both target words and incorrect words. For example, different images of a cat can be included to support generalization and the program will randomly cycle through them.

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Here’s a brief demonstration of the Listening Comprehen- sion and Reading Comprehension levels of ARC Intervention:

TABLET OR PHONE USE The program is accessed from a web browser (like Chrome or Safari) and is intended to be used with a touch-screen device, such as a tablet (iPad or Android) or a phone. The program is not meant to be accessed via a laptop and a mouse (although a laptop with a touch screen would work). The reason for using a touch-screen device, like tablets and phones, is that the action of touching an image on a screen is meant to replicate the real- life gesture of touching pictures when reading a book. There is research to suggest that when the real-world response is used, (e.g., a natural response of finger pointing) greater generaliza- tion can occur (McEwan & Dubé, 2017). Using a mouse does not imitate a real-life pointing response. Along similar lines, the program is also meant to be used like a book, with parents commenting on the pictures, providing feedback and positive reinforcement. FULLY CUSTOMIZABLE The app is fully customizable. Although the existing images are in English, you can privately upload your own images and label them with words in any language. While you cannot delete existing images, as these are shared with everyone using the web-based app, you can customize images for a participant by blocking any existing images you don’t want and selecting only those you choose/upload for a participant. Though the images you upload are private, you can decide to share them with other participants that you’ve created. Finally, the program also accepts short and long paragraphs that can be uploaded with specific images. CARRYOVER/GENERALIZATION After each session, a list of the words the child learned in that session will be displayed. You can take a screen shot of these words so that they can be practiced during other activities with the child/student/client. HOW TO ACCESS THE FREE APP The links and instructions for the free app are available online at www.readingcomprehension.ca. Select the tab “ARC APP ACCESS” to see setup instructions. The first step is for a parent, educator, or clinician to create an account. Once your account has been set up, you can begin adding participants (e.g., your child, student, or client).

YouTube Video: Activities for Reading Comprehension (ARC) Short demo https://youtu.be/1HLFD1waPAs

As a reminder, this sequence of first practicing Listening Comprehension then Reading Comprehension is in keeping with the Simple View of Reading which states that acquiring listening comprehension is the key to acquiring reading comprehension (for children on the autism spectrum with hyperlexia who are already strong decoders). Pairing the written word to the image to facilitate vocabulary comprehen- sion agrees with the Dual Coding Theory.

POSITIVE REINFORCEMENT, PRACTICE, AND DATA COLLECTION

The ARC program always ends each turn by providing posi- tive reinforcement for selecting the correct word. That is, if the child selects the incorrect word twice, the incorrect word is greyed out and only the correct word is available for selection. As such, the child always ends each turn with positive reinforce- ment. The app is meant to be used for 15 minutes per day. This is in keeping with a distributed model of learning schedule (i.e., practicing small amounts over consecutive days) that has been shown to be a superior model of learning to mass practice, (i.e., practicing all in one day; Haq et al., 2015). The program privately collects data on how the child has done in each session and displays the words they have learned for more specific tracking of progress and to support general- ization, (i.e., parents/educators and clinicians can practice these same words outside the session).

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First: Set up an Account for Yourself as a Parent, Educator, or Clinician. To set up your account, click on ARC Instructions (Parents, Educators or Clinicians) https://www.readingcompre- hension.ca/arc-instructions-parents-educators-or-clinicians. html This section outlines how to use the Administrative portion of the app. It also explains the various sections of the adminis- trative portion of the app including the Dashboard; how to set up Groups (for parents with more than one child, or teachers and clinicians; how to add multiple students/clients); how to add different children/students or Participant, and finally, how to add or change the Content, e.g., words, phrases, sentences, paragraphs and their corresponding images. The app can also support short and long paragraphs that can be uploaded by the user. Next: Log on for the Child/Student/Client. Once the app has been set up for a Participant (your child/student/client), you or your child/student/client can log into the app on your web browser (on your tablet) using https://arc.readingcompre- hension.ca/. This address is where you will always access the app going forward. You or your child will click on “Welcome! Please log in” and enter the User Number and password that you created for the child/student/client in the Administrative section when you set the child up as a participant. Click on the ARC Instructions (child user) https://www.readingcomprehen- sion.ca/arc-instructions-child-user.html for more information. SETTINGS There are some settings worth mentioning. The default setting for audio instructions is set to OFF. Instructions are auto- matically spoken once at the beginning to teach the child, but most children quickly understand what they must do. There- fore, it is recommended to keep audio instructions set to OFF to discourage echolalia by listening to the instructions repeated constantly. Adults can easily re-instruct the child to touch the word first to avoid the repetitive instructions, if necessary. As mentioned, the app always begins with an assessment to set the level which is appropriate for your child to begin. The Intervention cannot be accessed until the Assessment has been completed. Re-assessment can be controlled by the parent/ educator/clinician to measure progress. To do so, select Partici- pants and then the Edit button beside the child’s name. Scroll down to change Assessment from “Disable” to “Enable”. BENEFITS OF EARLY INTERVENTION FOR HYPERLEXIA We are all aware of the benefits of early intervention for chil- dren on the autism spectrum (see Landa, 2018 for a summary). However, the benefits of early reading comprehension for chil- dren on the autism spectrum with hyperlexia is still in its infancy. The results of our study (Macdonald et al., 2022) suggests that reading comprehension and listening comprehension can be increased by using the strengths in, and the passion for, early

word reading of preschoolers as young as 3 years old on the autism spectrum with hyperlexia. Our study proposes that there is no reason to wait until the later grades to work on reading comprehension. Although reading comprehension is typically not targeted until the later primary grades, the results from our study imply that reading comprehension, beginning at the single word level, can be practiced by very young children on the autism spectrum with hyperlexia. THE LINK BETWEEN READING, VOCABULARY, LANGUAGE, AND SOCIAL LANGUAGE DEVELOPMENT We also know that there is a strong link between vocabu- lary development and reading success (Perfetti et al., 2008; Stanovich, 1986), and between vocabulary development and linguistic ability (Sparks,et al., 2014). In addition, receptive language and social development are linked to social language skills like joint attention (both initiating and following a point; Delinicolas & Young, 2007) Therefore, using the strength in early word decoding to facilitate early vocabulary acquisition may also simultaneously support oral, written, and social language skill development for young children on the autism spectrum. EFFICACY OF AN APP FORMAT The app format of ARC makes it easy for parents, educators, and clinicians to implement the program in their own homes, classrooms, or clinics. This means that treatment can begin while awaiting services or in between sessions (for parents) or used during classroom (for teachers) or language-based lessons (for clinicians). Clinicians can use the app both in and between sessions (i.e., parents can use the app as carryover). For parents, there can be long wait times for early intervention services, therefore, this app provides an interim, cost-effective option for early service provision. In addition, it provides teachers an alternative to phonological awareness instruction for children on the autism spectrum with hyperlexia. FOCUS ON THE READING COMPREHENSION LEVEL, NOT THE WORD DECODING LEVEL While many parents and educators encourage the child on the autism spectrum to read, and support their reading skills, reading more simply isn’t enough. The ARC app allows parents, educators, and clinicians to target the specific underlying chal- lenges these children are experiencing, while encouraging their special interest. So, while a preschooler on the autism spec- trum with hyperlexia may be able to read books at a 3rd grade level, their reading comprehension is likely well below that of a kindergarten child. Therefore, the key is really targeting their reading comprehension level, not their word decoding level. The Oral and Written Language Scales (OWLS-II; Carrow-Wool- folk, 2011) Reading Comprehension (a word-picture matching test) is a good test for clinicians to use to determine where the

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child’s reading comprehension skills lie, as compared to their word decoding skills.

While the studies, upon which these results are based, are the largest sample size of a group of preschoolers on the autism spectrum with hyperlexia to date, it is still a relatively small sample statistically. As such, more studies are needed on this wonderful group of children on the autism spectrum with hyperlexia to better understand their learning needs. Further- more, based on these limited studies, Dianne Macdonald and co-authors, Communication Works, and McGill University cannot guarantee the efficacy or success of this intervention for your child/student/client. REFERENCES Bejnö, H., Johansson, S., Ramnerö, J., & Cepeda, R. (2018). Emergent language responses following match-to-sample training among children with autism spectrum disorder. Inter- national Journal of Psychology and Psychological Therapy.18 (1)1– 14. Bell, N. (1991). Visualizing and verbalizing: For language comprehension and thinking. Academy of Reading Publications. Bondy, A., & Frost, L. (1985). Picture Exchange Communication System (2nd ed.). Pyramid Educational Consultants. Carrow-Woolfolk, E. (2011). OWLS-II Oral and Written Language Scales – Second Edition: Foundations of Language Assessment. Western Psychological Services. Delinicolas, E. K., & Young, R. L. (2007). Joint attention, language, social relating, and stereotypical behaviours in chil- dren with autistic disorder. Autism, 11 (5), 425–436. https://doi. org/10.1177/1362361307079595 Frank, M. C., Braginsky, M., Yurovsky, D., & Marchman, V. A. (2017). Wordbank: An open repository for developmental vocabulary data. Journal of Child Language, 44 (3), 677–694. https://doi.org/10.1017/S0305000916000209 Grigorenko, E. L., Klin, A., Pauls, D. L., Senft, R., Hooper, C., & Volkmar, F. (2002). A descriptive study of hyperlexia in a clini- cally referred sample of children with developmental delays. Journal of Autism and Developmental Disorders, 32 (1), 3–12. https://doi.org/10.1023/A:1017995805511 Haq, S. S., Kodak, T., Kurtz-Nelson, E., Porritt, M., Rush, K., & Cariveau, T. (2015). Comparing the effects of massed and distributed practice on skill acquisition for children with autism. Journal of Applied Behavior Analysis, 48 (2), 454–459. https://doi. org/10.1002/jaba.213 Hoover, W. A., & Gough, P. B. (1990). The simple view of reading. Reading and Writing: An Interdisciplinary Journal, 2 , 127–160. Macdonald, D., Luk, G., & Quintin, E.M. (2021). Early word reading and preschoolers with ASD, both with and without hyperlexia, compared to typically developing preschoolers. Journal of Autism and Developmental Disorders, 51 (5), 1598- 1612. https://doi.org/10.1007/s10803-020-04628-8

THE LITERACY NEEDS OF CHILDREN ON THE AUTISM SPECTRUM WITH HYPERLEXIA IN THE EARLY GRADES It is important to keep in mind that children on the autism spectrum with hyperlexia may not need the same early reading intervention as their peers. Findings from our earlier study (Macdonald, 2021) suggest that preschoolers on the autism spectrum do not learn to read like their peers by using phono- logical awareness strategies. As such, this type of instruction in the early years, when their peers are learning to decode words, may not serve the needs of children on the autism spectrum with hyperlexia. Children on the autism spectrum with hyperlexia already know how to decode words. Children on the autism spec- trum with hyperlexia may benefit more from targeted reading comprehension intervention rather than phonological aware- ness support like their typically developing peers. Therefore, focusing on language and reading comprehension should be prioritized. Our recent study (Macdonald, 2022) suggests that developing vocabulary, using the written word as support, and targeting reading comprehension at a basic vocabulary level, is an effective model to use to develop oral and written language comprehension. Beginning at the word level is the most basic level to start for reading comprehension intervention, just like learning single words is the most basic level to start for oral language development. LONG-TERM GOALS AND TAKE-HOME MESSAGE Reading comprehension is the ultimate goal of learning to read. While word decoding is a critical skill in the reading process, gaining meaning from the written word is the real purpose of reading. To this end, whether you use this app, or physical picture cards and words, the take-home message is that we don’t have to wait until the later primary grades to work on reading comprehension for preschoolers on the autism spec- trum with hyperlexia. These young children have an incredible strength in word reading that can be leveraged to assist with both language comprehension and reading comprehension. By practicing reading comprehension early, using their strength in word decoding, we hope to encourage a life-long love of reading, and support their special interest, while enriching their oral and written language and academic skills simultaneously. DISCLOSURE, LIMITATIONS AND DISCLAIMER ARC app was supported by grants from the Organization for Autism Research (OAR) and the Fonds de recherche du Québec – Société et Culture (FRQSC). Intellectual property for the ARC app is shared by McGill University and Dr. Dianne Macdonald.

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Macdonald, D., Luk, G., & Quintin, E.M. (2022). Early reading comprehension intervention for preschoolers with autism spectrum disorder and hyperlexia. Journal of Autism and Devel- opmental Disorders, 52 (4), 1652-1672. https://doi.org/10.1007/ s10803-021-05057-x McEwen, R., & Dubé, A. (2017). Understanding tablets from early chilhood to adulthood . Routledge. Needleman, R. (1982). A linguistic analysis of hyperlexia. In C. Johnson & C. Thew (Eds.), Proceedings of the Second Interna- tional Congress for the Study of Child Language – Volume I (pp. 473–481). University Press of America Inc. Newman, T. M., Macomber, D., Naples, A. J., Babitz, T., Volkmar, F., & Grigorenko, E. L. (2007). Hyperlexia in children with autism spectrum disorders. Journal of Autism and Developmental Disor- ders, 37 (4), 760–774. https://doi.org/http://dx.doi.org/10.1007/ s10803-006-0206-y O’Connor, N. O., & Hermelin, B. (1994). Two Autistic Savant Readers. Journal of Autism & Developmental Disorders, 24 (4). Ostrolenk, A., Forgeot d’Arc, B., Jelenic, P., Samson, F., & Mottron, L. (2017). Hyperlexia: Systematic review, neuro- cognitive modelling, and outcome. Neuroscience and Biobe- havioral Reviews, 79 , 134–149. https://doi.org/10.1016/j. neubiorev.2017.04.029 Perfetti, C., Yang, C. & Schmalhofer, F. (2008). Comprehension skill and word-to-text integration. Applied Cognitive Psychology, 22, 303–318. Sadoski, M. (2005). A dual coding view of vocabulary learning. Reading & Writing Quarterly, 21 (3), 221–238. https:// doi.org/10.1080/10573560590949359 Sparks, R. L., Patton, J., & Murdoch, A. (2014). Early reading success and its relationship to reading achievement and reading volume: Replication of “10 years later.” Reading and Writing, 27 (1), 189–211. https://doi.org/10.1007/s11145-013- 9439-2 Stanovich, K. E. (1986). Matthew effects in reading : Some consequences of individual differences in the acquisition of literacy. Reading Research Quarterly, 21 (4), 360–407.

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Accessible Educational Math Games for Students with Physical and Cognitive Disabilities

Millions of students in the United States struggle to learn mathematics. Foundations such as the Gates Foundation, Na- tional Science Foundation, and Institute of Educational Science are spending billions of dollars funding researchers to explore methods of improving student learning. Many educational companies have also been created to help students improve their math skills. Applying recent advancements in technology and artificial intelligence, researchers and developers dem- onstrate the high potential of new educational technology (EdTech). Artificial intelligence helps us personalize learning to each individual student by providing students with optimal

math levels, question designs, and feedback. However, few EdTech companies develop platforms suitable for children with disabilities and limited research focuses on special needs students. Thus, students with disabilities are left behind as the EdTech industry and research field advance to support the gen- eral student population. Inspired by her younger sister Lara who has a severe neuro- logical disorder, Adele Smolansky founded AI-Learners in June 2020. AI-Learners (www.ai-learners.com) is the first educational technology company with digital math games for children with physical, cognitive, and behavioral disabilities. AI-Learners has

ADELE SMOLANSKY is the founder and CEO of AI-Learners. She is an undergraduate senior studying Computer Science at Cornell University. Adele has also worked at Google as a Software Engineering Intern for two summers. She worked on the Google Drive team during the summer of 2021 and on the Android Acces- sibility team during the summer of 2022. At Cornell, Adele is conducting research at the Enhancing Ability Lab and the Future of Learning Lab to investigate how AI-driven educational technology can help elementary school students learn math and how to design and evaluate games for people with physical disabilities. Upon Adele’s graduation in May 2023, she will pursue a PhD in accessible Educational Technology. Ultimately, her

goal is to help all students have equal access to educational resources and maximize learning for each student with technology. Adele was inspired to create AI-Learners by her younger sister Lara who has a severe neurological disorder called Rett Syndrome. Lara

cannot talk or walk and uses an Eye Gaze assistive device to commu- nicate. During the COVID pandemic, Adele saw a clear need to improve educational technology for her sister and many other children with disabili- ties. In June 2020, Adele founded AI-Learners, an educational technology company, to help children with disabilities learn math. Since then, Adele has worked with over 50 Cornell students and faculty, assistive technology specialists, special needs educators, and business advisors to develop AI-Learners. She is proud that her sister Lara and hundreds of other students are learning math on the AI-Learners platform. You can reach Adele at adele@ai-learners.com or 917-744-2164. She is happy to answer questions and discuss more ways to support learners.

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Example of an AI-Learners Addition Game: Add Fruit

over seventy math games across six core math areas for stu- dents learning math at the PreK-2nd grade level. All games meet the highest level of accessibility standards and are com- patible with assistive technology such as screen readers, mag- nifiers, switch devices, eye gaze, and more. The games are en- gaging and personalized to meet students’ complex needs, and AI-Learners provides comprehensive analytics to help parents and teachers support their students. AI-Learners is free for all students, and parents and educa- tors can create individual accounts for their students. Hundreds of parents have already created accounts for their children, and schools will begin free trials during the 2023-2024 school year. You can check out the website at www.ai-learners.com and create a free account for your children to practice their math skills now! Please reach out to Adele with questions or feed- back. You can reach her at adele@ai-learners.com PROBLEM WITH EXISTING EDTECH WEBSITES After speaking with hundreds of parents and educators, Adele learned that Lara is just one of many students with dis- abilities who cannot effectively learn from current Educational Technology (EdTech) websites. These websites are designed for the general student population and thus do not meet the com- plex needs of students with cognitive, behavioral, and physical disabilities. Existing EdTech games are inaccessible due to poor color contrast, small buttons, stressful features, or incompat- ibility with assistive technology. Games are not personalized to a student’s abilities and thus give students math questions that are too easy or too hard. Moreover, engagement features are overwhelming for students with cognitive disabilities like dys- lexia or ADHD who struggle to concentrate. Parents and edu- cators also voiced that they want to see more analytics about how their students learn to understand their student’s abilities

Adele’s younger sister Lara

better. Overall, EdTech companies are not effectively support- ing the learning of students with disabilities, and parents and educators are seeking a new tool that helps their students learn math. EQUITY IN EDTECH DEVELOPMENT EdTech is becoming an increasingly popular method of sup- porting students’ learning. Recent advances in artificial intelli- gence and machine learning help us apply data analysis and scientific methods to optimize game designs, integrate adap- tive algorithms, and create comprehensive analytics. Students with disabilities can greatly benefit from this style of learning as individualized instruction is necessary to meet students’ com- plex needs. However, academic research and commercial prod- ucts focus on helping the general student population, leaving out students with disabilities. Little scientific evidence is avail- able to demonstrate how students with disabilities learn, and few companies and researchers are collecting and analyzing data on the learning patterns of students with disabilities. In the 2020–2021 school year, the number of students ages 3–21 who received special education services under the Indi- viduals with Disabilities Education Act (IDEA) was 7.2 million, or

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15 percent of all public school students. According to the IDEA, all of these students are legally entitled to equal education and access to resources. So if a school activity involves playing edu- cational math games and students cannot play them because they are incompatible with assistive technology, then students are not receiving fair education. Thus, we must ensure that stu- dents with disabilities are included within the EdTech industry and research field. AI-LEARNERS HELPS STUDENTS WITH DISABILITIES AI-Learners is designed to meet every child’s complex needs by adapting to a student’s physical, cognitive, and behavioral abilities. As more students play math games, AI-Learners will gain novel insights into how special needs students learn and share findings with other researchers and developers to help improve education for more students. Adele is confident that AI-Learners can help a wide range of students, and she is deter- mined to develop technology for students with disabilities, so no one is left behind. AI-LEARNERS PRODUCT OFFERING AI-Learners (www.ai-learners.com) is an educational tech- nology website for students learning math at the PreK-2nd grade level. The platform features 70+ math games across six core foundational math areas. The games are accessible and engaging for students with physical, cognitive, and behavioral disabilities. Students receive a personalized learning experi- ence based on their disability, math level, and progress. On a student’s individual account, all games are set to a student’s math level, and the games feature dynamic difficulty levels and instructional support. Students can also create their own ava- tar, which they see throughout the games. Lastly, AI-Learners provides comprehensive analytics to help parents and teachers better understand their student’s mathematical abilities.

AI-Learners is free for all parents to create individual ac- counts for their children to practice math at their own pace. School accounts will be available for the 2023-2024 school year. Once a student has an account, they can practice counting, ad- dition, subtraction, comparison, shapes, and logic. Students can play games at home with parents or therapists, at school with teachers, or independently from anywhere. Additionally, the website works on any computer, tablet, or mobile device. To ensure AI-Learners meets the complex needs of all learn- ers, AI-Learners provides value in four areas: (1) AI-Learners is accessible for all students; (2) AI-Learners actively engages students and motivates them to learn mathematics; (3) AI- Learners personalizes the learning experience to each individ- ual student; (4) and AI-Learners provides comprehensive ana- lytics to help parents and educators better understand their students math abilities.

ACCESSIBILITY

AI-Learners is accessible for students with physical, cogni- tive, and behavioral disabilities. The website meets the highest level of accessibility standards from the W3C Web Accessibility Initiative, and the games are compatible with a wide range of assistive technology. Most importantly, the AI-Learners games are clear and easy to understand. In line with the Web Content Accessibility Guidelines (WCAG), games have no flashing con- tent or time limits, sufficient color contrast, and the text is large and easy to read. Additionally, the games provide a multisen- sory experience with visual and audio cues at every step of the games. Adele has worked with many special education teachers, occupational therapists, and assistive technology specialists to ensure the AI-Learners games met the complex needs of stu- dents with physical disabilities. First, Adele ensured that the AI-Learners games were compatible for students who use an

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eye gaze assistive device to help her sister Lara practice math. Next, Adele researched how to make games compat- ible with other alternative in- put devices such as joystick, switch device, and track- pads to help students with motor impairments. Lastly, Adele explored compatibility with screen readers, text-to- speech, and magnification to ensure the games were acces- sible to students with vision impairments. For example, buttons are large enough for students to click on, the games are available on all screen sizes and support magnification up to 400%, and all visuals have clear al- ternate text labels.

students with rewards and breaks for their hard work. Every few questions, students see animations with fireworks or balloons or can sign along to a good job song. Caretakers can adjust the frequency and length of breaks for further customization.

In addition to sufficient feedback in the games, AI-Learners helps students improve their understanding of underlying math concepts through instructional support. Not only are students practicing math questions through drill-and-practice, but students also see question explanations and examples to understand the math concepts better. Every game begins with an example. For instance, when a student plays a count- ing game, the game starts with an example of a counting se- quence, showing how to count 10 apples (audio plays for each number and the apple enlarges as the audio plays). During the game, students can click a hint button and see another exam- ple of how to count.

ENGAGEMENT

AI-Learners activity engages students using applied behav- ior analysis principles to provide students with an optimal learn- ing experience. Research shows that one of the most important aspects of engagement is feedback. When a student clicks on an answer, whether right or wrong, they should receive feed- back to understand whether they answered a question right or wrong. Applying this principle, the AI-Learners games provide students with immediate feedback through visual and auditory cues. For example, after selecting an answer choice, the answer box turns red or green, and students hear “good job” or “try again”. The games also reinforce correct answers by offering

To further engage students, AI-Learners provides students with a plethora of visuals to choose from. Students can play

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games with food, animals, toys, school objects, and more. At the start of a game, students choose their favorite character or color, which they see throughout the game. Lastly, students create their own avatar on the AI-Learners website, which they see during the game. Students can choose their own skin color, hair color, shirt, and accessories. As students play more games, they receive stars which they can use to unlock new avatar fea- tures to further customization.

math abilities. As students play more games, the difficulty level adapts to a student’s strengths, weaknesses, and current per- formance. Some days, students have a bad day and may need to play easier questions. Some days, students perform really well and can try harder questions. Thus, during each game, the AI-Learners algorithms adjust to a student’s game play and provide students with appropriate difficulty levels to ensure students are most effectively learning math. Additionally, since all games on a student’s account are already set to a student’s math level, parents and teachers do not need to select a math level for a student at the start of a game. Not only does this ensure that students are playing games at their math level, but now students can independently play games. Lastly, AI-Learners recommends games for students to play based on their disability and past performance. Games are clearly organized in sections: “picked for you,” “more games,” and “challenge yourself.” For example, if a student has played many addition word problems, but is struggling with mental math, then a game to help students practice addition mental math will appear in the “picked for you” section. The games in these sections change every few days to further personalize the learning experience for each student. ANALYTICS AI-Learners provides parents and educators with clear ana- lytics to help them gain a deep understanding of their student’s progress, strengths, and weaknesses. The analytics section is split into four sections: highlights, current progress, game play history, and topic guide. Each section features clear and inter- active graphics to provide caretakers with a plethora of infor- mation on their student’s mathematical abilities. The highlights section provides an overview of a student’s game play in the past week. Highlights include the number of questions a student has played, the amount of time a student played, a student’s overall accuracy in a math skill, and the va- riety of games a student practiced. Additionally, all math skills (e.g., counting, addition, etc.) are color-coded to clarify what skills a student has been practicing. Parents expressed that this page was their favorite due to the conciseness and clarity of graphics. For more information on a student’s progress, parents and educators can view the Current Progress tab. This page pro- vides interactive graphics displaying how a student’s math abilities have changed over time. A line chart shows the total questions, math level, and time spent playing over time. Filters for math skill, topics, and time duration are available for further customization. The page also provides details on a student’s strengths and weaknesses. Educators expressed that the Cur- rent Progress page was their favorite, as they could better un- derstand what additional support a student would need.

PERSONALIZATION

AI-Learners provides students with personalized learning experience to improve the effectiveness of the math games. Following the common saying, “if you’ve met one person with autism, then you’ve met one person with autism,” AI-Learners utilizes the powers of technology to create individualized learning experiences for each student and meet their complex needs. After a student has their own account, all games on the AI-Learners website are set to the student’s math level and game difficulty dynamically changes overtime. When a parent or educator creates an account, they enter initial information about a student, such as a student’s disability and approximate

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