Assistive Technology and Alternative and Augmentative Communication Options in the Language Skills Development of Students with Specific Learning Disorders

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The study is really interesting. The topic under study is very relevant and necessary and constitutes a great contribution to the scientific community. The theoretical framework is interesting, as is the methodology. However, only 22 studies seem scarce to me, although in truth the topic is very specific. Being at the end of 2024, it would be interesting to extend the search from 2022 to 2024. The results, conclusion and discussion are correct.

Author Response

Point 1

The study is really interesting. The topic under study is very relevant and necessary and constitutes a great contribution to the scientific community. The theoretical framework is interesting, as is the methodology. However, only 22 studies seem scarce to me, although in truth the topic is very specific. Being at the end of 2024, it would be interesting to extend the search from 2022 to 2024. The results, conclusion and discussion are correct.

Response 1

Thank you for your positive feedback! Regarding the number of studies included in our analysis, we agree that 22 studies might seem limited. However, as you noted, the topic we aimed to investigate is specific and based on the data from our search was not that high, we tried to identify other relevant studies using also the references list from the studies selected in our review. Nevertheless, we acknowledge the importance of expanding the scope to include the most recent developments in the field. Therefore, we have done a search for the studies from the last two years, and we included input from them in discussion section. We marked all modifications in track changes for an easier detection.

Some references were made to the following papers:

Leckenby, K., & Ebbage-Taylor, M. (2024). AAC and Aided Language in the Classroom: Breaking Down Barriers for Learners with Speech, Language and Communication Needs. Taylor & Francis.

Turriziani, L., Vartellini, R., Barcello, M. G., Di Cara, M., & Cucinotta, F. (2024). Tact Training with Augmentative Gestural Support for Language Disorder and Challenging Behaviors: A Case Study in an Italian Community-Based Setting. Journal of Clinical Medicine, 13(22), 6790. https://doi.org/10.3390/jcm13226790

Keelor, J. L., Creaghead, N. A., Silbert, N. H., Breit, A. D., & Horowitz-Kraus, T. (2023). Impact of text-to-speech features on the reading comprehension of children with reading and language difficulties. Annals of Dyslexia, 73(3), 469-486. https://doi.org/10.1007/s11881-023-00281-9

Schaur, M., & Koutny, R. (2024). Dyslexia, Reading/Writing Disorders: Assistive Technology and Accessibility: Introduction to the Special Thematic Session. In International Conference on Computers Helping People with Special Needs (pp. 269-274). Cham: Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-62849-8_33

Alqahtani, S. S. (2023). Ipad text-to-speech and repeated reading to improve reading comprehension for students with SLD. Reading & Writing Quarterly, 39(1), 1-15. https://doi.org/10.1080/10573569.2021.1987363

We appreciate the opportunity to address your concerns and welcome any further suggestions you may have for improving the manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

I appreciate the research topic here, as it is innovative, up-to-date and inclusive in its approach. Some uncodified and not generally known abbreviations are frequently used but not explained in the manuscript (SC, SLR, GD, MBD...). The whole report seems to be well understandable, sufficiently structured and descriptive, but the conclusions are too general, lacking the short but structured overview of the results related to the research questions (as the discussion section does not directly correspond to all research questions). I recommend that this part should be adapted (developed) to the specific research aims (questions). As for the references, I see a considerable number of older (10 and more years) articles, which should probably be updated with the newer literature.

Author Response

Point 1

I appreciate the research topic here, as it is innovative, up-to-date and inclusive in its approach. Some uncodified and not generally known abbreviations are frequently used but not explained in the manuscript (SC, SLR, GD, MBD...).

Response 1

Thank you for your constructive and positive feedback! To address your concern regarding the use of abbreviations, we will ensure that all of them are clearly defined when they are first introduced in the manuscript. The changes cand be detected in track changes.

Point 2

The whole report seems to be well understandable, sufficiently structured and descriptive, but the conclusions are too general, lacking the short but structured overview of the results related to the research questions (as the discussion section does not directly correspond to all research questions). I recommend that this part should be adapted (developed) to the specific research aims (questions).

Response 2

In response to your recommendation, we revised the conclusion section to include a concise, structured summary of the results, ensuring that each research question is addressed directly. The modification made are marked in the manuscript with track-changes.

Point 3

As for the references, I see a considerable number of older (10 and more years) articles, which should probably be updated with the newer literature.

Response 2

Thank you for your comment, we acknowledge the importance of expanding the scope to include the most recent developments in the field. Therefore, we have done a search for the studies from the last two years, and we included input from them in discussion section. We marked all modifications in track changes for an easier detection.

Some references were made to the following papers:

Leckenby, K., & Ebbage-Taylor, M. (2024). AAC and Aided Language in the Classroom: Breaking Down Barriers for Learners with Speech, Language and Communication Needs. Taylor & Francis.

Turriziani, L., Vartellini, R., Barcello, M. G., Di Cara, M., & Cucinotta, F. (2024). Tact Training with Augmentative Gestural Support for Language Disorder and Challenging Behaviors: A Case Study in an Italian Community-Based Setting. Journal of Clinical Medicine, 13(22), 6790. https://doi.org/10.3390/jcm13226790

Keelor, J. L., Creaghead, N. A., Silbert, N. H., Breit, A. D., & Horowitz-Kraus, T. (2023). Impact of text-to-speech features on the reading comprehension of children with reading and language difficulties. Annals of Dyslexia, 73(3), 469-486. https://doi.org/10.1007/s11881-023-00281-9

Schaur, M., & Koutny, R. (2024). Dyslexia, Reading/Writing Disorders: Assistive Technology and Accessibility: Introduction to the Special Thematic Session. In International Conference on Computers Helping People with Special Needs (pp. 269-274). Cham: Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-62849-8_33

Alqahtani, S. S. (2023). Ipad text-to-speech and repeated reading to improve reading comprehension for students with SLD. Reading & Writing Quarterly, 39(1), 1-15. https://doi.org/10.1080/10573569.2021.1987363

We appreciate the opportunity to address your concerns and welcome any further suggestions you may have for improving the manuscript.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

See attached.

Comments for author File: Comments.pdf

Author Response

Point 1

L 107-110: I think you mean there is no need to use AAC to replace spoken language with the SLD population, as opposed to people who require AAC. Please clarify this.

Response 1

You are correct that our intention is to emphasise that AAC should not be viewed as a replacement for spoken or written language in students with SLD. Instead, we emphasise that the development of verbal language (both oral and written) remains the primary goal of intervention strategies for this population. To be clear, our statement is intended to emphasise that AAC can be used as a supportive tool to enhance literacy experiences and to complement oral language development in students with SLD, rather than as a substitute for spoken or written language, as in populations with more severe communication impairments who rely on AAC for primary communication. This distinction has now been clarified in the revised manuscript.

“There is no need to propose an alternative to verbal language (oral and written), which remains the primary goal of the speech and language development and learning process. AAC should not be viewed as a replacement for spoken or written language in students with SLD. Instead, the development of verbal language (both oral and written) remains the primary goal of intervention strategies for this population. AAC can be used as a supportive tool to enhance literacy experiences and to complement oral language development in students with SLD, rather than as a substitute for spoken or written language, as in populations with more severe communication impairments who rely on AAC for primary communication. Therefore, AAC tools can improve literacy experience.”

Point 2

This is an implementation science study. As such, I’d like to see the implementation framework that is guiding this study as well as an explanation of where how this study is positioned in this line of research. Where are you in the process, and what’s next? Where are you headed?

Response 2

Thank you for your observation. Being a systematic review, the methodology of the study was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020 guidelines). The study was guided by PRISMA methodology, and a supplementary material was added to the manuscript with study protocol and PRISMA checklist. This methodology provided a systematic structure to identify studies that explore the adoption, integration, and sustainability of AAC tools in educational interventions for students with SLD.

To address your query, this study is situated in the initial stages of implementation science, focusing on the exploration and preparation phases. Specifically, it examines the potential utility of AAC in improving reading and writing experiences and seeks to inform evidence-based educational decision-making. Our findings aim to identify barriers, facilitators, and contextual factors that influence the adoption of AAC tools in practice. These aspects can be found in the section 2 Materials and Methods, please let us know if more information is needed.

Point 3

What is SCR? I can’t find where this is defined. I think it’s some type of scoping review…

Response 3

Thank you for pointing out the abbreviation SCR, it was defined and clarified, based on the review we have done, we integrated it as a systematic literature review, and we made all the modification to eliminate any confusion with a scoping review.

Point 4

RQ3 is very broad. I thought this study was just focused on written language

Response 4

Thank you for your observation. To align RQ3 more closely with the study's focus, we emphasized the role of AAC specifically in written language development. Our intent with RQ3 is to explore how AAC tools can support and enhance the processes involved in written language skills development, particularly in students with SLD. In the revised manuscript, we have refined RQ3 to explicitly reflect this focus:

“RQ3: How can the process of written language skills development benefit from AAC?”

This reformulation narrows the scope of the question and ensures it is consistent with the study's objectives.

Point 5

The title implies a focus on AAC, but other information in the paper indicates and interest in other forms of assistive technology. Clarify.

Response 5

The focus of this study is indeed on AAC, specifically its role in supporting written language skills development for students with SLD. Initially, our study aimed to explore only AAC tools and their role in supporting written language development for students with SLD. However, during our research process, we identified a limited number of studies focused exclusively on AAC in this context. As a result, we broadened the scope of our research to include AT more generally, while still maintaining a central focus on AAC as a key subset. To address this, we have clarified the manuscript to better reflect this expanded focus. Specifically, we have adjusted the title and relevant sections of the text to ensure that they accurately represent the inclusion of both AAC and other assistive technologies, and we have clearly articulated how these tools collectively support language skills development.

The proposed revised title – “Assistive technology and alternative and augmentative communication options in language skills development of students with specific learning disorders”

Point 6

Thank you for stating the use of PRISMA. However, the method section overall is extremely scant and is lacking the details needed to evaluate the rigor of this study.

Response 6

We have added reference to a published study protocol on Prospero (#CRD42024607547). It can be accessed also on https://www.crd.york.ac.uk/prospero/#recordDetails. Also, we have added a Supplementary material with more details on study methodology and a PRISMA checklist to ensure all aspects were included.

Point 7

How did you define students with SLD? The number of articles found seems quite low based on the inclusion criteria. Perhaps this is due to how SLD was defined, at least in part.

Response 7

SLD – are defined in the paragraph 3 of the introduction section. Here it is:

“SLD refers to a range of difficulties that affect the acquisition of key academic skills, such as reading (dyslexia), writing (dysgraphia), and arithmetic (dyscalculia), all of which are essential for learning [2]. SLD serves as an umbrella term for a group of neurodevelopmental disorders that share common symptoms. The primary challenge faced by individuals with SLD is the inability to attain and maintain fluency in language skills, including spoken, written, sign language, or mathematical language, due to deficits in comprehension or production [2]. Children with SLD encounter difficulties in fluent and efficient reading, particularly in terms of speed, automaticity, or executive coordination [2]. These challenges typically arise during the early years of formal education and, without proper support, can significantly hinder learning [4]. Symptoms commonly include word decoding and spelling, phonological processing and orthographic-phonological integration [2]. As a result, the overall profile of reading and writing skills for students with SLD often falls below the level expected for their intelligence, motivation to learn, socio-cultural environment, and available learning opportunities [2].

In addition to difficulties with language and academic skills, researchers identified other challenges that students with SLD face in school settings. These include challenges in academic learning requiring reading skills [5], attention deficits and short attention span, poor motor skills [6], difficulties with coordination and spatial reasoning, poor time management, planning, and organisational skills [7], difficulties with processing and organising information [6]. Despite long-term intervention and remediation, these difficulties persist [8], and teachers report a significant gap between a student's potential and their actual performance [9]. As academic learning that hap-pens in schools is mostly based on literacy skills, it becomes crucial for students to practice using language in oral and written form, which is effortful for children with SLD, and their academic success is strongly correlated with personalised, intensive and continuous educational support [10-12]. Therefore, students with SLD would greatly benefit from individualised learning pathways and rehabilitation strategies to compensate for the challenges that a learning disorder may pose to the learning process. However, research is needed to provide a personalised user experience for the specific needs and challenges of students with SLD, based on a viable mechanism that can adapt to individual differences and specific learning and verbal behaviours, different interaction modalities and customised types of multimedia feedback [13]. The use of AAC and the adoption of new technologies offer potentially viable solutions for im-proving and enhancing literacy skills and communication for students with SLD [14].”

Point 8

Include all details of the search terms used and how they were (and were not) combined.

Response 8

Thank you for pointing out. The following string was used and added in the manuscript.

("augmentative and alternative communication" OR “assistive technology” OR “AAC”) AND ("specific learning disorder" OR “SLD” OR “dyslexia” OR "learning dis-orders") AND ("reading disorder" OR "reading difficulty" OR "reading impairment").

Point 9

What is the rationale for only including studies published in 2012 or after? This seems arbitrary, which is not acceptable.

Response 9

Thank you for your comment regarding the rationale for including only studies published from 2012 onwards. We appreciate the opportunity to clarify this decision. The decision to include studies published from 2012 onwards was not arbitrary but guided by the rapid advances in technology and educational tools over the past decade. AAC technologies, as well as assistive technologies more broadly, have evolved significantly in recent years, particularly in their applications to support language and literacy development. By focusing on studies from 2012 onwards, we aimed to ensure the inclusion of research that reflects contemporary tools, methodologies and pedagogical practices that are most relevant to current educational contexts.

However, we recognise the importance of transparency in explaining such decisions. To address this concern, we have revised the manuscript to explicitly justify this timeframe and ensure that it is clear to readers.

Point 10

Having 12 reports that were not retrieved is exceptionally high. Why was this the case? This is very unusual, as universities typically can retrieve any academic report through interlibrary loan.

Response 10

Thank you for bringing this issue to our attention. The inability to retrieve 12 reports was primarily due to a combination of factors. Some of the reports were published in lesser-known or niche journals, repositories, or conference proceedings that are not included in our university’s library subscriptions or accessible via interlibrary loan. A few reports were published in languages for which we did not have translation resources available, which limited our ability to include them in the analysis. To address this limitation, we have updated the manuscript to provide a detailed explanation of these retrieval challenges and their potential impact on our findings.

Point 11

Given the limited rigor included in the method section, I have difficulty trusting that the methods located all relevant literature for this review. The results section also is quite scant. This ultimately leads to challenges in accepting the issues presented in the results.

Response 11

Thank you very much for your feedback. We acknowledge that ensuring methodological rigour is critical to finding all relevant literature and presenting robust findings. In response to your comment, we have taken the following steps to improve the transparency and comprehensiveness of our methods and results. We have expanded the methods section to include more detail on the search strategy, including databases used, specific search terms, inclusion/exclusion criteria and screening procedures (e.g. PRISMA flowchart). We have reviewed and added to the results section to ensure that it includes detailed descriptions of findings, thematic categorisations and patterns observed across studies. We have included a discussion of potential limitations in our search and screening process that may have influenced the results, as well as steps taken to mitigate these biases. All the modifications are presented in the manuscript in track changes to be easier identifiable.

Point 12

I was confused by the presentation of Fig. 2 in the discussion section. If this framework is the foundation for this study, it should be presented and explored in the introduction.

Response 12

Thank you for your comment on the presentation of Figure 2 in the discussion section. Figure 2 was designed as a result of the systematic literature review, based on the analysis of the studies identified during the review process. It is not intended to serve as the basic framework of the study, but rather as a contribution of the literature review itself. We acknowledge that the presentation of this figure in the discussion section may have led to confusion about its role. To address this, we have revised the manuscript to explain more clearly that the framework in Figure 2 was developed after synthesising the findings of the reviewed studies. It is an outcome of the literature review rather than a guiding framework for the research.

Author Response File: Author Response.pdf