Balancing accessible teaching and knowledge acquisition: How teachers describe their reading instruction for students with intellectual disability

Abstract

Learning to read can be challenging for students with intellectual disability, but studies on reading interventions for this population show that it is possible when utilising evidence-based instructional methods. This study investigated how teachers in Swedish compulsory schools for students with intellectual disability described the content of their reading instruction. An abductive thematic analysis of 13 teachers’ logbooks revealed difficulties in balancing the required focus on knowledge acquisition while simultaneously making reading instruction accessible and motivating for students. These findings underscore the importance of guiding teachers in aligning individual adaptations, particularly those motivated by student interests, with evidence-based practices in reading instruction. This alignment is crucial to ensure that students receive instruction that engages them and effectively supports their reading development.

Keywords

intellectual disability teachers reading instruction thematic analysis logbooks

Introduction

Learning to read is crucial for full participation in society. An individual needs to be able to read to finish school, to get a job, and to manage daily chores. For students with intellectual disability, becoming a proficient reader is a challenge. Cross-sectional studies suggest that the development of decoding ability in individuals with intellectual disability plateaus early, while reading comprehension continues to develop for a longer period (Nilsson et al., 2024; Ratz and Lenhard, 2013). However, it should be noted that persons with intellectual disability benefit from intensive and systematic reading instruction (Reichow et al., 2019; Sermier Dessemontet et al., 2019), and that the aforementioned plateau could be attributed to varying quality of reading instruction. For students with moderate to severe intellectual disability, reading acquisition is even more challenging due to more severe cognitive difficulties. The majority of these students also have difficulties understanding and using spoken language and require augmentative and alternative communication (AAC, most often manual signs, pictures/graphic symbols, or communication apps with speech output). Students in need of AAC also require adapted educational methods to benefit from the reading instruction, as well as more time and repetition to achieve mastery, compared to their peers without disabilities. Delivering reading instruction while at the same time adapting the content to the student’s individual needs is challenging and might lead to programs lacking key instructional components (Ainsworth et al., 2016; NICHHD, 2000). In the current study, we examined how teachers in the compulsory school for students with intellectual disability in Sweden described their reading activities for students in need of AAC at the early stages of reading development.

The compulsory school for students with intellectual disability has been criticised for being too focused on functional skills, such as activities of daily living, rather than academic development (Browder et al., 2006). While practising daily living activities is important for this group of students, it should not outweigh their academic instruction. A Swedish survey study by Klang et al. (2020) found that teachers of students with intellectual disability integrated into mainstream school settings reported higher expectations for their students. In contrast, teachers in schools where all students had intellectual disability reported lower expectations. The opposite pattern was observed regarding the teachers’ focus on social participation (Klang et al., 2020).

Reading instruction for students with intellectual disability

Studies investigating reading comprehension and decoding in students with intellectual disability have found that the development of these abilities is delayed and that these students struggle to reach a level of ability that is comparable to peers of the same chronological age (Jones et al., 2006; Lemons et al., 2013; Ratz and Lenhard, 2013). At the same time, studies show that the set of predictors that are important for reading development in children with typical development applies to students with intellectual disability as well (Nilsson et al., 2021a, 2021b). In addition, studies investigating reading interventions for students with intellectual disability have found that methods that are developed for strengthening reading ability in struggling readers with typical development are also effective for students with intellectual disability, with the addition that interventions need to be delivered for a longer period (Allor et al., 2014; Sermier Dessemontet et al., 2019). For example, in the study by Allor et al. (2014), a comprehensive reading instruction program was delivered to students with intellectual disability. Besides the main finding that the program was effective, the study also showed that the lower the IQ of the student, the longer the program needed to be delivered to be effective. For the students with IQs between 70 and 80 (just around the cut-off for intellectual disability), it took approximately one and a half school year to move from 20 words per minute to 60 words per minute, while for the students with IQs between 56 and 69 (in the range of mild intellectual disability), it took three school years to move from 10 words per minute to 60 words per minute (Allor et al., 2014). The authors also stress the fact that students with lower IQs require intensive reading instruction to gain an effect.

Two decades ago, the National Reading Panel outlined five components that were scientifically proven to be efficient in teaching reading in alphabetic languages, namely phonemic awareness, phonics, fluency, vocabulary, and text comprehension (NICHHD, 2000). Phonemic awareness is the ability to intentionally reflect upon and manipulate speech sounds (phonemes) in words and instruction. Phonics instruction includes the teaching of letter-sound correspondence and how that is used to read and spell words. Phonics should be taught explicitly and systematically using a planned, sequential introduction of phonic elements (NICHHD, 2000). For students with intellectual disability, it is further recommended to use a direct instruction approach and to model the targeted skills more often. It has been proven beneficial to use a system of prompts when providing corrective feedback to the students (Ahlgrim-Delzell et al., 2014; Sermier Dessemontet et al., 2022). Fluency is the ability to read text with speed, accuracy, and proper expression. Fluency is often trained using repeated oral readings or efforts to increase the amounts of informal and recreational reading. Vocabulary is an important part of reading comprehension and is often taught using explicit instruction, where students are given definitions or implicit instructions, such as shared reading. Finally, text comprehension could be explicitly taught using comprehension monitoring, cooperative learning, graphic organisers, and question-answering (NICHHD, 2000). A Cochrane review found that early reading interventions for children with intellectual disability comprising these five components showed medium effect sizes for several reading skills (Reichow et al., 2019). In addition, another review concluded that the effectiveness of phonics instruction for students with intellectual disability has been repeatedly proven, meaning that the method should be regarded as evidence-based practice for students with intellectual disability (Sermier Dessemontet et al., 2019). An observational study, from the United States, concluded that phonics instruction for students with ID is becoming increasingly popular, but teachers in special education classrooms need more professional development to adequately aid their students with intellectual disability in building foundational skills to become independent readers (Lindström and Lemons, 2021). Further, even though research suggests that interventions based on the five components are effective for students with intellectual disability, it seems like many classrooms have not implemented them. An observational study from Switzerland showed that phonics instruction was used in over 90% of the observed classrooms but was delivered systematically in only 46% of the classrooms (Sermier Dessemontet et al., 2022). Instruction focusing on phonological awareness was quite common, but vocabulary and comprehension were taught only in 54% and 38% of the classrooms, respectively. No classroom-implemented instruction focused on fluency (Sermier Dessemontet et al., 2022). Given that these five components are effective for students with intellectual disability, it is important to investigate how teachers describe their reading activities for this group.

For students with intellectual disability who rely on AAC, traditional reading instruction, such as phonics, may be challenging to teach due to difficulties with speech production. Phonics typically requires learners to produce specific phonemes for letters, which can be a barrier for students unable to vocalise these sounds. However, research indicates that integrating AAC into reading instruction, focusing on methods like letter-sound correspondence (Caron et al., 2023; Samuelsson et al., 2024) and adapting phonics instruction (Ainsworth et al., 2016; Samuelsson et al., 2024), can support reading development. When AAC is used alongside these strategies, students can engage with phonics without using speech, allowing them to build foundational reading skills despite speech challenges (Williams, 2024). However, there is a risk that the adapted instruction misses key instructional components (Ainsworth et al., 2016; NICHHD, 2000). Exploring how teachers describe their reading practices may help illuminate how they integrate key components of instruction with adapted methods.

Aim

This study aimed to investigate how teachers in compulsory schools for students with intellectual disability describe their reading instruction for students in need of AAC who are in their early reading development.

Method

The data used for this study were based on teacher-reported digital logbook surveys that were collected as part of a larger reading intervention study designed to evaluate the effects of phonics-based, comprehension-based, and multicomponent (combined) digital reading instruction for beginning readers with intellectual disabilities in need of AAC. The logbooks were filled out weekly for 18 weeks. The teachers in the present study constituted the comparison group, which followed teaching-as-usual as outlined in the Swedish national curriculum for students with ID (for the intervention study, please see Palmqvist et al., 2025).

Participants

Thirteen teachers participated in this study (see Table 1). These teachers instructed 23 students attending Swedish compulsory schools for children with intellectual disability, a specific form of schooling that follows a national curriculum adapted to the needs of students with intellectual disability (Skolverket, 2022). Students can choose if they want to attend a classroom where all students have intellectual disability or if they want to be integrated into a general classroom. Regardless of their choice, they will follow the adapted curriculum. Before being enrolled in the Swedish compulsory school for students with intellectual disability, the student needs an intellectual disability diagnosis according to the ICD-10 (World Health Organization, 2016). The selection criteria for the study were based on the characteristics of the student. The teachers were instructed to identify students who would benefit from AAC and could not read more than approximately 20 words, which was defined as being a beginning reader. To make the sample representative of the population of students with intellectual disability, no exclusion criteria were set for additional diagnoses, aetiology of the intellectual disability, or age.

Table 1.

Overview of teacher and student characteristics.

Teacher	Teacher characteristics					Student characteristics
Teacher	Age in years^a	Highest education	Graduation year	Experience in years	N students /teacher	Student	Level of intellectual disability	Additional diagnoses	Form of AAC
T1	55-59	Spec. ed. teacher	2005	11	2	Student 1	Severe	ASD, multiple/rare	Manual signs, pictures, speech generating device
T1	55-59	Spec. ed. teacher	2005	11	2	Student 2	Severe	ASD, Ep, multiple/rare	Manual signs, pictures
T2	60-64	Spec. ed. teacher	1987	15	1	Student 1	Severe	ASD, Ep, multiple/rare	Manual signs, pictures
T3	60-64	Spec. ed. teacher	2018	5	1	Student 1	Moderate	ASD, Ep, hearing impairment	Manual signs, pictures
T4	50-54	Spec. ed. teacher	2018	6	2	Student 1	Moderate		Manual signs, pictures
T4	50-54	Spec. ed. teacher	2018	6	2	Student 2	Moderate	DS
T5	40-44	Spec. ed. teacher	2017	9	1	Student 1	Severe		Manual signs, pictures
T6	50-54	Spec. ed. teacher	2019	9	2	Student 1	Mild	CP, AD(H)D, Ep	Manual signs, pictures
T6	50-54	Spec. ed. teacher	2019	9	2	Student 2	Moderate	Multiple/rare	Manual signs, pictures
T7	55-59	Spec. ed. teacher	2000	25	1	Student 1	Mild	ASD	Manual signs, pictures
T8	55-59	Primary ed. teacher	NA^b	18	5	Student 1	Moderate	ASD	Pictures
						Student 2	Severe		Manual signs, pictures
						Student 3	Moderate	DS	Manual signs
						Student 4	Moderate
						Student 5	Moderate	Multiple/rare
T9	55-59	Preschool teacher	2016	18	1	Student 1	Moderate	DS	Manual signs
T10	50-54	Spec. ed. teacher	2011	15	1	Student 1	Moderate	DS	Manual signs, pictures, speech generating device
T11	45-49	Spec. ed. teacher	2003	22	1	Student 1	Mild	AD(H)D	Pictures
T12	45-49	Spec. ed. teacher	1996	20	3	Student 1	Moderate	ASD, multiple/rare	Manual signs, pictures, speech generating device
						Student 2	Moderate	DS, Ep	Manual signs
						Student 3	Moderate	ASD, DS	Manual signs, pictures
T13	55-59	Spec. ed. teacher	2015	15	2	Student 1	Moderate	ASD, DS	Manual signs
T13						Student 2	Moderate	Ep, multiple/rare	Pictures

Note. Spec. ed. = Special education, Experience in years = years working in their current school form, Multiple/Rare = either multiple disorders or rare syndromes. Abbreviations: AAC = augmentative and alternative communication, ASD = autism spectrum disorder, CP = cerebral palsy, AD(H)D = attention deficit (hyperactive) disorder, DS = Down Syndrome, Ep = Epilepsy.

^a = Age is presented in a span of years to ensure anonymity.

^b = Unreliable data input (i.e., 1914).

Recruitment took place in southern Sweden. Teachers were contacted via email and asked if they were interested in participating in the project. Upon giving a notification of interest, the teacher specified the number of students at their school who fulfilled the inclusion criteria. This means that the number of students per teacher in this study is the number of students that met the inclusion criteria, not the number of students in each teacher’s classroom. Teachers with notification of interest were asked to send information about the study, together with a consent form, to the caregivers of potential participating students. The information provided to the parents and students was written in an easy-to-read language and supported with pictures.

All included teachers and caregivers to the included students signed an informed consent before participation. The study followed the Ethical principles for research involving human subjects from the WMA Declaration of Helsinki (World Medical Association, 2013) and was approved by the Swedish Ethical Review Authority (no. 2019-03845). The authors of this study have strived to do justice to the informants while considering earlier research to identify and illustrate gaps in existing theory. The collected material consists of a diversity of voices, and the results that are presented in the article represent the most common themes. Part of our focus for the analysis has been to identify the areas of improvement in the instructional methods that are being used by teachers in the compulsory school for students with intellectual disability. Nevertheless, we have also included themes that show examples of good educational practices for this population.

Caregiver interview

The caregivers of the included students were interviewed via telephone. Via the interview, the caregiver reported the student’s date of birth, level of intellectual disability, and mode of communication (including AAC).

Logbooks and procedure

This is a longitudinal qualitative study using teacher-reported logbook surveys. The participating teachers were asked to fill in an online weekly logbook for each student for a period of 18 weeks by answering questions about the amount, delivery, and content of the reading instruction (see online Supplemental Material). The teachers also provided demographic data (see Table 1).

Researcher description

All authors of this manuscript live and work in different parts of Sweden. We come from different backgrounds: cognitive science, linguistics, speech and language pathology, psychology, and pedagogy. Some authors have worked clinically with various disability groups; some have worked as teachers; and others come from a pure academic background. There was no relationship between the researchers and the participants prior to data collection.

Analysis

Data was analysed using an abductive thematic analysis using both deductive and inductive elements. The analysis was conducted by the authors KN and LP. The data file used for the analysis had 258 entries, each representing a description of one week of reading instruction for one student. In the deductive part of the analysis, each reading activity described in the logbooks was sorted into categories based on the five components of reading instruction outlined by the National Reading Panel (NICHHD, 2000), namely phonemic awareness, phonics, fluency, vocabulary, and text comprehension. Two additional categories, “sight-word reading” and “other”, were added after the initiation of the analysis. Inter-rater reliability, before re-coding to achieve consensus, was calculated in two different ways: (1) Across entries, meaning the percentage of entries where the coders sorted all reading activities (per week, per student) correctly into the seven categories (40%); (2) Across categories, meaning the agreement between the coders on the categorisation of each reading activity (mean: 78%, phonemic awareness: 84%, phonics: 56%, fluency: 95%, vocabulary: 90%, text comprehension: 92%, sight-word reading: 67%, other: 58%). The large difference between these figures is due to the fact that for the majority of coding across entries, there was at least one disagreement. Disagreements were resolved by re-coding until a consensus between the coders was achieved. The deductive thematic analysis using the seven categories described in the methods section is presented under the sub-theme “content of reading instruction”.

The thematic analysis was guided by Braun and Clarke (2006, 2022). First, the authors read and re-read the material with notes taken in a separate document. This inductive process was guided by the aim of the study. Secondly, the authors generated initial codes. The authors employed semantic coding and continuously refined and adapted the codes based on the data. A response could be sorted into several codes. This part of the analysis was thorough, and codes were collapsed, renamed, or omitted based on which codes were most frequent. Thirdly, the authors searched for themes and sub-themes by looking for patterns of shared meaning between codes. The codes were adjusted based on the themes and sub-themes, and the writing process started. Fourth, the authors reviewed the themes and checked against each other and the original data. Some themes were merged and rewritten, and others were excluded. Fifth, the themes were named, defined, and suitable quotes representing the themes were chosen. Sixth, the result was written. The overall analysis process involved an iterative approach going back and forth to the data. It began with detailed coded extracts, moved on to initial themes, and ended by looking at broader patterns and stories.

Results

A total of 258 logbook notes were sent to the research group, each representing a description of one week of reading instruction for one student. The teachers’ number of logged weeks ranged from 3 to 17 weeks. The number of reading sessions per week ranged from 1 to 16, and the time per week spent on reading instruction ranged from 10 minutes to about 10 hours per week. The students were between 9 and 19 years old, and about half of the students were girls (girls = 11, boys = 12). It was almost as common for the students to work with a teacher as with a teaching assistant (not certified teachers). A less common practice, but still present, was for students to work on their own.

Thematic analysis of the reading instruction

The analysis resulted in two main themes: the what and the how, and the scaffolding teacher. Each main theme and included sub-themes will be described below and are also displayed in Figure 1. All parentheses in quotes are part of the original quote and, hence, provided by the teachers. Information added by the authors, such as translations and descriptions of materials, is provided within square brackets.

Figure 1.

Visualization of the two main themes and their respective sub-themes.

The what and the how

This main theme includes how teachers described the content of their reading instruction in terms of what they taught, and how they taught it. Three sub-themes were associated with this main theme: teacher terminology, content of reading instruction, and delivery of reading instruction.

Teacher terminology

This sub-theme focuses on what language teachers used when they described their teaching activities. Teachers often mentioned specific materials, for example, an app or a specific textbook, but left out information on what instructional method they used or which reading ability they targeted. Hence, the descriptions often included a how in terms of material, but rarely a what in terms of targeted ability. In addition, the how was often vaguely described, and the descriptions lacked proper educational terminology. The following three quotes exemplify the contrast between the way of describing teaching activities explained above (first and second quote), and the less common way of describing teaching activities where the description was clearer (third quote):

T3: “Held morning meetings and therefore have been reading and writing a lot”

T7: “Worked with letters and words in different ways”

T6: “Worked with reading comprehension through forecasting and selection of keywords”

The first and second quotes do not mention the targeted ability, and the how is vaguely described, while the third quote states that the ability of interest is reading comprehension and clearly describes how they have worked with that.

Moreover, the teachers often described what material they used, rather than describing the instructional method that was being used. Hence, the description of the teaching activity is missing a clear goal and a pre-planned purpose, i.e., a what.

T13: “Reads a three - four-word sentence in the textbook The House on Alder Road [Huset på Alvägen; textbook]”

T9: “Letterplay [Bokstavslek; an app]”

T13: “Works with reading homework. (Beta educator, Fairytale treasure level (2) [Betapedagog, Sagoskatten nivå 2; textbook]”

These three quotes exemplify a narrow focus on the material rather than the actual content of teaching, a pattern that was identical for almost all teachers. This is probably a consequence of that it is common for teachers to describe their teaching this way when discussing with colleagues in the same school who are likely to use the same material.

Content of reading instruction

This sub-theme focuses on the content of the described teaching activities, i.e., the what. The teachers described teaching activities that included aspects of all reading components, namely phonemic awareness, phonics, sight-word reading, fluency, vocabulary, and text comprehension. In addition, teaching also included activities such as letter naming, pure writing training, or activities that were not directly related to reading instruction, such as visiting the library, communication training, or language activities (e.g., talking about a picture). Phonics and sight-word reading were the two most described teaching activities; therefore, this theme will focus on these two components. Most descriptions of the content did not mention which reading component was being targeted in the described teaching activity, meaning that this had to be inferred based on the description. This relates to the former sub-theme, where we describe the tendency to mention materials but not the targeted ability or method used for teaching. The following two quotes are examples of descriptions that have been labelled as phonics activities:

T2: “he has been instructed to put down the letters in his name while we are sounding out letter by letter”

T8: “Copy a word with a picture onto paper and read the word together. Write to a picture (that the student/teacher has taken during the day) with text-to-speech synthesis on iPad.”

The reason for the second quote to be labelled as a phonics activity is the use of text-to-speech synthesis. When this tool is used while writing in apps, the synthesis could provide the corresponding sound to each letter that is being written by the student. In that way, correspondence is indirectly practised. However, it should be noted that it is unlikely that this function was used every time a text-to-speech synthesis was used in teaching activities, meaning that this interpretation is very liberal.

The specific word “phonics” was in fact not used by any of the teachers, even though that word is commonly used when discussing reading instruction in Sweden (there is no perfect translation, whereby many choose to use the English word). The descriptions did not contain synonyms or descriptions, such as “grapheme-phoneme correspondence”, either.

A notable theme in the described content was the focus on sight-word reading activities. In sight-word approaches, it is common to teach words that are important for the student in some way, for example, warning words or words connected to the student’s interests. However, the teachers’ descriptions lacked information about what kind of words were being taught. These three quotes are examples of how sight-word reading instruction was described:

T3: “Read sight-words Read sentences with words and pictures of signs”

T6: “Practised sight-words”

T4: “Practising to ‘read’ based on pictures and manual signs”

Delivery of reading instruction

This sub-theme focuses on the delivery of reading instruction, namely, the how. The teachers’ descriptions often contained a multitude of teaching activities for each student. There was a large variety of activities within each week, but also in between weeks. The multitude could be described with the use of different media such as printed books, tablets (apps or educational TV shows), picture support, and manual signs. To exemplify the variety of activities, the following quotes stem from one teacher-student interaction, and they are taken from each week of reading instruction for that student:

T3:

Week 1: “Read sight-words. Read sentences with words and [manual] sign pictures. Worked with Praxis sounds. Rhymes”

Week 2: “Read a reading book with pictures and text, Rhymes, Read a book, Morning meeting - sight-words Writing – reading”

Week 5: “Rhymes, read Widgit book, Praxis, letter elevator [Bokstavshissen; TV show on letter knowledge for children with a hearing disability], model sentences”

Week 7: “Listened to sounds, a film about letters, Praxis sounds, rhymes, [manual] sign books”

Week 8: “[Manual] sign cards, morning meeting - sight-words”

Week 10: “Responsible for morning meetings and during these read and wrote a lot. Listened to sounds. Paired [manual] signs and pictures. Sign books. Palin [educational material].”

Week 14: “Letter elevator [Bokstavshissen; TV show on letter knowledge for children with hearing impairment], listened to letter sounds, wrote on the computer and by hand while listening to sounds. Morning meeting with sounding out.”

The quotes above come from seven weeks of reading instruction (notes from four weeks have been removed as the student either had a holiday or was on sick leave, and seven weeks are missing because the teacher did not send in the logbook). The teaching activities during these weeks included phonics, phonemic awareness, and many different general reading activities. The student being taught in these quotes had a hearing impairment and used AAC in the form of manual signs and pictures (see Table 1). In these quotes, it is evident that the teacher used these modes of AAC in many of the reported reading activities, both when reading books and sentences.

The scaffolding teacher

This main theme encompasses the supportive and adaptive roles that the teachers play in their students’ learning. This theme highlights how teachers employed various strategies to scaffold students’ learning experiences, in that instructional methods were tailored to individual needs and motivation. Two sub-themes emerged within this context: inclusive wording and student-motivated instruction. These sub-themes show how teachers used language and personalised approaches to create a collaborative and engaging educational environment.

Inclusive wordings

This sub-theme highlights how teachers frequently used collaborative language to describe their instructional activities. Further, this sub-theme demonstrates an effort by teachers to present learning as a shared endeavour between themselves and their students. By employing phrases such as “we write” and “we read,” teachers emphasised joint participation in educational tasks. For example, in the quote below, the teachers used “we” when describing the reading activity.

T2: “We sound out and write together lamp, ball and cat. [The student] says/reads the words. We dramatise, sound out and write the words. [The student] manages some phonemes. Puts down the letters of his name (lowercase). I draw and sound out letter by letter. [The student] finds i, o and n. Train and bus. We write and read the words. [The student] decides who will go along and then I write these, and we read.”

It was also common to use the form “we” when describing an activity that included writing:

T11: “Practised the Phoneme Alphabet with cards - built words in Lexia [computer program with reading and writing activities] (sound split, arrange syllables). A dictionary where we write down the words we work with in Lexia.”

Other reports used the inclusive wording describing the entire reading activity:

T8: “Writing to a picture (that the student/teacher has taken during the day) with speech synthesis on an iPad. We decide together what to write, the staff writes the sentence/word on a piece of paper, and the student tries to find the correct letters on the iPad.”

In the quote above, the teacher described an activity where it is the teacher who writes the word, and the student tries to find the letters on an iPad. In another example, the teacher used inclusive wordings to describe that the student and teacher write together:

T7: “Every day we write a diary together, which also provides practice with letters and reading.”

Other examples of inclusive language in the logbooks included using paraphrases when describing the students’ reading activities. For example:

T1: “Written (placed) and read two-word sentences with the flashcards.”

In the quote, the teacher uses the word “written” but clarifies in brackets “(placed)” that the student did not write but used flashcards. The quote also illustrates how the teacher equates writing with building sentences using sight-words. This way of using alternative instructional methods can also be seen in the following quote:

T4: “Practising to ‘read’ based on pictures and manual signs.”

This teacher used quotation marks around the word “read”, indicating that the student might not be reading but rather interpreting pictures and manual signs.

In summary, the use of inclusive wordings in teachers’ descriptions of reading activities indicated a focus on joint participation between teachers and students. Teachers frequently used phrases like “we write” and “we read” to describe collaborative tasks. This approach was applied across various activities. The use of inclusive language highlighted the teachers’ efforts to present educational activities as cooperative efforts.

Student-motivated instruction

This sub-theme illustrates how teachers adapted their instructional methods to align with students’ motivations and interests. Teachers personalised tasks based on each student’s preferences and curiosity, often incorporating students’ personal experiences and immediate surroundings into the learning content. This approach focused on tailoring educational activities to the specific interests and contexts of each student.

T1: “Practised placing the letters of his name with concrete materials and in the app ‘Letter Puzzle’ [Bokstavspussel]. This week, he dared to try writing the new word - mum. … Practising with sight-words and forming sentences with flashcards. [The student] participates but wants the exercises to go as quickly as possible. He enjoys practising with stuffed fabric letters.”

This example shows how the teacher tailored the activities to what the student found engaging and manageable. The content and progression of the instruction are focused on the student’s well-being.

T1: “Worked systematically with exercises from the project ‘Writing as a Goal – Language as a Means’ [Skriften som mål – språket som medel] from the Karlstad Model. Practising recognising letters in writing, sound, and manual signs. Practising with sight-words and forming sentences with flashcards. (three times ten minutes this week). [The student] has been doing this since the middle of the term. She has worked with three words and two letters, o and i. This week she became curious about more words that were in the work box. Therefore, I have added two more words to the material.”

The above quote is another illustration where the teacher’s description of reading activities is guided by the student’s motivation, and the addition of words in the material is guided by the student’s curiosity. Other examples included student-directed choice of teacher:

T2: “[The student] is very motivated to practice reading. [He] has chosen to work only with me, but this week [he] has ‘let in’ [the teacher], who is a teacher in the class.”

The quote above illustrates that the student’s preference for working with a special teacher guided the form of the lecture. Another teacher described the content of the reading session as being focused on events that were in the student’s immediate surroundings and closely related to the student:

T13: “Monday: Bookcreator [an app]: Teacher/assistant writes on a paper what happened over the weekend. The student copies it into Bookcreator. Uses pictures that were sent. Presents to classmates by showing/reading from the iPad on the smartboard.”

The teacher described that the activity was based on this student’s experience. Another example:

T11: “Reading sentences to pictures for the parent-teacher conference that he has previously dictated.”

This quote is another example of the teaching activity being guided by the event that was happening around the student. It is worth noting that the quote above was the only reading activity reported for that week. Many teachers reported using known names as the basis for words to practice. It included practising the student’s name, names from the student’s family (or the words mum and dad), or names of the student’s classmates, see two examples below.

T10: “Praxis alphabet [Praxisalfabetet, The Nuffield Dyspraxia Programme for training speech sounds] short words, writing one's name, reading, recognising classmates’ names.”

The second example included the use of pictures of events that happened during the day, the usage of familiar names to read, and the student-directed choice of what to write.

T8: “Writing to a picture (taken by the student/teacher during the day) with speech synthesis on an iPad. We decide together what to write, the staff writes the sentence on a paper, and the student tries to find the correct letters on the iPad. Practice writing the staff's names - the student suggests names and together we try to spell them - the teacher first writes the names in a notebook and the student copies them a few times.”

These quotes illustrate how teachers adapted their teaching activities based on student motivation and immediate surroundings. Examples included using apps to document personal experiences, practising with familiar names, and student-directed choices of content and tutors. This approach focuses on engaging students through their interests and personal contexts.

Discussion

This study aimed to investigate how teachers in Swedish compulsory schools for students with intellectual disability described their reading activities directed towards students in need of AAC who were in their early reading development. The results indicated a continuous juggling act between including appropriate components of reading while at the same time keeping the instruction accessible and motivating for the student.

A need for a stronger focus on the what

The described reading activities analysed in this study mainly focused on a vaguely described how, rather than on the what. For example, the teachers often described the material they used rather than the underlying reading skill being targeted. Take the example of the reading component phonics, which is an essential part of decoding instruction for beginning readers both with and without intellectual disability (NICHHD, 2000; Sermier Dessemontet et al., 2019). No logbook entries contained the word phonics nor any synonyms of the like. Furthermore, the logbooks did not include any visible descriptions of systematic phonics instruction. Some teaching activities that were coded as phonics contained descriptions of letter-sound matching or similar activities, but no description included a clear systematic approach, such as phonemes being introduced in a planned and ordered sequence, going from low to high complexity. That is not to say that it did not exist in the instruction to the students, but the teachers did not include it in their logbook descriptions of the content of their reading instruction. However, if the teachers had indeed used a systematic approach, this pattern should have been reflected in the logbook notes over time, which was not the case. This finding is in line with the results from an observational study by Sermier Dessemontet et al. (2022), where most of the observed classrooms used phonics, but only half of the classrooms did it systematically. The reasons for this lack of systematicity in reading instruction are still unclear, but it might be that the extensive focus on keeping reading instruction accessible and motivating for the students overshadows a much-needed focus on systematicity and knowledge acquisition.

Further, sight-word approaches were commonly described in the logbooks. Sight-word approaches have shown some effectiveness for students with intellectual disability (Browder et al., 2006), but these methods restrict the generalisability of the learned outcome due to the limited teaching of language encoding. Therefore, it has been recommended that these approaches should be integrated into a comprehensive reading program rather than used in isolation (Browder et al., 2006; Lemons et al., 2012; Reichow et al., 2019). The results in the current study were in line with these recommendations because sight-word approaches were often mentioned in the logbooks but were rarely the only teaching activity for the students. Instead, the teachers tended to use a multitude of teaching activities each week. In addition, some teachers expressed a certain scepticism towards sight-word approaches, exemplified by the following quote: “Practising to ‘read’ based on pictures and manual signs”. The fact that the word ‘read’ was written within quotation marks could be interpreted as the teacher doubting that this practice could be regarded as proper reading, even though it was used as a form of reading instruction.

Based on the logbook reports, it became evident that the students in the current study received few daily reading instruction sessions, and it was rare to have lessons that were longer than 30 minutes. In addition, many of the reading-related teaching activities were delivered by an untrained teaching assistant rather than a licensed special education teacher. These results differ quite substantially from how effective reading instruction for students with intellectual disability is described in the research literature. For example, a study by Allor et al. (2014) evaluated an intervention delivered daily for approximately 40 to 50 minutes in small groups with a specially trained teacher during one to four academic years. The students in the intervention group showed substantially larger improvement than the comparison group, which received teaching as usual, where about half received instructional training according to a specific curriculum and half received a less instructed approach.

Several previous studies have reported positive effects of using interventions where several methods are combined for students with intellectual disability (Afacan et al., 2018; Allor et al., 2014; Browder et al., 2008; Lundberg and Reichenberg, 2013; Palmqvist et al., 2025). The common theme from those studies is that the combined method utilises the five components from the National Reading Panel report (NICHHD, 2000). The teachers in the current study reported a multitude of teaching activities, which included elements of phonemic awareness, phonics, and reading comprehension. However, the vague descriptions, which often focused on what material was used rather than which method, limited the understanding of how the different components from the National Reading Panel were integrated into a structured and effective reading instruction for this sample. The means of delivery that were reported in the logbooks, such as having morning meetings, watching TV shows, and diary writing using picture-based AACs, described a multitude of teaching activities in general, not a multitude of reading-related teaching activities. In addition, there is no information on how those activities are integrated to achieve effective reading instruction. Mixed instructional methods must explicitly include components of reading for the instruction to be effective in fostering reading development.

The scaffolding teacher

The use of familiar contexts and student-directed choices in the described reading activities highlighted the emphasis on making learning meaningful and engaging for students. This approach not only caters to the student’s interests but also fosters a sense of ownership and motivation in their learning process. However, while such methods could be effective in maintaining student engagement, which is fundamental for reading development, they may not always align with evidence-based practices that emphasise the importance of systematicity and intensity in reading instruction for students with intellectual disability (Allor et al., 2014; Reichow et al., 2019; Sermier Dessemontet et al., 2019, 2022). For example, it was common for teachers to use names of family members, classmates, or teachers as target words to practice letter-sound correspondence. Previous research has highlighted some general guidelines to consider when selecting words for reading instruction with beginning readers. Easy-to-read words are short and contain sounds that the child could linger on (e.g., vowels and fricative sounds; Alatalo, 2022). As the child becomes more proficient in reading, the complexity should gradually increase (Allor et al., 2010; NICHHD, 2000; Reichow et al., 2019). By selecting words and letters based on the student’s interests, teachers may have introduced words that were too complex for the student’s proficiency level. This poses the risk that, rather than scaffolding the student’s learning, the instruction could fall outside the student’s zone of proximal development (Vygotsky, 1978).

Balancing student motivation with structured, scientifically validated teaching methods is crucial to ensure that students receive comprehensive and effective reading instruction. Based on the descriptions in the logbooks, it seems like the teachers struggled with this dual focus. Many descriptions show that the focus is narrowed down to keeping reading instruction accessible and motivating for the students, instead of combining accessible and motivating reading instruction with a focus on knowledge acquisition. These results align with results from a case study of a high school special education literacy class, where the special education teacher and the special education assistants struggled with the alignment of their definitions of literacy and the content and delivery of instruction in the special education setting (Ruppar, 2017). The results from the current study are also consistent with Klang et al. (2020), who found that social participation, such as daily living activities, was regarded as an important aspect of teaching among Swedish teachers in compulsory schools for students with intellectual disability, while teachers to students with intellectual disability integrated in mainstream school settings reported higher academic expectations on their students. The focus on social participation and personalised support expresses the promotion of inclusion for students with intellectual disability. For this group of students, an adaptive, inclusive environment that prioritises the holistic development of students with intellectual disability is often a prerequisite for knowledge acquisition (Burd et al., 2019). However, the focus on adaptive instructions must be used merely as a base for the student to be able to benefit from education and acquire knowledge. Adaptive instructions should not be used instead of scientifically validated teaching methods, but as a complement, as learning otherwise can be affected negatively.

Students with intellectual disability often require individually tailored instructions to meet their specific ability levels, and they often have difficulty practising independently, especially students with moderate and severe intellectual disability (Allor et al., 2010). In the current study, the teachers’ descriptions of their reading-related teaching activities included several ways of structuring their teaching to keep the students engaged in the activity. The use of inclusive wordings and a focus on words that are familiar to the students (e.g., names of family members or friends) were two common ways of adapting the activity identified in the logbooks. In the teachers’ descriptions, there were also many reports of using different modes of AAC in combination with reading instruction. As the use of AAC is often a prerequisite for students with intellectual disability to engage in a teaching activity (Williams, 2024), this is likely to represent a very useful practice. However, some teachers described the use of AAC, more specifically the use of picture support, during sessions where the students are supposed to learn to read. This poses a risk of the student naming pictures rather than learning to decode the target word. AAC is, of course, strictly necessary for many students with intellectual disability to enhance their understanding of teaching activities and educational tasks, but if it is used in the wrong way so that the student does not actually practise decoding, it would be reasonable to assume that it could hamper further development in decoding. The results from the current study indicate that teachers struggled to find a balance between the students’ need for personal adaptation and the focus on knowledge acquisition, and the analysis revealed that teachers sometimes tended to adapt the content of reading instruction. This does not align with research on reading instruction for students with intellectual disability, where, for example, Allor et al. (2010) emphasised the importance of adjusting the delivery and context of instruction. Specifically, Allor et al. recommended that students should be given time to adjust to the learning process and engage for extended periods and that appropriate levels of difficulty should be maintained. Recommendations like this need to be implemented in the compulsory school for students with intellectual disability to enhance knowledge acquisition, while at the same time making the learning activity accessible. It might be that the struggle with balance in reading instruction is connected to teachers’ beliefs and perspectives on reading instruction for students who require AAC. A study by Ruppar et al. (2011), where special education teachers were surveyed about their perspectives on literacy instruction for students with severe disabilities who used AAC, showed that the surveyed teachers rated literacy instruction that was grounded in life skills, for example, following a picture schedule or identifying relevant words or phrases on an AAC system, higher than literacy instruction that was derived from the general curriculum, such as reading a textbook or defining words. The authors concluded that teachers may view their students’ characteristics as primary barriers to accessing literacy instruction (Ruppar et al., 2011).

Limitations

The analysis and discussions in this manuscript are based on how teachers described the content of their reading instruction. All data came from logbooks that the teachers who constituted a control group in a research project were asked to fill out every week for 18 weeks. Teachers were asked to report an estimate of the number of sessions and time spent on reading instruction and to briefly describe what they did during reading instruction. This instruction is broad and therefore open to interpretation. More detailed instructions might have led to more consistent answers focusing on, for example, specific teaching methods. This should be taken into consideration when reading the results and the discussion. The teachers’ sometimes vague descriptions of their reading instruction impeded the coding of which reading component was being targeted. This is mirrored in the low inter-rater reliability figures across entries. As can be seen in the reliability figures across categories, the lowest consensus was for phonics (56%), sight-word reading (67%), and other (58%). Many disagreements arose from difficulties deciding whether a reading activity should be coded as phonics or sight-word reading, hence the low figures for these categories. Although these low inter-rater reliability figures partly arose from vague terminology in the logbooks, we acknowledge that they are problematic. We undertook several measures to ensure the robustness of our coding, such as thorough consensus discussions. Further, to reduce the risk of understating the use of the different components, we used a liberal interpretation of, for example, what could be considered phonics. However, there might instead be a risk that we have overestimated the use of the different components. In addition, many logbook entries were missing, and many logbook entries consisted of information that the student was on sick leave. Data was collected during the pandemic, which could have contributed to the missing data. Thus, the data might not be representative of how much reading instruction was provided over the 18 weeks.

Conclusion

The themes found in this study highlight the difficulties of maintaining a balance between the required focus on knowledge acquisition and making reading instruction accessible and motivating for students. While there is a growing body of research on evidence-based practices for teaching students with intellectual disability to read, implementing these methods in compulsory school settings remains a challenge. The results suggest a need for further training and support to strengthen teachers’ competence in evidence-based reading instruction. Additionally, the lack of necessary resources may contribute to the difficulty in balancing accessible teaching with effective knowledge acquisition for students with intellectual disability.

Implications for practice and further research

The results of this study highlight the critical need for supporting teachers in keeping the balance between knowledge acquisition and accessible teaching. This support could come through targeted professional development, as well as increased resources that allow teachers to spend more time on direct instruction rather than developing individual adaptations on their own. The findings underscore the importance of guiding teachers in aligning personal adaptations, particularly those motivated by student interests, with evidence-based practices in reading instruction. This alignment is crucial for ensuring that students receive instruction that not only engages them but also effectively supports their reading development. Given that the data in this study were limited to logbook excerpts, further research is necessary to explore in greater depth how best to achieve these adaptations and integrate them into effective, evidence-based reading practices for students with intellectual disability. The significance of this study lies in its potential to inform both policy and practice, ensuring that adaptations do not compromise the systematic and structured instruction these students need to succeed.

Supplemental Material

Supplemental Material - Balancing accessible teaching and knowledge acquisition: How teachers describe their reading instruction for students with intellectual disability

Supplemental Material for Balancing accessible teaching and knowledge acquisition: How teachers describe their reading instruction for students with intellectual disability by Karin Nilsson, Gunilla Thunberg, Emil Holmer, Jenny Samuelsson, Mikael Heimann, Monica Reichenberg and Lisa Palmqvist in Journal of Intellectual Disabilities.

Footnotes

ORCID iDs

Karin Nilsson

Gunilla Thunberg

Emil Holmer

Jenny Samuelsson

Mikael Heimann

Monica Reichenberg

Lisa Palmqvist

Ethical considerations

The present study was approved by the Swedish Ethical Review Authority (no. 2019-03845). The study followed the Ethical principles for research involving human subjects from the WMA Declaration of Helsinki (World Medical Association, 2013).

Consent to participate

All included teachers and caregivers to the included students signed an informed consent before participation.

Consent for publication

All included teachers and caregivers to the included students received information that the results were to be published and signed an informed consent before participation.

Author contributions

Karin Nilsson: conceptualisation, methodology, formal analysis, writing – original draft, writing – review and editing, visualisation, project administration. Gunilla Thunberg: conceptualisation, writing – review and editing, supervision, project administration, funding acquisition. Emil Holmer: conceptualisation, writing – review and editing, supervision, project administration. Jenny Samuelsson: conceptualisation, investigation, writing – review and editing, project administration. Mikael Heimann: conceptualisation, writing – review and editing, supervision, project administration, funding acquisition. Monica Reichenberg: conceptualisation, writing – review and editing, supervision, project administration. Lisa Palmqvist: conceptualisation, methodology, formal analysis, investigation, writing – original draft, writing – review and editing, visualisation, supervision, project administration.

Funding

The research was supported by grants to Mikael Heimann from the Marcus and Amalia Wallenberg Foundation (Dnr 2018-0084) and to Gunilla Thunberg from the Swedish Research Council (Dnr 2018-04702).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Participant data will not be shared due to the risk of compromising the de-identification of the participating teachers. Pre-registered protocol for the larger intervention study that these teachers were part of can be found at . Supplemental material with a translated version of the logbook template is available.

Supplemental Material

Supplemental material for this article is available online.

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