Emergent Literacy Assessment in Children with Autism Spectrum Disorder who have Limited Verbal Communication Skills: A Tutorial

Purpose: Children with autism spectrum disorder (ASD) are at increased risk of experiencing 2 difficulties with the development of literacy, including the emergent literacy skills 3 recognized to underpin conventional literacy success. Comprehensive assessment is 4 essential. Characteristics of ASD can make assessment challenging, and this can be 5 compounded when children are unable to demonstrate their skills using spoken language. 6 The purpose of this clinical tutorial is to outline the process of emergent literacy assessment 7 for children with ASD who have limited verbal communication skills. A case example of a 8 five-year-old boy is presented. 9 Method: Pertinent literature is reviewed around the literacy profiles of children with ASD, 10 the subgroup of children with ASD who have limited verbal communication skills, key 11 components of emergent literacy, and previous research examining the emergent literacy 12 abilities of children with ASD. The case report is described in depth and emphasizes the key 13 factors to consider when designing an assessment battery and protocol. 14 Results: The case example information is interpreted, and its application is discussed. Key 15 outcomes are highlighted including a greater understanding of the child’s literacy strengths 16 and needs and the implications for individualized instruction. 17 Conclusion: The clinical tutorial highlights the need for a comprehensive, well-planned 18 assessment approach, that involves all members of the educational team, and that is 19 considerate to the needs of the individual child and responsive to their communication 20 needs. 21


children with ASD who have limited verbal communication skills and are in the early stages 48
of literacy learning, also referred to as the emergent literacy period. 49

Emergent Literacy 50
The goal of learning to read is the ability to read with comprehension. Gough and 51 Tunmer's (1986) Simple View of Reading is a useful model for conceptualizing the cognitive 52 skills needed to achieve this goal. Within this model, reading comprehension is viewed as 53 the product of two constructs, word recognition and language comprehension, with both 54 recognized as critically important for reading success. The Simple View of Reading can also 55 be used to categorize emergent literacy skills, with print-related skills (letter name and 56 letter sound knowledge, print concepts, early name writing, and early developing 57 phonological awareness) important precursors for later word recognition, and meaning-58 related skills (vocabulary knowledge, syntactic knowledge, and narrative skills) essential for 59 language comprehension (National Institute of Child Health and Human Development, 60 2005). 61 Children who start school with strengths in emergent literacy skills are more likely to 62 become successful readers (Catts, Herrera, Nielsen, & Bridges, 2015;Tunmer, Chapman, & 63 Prochnow, 2006). It is important to recognize that these emergent literacy skills also provide 64 a strong platform for conventional writing development (Rohde, 2015), and that beyond the 65 cognitive components identified above, there are important psychological (e.g., motivation, 66 self-efficacy) and ecological (e.g., social, cultural, and schooling experiences) factors that 67 have a powerful influence (Aaron, Joshi, Gooden, & Bentum, 2008;Rohde, 2015) and must 68 be considered within broader models of emergent and conventional literacy acquisition. 69

Emergent Literacy in Children with ASD 70
Recent research has begun to examine the emergent literacy abilities of children 71 with ASD and the links to later reading skills (e.g., Davidson & Ellis Weismer, 2014;Dynia, 72 Brock, Justice, & Kaderavek, 2017;Jacobs & Richdale, 2013;Westerveld et al., 2018;73 Westerveld et al., 2017). Results from this research have highlighted the wide variability in 74 (emergent literacy) performance in young children with ASD, with some children 75 demonstrating age-appropriate skills (e.g., in alphabet knowledge and phonological 76 awareness) and others demonstrating significant challenges. Davidson and Ellis Weismer 77 (2014) specifically evaluated early reading profiles in a group of 94 five-year-old children 78 with ASD (57 -79 months), based on performance on three subtests of the Test of Early 79 Reading Ability, Third Edition (Reid, Hresko, & Hammill, 2001) (Alphabet,Conventions,and 80 Meaning). Results revealed four early reading profiles. Two profiles, accounting for 62% of 81 the sample, showed higher print-related skills (alphabet knowledge) relative to meaning-82 related skills. A third profile (31%) showed poor performance on all three emergent literacy 83 subtests, while 7% (profile 4) showed high levels of performance across all subtests. These 84 results support an overall profile of relative strengths in print-related emergent literacy 85 skills, particularly alphabet knowledge, and challenges in meaning-related skills (e.g., oral 86 narrative comprehension; see  in preschool children with ASD. 87 Although we hypothesized that this relative strength in alphabet knowledge could be 88 autism-specific, our recent study revealed no differences in preschoolers with ASD and their 89 peers without ASD when controlling for language ability, IQ, age, gender, and SES 90 (Westerveld, Paynter, Brignell, & Reilly, 2020). Further research is clearly needed to better 91 understand why children with ASD are at such a high risk of literacy learning difficulties. 92 Barriers to Literacy Learning in ASD 93 emergent literacy skills, which is consistent with the diagnostic criteria for an intellectual 118 impairment (American Psychiatric Association, 2013). Previous research has supported this 119 link between IQ and emergent literacy development, with children with ASD with 120 intellectual impairment demonstrating significantly lower levels of emergent literacy across 121 most skills, except alphabet knowledge . 122 To address the high literacy needs in this population, it is important to outline some 123 of the beliefs around ASD and literacy that may have influenced the research conducted to 124 date, and served as access barriers to appropriate literacy instruction for children with ASD, 125 including those who have limited verbal communication skills (Westerveld, Paynter, & 126 Trembath, 2016). One prominent misconception is that these children show a particular 127 literacy profile with strengths in decoding. Much research has focused on children with ASD 128 having "hyperlexia," i.e. precocious abilities to decode text that are incongruent with, and 129 exceed, their reading comprehension abilities (Frith & Snowling, 1983). This contrasts with 130 research findings that indicate a hyperlexic profile (i.e., strong decoding, poor 131 comprehension) is not the most common (e.g., 25% in Nation et al., 2006) profile observed 132 in children with ASD. These findings highlight the importance of including detailed 133 assessment of word recognition skills in children with ASD rather than assuming this is an 134 easily learnt skill. To illustrate, in our recent study (Westerveld et al., 2018) investigating the 135 word reading abilities of 41 children with ASD who were in their first year of schooling, we 136 found that 56% performed below expectations in reading accuracy on a standardized 137 assessment of reading ability (York Assessment of Reading for Comprehension; Snowling et 138 al., 2012). 139 A second common misconception is that there are pre-requisites to literacy learning 140 and that some children will not benefit from literacy instruction. Keefe and Copeland (2011) 141 argued that the belief that some individuals cannot acquire literacy skills can then lead to 142 individuals being denied opportunities to acquire these skills. Mirenda (2003) also 143 highlighted this issue and argued that students with ASD who have cognitive impairments 144 may be excluded from literacy instruction due to mistaken beliefs that they do not have the 145 capacity for acquiring literacy skills, yet show skills that are directly related to literacy 146 learning such as interest in books, print awareness, and recognition of sight words. Mirenda 147 advocated abandoning a "readiness" model and the assumption that spoken language was 148 needed to benefit from instruction, and instead suggested a need for the use of multiple 149 strategies formulated at the child's level of literacy development, underpinned by 150 assessment of the child's strengths and needs. 151 Several studies have demonstrated that children who have limited verbal 152 communication skills can, and do, develop language and literacy skills when they are 153 provided with high quality literacy learning opportunities (e.g., Afacan, Wilkerson, & Ruppar, 154 2018;Allor, Mathes, Roberts, Cheatham, & Champlin, 2010;Erickson, Koppenhaver, Yoder, 155 & Nance, 1997). These findings are consistent with the view that every child sits somewhere 156 on a literacy learning continuum (Erickson, 2000), and that no child is "too anything" to 157 learn to read and write (Yoder, 2001, p. 5). To better understand each child's strengths and 158 challenges in literacy-related skills, in-depth assessment is required to help guide 159 individualized literacy instruction. 160

Communication Skills 162
During the last few years we have conducted a research project that had two key 163 aims: (1) to develop and refine an accessible literacy assessment approach for children with 164 ASD who have limited verbal communication skills, and (b) to pilot test this approach in 165 examining the literacy profiles of five children. From a research point of view, the battery 166 and the protocol needed to be comprehensive enough to gather critical information and 167 systematic enough to attain reliable information and ensure adherence to standardized 168 instructions and particular test requirements when possible (Paynter, 2015). However, it 169 also needed to be efficient and flexible to ensure a positive experience for the child with 170 ASD. The project involved revising and adapting assessment materials used in previous 171 research by members of this research team (Westerveld et al., 2018;Westerveld et al., 172 2017;Westerveld, Paynter, & Wicks, 2020), as well as including additional tools developed 173 at the Centre for Literacy and Disability Studies at the University of North Carolina at Chapel 174 Hill (Erickson, Clendon, Abraham, Roy, & Van de Carr, 2005;Erickson et al., 2008). 175

Our Approach 176
We will first outline factors we considered when developing this battery, followed by 177 a case example (Max, not his real name). 178

Factors Considered when Designing the Assessment Approach 179
Factors considered when designing the assessment approach (battery and protocol) 180 included having an evidence-based theoretical model, using a transdisciplinary model, 181 ensuring the battery was comprehensive, yet allowing for an individualized approach that 182 was suitable for children with ASD who have limited verbal communication skills. 183 Theoretical model. Our approach was firmly based on two key theories / models, 184 the Simple View of Reading (SVR) and a social constructivist framework (Vygotsky, 1978). In 185 line with the SVR, we categorized the emergent literacy skills as the print-related skills 186 needed for later word recognition and the meaning-related skills that are essential for 187 language comprehension. Social constructivism refers to the importance of social 188 interactions for developing knowledge. Pertinent to our assessment battery, emergent 189 literacy skills are generally nurtured in the home or (pre)school environment, based on 190 social interactions between the child and the parent/caregiver or educator. Therefore, our 191 assessments extended beyond appraising the child's skills to evaluating the child's literacy 192 environment, at home and/or (pre)school. 193 Transdisciplinary Approach. The importance of taking a transdisciplinary approach 194 to assessing children with ASD and involving parents in the assessment process is well 195 documented (e.g., Arciuli et al., 2013;Trembath, Paynter, Sutherland, & Tager-Flusberg, 196 2019; . This research project involved a partnership with 197 an independent school for children with ASD in a large Australian city. The head speech 198 pathologist from the school was a member of the research team and information about the 199 child was collected from educators and parents as part of the assessment approach. This 200 included information from informal questionnaires such as a home literacy questionnaire 201 (as used in Westerveld & van Bysterveldt, 2017); standardized parent questionnaires, such 202 as the communication section from the Vineland Adaptive Behaviour Scales -Second 203 Edition (VABS-II; Sparrow, Cicchetti, & Balla, 2005); as well as prior speech pathology 204 assessment results. In addition, less formal information was collected such as details on the 205 child's communication skills at home and school, their interests, their strengths, and the 206 strategies and supports identified as helping them to learn best (e.g., movement breaks, 207 visual schedules). 208 Comprehensive Battery. The assessment battery itself needed to take into account 209 the heterogeneity observed in the (emergent) literacy skills of children with ASD (e.g., 210 Nation et al., 2006;Westerveld, Trembath, Shellshear, & Paynter, 2016) and examine the 211 key emergent literacy skills considered important for supporting children's literacy learning, 212 i.e., letter name and letter sound knowledge, print concepts, early name writing, and early 213 developing phonological awareness; and the meaning-related emergent literacy skills of 214 vocabulary knowledge, syntactic knowledge, and text-level language skills. In addition, our 215 battery needed to include measures to evaluate the home and/or (pre)school literacy 216 environment. Finally, this battery included the combination of both formal standardized 217 measures and informal measures consistent with recommendations from Trembath et al. 218 (2019). This combination was deliberately selected to enable both comparison to 219 expectations for age, along with fine-grained investigation of child strengths and needs and 220 to capture discrete skills that standardized assessments may lack sensitivity to in this 221 population due to potential floor effects. Appendix 1 shows an overview of the 222 comprehensive emergent and early literacy assessment battery. 223 Individualized Approach. An individualized approach to assessment for children with 224 ASD was critical, consistent with published guidelines (Paynter & Fothergill, 2015;Trembath 225 et al., 2019). An individualized approach suggests considering both the ASD feature 226 presentation in a given child in preparation for the assessment by the examiner and in 227 informing the measure selection, implementation, and interpretation (Paynter & Fothergill, 228 2015), as well as a focus on looking within the child for areas of strength and need as 229 opposed to comparing the child to neurotypical peers or other children with ASD (see 230 Trembath, et al., 2019). An important implication was to go beyond standardized 231 assessment measures where floor effects may be present limiting meaningful interpretation 232 for individuals with higher levels of need to complement these approaches with informal 233 assessment tasks that could be adapted to an individual child's level of functioning, 234 language ability, interest, or needs. 235 Considerate, Adapted Approach. It was imperative when designing this battery and 236 the protocol for administration, that the assessment approach itself considered the 237 characteristics commonly associated with ASD (see Paynter, 2015), as well as the unique 238 needs of this subgroup of children who have limited verbal communication skills. As a 239 group, these children are unable to respond to an assessment using spoken language, may 240 use some form of AAC, and may have significant receptive and expressive language 241 challenges. 242 Specific Considerations for Children with ASD. As with all assessment sessions with 243 young children, numerous factors needed to be taken into consideration, such as deciding 244 whether a familiar adult (e.g., teacher) should be present, the most suitable environment 245 and setting for the assessment (e.g., location, at desk, or on the floor), watching carefully for 246 signs of tiredness or distress, giving regular short breaks, and/or stopping completely if 247 necessary. However, obtaining valid assessment data from children with ASD can be 248 particularly challenging due to the comorbid conditions and behaviors described earlier. As 249 Paynter (2015) and Paynter and Fothergill (2015) argued, a better understanding of 250 common autism-specific traits may assist the clinician in not only choosing appropriate 251 assessment tools, but also in preparing for the assessment session, and in using the 252 appropriate supports during the assessment. The following factors were therefore taken 253 into consideration in designing the assessment protocol for the current research project and 254 are summarized in the assessment preparation checklist provided in Appendix 2. 255 Routine and Structure. Given children with ASD characteristically show rigidity in 256 thinking (American Psychological Association, 2013) and accordingly benefit from routines 257 and structure, the environment, timing and structure of assessment sessions should be 258 carefully considered. This may include consideration of the child's usual routine, preferred 259 activities, and circadian rhythm given the high prevalence of sleep disturbances in this 260 population (Carmassi et al., 2019). In addition, flexibility on behalf of the examiner regarding 261 the most appropriate setting and location to allow the child the best opportunity for success 262 is also recommended within this routine/structure. This may include for example, assessing 263 the child in a more comfortable or familiar environment, and focusing on essential elements 264 of the task rather than whether the child sits at a table or makes eye contact, both of which 265 may be challenging for some children with ASD. Providing routine and structure both in 266 timing of the assessment and during the assessment can also reduce anxiety which is also 267 often elevated in this population (White, Oswald, Ollendick, & Scahill, 2009), as well as 268 support motivation. 269 Anxiety, communication challenges, and social understanding impairments can lead 270 young children with ASD to be more challenging to engage in assessment than typically 271 developing children who are often more eager to please examiners (see discussion by 272 Akshoomoff, 2006). Thus, scheduling assessments at a time that does not conflict with 273 preferred activities, considers the child's optimal functioning time in terms of sleep and 274 alertness, and includes alternation of easy/difficult tasks is particularly important for this 275 population (for further discussion see Paynter & Fothergill, 2015). This alternation may 276 include the use of extrinsic reinforcement (e.g., preferred activities and interests, toys for 277 short breaks, "high fives") to facilitate engagement and motivation (Paynter & Fothergill, 278 2015). This may be informed by a reinforcer assessment completed in advance by teachers 279 or caregivers (e.g., see http://www.aba-instituut.nl/back-280 site/upload/content/reinforcementinventory.pdf) to inform items or activities to prepare 281 and use during the assessment. 282 Careful preparation of assessment materials in advance can also reduce transition 283 times between tasks and provide fewer opportunities for challenges through facilitating a 284 more timely assessment and less time for distractions or challenges. Routine and structure 285 can be complemented through the use of visual supports and social stories to make these 286 more salient and comprehensible to the child with ASD. 287 Social Story and Visual Supports. Providing a social story (i.e., outlining the process 288 and procedure, and key information about the assessment) beforehand and using visual 289 supports during the assessment can aid the child's understanding of key details such as who 290 will be present, where the assessment will take place, how long it will last, the order of 291 activities, and what will happen at the end. This is important given the social communication 292 challenges and theory of mind difficulties associated with ASD, and the novelty of an 293 assessment more broadly, may mean children with ASD are unsure of expectations, 294 including appropriate behavior, and whether the assessment has an end. Furthermore, they 295 may be challenged by the change in routine, which may increase anxiety and challenging 296 behaviors. These strategies (social narratives and visual supports) complement the use of 297 routine and structure by making these tangible and comprehensible in advance to the child 298 with ASD and were selected as empirically supported practices (e.g., see Wong et al., 2015) 299 that can reduce anxiety and challenges that may arise in response to the change in routine. 300 Environmental Audit of Test Location. As with all child assessments, it is important to 301 ensure that the test location and environment is selected to fit with the child's needs and 302 has minimal distractions. However, for children with ASD this is particularly important for 303 two key reasons. First, hypo-or hyper-sensitivity to sensory input (e.g., sounds) is part of 304 the diagnostic criteria (APA, 2013), and as such sensory features of the environment can 305 greatly impact on the ability of children with ASD to engage in testing to the best of their 306 ability. Second, executive functioning difficulties such as inattention, difficulties changing 307 from one task to another, and difficulty inhibiting impulses are common in ASD (Geurts,308 Vries, & Bergh, 2014) which may be exacerbated by distractions in the environment such as 309 the presence of preferable items or sensory distractions. As such, the use of an 310 environmental audit (e.g., Attfield, Fowler, & Jones, ND) is recommended to consider the 311 sensory features of the environment such as light and noise, in order to reduce or remove 312 potential sources of distress or distraction. Such an approach is consistent with evidence-313 based practice in ASD and falls under the broader category of an antecedent-based 314 intervention (Wong et al., 2015). 315

Specific Considerations for Children who have Limited Verbal Communication Skills. 316
Two additional considerations that are essential for children who have limited verbal 317 communication skills are response mode accessibility and receptive language demands. 318 Children were encouraged to bring their AAC system and to use this to communicate during 319 the assessment. It was important to ensure, however, that their ability to demonstrate their 320 (emergent) literacy skills and understandings could not be restricted by their spoken 321 language abilities nor by the language available to them within their AAC system. For this 322 reason, it was important that the children were able to complete the assessment without 323 the requirement to respond using spoken language or AAC. but instead of the children being asked to read the words aloud, they were asked to select a 332 target word from a field of four, which included three distracter words that began with the 333 same letter and were of similar length. For example, the child was presented with the words 334 did, dig, dog, and do and asked to "show me the word that says dog". Adaptations such as 335 these need to be carefully considered, both in terms of choosing appropriate distracter 336 items (Erickson et al., 2008) and in terms of interpreting the child's performance on an 337 adapted task. This adapted task, for instance, requires a child to match speech to print but 338 does not require the child to access his or her own phonological representation for the 339 target word. In other words, the adult provides the speech, and the child links it with the 340 print. This process is the opposite of what occurs when children without spoken language 341 difficulties participate in these kinds of assessment tasks (refer to Clendon & Gillon, 2018, 342 for further information). 343 Receptive Language Demands. The receptive language demands of tasks are 344 important to consider, both in terms of possible adaptation for administration, and in terms 345 of interpretation. As discussed, many children with ASD exhibit language difficulties (Eigsti, 346 de Marchena, Schuh, & Kelley, 2011). Furthermore, it is well recognized that children who 347 have limited verbal communication skills are at significant risk for experiencing language 348 learning challenges (Erickson & Geist, 2016;Light, 1997;Sennott, Light, & McNaughton, 349 2016;Sturm & Clendon). We were particularly cognizant of the complexity of the 350 instructions provided to children when administering assessments. It was important that 351 instructions were kept as simple and concrete as possible and were delivered at a pace that 352 allowed sufficient processing time. This was balanced with the need to adhere to 353 standardized instructions and test requirements when standardized tests were used 354 (Paynter, 2015). As recommended in Paynter (2015), adaptations made for individual 355 children were clearly documented in the recording forms and in any reports shared with the 356 educational team and family. The receptive language demands of tasks were also 357 considered when interpreting the child's results. To help us prepare for the assessment, the school team shared a comprehensive profile 369 document introducing Max's interests, strengths, and the strategies and supports identified 370 as helping him to learn best. Max's profile document revealed that he had several interests 371 at school including reading books, interacting with numbers and counting, and being 372 physically active -climbing, swinging, and swimming. The Profile also documented strengths 373 in a variety of areas including numbers and counting, handwriting, following a visual 374 schedule, using his AAC system, recognizing letters, cooking, and looking after his 375 belongings. Transitions were identified as being difficult at times for Max; he established 376 routines very quickly and could find it challenging to accommodate changes. Visual supports 377 were identified as being supportive during transitions. It was also mentioned that Max 378 benefitted from movement built into his day, particularly if he was needing to sit for periods 379 of time. The Profile indicated that Max used a combination of spoken vocabulary (English 380 and three words in Mandarin), a picture communication folder using picture exchange as his 381 access method, his AAC system (Proloquo2Go) with a combination of line drawings and real 382 photos, gesture, and movement to communicate. 383 Assessment Results. We used our comprehensive assessment battery (see Appendix 384

1) to gather information on Max's emergent literacy skills. This included information from 385
Max's parents, his teachers and therapists and through direct assessment.

School-specific Checklists. The expressive communication checklist indicated that 392
Max was able to communicate yes and no using spoken language when he was in a well-393 regulated state and the content was familiar. Using multiple modes of communication (e.g., 394 spoken language, visuals, and/or his AAC system), he was able to make simple requests, as 395 well as label or comment on things of high preference and interest. He mainly 396 communicated using single words or 2-3 word combinations (e.g., "mumma home"). Max 397 rarely initiated interactions in class but would respond to fun interactions initiated by others 398 (e.g., action songs on the trampoline). His ability to jointly attend to an action or item was 399 developing. At times, he would look to an adult for their response, and was starting to shift 400 his gaze from his AAC system to an adult when communicating. 401 Home Literacy. Max's mum also completed a Home Literacy Questionnaire; She 402 indicated that they had more than 20 books at home and that they read to Max 403 approximately 1.5 hours per week at bedtime and had been doing this from about 1 year of 404 age. His mum rated Max's interest in books as 4 out of 5 when compared to other activities 405 and indicated that he would sit for 5-10 minutes for a story. Although he often filled in 406 words or lines from familiar stories, he reportedly 'seldom' independently pointed to or 407 talked about the pictures in the story. Finally, his mum indicated Max was able to recognize 408 all 26 letters of the alphabet and his name. He also recognized 5-10 sight words and was 409 sometimes able to write these. and learning initial letter sounds, and teachers provided many creative ways for children to 426 engage in literacy activities such as using an obstacle course or a water balloon toss game to 427 engage with sight words. Teacher interviews further revealed the use of themed literacy 428 units providing students with a range of focus texts over the course of a semester as well as 429 different types of texts (comics, posters, videos, other digital media, narratives -picture 430 books, short chapter books in a few classes, information texts, fact sheets, websites etc). 431 Finally, Max's teacher reported that repetition, predictability and the use of visual scaffolds 432 had been integral to Max's success in literacy across the school year. 433

Meaning-related Emergent Literacy Skills. 434
Direct Child Assessments. Max was happy to participate and obtained a standard 435 score of 53 on the PPVT-4 (receptive vocabulary). On the TROG-2 (Bishop, 2003), he passed 436 Block A -two element clauses (e.g., The sheep is running), but responded inaccurately to 437 subsequent blocks which tested understanding of structures such as negatives, simple 438 prepositions (in versus on), and three element clauses; this yielded a standard score of 55. 439 Max did not respond to text-level questions during the print concepts test. 440 School-Specific Checklists. Results indicated that Max was able to follow one and 441 two-part familiar instructions when the referent was present. He was also able to follow 442 one-part familiar instructions when the referent was not present. In terms of understanding 443 questions, Max was able to respond to who/what labelling questions (dependent on 444 knowledge of vocabulary), simple where questions, and choice questions. His teacher 445 indicated that he was motivated by the shared stories they had focused on in class, and that 446 he was able to "show some basic comprehension skills by identifying main characters and 447 features such as the title of the text". 448

Print-related Emergent Literacy Skills. 449
Direct Child Assessment. Max was able to identify all of the letter sounds in the 450 Letter Sound Knowledge task. Max showed understanding of some early print concepts such 451 as reading from left to right and sweeping back to the beginning of the following line of text, 452 as well as responding to an inverted picture, but was unable to demonstrate understanding 453 in the context of the assessment battery of other early concepts such as the front of the 454 book and awareness that the print carries meaning. On the Phoneme Matching task, max 455 obtained a score of 7 out of 10 when asked to match the beginning sound of a word to one 456 of three sounds /m/, /b/, or /s/. He was able to represent three initial sounds for words on 457 the Invented Spelling task, writing feet as 'f', step as 's', and picking as 'p'. Max was unable 458 to write his name in the context of the assessment battery. Finally, Max was able to read 7 459 words correctly on the adapted word reading task. The collated information provided a comprehensive overview of Max's literacy 473 profile. This is helpful for a range of reasons including: 474 Understanding Max's Areas of Strength and Need. In order to maximize outcomes, 475 students need access to a comprehensive literacy program that enables them to build all of 476 the skills and understandings recognized as important for literacy development (Clendon & 477 Erickson, 2009;Erickson & Koppenhaver, 2020). This includes skills that Max has yet to 478 acquire, as well as those he may be able to perform under particular conditions but needs to 479 work on generalizing. For example, even though name writing was a skill that his school 480 checklists indicated he was able to demonstrate in the classroom, Max was unable to do so 481 in the name writing task. This may be due to established challenges in generalization across 482 contexts for children with ASD that have been observed from early experimental learning 483 studies onwards (e.g., Rincover & Koegel, 1975). Understanding Max's areas of need is 484 important because it can influence decision-making regarding which team member supports 485 which parts of the literacy program and when (e.g., when his teacher versus a teaching 486 assistant might work with Max in the classroom) and help with prioritizing any additional 487 input and support that might be available (e.g., speech pathology, occupational therapy) 488 (Erickson, Koppenhaver, & Cunningham, 2016). opportunities (Koppenhaver & Erickson, 2003), and fostering Max's receptive and expressive 497 language development using AAC will be essential for supporting Max to develop as both a 498 reader and a writer. Children with literacy profiles like Max can be taught conventional 499 literacy skills, including being able to identify sight words. However, it is important that sight 500 words are not taught in isolation, without a focus on developing other skills and 501 understandings (e.g., print concepts, language comprehension at word, sentence, and text 502 levels), because emerging readers and writers will struggle to apply these skills in 503 meaningful ways to support their reading, writing, and/or communication with others 504 (Erickson, Hatch, & Clendon, 2010). Therefore, combining direct child assessments with 505 classroom observations and teacher interviews is important to obtain an in-depth picture of 506 the instructional methods and how these may suit the child's literacy profile. 507

Understanding Max's Interests and Motivation for Literacy. It is critical that literacy 508
instructional programs for all children feature meaningful activities that promote cognitive 509 engagement. One strategy that can facilitate this engagement, is the personalization of the 510 curriculum so that individual interests and motivations are incorporated (Clendon & 511 Erickson, 2009). Max's teachers reported that he enjoyed being physically active. Photos of 512 Max engaging in physical activities such as climbing, swinging, and swimming were 513 therefore an excellent basis for photo-based storybooks, for example, or prompts for 514 writing. 515 Taken together, Max's case highlights the importance of taking a comprehensive 516 approach to emergent literacy assessment that is theoretically driven, individualized and 517 adaptive and that involves contributions from key team members of the transdisciplinary 518 team including parents and teachers. Our assessment battery which combined both formal 519 and informal assessment measures collated a wealth of information about Max's emergent 520 literacy skills. This information provided the team with a detailed understanding of Max's 521 areas of strength and need. It also identified next steps for instruction and key supports 522 moving forward. 523

Future Directions 524
Further research is needed to identify the optimal emergent literacy assessment 525 approach for children with ASD who have limited verbal communication skills. For some 526 children, such as those with severely limited attention and engagement, a battery of direct 527 assessments such as those administered above may not be feasible or appropriate. For 528 these children, a more naturalistic assessment approach including observational 529 assessments of children's literacy skills in the classroom, which capture the children's 530 abilities in context will be more suitable. One example of such an assessment is the BRIDGE 531 Assessment (Pierce, Summer, & O'DeKirk, 2005) which is a portfolio-style assessment 532 drawing on adult observations and work sample analysis to evaluate and document 533 children's emergent literacy skills and understandings. 534 Research should also further explore the application of tools such as the ELLCO for 535 children with ASD including those who have limited verbal communication skills. While the 536 ELLCO has been used extensively in mainstream classrooms to assess literacy practices, 537 many of the items lacked applicability in Max's classroom environment. A more ASD specific 538 observational tool that considers factors that can impact student learning and engagement 539 (e.g. environmental management, visual supports, implications of challenges with theory of 540 mind and executive functioning, sensory considerations, diversity of learning environments 541 such as classroom, playground, community) is likely to provide richer data with respect to 542 the literacy environment and practices in classrooms specifically designed to cater for 543 children with ASD. 544 Although appraisal of expressive language skills in children who have limited verbal 545 communication skills may be possible by using naturalistic and ecologically valid approaches 546 such as natural language sampling (Trembath et al., 2019), future research is urgently 547 needed to identify similarly naturalistic approaches for evaluating children's receptive 548 language skills, particularly beyond word-and sentence-level, which are often difficult to 549 measure using formal assessment tools. 550 Many children grow up in homes where more than one language is spoken, including 551 Max, our case example. With Max we administered all assessments in English, based on the 552 family reporting they spoke English in the home. Although we recognize the importance of 553 meeting the needs of students who are culturally and linguistically diverse, including those 554 who speak more than one language and/or use AAC systems (e.g., Mindel & John, 2018;555 Smith, Summers, Mueller, Carillo, & Villaneda, 2018), it is beyond the scope of this tutorial. 556 The assessment approach used in this pilot research project incorporated several 557 formal and informal assessments. A further assessment type that should be explored in 558 future research is use of dynamic assessment (see also . With static 559 assessment, a child's performance is examined in the absence of any attempt to modify or 560 enhance it, or provide support (King, Binger, & Kent-Walsh, 2015;Tzuriel, 2000). Static 561 assessment can be useful for evaluating performance on a particular skill and tracking 562 progress, but it does not examine the learning process for the child and/or explore potential 563 barriers to learning (King et al., 2015;Tzuriel, 2000). Furthermore, it does not provide useful 564 information on skills for which a child may have had limited learning opportunities (King et 565 al., 2015). In contrast to static assessment, dynamic assessment combines instruction or 566 feedback with assessment which allows the examiner to evaluate what the child is able to 567 do with the addition of input and support (van der Veen, Dobber, & van Oers, 2016). 568 An additional area requiring research is the role of technology in the emergent 569 literacy assessment process for children with ASD who have limited verbal communication 570 skills. This may include computerized testing and applications (i.e. apps) that may minimize 571 the need for verbal input or test-taking skills such as pointing and support both emergent 572 literacy assessment and development (for a discussion of touch screen tablets and 573 emergent literacy see Neumann & Neumann, 2014). Trembath et al. (2019) explored the 574 role of technology highlighting advances in areas such as eye-tracking, consumer-worn 575 equipment (e.g., activity sensors in watches, recording vests), and automated approaches to 576 language sample collection and analysis (e.g., Language ENvironment Analysis [LENA] 577 equipment). These authors reminded clinicians of the importance of critically appraising 578 new technologies; identifying their strengths and weaknesses in terms of the assessment 579 process. They also cautioned that individualized approaches to assessment will remain 580 critical. 581 As evident from Max's case example, the assessment of emergent literacy skills in 582 children with ASD who have limited verbal communication skills is a multifaceted process. 583 There are various elements requiring careful consideration, from identifying key members 584 of the transdisciplinary team, to determining the information to collect and the assessments 585 to administer, to identifying and implementing strategies for supporting the children's 586 wellbeing and sustained attention and engagement through the assessment process, and 587 finally to interpreting and applying the assessment findings. Many teams will require 588 professional learning and development support to build their capacity to engage in this 589 assessment process effectively. This highlights a final area for future research in terms of 590 identifying effective training and coaching models to support teams to maximize their 591 effectiveness and in turn optimize child outcomes. 592

Summary 593
This clinical tutorial has used the case example of Max, a 5-year-old boy with ASD 594 who has limited verbal communication skills to provide an overview of the process for 595 conducting an emergent literacy assessment. Literacy assessment with these children is 596 multifaceted and complex with several important considerations. It requires input from all 597 members of the educational team. Optimizing the assessment process is critical for 598 understanding individual children's literacy profiles including their areas of strength and 599 need, monitoring progress, informing instruction, and prioritizing supports. Emergent 600 literacy skills lay the foundation for later literacy success which in turn impacts key elements 601 of living and learning including communication, participation, self-determination, and 602 wellbeing. 603 Print-Related Assessment Alphabet Knowledge: Letter Name Knowledge and/or Letter Sound Knowledge Letter-Sound Identification probe (Erickson et al., 2005) -Children are asked to point to a target letter from a field of six.
Informal; maximum score 26 Letters were arranged on an A4 sheet of paper with clear margins. This task can also be administered using eye-gaze technology.

Print Concepts
Assessed based on Marie Clay's (2000) Concepts about Print assessment, with modifications based on Erickson et al. (2015) Informal; maximum score 12. See Appendix 3 for the Score sheet.
Using Pip and Posy and the Scary Monster (Scheffler, 2013), we engaged the child in book sharing for at least 5 minutes and checked the child's knowledge of orientation, directionality, concepts of words and letters. Name Writing Assessed and scored using the procedure outlined in (Bingham, Quinn, & Gerde, 2017) -Children are asked to write their name.
All children were provided with a pencil and a blank piece of paper.
Subtest from a standardized test; maximum score 10.
Adapted from . The examiner labelled a picture; children were then asked to identify the first sound in a word, by posting the picture in one of three cups labelled /m/, /s/, and /b/. Invented Spelling Assessed using the Phoneme Awareness task from the Early Reading Screening Inventory (ERSI; Morris, 1998) -Children are asked to spell 12 words.
Informal. One point is awarded for each phoneme represented within each word.
Children were allowed to use their AAC system.

Word identification
Assessed using the pre-primer word list from the Basic Reading Inventory (BRI; Johns et al., 2016).
Informal; maximum score 12 This task was modified as per Erickson et al. (2008). Children were asked to select a target word from a field of four, which included three distracter words that begin with the same letter and are of similar length. 1 point for "she's scared" or "there's a monster"