This study investigated the effects of text-to-speech (TTS) on the reading outcomes of four high school students with learning disabilities. The researchers used a single-case experimental design to evaluate reading comprehension and oral reading fluency before, during, and after the use of TTS. All participants scored higher on reading comprehension measures when using TTS and maintained skills for 4 weeks after. Results also indicated increased words read per minute and two students increased their Lexile reading scores from pre-to-post testing. The findings provide additional evidence that TTS can improve reading outcomes for secondary students with learning disabilities.

1. Article
The Effects of Text-to-Speech on Reading
Outcomes for Secondary Students With
Learning Disabilities
Mary Cece Young1, Carrie Anna Courtad1, Karen H. Douglas1,
and Yun-Ching Chung1
Abstract
This study investigated the effectiveness of text-to-speech
(TTS) on the outcomes of reading comprehension and oral
reading
fluency (ORF) for four secondary students with learning
disabilities. The researchers used a single-case A–B–A–B
withdrawal
design to evaluate the effectiveness of TTS on reading
outcomes. All participants scored higher on reading
comprehension after
using TTS when reading instructional passages and maintained
the skills for 4 weeks. Results on participants’ ORF also
indicated an
increased level of words read per min at the end of each
accommodation condition. Comparison of pre- and posttest
achievement
on the Lexile assessment showed that two of the four
participants increased their reading scores. Major findings are
discussed
with implications for practice and recommendations for future
research to increase the use of TTS in the classroom.
Keywords

2. assistive technology, learning disabilities, legislation,
secondary, text-to-speech
Reading is a necessary and critical skill. The acquisition of
reading substantially impacts educational outcomes, employ-
ment success, and personal and professional growth (Strang-
man & Dalton, 2005). In the United States, roughly 6 million
secondary students are reading at a level far below their grade.
The National Assessment of Educational Progress (NAEP)
from 2017 indicated that 74% of eighth graders do not have
proficient-level reading skills even though the data showed an
overall slight increase of reading achievement since 2015.
However, it should be noted that the growth rate is with stu-
dents who were higher achieving, whereas students with dis-
abilities remained statistically the same. The NAEP reading
achievement scores for students with disabilities in 12th grade
across the nation have not increased since 2009, the earliest
available data for students with disabilities at that grade level.
In fact, the gap between 12th graders with and without disabil-
ities has increased by 3 points since 2009, indicating that those
with disabilities are continuing to fall behind their peers with-
out disabilities (U.S. Department of Education, 2015, 2009,
2017).
Students With Learning Disabilities (LDs)
Several legislative actions have focused on evidence-based
practices and inclusion of students with disabilities in the gen-
eral education curriculum; yet as indicated by NAEP results,
reading scores have not improved for many students with
disabilities over the years. These results are especially concern-
ing for students with LDs who are the highest population of
students receiving special education services at 35% (Snyder,
de Brey, & Dillow, 2016; Wanzek, Otaiba, & Petscher, 2014).
Approximately 80% of students with LD exhibit deficits in the

3. area of reading (Cortiella & Horowitz, 2014). In addition, 90%
of students with LD are not able to read material independently
(Vaughn & Wanzek, 2014). Students who have difficulties
making meaning from text are likely to encounter postschool
challenges, such as being unemployed, earning lower incomes,
and exhibiting poor health as adults (Snyder & Dillow, 2013).
In order to reduce the negative postschool outcomes associated
with reading difficulties, addressing adolescents’ lack of read-
ing progress in our high schools is imperative.
Students with LD often experience several years of reading
difficulties that involve deficits in making meaning from text
(Cortiella & Horowitz, 2014). Achieving success in school
requires proficient reading skills to understand all content areas
(Vaughn & Wanzek, 2014). This gap widens in high school as
students struggle to gain information from text that is necessary
1 Illinois State University, Normal, IL, USA
Corresponding Author:
Mary Cece Young, Illinois State University, Campus Box 5910,
Normal,
IL 61790, USA.
Email: [email protected]
Journal of Special Education Technology
2019, Vol. 34(2) 80-91
ª The Author(s) 2018
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0162643418786047
journals.sagepub.com/home/jst
for learning (Saenz & Fuchs, 2002). To prevent the achieve-
ment gap from further widening between special and general

4. education students, additional types of reading accommoda-
tions need to be implemented. Technological accommodations
have been known to increase academic outcomes for secondary
students with LD (Stetter & Hughes, 2011).
The National Educational Technology Standards and the
Council for Exceptional Children Technology Specialist estab-
lished standards to train teachers on the use of assistive tech-
nology (AT) when instructing students with disabilities (Parette
& Peterson-Karlan, 2010; Smith & Allsopp, 2005). Even with
these guidelines, many teachers are not routinely using tech-
nology to make content accessible (Okolo & Diederich, 2014).
Adding to this dilemma is that classroom curricula are primar-
ily based in print (Rose, Meyer, & Hitchcock, 2011). Given
this, students who are able to read the text may benefit more
than students who struggle to read. This may lead to a Matthew
Effect that causes the word-rich to get richer and the word-poor
to get poorer (Stanovich, 1986). To aid in addressing this issue,
teachers need to boost students with disabilities’ motivation to
read. Technology is highly motivating to secondary students
with LD and can potentially increase the amount of content
they learn and read (Anderson-Inman, 2009; Bouck, Flanagan,
Miller, & Bassette, 2012).
AT
The availability of AT for individuals with disabilities has
increased dramatically since the 1970s (Poel, 2007). In a recent
state survey, 67% of teachers reported that they believed AT
increased student access to curriculum and outcomes, but only
33% of respondents could make print accessible on the com-
puter for their students (Okolo & Diedrich, 2014). When asked
what contributes to using technology, more than half of the
teachers identified the severity of the students disabilities, as
in, the more severe a students’ disability, the more likely they
were to use technology. The teachers in this study also identi-

5. fied staff knowledge as a barrier (70%) along with availability
of technology (61%) and funding (61%). Despite increased AT
device presence, teachers are not typically using AT in the
classroom, especially classrooms with students who have a less
severe disability (e.g., LD). Unfortunately, many teachers per-
ceive AT for a certain type of disability, have a lack knowledge
of how to use AT, and identify obtaining devices as
problematic.
The Tech Act, reauthorized in 2004, intensified the previous
legislation to promote the access, knowledge, and obtainability
of AT among students with all disabilities to access curriculum.
Prior to that in 1998, The Tech Act only defined AT as any
piece of equipment or product system, whether acquired com-
mercially, off the shelf, modified, or customized, that is used to
increase, maintain, or improve the functional capabilities of
individuals with disabilities (Assistive Technology Act of.
1998). Additionally, Individuals With Disabilities Act (2004)
requires every individualized education program (IEP) team to
consider AT for students with disabilities during annual
meetings (Parette & Peterson-Karlan, 2010). If the IEP team
determines AT is needed, an AT evaluation is conducted and
listed as a related service or supplementary aid in the student’s
IEP (Parette & Peterson-Karlan, 2010). The intention of this
mandate along with the discussion of Universal Design for
Learning was to increase the consideration of using AT more
frequently to help students access curriculum in the classroom,
regardless of the severity of the disability. However, these
legislative actions did not increase AT in the classrooms as
indicated by Okolo and Diedrich’s study in 2014.
Benefits of Text-to-Speech (TTS)
To assist secondary students in accessing curriculum, students
with reading disabilities oftentimes need compensatory tools

6. (e.g., TTS). TTS is an AT that can compensate for reading
difficulties and can increase access to text (Stodden, Roberts,
Takahashi, Park, & Stodden, 2012). AT used as a compensa-
tory tool is defined as any tool permitting a person to complete
a task where without the tool, the person is unable to perform
the task at the expected level (Courtad & Bouck, 2013). Gen-
erally, technology has shown to promote independence and
self-worth and to increase motivation and productivity among
students with LD (Edyburn, Higgins, & Boone, 2005). More
specifically, technological speech–synthesized accommoda-
tions have resulted in reading gains for students with LD
(Moorman, Boon, Keller-Bell, Stagliano, & Jeffs, 2010).
Following the use of TTS, Gruner, Ostberg, and Hedenius
(2017) found that students improved reading rates, increased
time spent on reading, and performed better on comprehension
measures. They also noted that both elementary-aged and sec-
ondary students improved their reading rates when using TTS.
However, only elementary school students showed improve-
ment in reading comprehension. Furthermore, Moorman,
Boon, Keller-Bell, Stagliano, and Jeffs (2010) found that the
lowest readers benefited the most from TTS in comprehension.
Specific TTS features have been known to enhance students’
engagement and outcomes (Wood, Moxley, Tighe, & Wagner,
2018). When individualizing TTS through the use of embedded
features (e.g., reading rate, voice type, and highlighting), stu-
dents with LD exhibited educational gains including increased
reading rates and comprehension (Moorman et al., 2010; Tian
& Okolo, 2007; Young, 2013). Research also showed that when
computerized reading speed was set at a faster rate than present
oral reading fluency (ORF), students increased their compre-
hension (Coleman, Carter, & Kildare, 2011).
Reading difficulties for secondary students who struggle to
make meaning from text will likely continue beyond the school
years in their postschool life. TTS is an accommodation that is

7. nearly ubiquitous, across operating systems, platforms, and
applications (Stodden et al., 2012); yet classroom teachers
reported not using AT on a regular basis (Okolo & Dietrich,
2014). As Okolo and Dietrich wrote, “ . . . research about the
impact of AT remains limited. Few papers in an educational
journal end without a plea for more research” (p. 18).
Young et al. 81
Purpose
In order to answer the professional call for more research on the
impact of AT for students with LD and add to previous research
indicating positive outcomes for students with disabilities, this
study uses AT as an accommodation for secondary students
with LD who struggle to make meaning from text in a tradi-
tional print form. Specifically, this study evaluated the effec-
tiveness of TTS on the reading comprehension of high school
9th graders with LD in a self-contained class. The first author
(i.e., a special education teacher) used the reading accommo-
dation of TTS, Kurzweil 3000, to assist with reading material
for students with LD. She monitored participants’ performance
in reading comprehension through curriculum-based assess-
ments (CBAs) to ensure improvement before measuring the
effects on outcomes in maintenance sessions. The results pro-
vided additional empirical evidence on the effects of TTS when
used as an accommodation for secondary students with LD.
The research questions included the following: (a) Does the
reading comprehension of freshman students with LD increase
when using TTS as measured by CBAs? (b) Will students
maintain the use of TTS following intervention? (c) Does ORF
increase after students use TTS? (d) and To what extent do the
students generalize reading comprehension to pre and post uni-

8. versal screening assessments (e.g., Lexile)?
Method
Participants
The first author selected participants based on purposive and
convenience sampling. She recruited potential participants for
this study if they met the following criteria: (a) were identified
as having a LD in reading, (b) received services in a 9th-grade
self-contained English class, and (c) had a 95% attendance rate
at the start of the study. In this district and state, students
qualified as having LD after progressing through a response
to intervention (RtI) model, demonstrating a lack of progress at
level three, and having a discrepancy between their cognitive
abilities and their performance. The self-contained English
class was required for all students with LD in reading who had
a Lexile score in the bottom 25% locally or below 900 and had
an IEP with a reading comprehension goal. This class had a
total of enrollment of 11 students. The students in the self-
contained English class were also enrolled in a self-contained
reading class using a different curriculum package, READ 180
by Houghton Mifflin Harcourt (n.d.). Four of the 11 students
meeting the inclusion criteria provided informed assent and
parent permission (see Table 1 for participant demographics).
Only three students completed the entire study through main-
tenance and generalization. Vincent left the study early because
of a change in his class schedule.
Setting
The study took place in a large, Midwest public high school
with an estimated overall student enrollment of 3,500 and
approximately 15% of the students receiving special education
services. Forty percent of these students receiving special edu-

9. cation services had LD. Twenty percent of the overall student
population received free and/or reduced-price lunch. Research
activities occurred in a computer lab close to the students’ self-
contained English classroom. The computer lab had at least 15
desktop computers with the TTS program, Kurzweil 3000
(Kurzweil Education, 1996), installed on each computer. All
students in the class (n ! 11) used TTS during the scheduled
self-contained English class to access the curriculum; however,
the first author only collected data on the four students parti-
cipating in this study. Students sat at least one seat away from
their peers to minimize distractions. Each TTS session lasted
one class period (i.e., 48 min) for 3 times per week during the
scheduled English class time in the early morning.
Materials
Classroom textbook. The district adopted a complete curriculum
called Hampton-Brown Edge: Reading, Writing, & Language
(Moore, Short, Smith, & Tatum, 2014). This curriculum con-
tains four reading levels for adolescent students. All partici-
pants in this study used Level A based on students’ reading
levels in the bottom 25th percentile on Lexile scores locally.
Table 1. Participant Demographics.
Name
Age
Initial Eligibility
Ethnicity Used TTS Previously Initial Lexile Scores Percentage
in General EducationGender
Primary and Secondary
Characteristic

10. Dianna 15 11/2012 African American No 772 40–79
(F) SLD/ADHD
Donald 14 4/2008 African American No 872 40–79%
(M) SLD
Jack 14 12/2009 African American No 186 Less than 40%
(M) SLD/AU
Vincent 15 5/2011 African American No 864 40–79%
(M) SLD
Note. ADHD ! attention deficit/hyperactivity disorder; AU !
autism; SLD ! specific learning disability.
82 Journal of Special Education Technology 34(2)
Before the study began, the first author selected 29 fiction
stories from the The Edge Level A (Moore et al., 2014). In
addition, she used The Edge curricular comprehension assess-
ments for each story. The comprehension assessments con-
sisted of 15 multiple-choice questions, including eight
vocabulary, four literary analysis, and three reading compre-
hension questions.
TTS. Prior to beginning the study, participants attended a train-
ing session conducted by the first author on how to use Kurz-
weil 3000. During this training sessions, students were allowed
to personalize the settings for highlighting text and choose the
voice reading the text. The first author choose the setting for
the
read aloud rate (i.e., how fast the TTS read). These individua-
lized settings became the default each time a participant logged
into Kurzweil 3000 to access the stories.
Dependent Measures

11. Reading comprehension measures. For this study, the first
author
used a reading comprehension measure to evaluate the effec-
tiveness of TTS among students with reading deficits within a
withdrawal design study as recommended by Perelmutter,
McGregor, and Gordon (2017). After students read each fiction
story, the reading comprehension measures included the CBAs
from the Edge assessments (Moore et al., 2014). The first
author scored the CBAs by grading the percentage of correctly
answered questions out of the 15 total questions for each story.
Additionally, she used the Scholastic Reading Inventory (SRI)
assessment to obtain pre- and posttest Lexile score (Lexile,
n.d.). The SRI is a computerized reading comprehension
assessment that lasts approximately 30 min. It is used to obtain
a reader’s Lexile score ranging from 0 to 1500 and as a uni-
versal screener to determine placement in English courses. The
SRI recommends placing students into categories to identify
their reading needs.
ORF. The first author also used an ORF measure to determine
whether students increased their words read per minute after
auditory and visual exposure to text. The RtI specialist
employed at the high school selected the ORF passages from
Aimsweb (Pearson, 2012). Each student read three paper-based
1-min 8th-grade passages while the teacher documented the
number of words read correctly. Each ORF passage contained
a different topic, so students did not repeatedly read the same
passage. After participants read three passages in one session,
the teacher averaged the scores to determine ORF scores for
that date and time. The teacher conducted ORF assessments in
this manner 6 different times throughout the study: prebaseline,
after each condition, and after the maintenance condition. She
administered a total of 18 ORF assessments during the first half
of the school year.

12. Social validity. The classroom teaching assistant administered a
teacher-created 8-item Likert-type scale survey to each parti-
cipant in the instructional classroom to gather social validity
information on the procedures and outcomes of the TTS
accommodation (survey available upon request). The survey
asked participants to rate their levels of satisfaction on a 5-
point scale (i.e., 1 ! strongly disagree; 5 ! strongly agree)
regarding the use of TTS. Because the teacher created the
survey at the participants’ readability levels, the participants
read the survey on their own. Mean scores on each item were
reported.
Experimental Design
A single-case A–B–A–B withdrawal design (Gast & Ledford,
2014) was used to evaluate the effectiveness of the TTS accom-
modation on the students’ reading comprehension after reading
passages from the classroom text. Each student served as her or
his own control as this design allowed for intra- and intersub-
ject replication. Students changed conditions after they com-
pleted a predetermined number of CBAs (i.e., five, seven, six,
and seven in the first baseline, first accommodation, the second
baseline, and the second accommodation conditions, respec-
tively). The number of sessions in each condition varied as a
way to control for cyclical threats to internal validity in a
withdrawal design.
Procedures
Training. Before the baseline condition began, students engaged
in a 48-min training session on the use of TTS in the computer
lab with the first author. Students practiced using headphones
to hear the audio readings, turning pages with an example story,
and logging off when they had completed the reading. Training
ended when all students could independently log in, access

13. stories, and use TTS features for one session with 100%
accuracy.
Generalization. At the beginning and end of the study, the first
author administered the SRI assessment to obtain a current
Lexile score to check for generalization of reading comprehen-
sion skills. She administered the assessment in the computer
lab with all students at one time.
Baseline. The baseline condition (A1) began after students com-
pleted their training on the use of TTS. At the beginning and
end of this condition, the first author administered an ORF test
to measure each student’s words read correctly individually in
a separate setting. Throughout this condition, students read the
fiction stories on the computer while using only the page-
turning icon to progress from page to page. No auditory or
highlighting features of TTS were used when reading during
A1. There was no explicit instruction on the reading material,
nor any specific feedback or reinforcement provided.
When students finished reading, they logged off the com-
puter and answered the reading comprehension CBA questions
in pencil-and-paper format without looking back at the text.
Students read the stories on the computer without TTS for five
sessions in this baseline condition.
Young et al. 83
TTS as an accommodation. Immediately after students
completed
baseline sessions, students began using TTS as an accommoda-
tion with the stories on the computer in the first accommoda-
tion condition (B1). Students accessed the reading in the same
way as in A1 but this time enabled the individualized TTS

14. features to provide support while reading. Participants enabled
the voice, highlighting, and rate of speed features previously
customized from the training session. After reading the story
with TTS support, each student logged off the computer and
completed the paper-based reading comprehension assessment
without TTS support. Students received no explicit instruction
on the reading material, no specific feedback or reinforcement,
nor any feedback on the use of TTS. Students enabled TTS as
an accommodation to support reading for seven sessions. At the
end of B1, the first author administered an ORF test to each
student in the same manner as baseline.
Second baseline and accommodation conditions. Participants
began the second baseline condition (A2) in the computer lab
immediately following B1. This condition was conducted in
the same manner as A1, without enabling any TTS features,
for six sessions. Immediately following A2, students returned
to enabling the TTS features on desktop computers to read new
fiction stories in the second accommodation condition (B2).
These sessions were identical to the B1 condition and contin-
ued for seven sessions.
Maintenance. After the second accommodation condition, stu-
dents moved into the maintenance condition. Maintenance data
were collected following the same procedures and instructions
as during baseline conditions, on participants’ accuracy for
reading comprehension questions. No new instructions were
provided to the students. Maintenance sessions were conducted
once a week for 4 weeks. An ORF measure was also collected
at the end of the maintenance condition.
Interobserver Reliability
Interobserver agreement (IOA) data were collected on the
dependent variable during 30% of all sessions or at least once
per condition for each student, whichever was greater (Horner

15. et al., 2005). Before the study began, the first author trained an
independent observer on how to score the CBAs using similar
practice CBAs. Once the observer scored two CBAs with
100% accuracy, she began scoring CBAs from the study. The
first author gave a copy of each participant’s CBAs to inde-
pendently score. The first author and the secondary scorer
compared scores after independently grading the CBAs. IOA
was calculated by dividing the total number of agreements by
the number of agreements and disagreements and then multi-
plied by 100.
Procedural Reliability
Procedural reliability data were collected in 30% of the ses-
sions for each participant or at least once per condition to
measure treatment fidelity. The first author trained the same
independent observer on how to record the occurrence of the
teacher-directed activities on the researcher-created checklist
of procedures prior to the start of the study. The checklist
entailed activities in baseline, accommodation, and mainte-
nance conditions (available upon request). The procedural
reliability percentages were based on the calculation of the
observed components divided by the number of possible com-
ponents and then multiplied by 100. The resulting calculations
determined the mean procedural reliability for each participant.
Results
The primary purpose of this study was to investigate the effec-
tiveness of TTS on the reading comprehension of 9th-grade
students with LD. Results showed a functional relation
between TTS and reading comprehension performance for all
three participants who completed the study (see Figures 1
and 2). Vincent exited the study during B2 due to a change
in his school schedule. The effects of the TTS maintained for

16. the three remaining participants. Furthermore, ORF outcomes
indicated that all participants increased the number of words
read correctly throughout the study (see Table 2). Lexile
scores on the district’s universal screener, the SRI, indicated
that two of the four participants increased scores between
the pre- and posttests.
Dianna
The first graph in Figure 1 represents Dianna’s comprehension
and ORF scores during all conditions. Dianna’s comprehension
score in baseline (A1) was between 53% and 66% correct with
a mean of 63%. A Web-based application, Single Case
Research, was used to calculate Tau-U, a measure that esti-
mated the intervention effects by taking into account the non-
overlapping data points and trend between phases (Vannest &
Ninci, 2015; Vannest, Parker, Gonen, & Adiguzel, 2016). Tau-
U is interpreted as small effect (<.20), moderate effect (.20–
.60), large effect (.60–.80), or very large effect (>.80; Vannest
& Ninci, 2015). While in B1, Dianna’s accuracy on reading
comprehension CBAs demonstrated an immediacy of effect
and a Tau-U effect size of 1 CI90% [.42, 1.00] (p ! .00). Her
comprehension scores in B1 ranged between 73% and 93%
correct with a mean of 83%. After moving from B1 to A2,
Dianna’s comprehension score abruptly decreased from 80%
to 53%. While in A2, Dianna’s mean comprehension score was
the same as in A1 at 63%, displaying repeated lower levels
even with one overlapping data point. With the presence of
TTS, Dianna’s B2 data were higher than in A2 and the mean
for B2 was 77% with a Tau-U of .83 CI90% [.29, 1.00] (p ! .01).
Overall, Dianna’s data showed the presence of a functional
relation between TTS and reading comprehension with three
demonstrations of effect across the conditions. In maintenance,
Dianna consistently maintained reading scores with a mean
score of 77%.

17. 84 Journal of Special Education Technology 34(2)
Dianna’s ORF score started at 115 and ended at 127 by the
completion of the study. Using ORF as a progress monitoring
tool, Dianna’s ORF in the fall ranged between the 25th percen-
tile (106 WCPM) and the 50th percentile (133 WCPM). Dia-
nna’s ORF at a winter progress monitoring session was 127
WCPM, still in-between the winter progress monitoring of 25th
percentile (115 WCPM) to 50th percentile (146 WCPM). The
growth expected in that percentile from fall to winter would be
9 in the 25th percentile and 13 in the 50th percentile. Dianna’s
WCPM was 12. Hosp, Hosp, and Howell (2007) suggested
aiming for the last session when using progress monitoring
data. In that case, spring progress monitoring would be in the
50th percentile if the student is below the 50th percentile at the
first progress monitoring data session. The suggested growth
rate in that time frame, according to Hasbrouck and Tindal
(2005), is an additional 9.6 WCPM. Dianna exceeded this with
an additional 12 WCPM. Furthermore, her Lexile scores con-
tinued to increase throughout the study. Her score was 772 at
the start of the study, increased to 879 after B2, and ended at
902 after maintenance.
Donald
Donald’s performance on the comprehension measures during
A1 ranged between 33% and 53% on questions answered cor-
rectly with a mean of 44% (see Figure 1, Graph 2). An imme-
diate increase occurred when Donald moved from A1 to B1. In
B1 with the TTS accommodation, Donald’s accuracy in
10

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23. on
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Baseline A1 Accommodation B1 Baseline A2 Accommodation
B2 Maintenance
Figure 1. Reading comprehension (") and oral reading fluency
(~) data for Dianna and Donald, respectively.
Young et al. 85
comprehension questions ranged from 60% to 80% with data
moving in a therapeutic, accelerating direction documenting
the effectiveness of TTS. The mean of Donald’s B1 phase was
70% and the Tau-U was 1 CI90% [.42, 1.00] (p ! .00). When
returning to A2, removing TTS, there was an abrupt decrease to
33%. Donald’s range of answering comprehension questions
correctly without TTS was between 33% and 53% and a mean
of 42% in A2. Donald’s data demonstrated another immedi-
acy of effect in B2 with only one data point overlapping
with data in A2 resulting in a Tau-U of 0.9 CI90% [.34, 1.00]
(p ! .01). Donald’s range of answering comprehension
questions in B2 was from 47% to 73% with a mean of
64%. Donald’s data showed intrasubject replication through
the three demonstrations of effect. In maintenance, Donald’s
mean data slightly increased from B2 levels and remained
above baseline levels with a mean of 68%. Donald’s overall
performance on his CBAs was maintained, further support-
ing the effectiveness of TTS on reading comprehension
outcomes.

24. Initially, Donald had an ORF score of 93. By the end of the
study, his ORF increased to 101. Using ORF as a progress
monitoring tool, Donald’s ORF in the fall ranged between the
10th percentile (77 WCPM) and 25th percentile (98 WCPM).
Donald’s ORF at a winter progress monitoring session was 101
WCPM, still in-between the winter progress monitoring of 10th
percentile (84 WCPM) to 25th percentile (107 WCPM). The
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Baseline A1 Accommodation B1 Baseline A2 Accommodation
B2 Maintenance
Figure 2. Reading comprehension (") and oral reading fluency
(~) data for Jack and Vincent, respectively.
86 Journal of Special Education Technology 34(2)
growth expected in that percentile from fall to winter would be
7 in the 10th percentile and 9 in the 25th percentile. Donald’s
WCPM was 8. Donald did not meet the suggested growth in
ORF of 9.6. In addition, he had variable Lexile scores. He went
from 872 to 887 after B2 but decreased to 832 at the end of
the study.
Jack
Jack’s accuracy on CBAs during A1 baseline was between 26%
and 47% with a mean of 34% (see Figure 2, Graph 1). A

30. demonstration of an immediacy of effect occurred when Jack
moved from A1 to B1, showing comprehension reading gains
with the accommodation of TTS. Once in B1, Jack’s accuracy
in reading comprehension scores ranged from 53% to 80% and
a mean score of 64% with data moving in an accelerating and
therapeutic direction when using TTS. The Tau-U was 1 CI90%
[.42, 1.00] (p ! .00). Similar reading comprehension scores
were repeated in A2 and B2 with a Tau-U of 1 CI90% [.45,
1.00] (p ! .00), documenting intrasubject replication. Jack’s
comprehension scores in A2, without TTS support, ranged
from 33% to 47% with a mean of 39% of the comprehension
questions correctly answered. In B2 with TTS support, Jack’s
comprehension scores ranged between 53% and 73% with a
mean of 64%. Jack’s data displayed three demonstrations of
effect between A1 and B1, B1 and A2, and A2 and B2. Jack’s
maintenance data on reading comprehension CBAs displayed
consistent high scores indicating that Jack maintained his read-
ing comprehension skills when using TTS.
Jack began with a fall progress monitoring ORF score of 59
and ended with a winter progress monitoring ORF of 79. This is
an increase of 20 WCPM. This nearly doubled the suggested
growth rate of 0.6 words per week (Hasbrouck & Tindal, 2005).
Jack was far below the 10th percentile with a 59 on ORF
measure. In winter, he was closer to a 10th percentile mainly
due a growth of 20 WCPM. Jack showed an increase in his
Lexile score throughout the study. He went from 186 at the
beginning of the study, to 221 after B2, and then to 245 at the
end of the study.
Vincent
Vincent’s accuracy on CBAs during A1 was between 53% and
73% with a mean of 65% (see Figure 2, Graph 2). Data within
B1 ranged from 53% to 100% with a mean of 76%, and the

31. second half showed data moving in a therapeutic direction.
Between conditions analysis for Vincent in A1 and B1 revealed
no change and a relative level change of 6% (i.e., 67–73%). His
Tau-U was 0.46 CI90% [#0.12, 1.00] (p ! .19) further con-
firmed no effect. In A2, his comprehension scores ranged
between 53% and 67% correct with a mean of 62%. In B2,
he had three comprehension scores of 73%, 67%, and 73%
correct with a mean of 71% and an increased Tau-U of .83
CI90% [0.13, 1.00] (p ! .05). However, there were few data
points in B2 and no data in the maintenance condition due to
Vincent changing classes and exiting the study in the middle of
B2. These limited data do not show a functional relation like
the other participants. Vincent’s ORF score started at 110 and
ended at 113 during B2. Because Vincent left the study early,
his winter benchmark was not included in progress monitoring
data.
Interobserver and Procedural Reliability
Interobserver reliability data were collected on the reading
comprehension measure during 30% of the sessions for all
participants. IOA was collected on nine sessions (i.e., two in
each baseline and accommodation conditions and one in the
Table 2. Comprehension Mean, ORF, and Lexile Scores.
Student Prebaseline
Baseline Accommodation Baseline Accommodation
PostaccommodationA1 B1 A2 B2
Dianna
Mean 115 63 83 63 77 77
ORF 772 118 124 119 121 127
Lexile 879 902

32. Donald
Mean 93 44 70 42 64 68
ORF 972 96 97 95 98 101
Lexile 887 832
Jack
Mean 59 34 64 39 64 75
ORF 186 60 66 66 78 79
Lexile 221 245
Vincent
Mean 110 65 76 62 71
ORF 864 112 116 117 113
Lexile 810
Note. ORF ! oral reading fluency.
Young et al. 87
maintenance condition) for Jack, Dianna, and Donald and
seven for Vincent due to his early exit from the study. Jack,
Dianna, and Donald’s IOA scores were 100% on all CBAs.
Vincent’s IOA was 99% on his CBAs with a range of 96–
100%. Procedural reliability data were collected during the
same 30% of the sessions for all students as for IOA. The
procedural reliability data indicated 96% for Vincent and Jack,
98% for Dianna, and 97% for Donald.
Social Validity
The first author reported data by calculating the participants’
averages in each category of a social validity survey. The par-
ticipants who completed the survey (Dianna, Donald, and Jack)

33. said they enjoyed using the visual and auditory support of TTS
(M ! 4.0) on a scale of one to five. The participants were
neutral in their response to using TTS’ highlighting and voice
selection features (M ! 2.7, 3.0, respectively), but they enjoyed
using the rate of speed (M ! 3.7). With regard to the participant
outcomes, participants agreed that they remembered more
information after using TTS (M ! 3.7); however, they were
less likely to use TTS in the future for class assignments (M !
2.7) because they felt it was difficult to access the lab on their
own. Lastly, one of the three participants agreed that she or he
would use TTS in the future for fun when reading (M ! 2.7).
Discussion
The purpose of this study was to investigate the benefit of TTS
as an accommodation for students with LD. In addition to
seeing the benefits at a curricular level, this study investigated
whether TTS would generalize to reading scores on standardize
assessments including ORF and Lexile scores. All students
who completed this study showed an increase in comprehen-
sion of print material using TTS as an accommodation. In
particular, students with the lowest reading comprehension
scores made the most gains using TTS, while also maintaining
their new skills in the maintenance condition. This would be
typical of students who started off with the lowest achievement
had the most to gain. Below, we will discuss our key findings in
relation to each of our research questions.
Reading Comprehension Performance With TTS
In this study, TTS increased the reading comprehension of high
school students with LD on curricular assessments. These find-
ings are similar to previous outcomes by Stetter and Hughes
(2011) and Stodden, Roberts, Takahashi, Park, and Stodden
(2012). Conversely, Gruber et al. (2017) found that only
elementary-aged students increased comprehension with TTS.

34. Findings from this study add to the literature base through
showing increased outcomes for struggling readers in high
school using TTS as an accommodation. When accessing print
through a TTS system, students have an opportunity to better
comprehend the written text because the TTS releases the cog-
nitive effort required for word recognition, resulting in more
effort put toward comprehending reading material. This
impacts several areas of instruction beyond reading instruction.
At the secondary level, students are frequently required to read
traditional print to learn. Social studies, science, and other
academic content area present foundational knowledge in text-
book form. TTS has proven to be an effective accommodation
especially. In the withdrawal phase of our study, it appears that
TTS continued to improve reading ability although minimally.
However, the improved performance of garnering meaning
from the printed text occurred when auditory and visual aspects
of the accommodation were used. TTS is a possible support
solution for secondary students who are struggling to make
meaning from a variety of printed texts.
ORF After TTS
All participants made gains in their ORF from their initial score
at the start of the study to their final score in the maintenance
condition. In the prebaseline condition, all participants’ ORF
scores were well below the 50th percentile. This initial ORF
score was used to calculate the rate of speed in the TTS soft-
ware and was used as the default for future readings. Previous
research indicated that when TTS is individualized at a rate
faster than readers’ initial ORF, students with LD read more
words in less time (Coleman et al., 2011; Young, 2013). Repli-
cating previous research, these students’ ORF continued to
increase throughout the study. The second ORF score, after
A1, indicated participants’ ORF scores increased one to three
words per min. However, at the end of the accommodation

35. condition, only two students increased their ORF by more than
the suggested average weekly improvement of 0.6 (Hasbrock &
Tindal, 2005), whereas Donald increased his ORF at or just
below the suggested level. At the end of the second accommo-
dation condition, three participants increased ORF scores and
the participant with the lowest score showed the highest gains.
Social Validity
The survey indicated students generally liked the TTS as an
accommodation to support reading. In addition, they generally
agreed that TTS helped them to “remember” the stories. How-
ever, they felt like they would not use TTS with future assign-
ments because it was difficult to access the computer lab. These
results indicated that these students have a very specialized
view of the TTS and that TTS is one type of accommodation
only offered on lab computers. The students did not appear to
perceive that TTS could be offered in a variety of settings or on
their own personal computers.
Maintenance of Reading Comprehension Performance
Assessing continued use and benefits of accommodations is an
important consideration when planning studies. Few previous
studies involved the use of technology and assessed reading
comprehension during maintenance (e.g., Kennedy, Deshler,
& Lloyd, 2015; Stetter & Hughes, 2011). For example, Stetter
88 Journal of Special Education Technology 34(2)
and Hughes (2011) found that participants increased their read-
ing comprehension on maintenance probes 2 weeks after exit-
ing the study. In another study, Kennedy, Deshler, and Lloyd
(2015) found participants significantly increased accuracy on

36. reading comprehension after three probes in maintenance fol-
lowing the intervention condition. The maintenance data col-
lected over 4 weeks in this study illustrated its uniqueness and
addition to the literature. These maintenance data also suggest
that when students accessed TTS consistently, they were able
to support their comprehension of material better even without
the accommodation of TTS, if previously using it. With strong
caution, these results could suggest that in addition to TTS
being an accommodation, TTS might provide some remedia-
tion qualities to struggling readers. However, more in this area
would need to be investigated.
Generalization of Reading Comprehension Performance
Overall, participants showed some variability in their Lexile
scores throughout the study. Dianna and Jack increased their
Lexile scores from pre- to posttest scores by 130 and 59 points,
respectively. According to the Lexile growth standards, raising
Lexile scores an average of 70 points in one semester is con-
sidered average growth (Scholastic, 2007). Dianna doubled
more than her average Lexile growth in one semester after
using TTS and Jack exhibited average Lexile growth. These
results may indicate the potential of generalization to other
reading assessments. However, the results should be inter-
preted cautiously as the teacher could not control for matura-
tion or outside reading instruction in other courses or at home.
Limitations
All studies have a certain amount of limiting factors. The lim-
itations for this study could be considered typical with single
subject designs given the small number of participants. When
one of the four participants withdrew, issues concerning the
generalizability of the findings to a larger population may arise.
However, this study does contribute to the larger literature base
of AT impacting reading outcomes of secondary students while

37. also replicating results of other studies (Moorman et al., 2010;
Young, 2013). Another limitation is that this study occurred in
a segregated, self-contained setting. Students learning in a
smaller, segregated environment are oftentimes given addi-
tional and individualized support as compared to in a general
education class. This class had 11 students and 2 adults. Given
that the researcher was the classroom teacher and familiar with
the students’ needs, her relationship with the students could
resulted in her providing student participants with additional
unintended support, which could have affected the outcomes.
In addition, this study occurred in the English classroom and
not in a reading classroom. All students were enrolled in the
same self-contained English and reading classes offering two
different curriculum packages during the time of the study. It
may be difficult to determine whether the TTS features can be
solely responsible for the demonstrated growth. However, the
use of a single subject withdrawal design aided in having each
participant act as his or her own control. The benefit of using
the single subject withdrawal design is to aid in mitigating
potential impact of other variables outside of the classroom
(e.g., curriculum in a reading classroom) may have on the
results.
Finally, given different participant characteristics in this
study, it is difficult to conclude that students with the charac-
teristics of LD are the only ones who would benefit from TTS
as a valid reading accommodation. Previous research also
found that students with comorbid diagnoses (i.e., attention
deficit/hyperactivity disorder and LD) may affect reading per-
formance (Wood et al., 2018). Students’ improvements may be
related to their secondary labels. For example, Jack’s learning
style presented differently from the other students, which raises
questions if the results were solely based on the accommoda-
tion. Dianna had attention issues which could have affected her

38. outcomes with the use of TTS as an accommodation.
Implications for Practice
Literacy skills are crucial when secondary students are learning
content. Technology is a way to alleviate some of the barriers to
learning content through reading. Therefore, it is important that
students with LD to learn to use technology to increase their
acquisition of content. Technology, in particular TTS, is nearly
ubiquitous and students should be encouraged to practice using
technology to maximize their ability to understand material.
Teachers should implement and understand how to teach and
use technology to meet students’ needs. Instead, our study
indicated that students view TTS as burdensome, specialized
equipment only to be used in a lab setting. Using TTS on a
regular basis appears to benefit the secondary learner with very
few drawbacks noted.
The effects of using TTS could result in long-lasting
improvement in understanding content. TTS is sometimes
referred to as a “compensatory” tool, indicating teachers no
longer need to remediate a reading difficulty rather work
around one, removing the barrier of access. However, if stu-
dents can maintain the improvements made with TTS as an
accommodation regularly, perhaps TTS could also be looked
at as a remediation tool, not a permanent need.
Our findings imply suggestions for practitioners to consider
when planning instruction to increase student outcomes. All
teachers should be made aware of the benefits of TTS and the
ease at which it can be utilized across content areas for strug-
gling readers. Administrators should promote the use of TTS as
an available accommodation for secondary students who strug-
gle with reading by increasing professional development to
faculty on the use of TTS when acquiring content. With pro-
fessional development for teachers and more access to TTS

39. beyond a computer lab, students might improve beyond the
one content area. When students can access the meaning of
text by being able to comprehend traditional print text using
TTS, they will comprehend the print instruction better and
therefore achieve at a higher rate and are more likely to engage
Young et al. 89
when using technology. Using technology during instruction
for students with LD is a win-win for instructors and learners.
Future research should examine students’ independent use
of TTS while exploring ways to increase academic outcomes.
More specifically, as technology continues to improve with
advanced features, more research is needed to investigate
whether other TTS features are helpful accommodations to
increase student outcomes in areas other than reading. Also,
as students increase their comfort level of using TTS and recog-
nize TTS’s capability of providing access to printed word, they
may expand their use of technology to read the printed word.
As technology becomes more prevalent in education, using it as
an accommodation will assist teachers in customizing lessons
to meet their students’ needs, which can result in increased
student outcomes.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research,

40. author-
ship, and/or publication of this article.
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50. Author Biographies
Mary Cece Young, EdD, is a doctoral graduate from the
Department of Special Education at Illinois State University.
Mary Cece is a special education program chair and has been a
teacher for 22 years. Her research interests include assistive
technology, inclusion, and reading accommodations for stu-
dents with learning disabilities.
Carrie Anna Courtad, PhD, is an associate professor in the
Department of Special Education at Illinois State University,
Normal, IL. Her research interests include assistive technology,
literacy, preservice teacher learning, and teacher globalization.
Prior to her current position at Illinois State, Dr. Courtad was a
classroom special education teacher in Texas and Michigan.
Karen H. Douglas, PhD, is an associate professor in the
Department of Special Education at Illinois State University.
Her research interests include technology, literacy, and com-
munication supports for students with intellectual disabilities
and autism spectrum disorders. She is a contributor to profes-
sional journal articles, book chapters, and national conference
presentations.
Yun-Ching Chung, PhD, is an associate professor in the
Department of Special Education at Illinois State University
in Illinois, United States. Her research interests include peer
interactions, inclusion outcomes of students who use augmen-
tative and alternative communication, and paraprofessional
facilitation.
Young et al. 91